Preliminary data indicate that closing schools completely may only have a small effect on limiting the spread of COVID-19, researchers reported yesterday (April 6) in The Lancet Child and Adolescent Health.
“Data on the benefit of school closures in the coronavirus outbreak is limited, but what we know shows that their impact is likely to be only small,” one of the study coauthors, Russell Viner, a professor of adolescent health at University College London, tells the BBC. The team notes that more research needed to be done to confirm the result.
To draw this conclusion, Viner and colleagues performed a meta-analysis of 16 studies, nine of them peer-reviewed publications and seven of them preprints. The papers reported on school closures as part of containment measures against the first SARS outbreak in 2003 or against COVID-19, modeled the transmission of SARS, and analyzed the effect of class cancellations on the transmission of other human coronaviruses during wintertime.
In one study that analyzed data from the first SARS outbreak in China, the researchers found that students attending school did not play a substantial role in the transmission of the virus to the broader community and that school closures did not contribute to controlling infections. Modeling studies of that outbreak generated mixed results, with one arguing school closures might have played an important role in reducing transmission and another finding the spread of SARS-CoV in classrooms was low.
For COVID-19, there’s similar disagreement in results, with two studies claiming school closures as part of larger containment measures helped tamp down the spread of the disease. At the same time, a modeling study looking at the effect of school closure alone on COVID-19 cases in the UK predicted the containment measure might reduce deaths in the country by only 2–4 percent. That team concluded that individual containment strategies, such as case isolation, would be more effective, and that a combination of containment strategies including school closures would be most effective.
Although the results did not seem to suggest school closings played a substantial role in preventing the transmission of infection, the authors pointed out caveats with their meta-analysis. Only one of the studies “was designed to specifically examine the effectiveness of school distancing measures,” they note in their report. “Thus, data provided on the effect of school measures were of relatively low quality.”
Still, the team argues in the article that it is concerned that the benefits of school closures, which might be low, don’t outweigh the economic costs, if they prevent parents from working, and the mental and physical tolls, if students lose large amounts of class and social time.
With school closures, “children’s education is damaged and their mental health may suffer, family finances are affected, key workers may need to stay home to look after children and vulnerable children may suffer most,” Viner tells The Guardian.
“This is an important study that confirms what many of us suspected, namely that the public health benefits of school closures were not proportionate to the social and economic costs imposed on children and their families,” Robert Dingwall, a professor of sociology at Nottingham Trent University, tells the BBC. “It also underlines how the assumptions used in modeling the pandemic may rest on very flimsy foundations in terms of scientific evidence. This work suggests that UK schools could, and should, begin to reopen as soon as practicable after the initial wave of cases has passed through.”
Imperial College London’s Neil Ferguson, one of the authors of the UK modeling study used in the meta-analysis, is more cautious in interpreting the collective results. “While school closure as a measure on its own is predicted to have a limited effectiveness in controlling COVID-19 transmission,” he tells The Guardian, “when combined with intense social distancing it plays an important role in severing remaining contacts between households and thus ensuring transmission declines.”
Viner and colleagues admit that their meta-analysis is inconclusive on what to do about school closures other than to argue for additional data collection and analysis. “More research,” they write, “is urgently needed on the effectiveness of school closures and other school social distancing practices to inform policies related to COVID-19.”