Since the coronavirus disease 2019 (COVID-19) outbreak was identified in Wuhan, China, in December 2019, many countries have introduced restrictive measures to curb the circulation and spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).
Measures imposed have included social distancing and isolation, the banning of all nonessential activities, and the closure of many establishments, including schools.
Although social distancing and the closure of various businesses and buildings are effective measures for reducing the spread of SARS-CoV-2, experts are less sure that closing schools is beneficial.
Now, in a commentary article recently published in JAMA Pediatrics, Susanna Esposito (University of Parma, Italy) and Nicola Principi (Università degli Studi di Milano, Italy) has outlined some of the debate surrounding the decision made in most countries to close schools and continue education through distanced learning from home instead.
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The parallels made with influenza pandemics
The authors say the most likely reason that many governments introduced school closure is the parallels that have been made with pandemic influenza outbreaks, where school closure was effective at reducing the incidence and the associated clinical, social, and economic impacts.
"However, it is not at all certain that the same advantages can be expected in the case of the COVID-19 pandemic," writes the team.
Although school closure may be effective at controlling the spread of influenza, which children are more susceptible to than adults, this does not seem applicable to coronaviruses, say the authors; coronaviruses are transmitted differently and primarily affect adults and elderly people.
What has previous research found?
Researchers have calculated that the reproductive number (R0; number of secondary cases resulting from an original case) of SARS-CoV-2 infection is high (at least 2.5), but children under the age of 10 only accounts for 1% of cases.
Esposito and Principi suggest that the poor relevance of school closure is demonstrated by the fact that in Taiwan, the spread of COVID-19 was successfully curbed, without the widespread introduction of this measure. Early pandemic data gathered on the transmission dynamics in China also showed that school closure would not be enough to curtail the pandemic.
Furthermore, other research carried out in China during the SARS epidemic has already demonstrated the ineffectiveness of closing schools, say the authors. One study found that the rate of symptomatic disease is so low among school-age children that closing schools for two months had no significant impact on disease prevention.
An investigation in Taiwan also found that the R0 among children in a classroom was so low – less than 1 – that school closure would have little effect.
UK researchers who used data from the Wuhan outbreak predicted that closing schools would only prevent between 2% and 4% of deaths, which is a much smaller proportion than would be prevented with other restrictive measures.
The potential negative impacts of school closure
The authors say that at the same time, as the effectiveness of school closure being debatable, the potential negative impacts such as parents having to stay home to look after children cannot be overlooked.
"In the US, it has been calculated that the absence from work of 15% of health care workers may be associated with a significant increase in COVID-19 mortality," writes the team. "If parents must work and grandparents must become the primary caretakers of children, the risk significantly increases that these persons, who are per se at the greatest risk of serious illness, may become infected."
Another concern is the replacement of traditional schooling with distance learning, which many countries have implemented.
One 2015 survey carried out in Italy indicated that, in the poorest regions, the digital technology needed to enable distance learning was not available in 41% of households. Therefore, a significant proportion of children could be excluded from schooling, socializing with other children, and interacting with the world around them.
The authors say all these associated disadvantages are the reasons some experts suggest that the potential benefits, if any, should be weighed up against the secondary negative impacts: "Instead of total school closure, alternative strategies to contain transmission, such as reducing class size, physical distancing, and hygiene promotion, could be implemented."
The situation in the United States
In an associated editorial, also published in JAMA Pediatrics, Dimitri Christakis (Seattle Children's Research Institute) considers the situation in the United States. He says that to help inform states and counties struggling to decide how to proceed in the fall, an expert task force focusing exclusively on school closure should be arranged.
"They should review the state of the evidence regarding horizontal transmission among children and their families, as well as what is known about the feasibility of distance learning and the psychological implications of children continuing to stay at home," writes Christakis.
"We owe this to our children. Years from now, when they reflect on the pandemic, they will hold us accountable," he concludes.
- Esposito S and Principi N. School Closure During the Coronavirus Disease 2019 (COVID-19) Pandemic. JAMA Pediatrics 2020. doi:10.1001/jamapediatrics.
- Christakis D. School Reopening—The Pandemic Issue That Is Not Getting Its Due. JAMA Pediatrics 2020. doi:10.1001/jamapediatrics.2020.2068