Dataset Information

Association Between Statewide School Closure and COVID-19 Incidence and Mortality in the US.

ABSTRACT:

Importance

In the US, states enacted nonpharmaceutical interventions, including school closure, to reduce the spread of coronavirus disease 2019 (COVID-19). All 50 states closed schools in March 2020 despite uncertainty if school closure would be effective.

Objective

To determine if school closure and its timing were associated with decreased COVID-19 incidence and mortality.

Design, setting, and participants

US population-based observational study conducted between March 9, 2020, and May 7, 2020, using interrupted time series analyses incorporating a lag period to allow for potential policy-associated changes to occur. To isolate the association of school closure with outcomes, state-level nonpharmaceutical interventions and attributes were included in negative binomial regression models. States were examined in quartiles based on state-level COVID-19 cumulative incidence per 100?000 residents at the time of school closure. Models were used to derive the estimated absolute differences between schools that closed and schools that remained open as well as the number of cases and deaths if states had closed schools when the cumulative incidence of COVID-19 was in the lowest quartile compared with the highest quartile.

Exposures

Closure of primary and secondary schools.

Main outcomes and measures

COVID-19 daily incidence and mortality per 100?000 residents.

Results

COVID-19 cumulative incidence in states at the time of school closure ranged from 0 to 14.75 cases per 100?000 population. School closure was associated with a significant decline in the incidence of COVID-19 (adjusted relative change per week, -62% [95% CI, -71% to -49%]) and mortality (adjusted relative change per week, -58% [95% CI, -68% to -46%]). Both of these associations were largest in states with low cumulative incidence of COVID-19 at the time of school closure. For example, states with the lowest incidence of COVID-19 had a -72% (95% CI, -79% to -62%) relative change in incidence compared with -49% (95% CI, -62% to -33%) for those states with the highest cumulative incidence. In a model derived from this analysis, it was estimated that closing schools when the cumulative incidence of COVID-19 was in the lowest quartile compared with the highest quartile was associated with 128.7 fewer cases per 100?000 population over 26 days and with 1.5 fewer deaths per 100?000 population over 16 days.

Conclusions and relevance

Between March 9, 2020, and May 7, 2020, school closure in the US was temporally associated with decreased COVID-19 incidence and mortality; states that closed schools earlier, when cumulative incidence of COVID-19 was low, had the largest relative reduction in incidence and mortality. However, it remains possible that some of the reduction may have been related to other concurrent nonpharmaceutical interventions.

SUBMITTER: Auger KA

PROVIDER: S-EPMC7391181 | biostudies-literature | 2020 Sep

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Association Between Statewide School Closure and COVID-19 Incidence and Mortality in the US.

Auger Katherine A KA Shah Samir S SS Richardson Troy T Hartley David D Hall Matthew M Warniment Amanda A Timmons Kristen K Bosse Dianna D Ferris Sarah A SA Brady Patrick W PW Schondelmeyer Amanda C AC Thomson Joanna E JE

JAMA 20200901 9

<h4>Importance</h4>In the US, states enacted nonpharmaceutical interventions, including school closure, to reduce the spread of coronavirus disease 2019 (COVID-19). All 50 states closed schools in March 2020 despite uncertainty if school closure would be effective.<h4>Objective</h4>To determine if school closure and its timing were associated with decreased COVID-19 incidence and mortality.<h4>Design, setting, and participants</h4>US population-based observational study conducted between March 9 ...[more]

PMID: 32745200

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Project description:ImportanceSchool closures because of COVID-19 have left 1.6 billion students around the world without in-person classes for a prolonged period. To our knowledge, no study has documented whether reopening schools in low- and middle-income countries during the pandemic was associated with increased aggregate COVID-19 incidence and mortality with appropriate counterfactuals.ObjectiveTo test whether reopening schools under appropriate protocols during the COVID-19 pandemic was associated with increased municipal-level COVID-19 cases and deaths in São Paulo State, Brazil.Design setting and participantsThis observational study of municipalities in São Paulo State, Brazil, uses a difference-in-differences analysis to examine the association between municipal decisions to reopen schools during the COVID-19 pandemic and municipal-level COVID-19 case and death rates between October and December 2020. The study compared 129 municipalities that reopened schools in 2020 with 514 that did not and excluded data for 2 municipalities that reopened schools and closed then again.Main outcomes and measuresNew COVID-19 cases and deaths per 10 000 inhabitants up to 12 weeks after school reopenings and municipal-level aggregate mobility for a subset of municipalities.ResultsThere were 8764 schools in the 129 municipalities that reopened schools compared with 9997 in the control group of 514 municipalities that did not reopen schools. The municipalities that reopened schools had a cumulative COVID-19 incidence of 20 cases per 1000 inhabitants and mortality of 0.5 deaths per 1000 inhabitants in September 2020 (the baseline period) compared with an incidence of 18 cases per 1000 inhabitants and mortality of 0.45 deaths per 1000 inhabitants during the baseline period in the comparison group. The findings indicated that there were no statistically significant differences between municipalities that authorized schools to reopen and those that did not for (1) weekly new cases (difference-in-differences, -0.03; 95% CI, -0.09 to 0.03) and (2) weekly new deaths (difference-in-differences, -0.003; 95% CI, -0.011 to 0.004) before and after October 2020. Reopening schools was not associated with higher disease activity, even in relatively vulnerable municipalities, nor aggregate mobility.Conclusions and relevanceThe findings from this study suggest that keeping schools open during the COVID-19 pandemic did not contribute to the aggregate disease activity.

Project description:ObjectivesCOVID-19 pandemic affected majority of students worldwide because school closures were one of the first and frequently taken measures in tackling epidemic. This study analyzed trends in COVID-19 morbidity and mortality from the beginning of pandemic in Croatia, in relation to schools opening and closing.Study designRetrospective data review.MethodsData on COVID-19 positive patients in Croatia from week 9 of 2020 to week 10 of 2021 in Croatia were analyzed using joinpoint regression. Analysis also included hospitalizations and mortality trends for age groups 26 to 65 and 66+ from week 30 of 2020.ResultsSchools opened in fall after the summer holidays in week 37. Joinpoint regression analysis revealed a statistically significant increase in cumulative incidence rates of COVID-19 in all age groups until 50th week, except in the 19-25 age group which saw an increase until 49th week. During the period of increase, there were periods of moderate increases and rapid increases in incidence that were present between 39/41 week and 43/44 week in all age groups except in those 0-6 years [from 40th till 43rd week in age groups 7-14 and 15-18, average percentage change (APC) = 87.41, P = 0.035, and APC = 83.47, P = 0.013; from 39th till 43rd in 19-25, APC = 91.90, P = 0.002; from 40th till 44th in 26-65, APC = 74.79, P < 0.001; from 41st till 44th in 66+, APC = 81.95, P = 0.004]. Steeper increase in hospitalizations was seen in 40th week for age groups 26 to 65 (40th to 45th week APC = 34.67, P < 0.001) and 66+ (40th to 45th week APC = 38.76, P < 0.001). Steeper increase in mortality started in 41st week for both age groups 26 to 65 and 66+ (41st to 46th week APC = 59.59, P < 0.001 and 41st to 45th week APC = 70.28, P < 0.001). Schools were closed for winter holidays in week 51. A steep decrease occurred in week 50 for cases and in week 51 for mortality and hospitalizations. There was no significant increase in hospitalizations and mortality after schools were re-opened in week 03 of 2021 (primary schools) and week 07 (secondary schools).ConclusionCOVID-19 morbidity and mortality trends in Croatia observed in fall 2020 in Croatia perhaps cannot completely exclude potential association of school opening in all age groups. However, in winter 2021 effect was completely lacking and numbers were independent of schools' dynamics. The observed inconsistent pattern indicates that there were no association of school openings and COVID-19 morbidity and mortality trends in Croatia and that other factors were leading to increasing and decreasing numbers. This emphasizes the need to consider the introduction of other effective and less harmful measures by stakeholders, or at least to use school closures as a last resort.

Dataset Information

Association Between Statewide School Closure and COVID-19 Incidence and Mortality in the US.

Importance

Objective

Design, setting, and participants

Exposures

Main outcomes and measures

Results

Conclusions and relevance

Publications

Association Between Statewide School Closure and COVID-19 Incidence and Mortality in the US.

Similar Datasets

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