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: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.

Project description:ImportanceIn-person schooling has been disrupted for most school-aged youth during the COVID-19 pandemic, with low-income, Black, and Hispanic populations most likely to receive fully remote instruction. Disruptions to in-person schooling may have negatively and inequitably affected children's mental health.ObjectiveTo estimate the association between school closures and child mental health outcomes and how it varies across sociodemographic factors.Design, setting, and participantsThis cross-sectional population-based survey study included a nationally representative sample of US adults aged 18 to 64 years with at least 1 child in the household. The survey was administered between December 2 and December 21, 2020, via web and telephone in English and Spanish. Participants were recruited from the NORC AmeriSpeak panel, an address-based panel with known probability sampling and coverage of 97% of US households.ExposuresSchooling modality (in person, fully remote, or hybrid), household income, age.Main outcomes and measuresChild mental health difficulties were measured with the parent-report version of the Strengths and Difficulties Questionnaire, with small, medium, and large effect sizes defined as 1.3-, 3.3-, and 5.2-point differences, respectively.ResultsA total of 2324 adults completed the survey. Overall, 1671 respondents (71.9%) were women, 244 (10.5%) were Black, 372 (16.0%) were Hispanic, and 421 (18.1%) had a high school education or less. Children attending school in-person had higher household incomes (mean difference, $9719; 95% CI, $4327 to $15 111; P < .001) and were more likely to be White compared with those attending remotely (366 of 556 [65.8%] vs 597 of 1340 [44.5%]; P < .001). Older children in remote schooling had more mental health difficulties than those attending in-person schooling (standardized effect size, 0.23 [95% CI, 0.07 to 0.39] per year older; P = .006), corresponding to small effect sizes in favor of in-person schooling for older children and very small effect sizes favoring remote schooling for younger children. Children from families with higher income benefitted more from attending schools in-person compared with their peers from families with lower income (B = -0.20 [95% CI, -0.10 to -0.30] per $10 000-increase in annual income; P < .001), although this advantage was not apparent for children attending hybrid school (B = -0.05 [95% CI, -0.16 to 0.06] per $10 000-increase in annual income; P = .34), and directionally lower but not significantly different for children attending remote school (B = -0.12 [95% CI, -0.04 to -0.20] per $10 000-increase in annual income; P < .001). Learning pods fully buffered the associations of hybrid schooling (d = -0.25; 95% CI, -0.47 to -0.04) but not remote schooling (d = 0.04; 95% CI, -0.10 to 0.18) with negative mental health outcomes.Conclusions and relevanceThe findings of this study suggest that older and Black and Hispanic children as well as those from families with lower income who attend school remotely may experience greater impairment to mental health than their younger, White, and higher-income counterparts. Ensuring that all students have access to additional educational and mental health resources must be an important public health priority, met with appropriate funding and workforce augmentation, during and beyond the COVID-19 pandemic.

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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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