Association of the Timing of School Closings and Behavioral Changes With the Evolution of the Coronavirus Disease 2019 Pandemic in the US

Abstract

IMPORTANCEThe consequences of school closures for children's health are profound, but existing evidence on their effectiveness in limiting severe acute respiratory syndrome coronavirus 2 transmission is unsettled.OBJECTIVE To determine the independent associations of voluntary behavioral change, school closures, and bans on large gatherings with the incidence and mortality due to coronavirus disease 2019 . DESIGN, SETTING, AND PARTICIPANTSThis population-based, interrupted-time-series analysis of lagged independent variables used publicly available observational data from US states during a 60-day period from March 8 to May 18, 2020. The behavioral measures were collected from anonymized cell phone or internet data for individuals in the US and compared with a baseline of January 3 to February 6, 2020. Estimates were also controlled for several state-level characteristics.EXPOSURES Days since school closure, days since a ban on gatherings of 10 or more people, and days since residents voluntarily conducted a 15% or more decline in time spent at work via Google Mobility data. MAIN OUTCOMES AND MEASURESThe natural log of 7-day mean COVID-19 incidence and mortality.RESULTS During the study period, the rate of restaurant dining declined from 1 year earlier by a mean (SD) of 98.3% (5.2%) during the study period. Time at work declined by a mean (SD) of 40.0% (7.9%); time at home increased by a mean (SD) of 15.4% (3.7%). In fully adjusted models, an advance of 1 day in implementing mandatory school closures was associated with a 3.5% reduction (incidence rate ratio [IRR], 0.965; 95% CI, 0.946-0.984) in incidence, whereas each day earlier that behavioral change occurred was associated with a 9.3% reduction (IRR, 0.907; 95% CI, 0.890-0.925) in incidence. For mortality, each day earlier that school closures occurred was associated with a subsequent 3.8% reduction (IRR, 0.962; 95% CI, 0.926-0.998), and each day of advance in behavioral change was associated with a 9.8% reduction (IRR, 0.902; 95% CI, 0.869-0.936). Simulations suggest that a 2-week delay in school closures alone would have been associated with an additional 23 000 (95% CI, 2000-62 000) deaths, whereas a 2-week delay in voluntary behavioral change with school closures remaining the same would have been associated with an additional 140 000 (95% CI, 65 000-294 000) deaths. CONCLUSIONS AND RELEVANCEIn light of the harm to children of closing schools, these findings suggest that policy makers should consider better leveraging the public's willingness to protect itself through voluntary behavioral change.

Challenges for Child Mental Health Raised by School Closure and Home Confinement During the COVID-19 Pandemic

“…The benefit of school closure relative to other containment measures is unclear. A population-based study in the United States (U.S.) during a 60-day period beginning in March 2020, relative to baseline data beginning in January 2020, revealed a negative association of school closure with COVID-19 incidence and with COVID-19-related mortality, but the associations were stronger with voluntary behavioral changes (e.g., reduced time at the workplace and restaurant dining) than with school closure [ 10 ]. Using similar data and methodology, Auger and colleagues [ 11 ] also found that the incidence of COVID-19 and related mortality decreased with school closure, while Courtemanche and colleagues [ 12 ] found no association of school closure with the incidence of COVID-19 or with related mortality, but these studies failed to control for other voluntary behavior changes.…”

Results of WICOVIR Gargle Pool PCR Testing in German Schools Based on the First 100,000 Tests

“…Children and youth are still severely affected by the COVID-19 pandemic, even though the acute phase of the disease is mostly mild in the young (1). They are over-proportionally affected by secondary consequences of the pandemic such as social deprivation, lack of physical activity, decrease in economic status, and dysconnectivity, especially in rural communities (2,3), and in countries like Germany, where closing of schools was not perceived as the last option in fighting the pandemic but as the first (4,5).…”

Face Masks in Young Children During the COVID-19 Pandemic: Parents' and Pediatricians' Point of View

“…Nevertheless, the contamination at school exists but is minor ( 13 , 14 ). Moreover, the prolonged closure of schools has resulted in adverse consequences for both children and their parents who work from home ( 15 , 16 ). All of these drawbacks were even greater in low-income families ( 17 ).…”