Impacts of K-12 school reopening on the COVID-19 epidemic in Indiana, USA

Abstract

Importance: In the United States, schools closed in March 2020 to reduce the burden of COVID-19. They are now reopening amid high incidence in many places, necessitating analyses of the associated risks and benefits. Objective: To determine the impact of school reopening with varying levels of operating capacity and face-mask adherence on COVID-19 burden. Design: Modeling study using an agent-based model that simulates daily activities of the population. Transmission can occur in places such as schools, workplaces, community, and households. Model parameters were calibrated to and validated against multiple types of COVID-19 data. Setting: Indiana, United States of America. Participants: Synthetic population of Indiana. K-12 students, teachers, their families, and others in the state were studied separately. Interventions: Reopening of schools under three levels of school operating capacity (50%, 75%, and 100%), as well as three assumptions about face-mask adherence in schools (50%, 75%, and 100%). We compared the impact of these scenarios to reopening at full capacity without face masks and a scenario with schools operating remotely, for a total of 11 scenarios. Main outcomes: SARS-CoV-2 infections, symptomatic cases, and deaths due to COVID-19 from August 24 to December 31. Results: We projected 19,527 (95% CrI: 4,641-56,502) infections and 360 (95% CrI: 67-967) deaths in the scenario where schools operated remotely from August 24 to December 31. Reopening at full capacity with low face-mask adherence in schools resulted in a proportional increase of 81.7 (95% CrI: 78.2-85.3) times the number of infections and 13.4 (95% CrI: 12.8-14.0) times the number of deaths. High face-mask adherence resulted in a proportional increase of 3.0 (95% CrI: 2.8-3.1) times the number of infections. Operating at reduced capacity with high face-mask adherence resulted in only an 11.6% (95% CrI: 5.50%-17.9%) increase in the number of infections. Conclusions and Relevance: Reduced capacity and high face-mask adherence in schools would substantially reduce the burden of COVID-19 in schools and across the state. We did not explore the impact of other reopening scenarios, such as alternating days of attendance. Heterogeneous decisions could be made across different districts throughout the state, which our model does not capture. Hence, caution should be taken in interpreting our results as specific quantitative targets for operating capacity or face-mask adherence. Rather, our results suggest that schools should give serious consideration to reducing capacity as much as is feasible and enforcing adherence to wearing face masks.

Using an Agent-Based Model to Assess K-12 School Reopenings Under Different COVID-19 Spread Scenarios – United States, School Year 2020/21

“…The results show similar trends for the Baseline, 80% in-person learning, 40% 2-day and alternating week, and offsite school scenarios with Fewer Open Workplaces and More Open Workplaces assumptions for both regional and national simulations. All the partial onsite learning scenarios delay the epidemic peak and flatten the curve for Fewer Open Workplaces, which is consistent with previous studies on school closures [13][14][15][16] (Figure 2, 3). However, for More Open Workplaces, the peak for most scenarios is spread around three weeks regardless of school reopening scenario and the impact of hybrid school reopenings is reduced.…”

“…Mathematical and computational models of COVID-19 spread provide a platform to examine which modalities of in-person instruction may be feasible during the ongoing COVID-19 pandemic. Several recent studies have begun to quantify the impact of various non-pharmaceutical interventions in combination with different school reopening strategies and have found that reopening schools as normal is likely to increase the number of COVID-19 cases [13,14]. Other studies have found that closing schools and incorporating social distancing measures in classrooms are effective in reducing the spread of COVID-19 [15].…”

“…Other studies have found that closing schools and incorporating social distancing measures in classrooms are effective in reducing the spread of COVID-19 [15]. In addition, hybrid approaches to learning, such as capping the in-person classroom size, may be effective in reducing transmission [14,16] and provide a balance approach between supporting education while limiting the spread of COVID-19.…”

The Impact of School Opening Model on SARS-CoV-2 Community Incidence and Mortality: A Nationwide Cohort Study

“…Early reports suggested that school closures were associated with reductions in COVID-19 deaths, although study authors acknowledged that, due to the simultaneous implementation of a variety of public health measures, the impact of school closure could not be fully delineated. 5,[9][10][11] Other investigations found con icting results, with some suggesting that opening schools is associated with an increase in SARS-CoV-2 cases in the community and others suggesting minimal or no impact. A recent meta-analysis found that studies with the lowest risk of statistical bias did not nd a substantial impact of school mode on community incidence.…”

“…If children and school staff become infected at school, these transmissions may lead to subsequent transmissions to family members and other contacts, potentially resulting in increases in community transmission of SARS-CoV-2. Recently published studies about the impact of school mode on community transmission from Indiana, Texas, and other states found con icting results, [8][9][10] with some analyses suggesting substantial increases in case rates associated with school openings, others suggesting a small impact, and still others suggesting that opening schools to in-person learning has no impact on community case rates.…”