Reopening Primary Schools during the Pandemic

Levinson, Meira; Çevik, Müge; Lipsitch, Marc

doi:10.1056/nejmms2024920

Cited by 157 publications

(179 citation statements)

References 7 publications

(11 reference statements)

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“…To which extent children are inflicted by SARS-CoV-2 and to which extent opening or closing of schools impacts the dynamics of the SARS-CoV-2 pandemic is much debated. 1,4 One aspect of this debate concerns the occurrence of SARS-CoV-2 infection in children compared to adults. In our study, we detected SARS-CoV-2 infection in 1.42% (95% CI 1.06-1.90%) of study participants at the second round of examinations (10)(11)(12)(13)(14)(15)(16).…”

Section: Discussionmentioning

confidence: 99%

“…2 School closures represent a very effective non-pharmaceutical intervention to reduce the transmission of SARS-CoV-2, 3 but have many adverse consequences. 1 Thus, there is extensive debate about the role of schools and children in the SARS-CoV-2 pandemic. 1,4 Several prior studies have examined representative samples of the general population to assess how frequently SARS-CoV-2 infections occur in children compared to adults.…”

Section: Introductionmentioning

confidence: 99%

“…1 Thus, there is extensive debate about the role of schools and children in the SARS-CoV-2 pandemic. 1,4 Several prior studies have examined representative samples of the general population to assess how frequently SARS-CoV-2 infections occur in children compared to adults. For instance, seroepidemiological studies [5][6][7] showed a somewhat lower prevalence of SARS-CoV-2 antibodies in children than in adults, but it remains unclear whether this difference arises from reduced exposure related to schools closures, a distinct immune response, orindeedreduced susceptibility.…”

Section: Introductionmentioning

confidence: 99%

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Prevalence of RT-qPCR-detected SARS-CoV-2 infection at schools: First results from the Austrian School-SARS-CoV-2 prospective cohort study

Willeit

Krause

Lamprecht

et al. 2021

Preprint

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BackgroundThee is much debate about the role of schools and children in the SARS-CoV-2 pandemic. We aimed to quantify reliably the prevalence of SARS-CoV-2 infections at schools detected with reverse-transcription polymerase-chain-reaction (RT-PCR).MethodsThis nationwide prospective cohort study monitors a representative sample of pupils (grade 1-8) and teachers at Austrian schools throughout the school year 2020/2021. We repeatedly test participants for SARS-CoV-2 infection using a gargling solution and RT-PCR. We herein report on the first two rounds of examinations. We used mixed-effect logistic regression to estimate odds ratios and robust 95% confidence intervals (95% CI).FindingsWe analysed data on 10734 participants from 245 schools (9465 pupils, 1269 teachers). Prevalence of RT-PCR-detected SARS-CoV-2 infection increased from 0.39% at round 1 (95% CI 0.28-0.55%, 29 September-22 October 2020) to 1.42% at round 2 (95% CI 1.06-1.90%, 10-16 November). Odds ratios for SARS-CoV-2 infection were 2.29 (95% CI 1.26-4.17, P=0.007) in regions with >500 vs. ≤500 inhabitants/km2, 1.69 (95% CI 1.42-2.00, P<0.001) for a two-fold higher regional 7-day incidence, and 2.71 (95% CI 1.68-4.39, P<0.001) in pupils at schools with a high/very high vs. low/moderate social deprivation index. Associations of community incidence and social deprivation persisted in multivariable models. There were no differences between age groups, sexes, pupils vs. teachers, or primary (grade 1-4) vs. secondary schools (grade 5-8).InterpretationThis monitoring study in Austrian schools revealed SARS-CoV-2 infection in 0.39%-1.42% of participants and identified associations of regional community incidence and social deprivation with higher prevalence.FundingBMBWF Austria.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Prevalence of RT-qPCR-detected SARS-CoV-2 infection at schools: First results from the Austrian School-SARS-CoV-2 prospective cohort study

Willeit

Krause

Lamprecht

et al. 2021

Preprint

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“…While COVID-19 generally causes mild disease in children and adolescents, school closures are known to adversely impact children and families economically, educationally, and psychologically, while worsening race, gender, and economic disparities. [1][2][3][4][5] Hence, school reopening is a priority for the well-being of children and adolescents. However, it must be done safely for the sake of teachers, staff, and student families.…”

Section: Introductionmentioning

confidence: 99%

Supervised self-collected SARS-CoV-2 testing in indoor summer camps to inform school reopening

Cooch¹,

Watson

Olarte

et al. 2020

Preprint

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Background and Objectives: Testing strategies for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in school settings are needed to assess the efficacy of infection mitigation strategies and inform school reopening policies. We hypothesized that supervised serial self-collected non-nasopharyngeal testing in summer camp settings would be acceptable and feasible. Methods: We performed a cohort study at two urban day camps for kindergarten-8th graders in June and July 2020. Eligible participants were campers, up to two adult household contacts, and camp staff. We assessed participation rates for providing, at two time points, supervised, self-collected anterior nares samples for reverse transcription polymerase chain reaction (RT-PCR) and saliva samples for antibody testing. We qualitatively assessed testing feasibility and adherence to stated camp infection mitigation strategies. Results: 76% (186/246) of eligible participants consented. The cohort completing both rounds of testing (n=163) comprised 67 campers, 76 household contacts, and 20 staff. Among those present, 100% of campers and staff completed test collection at both time points. Testing was feasible to implement, including staff participation supervising camper test collection. No virus was detected by RT-PCR; seven participants had antibodies. Observed adherence to stated camp mitigation policies for masking, physical distancing, and stable cohorting was generally high. Conclusions: Supervised, self-collected serial anterior nasal and saliva-based SARS-CoV-2 testing was acceptable, with successful repeated participation by children ages 5-14. This strategy for testing and the observed infection mitigation practices comprise potential core components for safe school reopening.

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“…Emergent evidence on a lower force of infection in children under the age of ten suggests that primary schools and childcare facilities are at comparatively lower risk. 1 However, secondary schools may be at higher risk because transmission appears to be more dynamic in adolescents than in children, possibly approximating transmission dynamics in adults Goldstein, M. Lipsitch, and Cevik 2020;Levinson, Cevik, and Lipsitch 2020;Park et al 2020;. But even if adolescents were less susceptible than adults, their frequent contacts and exposure to transmission-facilitating contexts such as schools may amplify the spread of communicable diseases in this age group (Dattner et al 2020).…”

Section: Introductionmentioning

confidence: 99%

Social network-based strategies for classroom size reduction can help limit outbreaks of SARS-CoV-2 in high schools. A simulation study in classrooms of four European countries

Kaiser

Kretschmer

Leszczensky

2020

Preprint

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Background Until pharmaceutical measures are widely available to slow the spread of SARS-CoV-2, social distancing strategies are key to avert overwhelmed health systems. Since schools host large numbers of students in enclosed spaces, they are feared to produce infection clusters. With school closures coming at high social and economic costs, social distancing measures within schools are needed to make them as safe as possible. One widely discussed distancing measure in the school context is to use cohorting strategies, i.e., to split larger clusters such as classrooms into smaller groups that are instructed separately. In addition to facilitating social distancing within these cohorts, cohorting strategies also aim to prevent transmission across cohorts. However, little is known about which cohorting strategies are particularly effective to prevent disease transmission between cohorts in schools. Methods Using nationally representative data on adolescents in classrooms in four European countries, we simulate how four different cohorting strategies can mitigate the spread of SARS-CoV-2 in high schools. We model the effect of forming two cohorts randomly, splitting cohorts by gender, optimizing cohorts by minimizing students' out-of-school cross-cohort contacts, and approximating this optimization strategy by network chains. The rationale of all non-random cohorting strategies is to prevent the spread of SARS-CoV-2 from one cohort to the other by reducing cross-cohort out-of-school contact. We also compare the overall effect of cohorting to no cohorting and differentiate between a rota-system in which cohorts receive in-person instruction in alternating weeks and a system with separate but same-day in-person instruction for both cohorts. Data were collected between 2010 and 2011 as part of the CILS4EU project, a network panel study of 14-15-year-olds in England, Germany, the Netherlands, and Sweden. Across all four countries, we model the transmission of SARS-CoV-2 in 507 classrooms, capturing a total of 12,291 students. Findings Our simulations suggest that all four cohorting strategies reduce the spread of SARS-CoV-2 in classrooms, but vary in their effectiveness. Relative to random cohorting, all strategies that factor in out-of-school cross-cohort ties have particularly strong effects on the frequency of cross-cohort transmission but also substantively reduce the total number of infections and the share of students in quarantine when transmission dynamics are strong. Cohorting that explicitly minimizes out-of-school contact between students in different cohorts is most effective, but network-based approximation also breaks many cross-cohort ties and thus performs well. Because adolescents' out-of-school contacts tend to be strongly segregated by gender, dividing classrooms by gender also outperforms random cohorting but is less effective than directly using network information. For all cohorting strategies, rota-systems with instruction in alternating weeks contain outbreaks more effectively than same-day in-person instruction. Interpretation Cohorting of school classes as a social distancing measure can help to effectively curb SARS-CoV-2 outbreaks in the school context. If schools consider splitting up classes into two smaller cohorts, factoring in out-of-school contacts can help achieve a more effective separation of cohorts. The paper proposes effective cohorting strategies that outperform naive random cohorting in preventing the spread of SARS-CoV-2. These strategies may limit outbreaks to one cohort, keep the size of infection clusters low, and reduce the number of students in quarantine if an index case occurs in the student body. Our findings thus suggest that if schools consider cohorting, they should assign students who meet after school to the same cohort. In particular, cohorting on the basis of gender or network chains is effective and may be successfully implemented within the constraints posed by the classroom context.

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Reopening Primary Schools during the Pandemic

Cited by 157 publications

References 7 publications

Prevalence of RT-qPCR-detected SARS-CoV-2 infection at schools: First results from the Austrian School-SARS-CoV-2 prospective cohort study

Prevalence of RT-qPCR-detected SARS-CoV-2 infection at schools: First results from the Austrian School-SARS-CoV-2 prospective cohort study

Supervised self-collected SARS-CoV-2 testing in indoor summer camps to inform school reopening

Social network-based strategies for classroom size reduction can help limit outbreaks of SARS-CoV-2 in high schools. A simulation study in classrooms of four European countries

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