School closures help reduce the spread of COVID-19: A pre- and post-intervention analysis in Pakistan

Abstract

Closing schools to control COVID-19 transmission has been globally debated, with concerns about children’s education and well-being, and also because of the varied effectiveness of the intervention in studies across the world. This paper aims to determine the effect of school closure policy on the incidence of COVID-19 in Pakistan. A Difference-in-Differences (DiD) analysis compared changes in COVID-19 incidence across cities that completely (Islamabad) and partially (Peshawar) closed schools during the second wave of COVID-19 in Pakistan. Effects of closing (November 2020) and reopening schools (February 2021) were assessed in Islamabad and Peshawar 10 and 20 days after policy implementation. In Islamabad, there was a greater decline in cases than in Peshawar when schools closed. After 10-days, the average reduction of daily COVID-19 incidence in Islamabad was lower by 89 cases (95% CI: -196, 18), due to complete school closure, with a relative reduction of 125 cases (95% CI: -191, -59) compared to Peshawar. Similarly, the relative increase in Islamabad after schools re-opened was 107 cases (95% CI: 46, 167) compared to Peshawar. After 20-days, the average daily COVID-19 incidence in both cities declined after school were closed (Islamabad: -81 [95% CI: -150, -13] versus Peshawar: -80 [95% CI: -148, -12]). COVID-19 incidence appeared to decline after schools reopened as well (Islamabad: -116 [95% CI: -230, -3] versus Peshawar: -30 [95% CI: -124, 63]). However, Peshawar’s decline is not statistically significant. These results control for changes in testing as well as a daily time trend. The magnitude and speed of reduction in cases with a complete school closure, and a similar but reverse trend of increasing cases upon reopening, suggests that closing schools reduces COVID-19 transmission in communities. However, there are learning-loss and well-being costs for children and their parents.

Impact of school closures and reopening on COVID-19 caseload in 6 cities of Pakistan: An Interrupted Time Series Analysis

“…Our findings are consistent with the global evidence, as well as the results of our own previous work [25], that school closures are associated with reduction in COVID-19 transmission in communities [17,30]. In the US, school closures were associated with reduced COVID-19 caseloads [15], deaths [19,42,43], and hospitalizations by as much as half [19].…”

“…This paper is a continuation of our earlier work, which examined the effects of school closures on the daily cases of COVID-19 in Islamabad vs. Peshawar, during the same period as in this study [25]. However, this study attempts to examine the effect of school closures with a different methodology, and also with a larger sample of cities.…”

Impact of school closures and reopening on COVID-19 caseload in 6 cities of Pakistan: An Interrupted Time Series Analysis

“…Our findings are consistent with the global evidence, as well as the results of our own previous work [25], that school closures are associated with reduction in COVID-19 transmission in communities [17, 29]. In the US, school closures were associated with reduced COVID-19 caseloads [15], deaths [19, 38, 39], and hospitalizations by as much as half [19].…”

“…We explore the changes in daily cases on COVID-19 pre and post school closures in Pakistan using a single-group Interrupted Time Series Analysis (ITSA). This paper is a continuation of our earlier work, which examined the effects of school closures on the daily cases of COVID-19 in Islamabad vs. Peshawar, during the same period as in this study [25]. However, this study attempts to examine the effect of school closures with a different methodology, and also with a larger sample of cities.…”

Impact of Lockdown Measures on Health Outcomes of Adults with Type 2 Diabetes Mellitus in Bangladesh

“…Several public health measures were introduced across various countries to reduce the spread of COVID-19, and its subsequent impact on morbidity and mortality, in the absence of proven effective treatments and vaccines [ 1 , 2 , 3 ]. The measures included lockdown and social distancing, wearing of personal protective equipment (PPE), closure of schools and universities, transport restrictions, as well as the introduction of tracing and quarantining measures [ 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 ]. Bangladesh was no exception, with multiple activities introduced at the start of the pandemic to slow the spread of the virus [ 12 , 13 , 14 ].…”