The Effect of In-Person Primary and Secondary School Instruction on County-Level Severe Acute Respiratory Syndrome Coronavirus 2 Spread in Indiana

Abstract

Objective To determine the county-level effect of in-person primary and secondary school reopening on daily cases of SARS-CoV-2 in Indiana. Methods This is a county-level population-based study using a panel data regression analysis of the proportion of in-person learning to evaluate an association with community-wide daily new SARS-CoV-2 cases. The study period was July 12-October 6, 2020. We included 73 out of 92 (79.3%) Indiana counties in the analysis, accounting for 85.7% of school corporations and 90.6% of student enrollment statewide. The primary exposure was the proportion of students returning to in-person instruction. The primary outcome was the daily new SARS-CoV-2 cases per 100,000 residents at the county level. Results There is a statistically significant relationship between the proportion of students attending K-12 schools in-person and the county level daily cases of SARS-CoV-2 28 days later. For all ages, the coefficient of interest (β) is estimated at 3.36 (95% CI: 1.91—4.81; p < 0.001). This coefficient represents the effect of a change the proportion of students attending in-person on new daily cases 28 days later. For example, a 10 percentage point increase in K-12 students attending school in-person is associated with a daily increase in SARS-CoV-2 cases in the county equal to 0.336 cases/100,000 residents of all ages. Conclusion In-person primary and secondary school is associated with a statistically significant but proportionally small increase in the spread of SARS-CoV-2 cases.

Association of In-person vs Virtual Education With Community COVID-19 Case Incidence Following School Reopenings in the First Year of the COVID-19 Pandemic

“…This study sought to build a more rigorous approach to examining the association between school reopenings and COVID-19 community transmission early in the pandemic by addressing limitations related to comparison groups, confounding of other cooccurring mitigation policies, or insufficient geographic samples. With a highly sophisticated matched design with multiple sensitivity analyses inclusive of enriched data on school and community factors, this study affirms findings of prior studies that detected a positive association between in-person school reopenings and community transmission . That this increase was fairly small may suggest that that adherence to mitigation strategies within schools that resumed in-person education might have been sufficient to narrow the difference in community case incidence between schools that reopened in-person vs virtually.…”

“…Moreover, the study sample is heavily weighted by the experience within the US South during this period. The reason is 2-fold: (1) summer and fall 2020 in-person school reopenings disproportionately occurred in southern states and (2) the analysis focused on single-district counties to ensure clean ascertainment of the school exposure context at the county-level. While the selection of single district counties represents a methodologic strength in reducing mismeasurement of exposures (opening dates, school safety protocols, sports initiation), it contributed to geographic skew in the study sample, as single-district counties are also more likely to be found in southern states.…”

“…The variability in timing for school reopenings in the 2020 to 2021 school year presents an opportunity to examine the association of these different approaches to in-person vs virtual instruction of students in secondary school classrooms with changes in community COVID-19 incidence during the early fall of 2020. Early research has suggested that in-person instruction at the primary and secondary levels is associated with increases in community transmission at the county-level in the US but that this association is modest in size and influenced by school mitigation policies . However, empirically studying the contribution of in-person instruction to community transmission has been challenging for several reasons.…”

“…Early research has suggested that in-person instruction at the primary and secondary levels is associated with increases in community transmission at the county-level in the US but that this association is modest in size and influenced by school mitigation policies. 1 , 2 However, empirically studying the contribution of in-person instruction to community transmission has been challenging for several reasons. Most significant has been unobserved confounding related to highly dynamic and variable school-community engagement with mitigation strategies that can be very difficult to measure over time.…”

The impact of school opening model on SARS-CoV-2 community incidence and mortality

“…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 conflicting results [10][11][12] , with some analyses suggesting substantial increases…”