The effect of in-person primary and secondary school instruction on county-level SARS-CoV-2 spread in Indiana

Abstract

Background: The effect of in person primary and secondary school instruction on the community transmission of SARS-CoV-2 remains unclear. Objective: To determine the county-level effect of in-person primary and secondary school reopening on daily cases of SARS-CoV-2 in Indiana. Design: Panel data regression analysis utilizing 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. Setting: A county-level population-based study. Participants: 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 enrollement statewide. Main outcomes and measures: 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. Limitations: Single state study; inability to stratify school age effects by age; cannot account for non-linear growth effects. Conclusion and relevance: In-person primary and secondary school is associated with a statistically significant but proportionally small increase in the spread of SARS-CoV-2 cases.

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

“…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.…”