Does closing schools reduce the spread of Covid-19?
So far there is little evidence to support this as most of the times when the schools have been closed this has been done while many other things are closed such as workplaces, restaurants, social gatherings etc. It makes it difficult then to look at the evidence around school closures alone.
A recent systematic review of the evidence (and they only included 9 studies), points out that school closure is at its most effective if the chance of spreading the disease (the R value – which is the number of people you will infect if you have Covid-19) is less than 2. Current estimates of the R value for Covid-19 put it at 2.5. School closure is also more effective if there is a high attack rate among children, and transmission between children is high. So far this does not appear to be the case with Covid-19.
So it probably doesn’t contribute a huge amount to reducing the spread of Covid-19.
What are the benefits of school closure?
It is thought that school closure will reduce transmission by reducing spread between children and from children to adults, helping to bring the epidemic under control.
However, this has been shown mainly in studies looking at influenza outbreaks. It is important to note that Covid-19 behaves quite differently to influenza, so the measures that would work in an influenza outbreak may have less of an effect during the current outbreak of Covid-19. This is thought to be the case for school closures during our current Covid-19 outbreak.
How is Influenza different from Covid-19?
Influenza is less infectious (or less transmissible) than Covid-19, transmitted to 1.3 people on average. Influenza is abundantly found in children (or has a high attack rate) during an outbreak and is easily passed between children. Children with influenza are unwell with symptoms of illness so they can be easily recognised and kept home if unwell to reduce the spread of the disease.
Covid-19 is more infectious than influenza able to be transmitted to 2.5 people. Covid-19 appears to have fewer symptoms in children, with some children being asymptomatic, so it is hard to identify and then keep them away from others when infectious. Covid-19 does not appear as frequently among children and seems to be less easily spread between children. So it appears that children are not the reservoirs for infection of Covid-19 as they are in influenza.
Hence the reduction in spread of covid-19 with the closing of schools is likely to be less effective or have less of an impact than closing schools during an influenza epidemic.
What are the negatives of school closure?
In order to look after children when schools are closed, a significant number of our workforce will be unable to participate in paid work. Some will be able to work from home, but many will not, which brings about reduced income to the family as well as reduced productivity to the economy as a whole. The mental toll of this is not shouldered by parents alone, children also suffer.
There are several harms related to the social isolation of school closure, directly impacting children and young people through their mental health and wellbeing. This can be due to the child’s own experience of isolation from their friends or school routine but is also impacted upon by the parental/caregiver’s stress which can be caused by a wide range of factors. There is no doubt that the stress of not being able to go to school is more acutely felt for some children and some family’s more so than others.
So how do we reduce the risks of infection when we open the schools?
Given that Covid-19 causes a less severe illness in children, the risks, should a child become infected, are fewer but still present. There are, however, evidence-based ways we can reduce that small risk. The first and most important way is with good hand hygiene and cough etiquette. Students can mix with each other being kept in smaller, constant groups with increased space between them as is able. The school weeks can be shortened and the breaks for lunchtime and play can be staggered. It is likely that schools will continue to employ the use of electronic learning which will be supplemented by the face to face time the students will have with the teacher.
Every school will have its own unique challenges of either student numbers or physical space and they will find the strategies that suit them the best. Our teachers are excellent professionals who have got this, supported by good public health advice.
Conclusions
Schools were closed under the assumption that the gains that would be seen could be similar to those seen with an influenza outbreak. The same cannot be said of Covid-19 given the current evidence. There is no doubt there has been a contribution to the fall in Covid-19 cases while schools have been closed, but perhaps the greater impact was by reducing the exposure of the working parents within their places of employment.
Re-opening schools is a good idea economically, socially and from a mental health aspect for everyone. The risks of infection are being appropriately addressed and managed to keep our children and teachers safe. Let’s move forwards.
References
School closures - systematic review of evidence
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