Is school closure necessary to combat COVID-19?
By Loyal Pattuwage and Peter Bragge from the SSE team.
Can the COVID-19 outbreak be compared to influenza?
The debate about whether schools should be open or closed is active across Australia as over 100 countries across the world have resorted to large-scale school closures to curtail the spread of COVID-19. Research shows that school closures can control influenza outbreaks – however children are more susceptible to influenza than adults. With COVID-19, children are either less likely to be infected (as reflected by the lower proportion of total cases) or remain asymptomatic or experience a mild case of the disease compared to adults. Therefore, the evidence in relation to influenza may not be fully applicable to the present COVID-19 crisis.
What does the research say?
A rapid systematic review published in April 2020, in the The Lancet Child & Adolescent Health, explored the evidence underpinning school closure or other school social distancing methods as a management practice during coronavirus outbreaks, including COVID-19. The review included 16 studies – nine concerned the SARS outbreak and seven concerned the COVID-19 pandemic and related endemic coronaviruses.
Key findings were:
- The specific contribution of school closures to controlling COVID-19 transmission is not known, because school closures have been rolled out as one of many social distancing measures;
- COVID-19 modelling studies predict that school closures alone would prevent 2-4% of deaths – much less than other social distancing interventions;
- Data from the SARS outbreak suggests that school closures did not contribute to the control of this epidemic;
- Unintended consequences with school closures include economic harms to working parents; transmission from children to vulnerable grandparents; harms to welfare; nutritional problems where children are dependent on free school meals; and psychological impacts of social isolation;
- Alternatives to fully closing schools include suspending classes / year groups; reducing mixing by closing playgrounds, cancelling non-essential activities and staggering break times; having the same class groups during the day; increasing physical spacing; and shortened weeks. However, there are few studies of these measures and none are specific to COVID-19. The review authors state that "schools remaining open only for the children of health-care and other essential workers might be a better strategy than a haphazard process of schools closing and therefore providing no childcare for any essential workers".
What did the authors conclude?
The authors conclude that "policy makers need to be aware of the equivocal evidence when proposing or implementing national or regional school closures for COVID-19, given the very high costs of lengthy school closures during pandemics. Decisions about closures and their timing and length involve a series of trade-offs between conflicting factors, and a substantial loss of health-care staff to childcare duties during closures might substantially reduce any benefit to health systems and populations brought by closures of schools."
This Review of the Moment: COVID-19 edition was brought to you by the Social Systems Evidence team at the Monash Sustainable Development Institute. Social Systems Evidence (SSE) is a continuously updated repository of systematic reviews, economic evaluations and policy briefs about pressing challenges faced by government and other organisations, including the Sustainable Development Goals. Access to SSE is free.
Viner, R.M. et al. (2020). School closure and management practices during coronavirus outbreaks including COVID-19: a rapid systematic review. The Lancet Child and Adolescent Health, 4(5), 397-404. https://doi.org/10.1016/S2352-4642(20)30095-X
Associate Professor and Director of Health Programs at BehaviourWorks Australia.
Lead, Monash-McMaster Social Systems Evidence Collaboration
Associate Professor Peter Bragge specialises in translating research evidence into practice and policy to address challenges faced in health and sustainable development.
Senior Coder, Social Systems Evidence (SSE)
Loyal joined MSDI in 2019 as a senior coder for Social Systems Evidence (SSE), the world's largest evidence resource for the Sustainable Development Goals, a collaboration between Monash Sustainable Development Institute and McMaster University in Canada.