School closures linked to fewer COVID-19 infections, deaths — but experts say it's complicated: Study
Going back to school has been a hot topic in a pandemic world, with parents, students and teachers concerned about whether it’s safe to do in-person learning while COVID-19 continues to spread in communities. Now a new study attempts to shed light on how spring’s school closures affected COVID-19 outcomes.
The study, which was published in JAMA, analyzed state data from March to May 2020, specifically looking at the rates of COVID-19 in each state per 100,000 people after schools closed. The data was separated into quartiles, and researchers used models to estimate the differences in COVID-19 cases and deaths in areas where schools closed compared with where they stayed open.
According to the findings, school closures may have led to a million fewer COVID-19 cases and prevented more than 40,000 deaths. Specifically, states that closed their schools quickly saw the fastest drops in COVID-19 on a weekly basis, when compared with those that were slower to close schools.
But experts say people shouldn’t assume that the findings mean that in-person learning is bad, or that it will lead to surges in COVID-19 cases and deaths. “The study is interesting, but it is important to note they found an association, which does not prove causality,” Dr. Richard Watkins, an infectious disease physician in Akron, Ohio, and an associate professor of internal medicine at Northeast Ohio Medical University, tells Yahoo Life. Meaning, while the study found a link between school closures and a decline in COVID-19 cases and deaths, it doesn’t prove that school closures actually caused those drops.
Even the study’s authors clearly state this in the study, noting, “It remains possible that some of the reduction may have been related to other concurrent non-pharmaceutical interventions.”
“It’s hard to draw definitive conclusions from this because lots of states did different things at the same time. It’s hard to decide what actions added to the decrease in transmission,” Dr. Amesh A. Adalja, senior scholar at the Johns Hopkins Center for Health Security, tells Yahoo Life. “At the same time as in-person learning stopped, stay-at-home orders were issued, shops closed and people made decisions about what they wanted to do to lower their risk of contracting COVID-19.”
The researchers tried to account for those variables, though. “It is impossible to completely, definitively link school closure with COVID-19 rates and deaths, but we did account for a lot of things in our modeling,” lead study author Dr. Katherine Auger, attending physician in the division of hospital medicine at Cincinnati Children’s Hospital, tells Yahoo Life. “This is arguably the best analysis for understanding the effect of school closure.”
But ultimately, Adala says, “the authors can only adjust so much.” It’s difficult to determine whether the decrease is due to changes in what the children did or how adults behaved, Adalja says. Many parents needed to work from home and stay home more than usual to care for their children, and that “likely decreased spread to some degree,” he says. But, Adalja says, “It’s hard to know how much.”
That doesn’t mean school closures didn’t help slow the spread of COVID-19, though. “It seems plausible that reducing the exposure of kids to other kids might reduce the amount of COVID-19 transmission, [but] it is just speculation,” Adalja says.
What does this mean as schools prepare to reopen?
The Centers for Disease Control and Prevention and the American Academy of Pediatrics (AAP) have issued guidance, pushing for in-person learning to resume in the fall — a move that’s controversial to many.
This new study doesn’t necessarily change anything, Adalja says. “It’s hard to make a direct extrapolation,” he says. “Right now we have widespread transmission in many parts of the country, and it’s in the middle of summer, when schools are closed. Will the opening of schools add to the transmission? It’s hard to know the exact answer to that.”
But Auger argues that her work can help lay a foundation for questions school systems should ask themselves before reopening to in-person learning. “How many cases of COVID-19 are there in a community? If you’re in the middle of an outbreak or hot spot, opening schools will almost certainly make that worse,” she says. “But in areas with very few cases, they should open schools immediately.”
As a whole, Adalja recommends looking at data from other countries as well as daycare centers in the United States that have stayed open for essential workers. That data has largely found that students and schools did not cause a large increase in COVID-19 cases.
One epidemiological study from New South Wales, Australia, found that between March and mid-April, 18 people (nine students and nine staff) in 15 schools had confirmed cases of COVID-19. All of them had the opportunity to transmit the virus to the 735 students and 128 staff who were in close contact with these individuals, but no teacher or staff member contracted COVID-19 from any of the initial school cases.
Another study, from France’s Institut Pasteur, focused on 1,340 people in a town outside Paris and found three probable cases of COVID-19 among children — and those didn’t lead to more infections in other students or teachers. The researchers also found that the data suggested that the parents gave it to the kids.
However, there isn’t much data to analyze since many schools closed after the pandemic swept through their area. It’s also difficult to directly compare data from other countries, where cases of COVID-19 are more controlled, with the U.S., where the spread of the virus is uncontrolled, Adalja says.
During a Facebook live stream with the American Federation of Teachers earlier this week, Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, admitted that experts just don’t know what will happen when in-person learning resumes. “In many respects, unfortunately, though this may sound a little scary and harsh, I don’t mean it to be that way, is that you’re going to be actually part of the experiment of the learning curve of what we need to know,” he said. “We don’t know the full impact. We don’t have the total database of knowing what there is to expect.”
As of now, experts recommend that students and teachers follow CDC guidelines on how to prevent the spread of COVID-19 as much as possible. “Schools need to take as many precautions as they can to reduce the potential spread of COVID-19, such as requiring masks, aggressive hand washing and spacing kids out inside schools,” Watkins says.
Auger agrees that things need to change from previous years. “We can’t go back to the old normal. We have to look at school in a different way,” she says.
For the latest coronavirus news and updates, follow along at https://news.yahoo.com/coronavirus. According to experts, people over 60 and those who are immunocompromised continue to be the most at risk. If you have questions, please reference the CDC’s and WHO’s resource guides.
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