School closures to prevent transmission of COVID-19 (multiple reviews)

Added November 18, 2020

What is this? Efforts to prevent the transmission of COVID-19 have included the closure of schools. Research on the impact of school closures, including research done during other pandemics, might provide useful information for policymakers. Several systematic reviews are summarised here and more details of these. including citations and links to the full text, are available lower down this summary.

What was found: The reviews noted uncertainties around the best timing and duration of school closures. They suggest that a multi-faceted approach to reducing transmission in schools may be most effective, with possible additional measures including staff remaining in work but pupils staying at home, and hygiene and environmental control measures.

At the time of the rapid review by Viner (search done on 19 March 2020), research showed that school closures alone might prevent 2-4% of deaths, which was less than other social distancing methods. They concluded that the available studies showed that the overall effects of school closures on COVID-19 transmission were uncertain.

The Bin Nafisah review (search done in March 2017) showed that implementing school closure before or after the peak of an influenza epidemic reduced the overall epidemic. Early and prolonged school closures had more impact on epidemic peaks.

The Jackson review (search done in January 2012) showed that school closure reduced transmission of seasonal and pandemic influenza among school children in some studies and that some studies found that influenza incidence increased when schools reopened.

The Saunders-Hasting review (search done in July 2016) showed that school closures reduced contact with infected people during an influenza pandemic.

The Fong review (search done in November 2018) showed that pre-emptive school closures which were early and sustained reduced mortality rates during influenza pandemics but the evidence for reactive school closures following an outbreak within a school was mixed.

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What are the reviews:

Citation: Bin Nafisah S, Alamery AH, Al Nafesa A, et al. School closure during novel influenza: a systematic review. Journal of Infection and Public Health. 2018;11(5):657-61.

In this systematic review, the authors searched for articles of the effects of school closures during influenza epidemics. They restricted their searches to studies published in English and did the search in March 2017. They identified 31 studies that had used either mathematical models or data from within an epidemic.

Citation: Fong MW, Gao H, Wong JY, et al. Nonpharmaceutical measures for pandemic influenza in non-healthcare settings: social distancing measures. Emerging Infectious Diseases. 2020 May;26(5):976.

In this series of systematic reviews, the authors searched for studies of the effects of social distancing measures for pandemic influenza. They reviewed six social distancing measures: isolating ill individuals, contact tracing, quarantining exposed individuals, school measures or closures, workplace measures or closures, and crowd avoidance, with multiple search periods documented up to November 2018. They included 107 epidemiological studies, 37 simulation studies, 12 observational studies, and one interventional study; and analysis of archival data from the 1918 pandemic.

Citation: Jackson C, Vynnycky E, Hawker J, Olowokure B, Mangtani P. School closures and influenza: systematic review of epidemiological studies. BMJ Open 2013;3(2):e002149

In this systematic review, the authors searched for epidemiological research into the effects of school closures on transmission and incidence of influenza. They restricted their searches to articles published in English and did their search in January 2012. They included 22 studies of seasonal influenza and 57 studies of pandemic influenza.

Citation: Saunders-Hastings P, Reisman J, Krewski D. Assessing the state of knowledge regarding the effectiveness of interventions to contain pandemic influenza transmission: a systematic review and narrative synthesis. PLOS One. 2016;11(12):e0168262.

In this systematic overview and narrative syntheses, the authors searched for existing systematic reviews and meta-analyses examining the effects of pharmaceutical and non-pharmaceutical interventions in containing pandemic influenza transmission. They did not restrict by date or language of publication and did their searches in July 2016. They included 17 reviews.

Citation: Viner RM, Russell SJ, Croker H, et al. School closure and management practices during coronavirus outbreaks including COVID-19: a rapid systematic review. Lancet Child & Adolescent Health. 2020;4(5):397-404.

In this rapid review, the authors searched for studies of the effects of school closure and other school-based social distancing practices on infection rates and transmission during coronavirus outbreaks. They did not restrict their searches by date or language of publication and did their most recent search on 19 March 2020. They included 16 studies. All the published articles concerned the 2003 SARS outbreak, one preprint assessed the effect of school closures on transmission of other (endemic) coronaviruses, and five preprints and one report concerned the COVID-19 pandemic.


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