Do school closures and school reopenings affect community transmission of COVID-19? A systematic review of observational studies

  1. Sebastian Walsh
  2. Avirup Chowdhury
  3. Vickie Braithwaite
  4. Simon Russell
  5. Jack Michael Birch
  6. Joseph L Ward
  7. Claire Waddington
  8. Carol Brayne
  9. Chris Bonell
  10. Russell M Viner
  11. Oliver T Mytton

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Abstract

To systematically reivew the observational evidence of the effect of school closures and school reopenings on SARS-CoV-2 community transmission.

Setting

Schools (including early years settings, primary schools and secondary schools).

Intervention

School closures and reopenings.

Outcome measure

Community transmission of SARS-CoV-2 (including any measure of community infections rate, hospital admissions or mortality attributed to COVID-19).

Methods

On 7 January 2021, we searched PubMed, Web of Science, Scopus, CINAHL, the WHO Global COVID-19 Research Database, ERIC, the British Education Index, the Australian Education Index and Google, searching title and abstracts for terms related to SARS-CoV-2 AND terms related to schools or non-pharmaceutical interventions (NPIs). We used the Cochrane Risk of Bias In Non-randomised Studies of Interventions tool to evaluate bias.

Results

We identified 7474 articles, of which 40 were included, with data from 150 countries. Of these, 32 studies assessed school closures and 11 examined reopenings. There was substantial heterogeneity between school closure studies, with half of the studies at lower risk of bias reporting reduced community transmission by up to 60% and half reporting null findings. The majority (n=3 out of 4) of school reopening studies at lower risk of bias reported no associated increases in transmission.

Conclusions

School closure studies were at risk of confounding and collinearity from other non-pharmacological interventions implemented around the same time as school closures, and the effectiveness of closures remains uncertain. School reopenings, in areas of low transmission and with appropriate mitigation measures, were generally not accompanied by increasing community transmission. With such varied evidence on effectiveness, and the harmful effects, policymakers should take a measured approach before implementing school closures; and should look to reopen schools in times of low transmission, with appropriate mitigation measures.

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  1. Version published to 10.1136/bmjopen-2021-053371
  2. ScreenIT

    SciScore for 10.1101/2021.01.02.21249146: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Search strategy We searched PubMed, Web of Science, Scopus, CINAHL, the WHO Global COVID-19 Research Database (including medRxiv and SSRN), ERIC, the British Education Index, and the Australian Education Index, searching title and abstracts for terms related to SARS-CoV-2 AND terms related to schools or NPIs.
    PubMed
    suggested: (PubMed, RRID:SCR_004846)
    To search the grey literature, we searched Google.
    Google
    suggested: (Google, RRID:SCR_017097)
    We used the Cochrane Risk of Bias In Non-randomised Studies of
    Cochrane Risk of Bias
    suggested: None

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: An explicit section about the limitations of the techniques employed in this study was not found. We encourage authors to address study limitations.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  3. Version published to 10.1101/2021.01.02.21249146 on medRxiv