Effectiveness of isolation policies in schools: evidence from a mathematical model of influenza and COVID-19
This article has been Reviewed by the following groups
Listed in
- Evaluated articles (ScreenIT)
Abstract
Non-pharmaceutical interventions such as social distancing, school closures and travel restrictions are often implemented to control outbreaks of infectious diseases. For influenza in schools, the Center of Disease Control (CDC) recommends that febrile students remain isolated at home until they have been fever-free for at least one day and a related policy is recommended for SARS-CoV-2 (COVID-19). Other authors proposed using a school week of four or fewer days of in-person instruction for all students to reduce transmission. However, there is limited evidence supporting the effectiveness of these interventions.
Methods
We introduced a mathematical model of school outbreaks that considers both intervention methods. Our model accounts for the school structure and schedule, as well as the time-progression of fever symptoms and viral shedding. The model was validated on outbreaks of seasonal and pandemic influenza and COVID-19 in schools. It was then used to estimate the outbreak curves and the proportion of the population infected (attack rate) under the proposed interventions.
Results
For influenza, the CDC-recommended one day of post-fever isolation can reduce the attack rate by a median (interquartile range) of 29 (13–59)%. With 2 days of post-fever isolation the attack rate could be reduced by 70 (55–85)%. Alternatively, shortening the school week to 4 and 3 days reduces the attack rate by 73 (64–88)% and 93 (91–97)%, respectively. For COVID-19, application of post-fever isolation policy was found to be less effective and reduced the attack rate by 10 (5–17)% for a 2-day isolation policy and by 14 (5–26)% for 14 days. A 4-day school week would reduce the median attack rate in a COVID-19 outbreak by 57 (52–64)%, while a 3-day school week would reduce it by 81 (79–83)%. In both infections, shortening the school week significantly reduced the duration of outbreaks.
Conclusions
Shortening the school week could be an important tool for controlling influenza and COVID-19 in schools and similar settings. Additionally, the CDC-recommended post-fever isolation policy for influenza could be enhanced by requiring two days of isolation instead of one.
Article activity feed
-
-
-
SciScore for 10.1101/2020.03.26.20044750: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
NIH rigor criteria are not applicable to paper type.Table 2: Resources
No key resources detected.
Results from OddPub: Thank you for sharing your code and data.
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:While our model is driven by virological data and calibrated to several outbreaks, a few limitations are inherent in our approach. First, the effect of any policy depends on the context where it would be applied. The details of the school or institution would matter, and therefore, we provide an online version of the model, which can be calibrated for multiple situations. It may be possible to apply our findings to school-like contexts …
SciScore for 10.1101/2020.03.26.20044750: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
NIH rigor criteria are not applicable to paper type.Table 2: Resources
No key resources detected.
Results from OddPub: Thank you for sharing your code and data.
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:While our model is driven by virological data and calibrated to several outbreaks, a few limitations are inherent in our approach. First, the effect of any policy depends on the context where it would be applied. The details of the school or institution would matter, and therefore, we provide an online version of the model, which can be calibrated for multiple situations. It may be possible to apply our findings to school-like contexts such as workplaces, prisons, or even the broader community, but such settings have significant features that may confound our findings. Lastly, symptom parameter information is based on average values for the population and it is expected that inter-individual and demographic variability might have some effect on outcomes. Future studies should attempt to evaluate isolation policies with agent-based models (e.g. 15,46) that can capture inter-individual variability in health trajectories and the network structure of the population47,48. Despite these limitations, our model captures essential aspects of acute respiratory outbreaks including progression through stages, the population structure and symptom trajectories. In conclusion, in this study we have created a model of transmission of respiratory infection and considered the effects of two isolation policies. We confirmed that symptom-based policies would be effective in controlling influenza in a variety of scenarios. Furthermore for influenza outbreaks, we recommend that isolation is mainta...
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.
-