Making school closures effective in preventing the spread of COVID-19

A new study by King's College London researchers has shown that many children continued to leave the house and mix with others during previous school closures despite public health recommendations. This has important implications for modeling infectious diseases and assessing the contribution these measures make to controlling an outbreak.

School closure is a measure taken during infectious outbreaks. However, school closure can have an impact on education, the healthcare system and the wider economy so it is important to understand how effective school closure is in terms of preventing interaction and what can potentially improve its effectiveness.

Researchers analysed 19 studies, the majority of which reported on school closures during the H1N1 pandemic or other influenza like outbreaks. Duration of school closures ranged from one day to two weeks.

Published in the journal Eurosurveillance, the analysis showed that participation in activities and interactions with others did appear to decrease during school closures compared to regular school days, but social contact still occurred. More activities and social contact were seen with older children, who tended to leave home on their own, and with younger children who needed to remain with parents when they went shopping or to do chores outside the house.

Parents generally agreed with school closures and several studies reported high rates of parents being at least moderately supportive of the closure, researchers found. Several of the main reasons for disagreeing with school closures appeared to be related to perceived risk and beliefs that closures do not protect against influenza. The other main reasons for disagreeing with school closures were related to the practicalities and subsequent impact of the closure: for example, concerns about the impact on the child's education, difficulties making childcare arrangements and concerns about the economic impact.

When parents considered school closure to be inappropriate, student participation in activities outside the home was greater than when parents considered it to be appropriate.

"Of the 19 papers that we identified, all of them reported that some degree of mixing continued to occur outside of the home. This is not surprising and, even for adults, self-isolation can be difficult and stressful. Ensuring parents understand why school closure is important will be a key factor in determining the success of the measure in the current COVID-19 outbreak," said lead author Dr. Samantha Brooks from the Institute of Psychiatry, Psychology & Neuroscience (IoPPN), Kings College London.

She continued, "In this regard, it was concerning that two studies appeared to highlight a lack of clarity in terms of advice about children's social activities and knowing what children were and were not advised to do. Any school closure should be accompanied by clear information on why this measure is being taken and what it should entail. Effectiveness of school closure to prevent the spread of COVID-19 will also depend on what other measures are in place."

Professor Andrea Danese, Professor of Child & Adolescent Psychiatry at the IoPPN, commented: "In order to prevent the spread of COVID-19, the government has taken drastic steps including school closure. On the one hand, families need to be motivated to engage in collective action through clear information sharing as well as practical and financial support. On the other hand, interventions to promote children's mental health can be key to facilitate their compliance in the face of significant demands, such as disruption of education and socialization."