April 6, 2020

expert reaction to systematic review on the effectiveness of school closures during coronavirus outbreaks (including COVID-19)

A study, published in The Lancet Child & Adolescent Health, reports on the effectiveness of school closures during coronavirus outbreaks (including COVID-19).

Prof Tamsin Ford, Professor of Child and Adolescent Psychiatry, University of Cambridge, said:                                                     

“This is good quality research.  They searched more than one database, including pre-prints and the references of published papers and they triple screened papers. Systematic reviews can only tell you about published or publicly available data – and research is time consuming – therefore for this review only 5 pre-prints and one report (so none of it peer reviewed) relate to COVID-19 – all the published papers relate to SARS – there was no formal quality assessment of the papers (this is common in rapid reviews) although the authors refer to the quality of data as low quality – this makes it difficult to be clear about the findings.

“The authors make the important point that we don’t understand the beneficial impacts of school closures in the absence of other social distancing strategies but we are much surer of the harms that will result – we need to be prepared to support children and young people back into school and for the amplification of health inequalities that school closures will have.

“An important issue raised by this work is the risk of a second surge in infections when schools reopen and how best to respond.

“This research also highlights the need to model and study alternatives – i.e. school dismissal (this is basically what the UK is doing and is described in the papers – the authors could have acknowledged this but perhaps submitted before this was the case) or staggering start, break and finish times or local versus national closures etc to minimise the time for which education is disrupted.

“This is an interesting and thought provoking paper – I commend the authors for doing a good job very rapidly.”

Dr Ellen Brooks Pollock, Senior Lecturer in Veterinary Public Health and Infectious Disease Modelling and NIHR Health Protection Research Unit in Evaluation of Interventions, University of Bristol, said:

“This paper highlights the urgent need to understand and quantify the role of children in the spread of COVID-19 and whether school closures are necessary to prevent a serious outbreak.”  

Dr Catherine Carroll-Meehan, Head of School of Education and Sociology, University of Portsmouth, said:

“This is good quality research. Systematic reviews by their nature scope the relevant literature and research to identify research that fits into predetermined search/keywords. The limitation of this type of research can be the narrowness selected by the research team. In this case, one of the limitations might be the paucity of research of this specific pandemic and we are still very early on in terms of China’s exit strategy and not yet seen a second peak. It may be premature in this pandemic to make strong and definitive conclusions as we are repeatedly told this is not just an ordinary flu!

“The paper hints about the impact on children and a clear exit strategy for reopening will need to be considered. The only way to make an informed decision will be mass testing to determine how widespread the virus has been in the population, those with mild ‘flu-like’ symptoms and asymptomatic carriers. The important aspect of this work is the description of a staged approach, include shielding up to 12 weeks for those families with vulnerable members but attempt to get the majority of children and young people back into education in a phased way.

“The longer schools, colleges and universities are closed we do risk the mental health and well-being of children and young people who are vulnerable because of the situation created by self-isolation and social distancing policies. We need more research into the social and emotional impact of isolation and impact of an epidemic on children’s views and sense of safety.”

Prof Neil Ferguson, Director, MRC Centre for Global Infectious Disease Analysis, Imperial College London, said:

“While school closure as a measure on its own is predicted to have a limited effectiveness in controlling COVID-19 transmission, when combined with intense social distancing it plays an important role in severing remaining contacts between households and thus ensuring transmission declines. While this new paper reviews some of the modelling our group undertook of school closure for less intensive mitigation, it did not include our results for school closure in combination with other lockdown measures.”

Dr James Cusack, Director of Science at autism research charity Autistica, said:

“The decision to close schools was clearly challenging for policymakers and this new evidence highlights the need to consider the potential harms of any intervention as well as its potential benefits. We’re particularly concerned about the impact of school closures on autistic children and their families. Many autistic children need increased support at this difficult time and may find the disruption to their routines especially hard. We know from parents of autistic children that the closure of schools has led to increased anxiety, particularly related to uncertainty.  We’re also concerned about the mental health problems this could cause or exacerbate in autistic children and the missed opportunities for support. Future research should consider the impact of school closures on autistic children, as well as children with other neurodevelopmental conditions or mental health problems.”

Dr Samantha Brooks, Research Worker, Institute of Psychiatry, Psychology & Neuroscience, King’s College London and team member of the NIHR Health Protection Research Unit in Emergency Preparedness & Response, said:

“This is a very timely paper. Closing schools has been an almost universal response to the current crisis, because it seems to make sense – keeping our children safe, and all of us who are parents know just how often children return from school with some bug or other.  But COVID-19 presents different challenges –unlike with most infections, where adult immunity is greater than children’s, this time no one is immune.  And we also know from work by our own unit^± that even when children are not at school, it should not be assumed that means social distancing is automatically assured. At the same time, no one is in any doubt that there are downsides to school closures.  It has a large impact on the adult workforce, particularly in health and social care, just when these are needed most. The long term effects on education and development are still unclear, but what is clear is that there are risks for the health and wellbeing of vulnerable children. Those at risk of maltreatment really need to be in regular schooling.  So the finding that school closures have at best only a small impact on the spread of COVID-19 is of great significance, especially linked with the sensible suggestions for how a gradual return to normal schooling could be implemented.”

^± https://www.eurosurveillance.org/content/10.2807/1560-7917.ES.2020.25.13.2000188

Prof Robert Dingwall, Professor of Sociology, Nottingham Trent University:

“This is an important study that confirms what many of us suspected, namely that the public health benefits of school closures were not proportionate to the social and economic costs imposed on children and their families. It also underlines how the assumptions used in modelling the COVID-19 pandemic may rest on very flimsy foundations in terms of scientific evidence. This work suggests that UK schools could, and should, begin to reopen as soon as practicable after the initial wave of cases has passed through. The biggest risk may come from gatherings of parents, grandparents and other carers at the school gate rather than anything that happens inside.”

“School closure and management practices during coronavirus outbreaks including COVID-19: a rapid narrative systematic review” by Russell Viner et al. was published in The Lancet Child & Adolescent Health on Monday 6 April at 23.30 UK time.

All our previous output on this subject can be seen at this weblink: www.sciencemediacentre.org/tag/covid-19

Declared interests

None received.