Measures implemented in the school setting to contain the COVID-19 pandemic: a scoping review.

Krishnaratne, Shari; Pfadenhauer, Lisa Maria ; Coenen, Michaela; Geffert, Karin; Jung-Sievers, Caroline; Klinger, Carmen; Kratzer, Stephan; Littlecott, Hannah; Movsisyan, Ani; Rabe, Julia E.; Rehfuess, Eva Annette; Sell, Kerstin; Strahwald, Brigitte; Stratil, Jan M.; Voss, Stephan; Burns, Jacob und Wabnitz, Katharina (17. Dezember 2020): Measures implemented in the school setting to contain the COVID-19 pandemic: a scoping review. In: Cochrane Database of Systematic Reviews, Bd. 12, CD013812

Abstract

Abstract

Background: In response to the spread of SARS-CoV-2 and the impact of COVID-19, national and subnational governments implemented a variety of measures in order to control the spread of the virus and the associated disease. While these measures were imposed with the intention of controlling the pandemic, they were also associated with severe psychosocial, societal, and economic implications on a societal level. One setting affected heavily by these measures is the school setting. By mid-April 2020, 192 countries had closed schools, affecting more than 90% of the world's student population. In consideration of the adverse consequences of school closures, many countries around the world reopened their schools in the months after the initial closures. To safely reopen schools and keep them open, governments implemented a broad range of measures. The evidence with regards to these measures, however, is heterogeneous, with a multitude of study designs, populations, settings, interventions and outcomes being assessed. To make sense of this heterogeneity, we conducted a rapid scoping review (8 October to 5 November 2020). This rapid scoping review is intended to serve as a precursor to a systematic review of effectiveness, which will inform guidelines issued by the World Health Organization (WHO). This review is reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist and was registered with the Open Science Framework.

Objectives: To identify and comprehensively map the evidence assessing the impacts of measures implemented in the school setting to reopen schools, or keep schools open, or both, during the SARS-CoV-2/COVID-19 pandemic, with particular focus on the types of measures implemented in different school settings, the outcomes used to measure their impacts and the study types used to assess these.

Search methods: We searched the Cochrane COVID-19 Study Register, MEDLINE, Embase, the CDC COVID-19 Research Articles Downloadable Database for preprints, and the WHO COVID-19 Global literature on coronavirus disease on 8 October 2020.

Selection criteria: We included studies that assessed the impact of measures implemented in the school setting. Eligible populations were populations at risk of becoming infected with SARS-CoV-2, or developing COVID-19 disease, or both, and included people both directly and indirectly impacted by interventions, including students, teachers, other school staff, and contacts of these groups, as well as the broader community. We considered all types of empirical studies, which quantitatively assessed impact including epidemiological studies, modelling studies, mixed-methods studies, and diagnostic studies that assessed the impact of relevant interventions beyond diagnostic test accuracy. Broad outcome categories of interest included infectious disease transmission-related outcomes, other harmful or beneficial health-related outcomes, and societal, economic, and ecological implications.

Data collection and analysis: We extracted data from included studies in a standardized manner, and mapped them to categories within our a priori logic model where possible. Where not possible, we inductively developed new categories. In line with standard expectations for scoping reviews, the review provides an overview of the existing evidence regardless of methodological quality or risk of bias, and was not designed to synthesize effectiveness data, assess risk of bias, or characterize strength of evidence (GRADE).

Main results: We included 42 studies that assessed measures implemented in the school setting. The majority of studies used mathematical modelling designs (n = 31), while nine studies used observational designs, and two studies used experimental or quasi-experimental designs. Studies conducted in real-world contexts or using real data focused on the WHO European region (EUR; n = 20), the WHO region of the Americas (AMR; n = 13), the West Pacific region (WPR; n = 6), and the WHO Eastern Mediterranean Region (EMR; n = 1). One study conducted a global assessment and one did not report on data from, or that were applicable to, a specific country. Three broad intervention categories emerged from the included studies: organizational measures to reduce transmission of SARS-CoV-2 (n = 36), structural/environmental measures to reduce transmission of SARS-CoV-2 (n = 11), and surveillance and response measures to detect SARS-CoV-2 infections (n = 19). Most studies assessed SARS-CoV-2 transmission-related outcomes (n = 29), while others assessed healthcare utilization (n = 8), other health outcomes (n = 3), and societal, economic, and ecological outcomes (n = 5). Studies assessed both harmful and beneficial outcomes across all outcome categories.

Authors' conclusions: We identified a heterogeneous and complex evidence base of measures implemented in the school setting. This review is an important first step in understanding the available evidence and will inform the development of rapid reviews on this topic.

• Dokumententyp: Zeitschriftenartikel
• Publikationsform: Publisher's Version
• Fakultät: Medizin > Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie
• Themengebiete: 600 Technik, Medizin, angewandte Wissenschaften > 610 Medizin und Gesundheit
• Sprache: Englisch

Literaturliste

References to studies included in this review

Anchordoqui 2020 {published data only} Anchordoqui LA, Chudnovsky EM, Paul TC. Risk assessment of COVID-19 airborne infection during hybrid learning. medRxiv [Preprint] 2020. [DOI: 10.1101/2020.09.24.20200782]

Balabdaoui 2020 {published data only} Balabdaoui F, Mohr D. Age-stratified model of the COVID-19 epidemic to analyze the impact of relaxing lockdown measures: nowcasting and forecasting for Switzerland. medRxiv [Preprint] 2020. [DOI: 10.1101/2020.05.08.20095059]

Bracis 2020 {published data only} Bracis C, Burns E, Moore M, Swan D, Reeves DB, Schiffer JT, et al. Widespread testing, case isolation and contact tracing may allow safe school reopening with continued moderate physical distancing: a modeling analysis of King County, WA data. medRxiv [Preprint] 2020. [DOI: 10.1101/2020.08.14.20174649]

Brooks-Pollock 2020 {published data only} Brooks-Pollock E, Read JM, McLean AR, Keeling MJ, Danon L. Using social contact data to predict and compare the impact of social distancing policies with implications for school re-opening. medRxiv [Preprint] 2020. [DOI: 10.1101/2020.07.25.20156471]

Buonsenso 2020 {published data only} Buonsenso D, De Rose C, Moroni R, Valentini P. SARSCoV-2 infections in Italian schools: preliminary findings aGer one month of school opening during the second wave of the pandemic. medRxiv [Preprint] 2020. [DOI: 10.1101/2020.10.10.20210328]

Burns 2020 {published data only} Burns A, Gutfraind A. Symptom-based isolation policies: evidence from a mathematical model of outbreaks of influenza and COVID-19. medRxiv [Preprint] 2020. [DOI: 10.1101/2020.03.26.20044750]

Campbell 2020 {published data only} Campbell JR, Uppal A, Oxlade O, Fregonese F, Bastos ML, Lan Z, et al. Active testing of groups at increased risk of acquiring SARS-CoV-2 in Canada: costs and human resource needs. Canadian Medical Association Journal 2020;192(40):E1146E1155. [DOI: 10.1503/cmaj.201128]

Cohen 2020 {published data only} Cohen JA, Mistry D, Kerr CC, Klein DJ. Schools are not islands: balancing COVID-19 risk and educational benefits using structural and temporal countermeasures. medRxiv [Preprint] 2020. [DOI: 10.1101/2020.09.08.20190942]

Coletti 2020 {published data only} Coletti P, Libin P, Petrof O, Willem L, Steven A, Herzog SA, et al. A data-driven metapopulation model for the Belgian COVID-19 epidemic: assessing the impact of lockdown and exit strategies. medRxiv [Preprint] 2020. [DOI: 10.1101/2020.07.20.20157933]

Curtius 2020 {published data only} Curtius J, Granzin M, Schrod J. Testing mobile air purifiers in a school classroom: reducing the airborne transmission risk for SARS-CoV-2. medRxiv [Preprint] 2020. [DOI: 10.1101/2020.10.02.20205633]

Di Domenico 2020 {published data only} Di Domenico L, Pullano G, Sabbatini CE, Boëlle P-Y, Colizza V. Expected impact of reopening schools aGer lockdown on COVID-19 epidemic in Île-de-France. www.epicx-lab.com/uploads/9/6/9/4/9694133/insermcovid-19_report_school_idf-20200506.pdf [Preprint] 2020.

Ehrhardt 2020 {published data only} Ehrhardt J, Ekinci A, Krehl H, Meincke M, Finci I, Klein J, et al. Transmission of SARS-CoV-2 in children aged 0 to 19 years in childcare facilities and schools aGer their reopening in May 2020, Baden-Wurttemberg, Germany. Eurosurveillance 2020;25(36):pii=2001587. [DOI: 10.2807/1560-7917.ES.2020.25.36.2001587]

Espana 2020 {published data only} Espana G, Cavany S, Oidtman RJ, Barbera C, Costello A, Lerch A, et al. Impacts of K-12 school reopening on the COVID-19 epidemic in Indiana, USA. medRxiv [Preprint] 2020. [DOI: 10.1101/2020.08.22.20179960]

Gandolfi 2020 {published data only} Gandolfi A. Planning of school teaching during COVID-19. Physica D. Nonlinear Phenomena 2020;415:132753.

Garchitonerena 2020 {published data only} Garchitorena A, Gruson H, Cazelles B, Roche B. Quantifying the efficiency of non-pharmaceutical interventions against SARSCOV-2 transmission in Europe. medRxiv [Preprint] 2020. [DOI: 10.1101/2020.08.17.20174821]

Gill 2020 {published data only} Gill B, Goyal R, Hotchkiss J. Operating schools in a pandemic: predicted effects of opening, quarantining, and closing strategies. Princeton, NJ: Mathematica. mathematica.org/ourpublications-and-findings/publications/operating-schools-ina-pandemic-predicted-effects-of-opening-and-quarantiningstrategies 2020.

Head 2020 {published data only} Head JR, Andrejko K, Cheng Q, Collender PA, Phillips S, Boser A, et al. The effect of school closures and reopening strategies on COVID-19 infection dynamics in the San Francisco Bay Area: a cross-sectional survey and modeling analysis. medRxiv [Preprint] 2020. [DOI: 10.1101/2020.08.06.20169797]

Isphording 2020 {published data only} Isphording I, Lipfert M, Prestel N. School re-openings aGer summer breaks in Germany did not increase SARS-CoV-2 cases. Bonn, Germany: Institute of Labor Economics; Gp.iza.org/ dp13790.pdf 2020.

Johnson 2020 {published data only} Johnson KE, Stoddard M, Nolan RP, White DE, Hochberg NS, Chakravarty A. In the long shadow of our best intentions: model-based assessment of the consequences of school reopening during the COVID-19 pandemic. medRxiv [Preprint] 2020. [DOI: 10.1101/2020.09.18.20197400]

Keeling 2020 {published data only} Keeling MJ, Tildesley MJ, Atkins BD, Penman B, Southall E, Guyver-Fletcher G, et al. The impact of school reopening on the spread of COVID-19 in England. medRxiv [Preprint] 2020. [DOI: 10.1101/2020.06.04.20121434]

Keskinocak 2020 {published data only} Keskinocak P, Asplund J, Serban N, Oruc Aglar BE. Evaluating scenarios for school reopening under COVID19. medRxiv [Preprint] 2020. [DOI: 10.1101/2020.07.22.20160036]

Kim 2020 {published data only} Kim S, Kim YJ, Peck KR, Jung E. School opening delay effect on transmission dynamics of coronavirus disease 2019 in Korea: based on mathematical modeling and simulation study. Journal of Korean Medical Science 2020;35(13):e143.

Kraay 2020 {published data only} Kraay AN, Hayashi MA, Berendes DM, Sobolik JS, Leon JS, Lopman BA. Risk of fomite-mediated transmission of SARSCoV-2 in child daycares, schools, and offices: a modeling study. medRxiv [Preprint] 2020. [DOI: 10.1101/2020.08.10.20171629]

Landeros 2020 {published data only} Landeros A, Ji X, Lange KL, Stutz TC, Xu J, Sehl ME, et al. An examination of school reopening strategies during the SARS-CoV-2 pandemic. medRxiv [Preprint] 2020. [DOI: 10.1101/2020.08.05.20169086]

Macartney 2020 {published data only} Macartney K, Quinn HE, Pillsbury AJ, Koirala A, Deng L, Winkler N, et al. Transmission of SARS-CoV-2 in Australian educational settings: a prospective cohort study. Lancet Child & Adolescent Health 2020;4(11):807-16.

McBryde 2020 {published data only} McBryde ES, Trauer JM, Adekunle A, Ragonnet R, Meehan MT. Stepping out of lockdown should start with school re-openings while maintaining distancing measures. Insights from mixing matrices and mathematical models. medRxiv [Preprint] 2020. [DOI: 10.1101/2020.05.12.20099036]

Monod 2020 {published data only} Monod M, Blenkinsop A, Xi X, Hebert D, Bershan S, Bradley VC, et al. Age groups that sustain resurging COVID-19 epidemics in the United States. medRxiv [Preprint] 2020. [DOI: 10.1101/2020.09.18.20197376]

Munday 2020 {published data only} Munday JD, Sherratt K, Meakin S, Endo A, Pearson CA, Hellewell J, et al. Implications of the school-household network structure on SARS-CoV-2 transmission under different school reopening strategies in England. medRxiv [Preprint] 2020. [DOI: 10.1101/2020.08.21.20167965]

National Centre for Immunisation Research and Surveillance (NCIRS). COVID-19 in schools and early childhood education and care services - the Term 2 experience in NSW. ncirs.org.au/ sites/default/files/2020-08/COVID-19%20Transmission %20in%20educational%20settings%20in%20NSW%20Term %202%20report_0.pdf 2020.

Otte Im Kampe 2020 {published data only} Otte Im Kampe E, Lehfeld AS, Buda S, Buchholz U, Haas W. Surveillance of COVID-19 school outbreaks, Germany, March to August 2020. Eurosurveillance 2020;25(38):pii=2001645. [DOI: 10.2807/1560-7917.ES.2020.25.38.2001645]

Panovska-Griffiths 2020a {published data only} Panovska-Griffiths J, Kerr CC, Waites W, Stuart RM, Mistry D, Foster D, et al. Modelling the potential impact of mask use in schools and society on COVID-19 control in the UK. medRxiv [Preprint] 2020. [DOI: 10.1101/2020.09.28.20202937]

Panovska-Griffiths 2020b {published data only} Panovska-Griffiths J, Kerr CC, Stuart RM, Mistry D, Klein DJ, Viner RM, et al. Determining the optimal strategy for reopening schools, the impact of test and trace interventions, and the risk of occurrence of a second COVID-19 epidemic wave in the UK: a modelling study. Lancet Child & Adolescent Health 2020;4(11):817-27.

Panovska-Griffiths 2020c {published data only} Panovska-Griffiths J, Kerr CC, Waites W, Stuart RM, Mistry D, Foster D, et al. The potential contribution of face coverings to the control of SARS-CoV-2 transmission in schools and broader society in the UK: a modelling study. medRxiv [Preprint] 2020. [DOI: 10.1101/2020.09.28.20202937]

Phillips 2020 {published data only} Phillips B, Browne D, Anand M, Bauch C. Model-based projections for COVID-19 outbreak size and student-days lost to closure in Ontario childcare centres and primary schools. medRxiv [Preprint] 2020. [DOI: 10.1101/2020.08.07.20170407]

Simonsen 2020 {published data only} Simonsen AB, Ruge IF, Quaade AS, Johansen JD, Thyssen JP, Zachariae C. High incidence of hand eczema in Danish schoolchildren following intensive hand hygiene during the COVID-19 pandemic: a nationwide questionnaire study. British Journal of Dermatology 2020;183(5). [DOI: 10.1111/bjd.19413]

Sneppen 2020 {published data only} Sneppen K, Robert JT, Lone S. Impact of superspreaders on dissemination and mitigation of COVID-19. medRxiv [Preprint] 2020. [DOI: 10.1101/2020.05.17.20104745]

Sparks 2020a {published data only} Sparks SR, Aspinall WP, Brooks-Pollock E, Danon L, Cooke R, Barclay J, et al. A novel approach for evaluating contact patterns and risk mitigation strategies for COVID-19 in English primary schools with application of structured expert judgement. medRxiv [Preprint] 2020. [DOI: 10.1101/2020.08.13.20170068]

Sparks 2020b {published data only} Sparks SR, Aspinall WP, Cooke R, Scarrow JH. Quantifying threat from COVID-19 infection hazard in primary schools in England. medRxiv [Preprint] 2020. [DOI: 10.1101/2020.08.07.20170035]

Stage 2020 {published data only} Stage HB, Shingleton J, Ghosh S, Scarabel F, Pellis L, Finnie T. Shut and re-open: the role of schools in the spread of COVID-19 in Europe. medRxiv [Preprint] 2020. [DOI: 10.1101/2020.06.24.20139634]

Stein-Zamir 2020 {published data only} Stein-Zamir C, Abramson N, Shoob H, Libal E, Bitan M, Cardash T, et al. A large COVID-19 outbreak in a high school 10 days aGer schools' reopening, Israel, May 2020. Eurosurveillance 2020;25(29):pii=2001352.

Yoon 2020 {published data only} Yoon Y, Kim K-R, Park H, Kim Sy, Kim Y-J. Stepwise school opening online and off-line and an impact on the epidemiology of COVID-19 in the pediatric population. medRxiv [Preprint] 2020. [DOI: 10.1101/2020.08.03.20165589]

Zhang 2020 {published data only} Zhang J, Litvinova M, Liang Y, Zheng W, Shi H, Vespignani A, et al. The impact of relaxing interventions on human contact patterns and SARS-CoV-2 transmission in China. medRxiv [Preprint] 2020. [DOI: 10.1101/2020.08.03.20167056]