The potential impact of School Closure Relative to Community-based Non-pharmaceutical Interventions on COVID-19 Cases in Ontario, Canada

ABSTRACT Importance Resurgent COVID-19 cases have resulted in the re-institution of nonpharmaceutical interventions, including school closure, which can have adverse effects on families. Understanding the impact of schools on the number of incident and cumulative COVID-19 cases is critical for decision-making. Objective To determine the quantitative effect of schools being open or closed relative to community-based nonpharmaceutical interventions on the number of COVID-19 cases. Design An agent-based transmission model. Setting A synthetic population of one million individuals based on the characteristics of the population of Ontario, Canada. Participants Members of the synthetic population clustered into households, neighborhoods or rural districts, cities or a rural region, day care facilities, classrooms – primary, elementary or high school, colleges or universities and workplaces. Exposure School reopening on September 15, 2020, versus schools remaining closed under different scenarios for nonpharmaceutical interventions. Main Outcome and Measures Incident and cumulative COVID-19 cases between September 1, 2020 and October 31, 2020. Results The percentage of infections among students and teachers acquired within schools was less than 5% across modelled scenarios. Incident case numbers on October 31, 2020, were 4,414 (95% credible interval, CrI: 3,491, 5,382) and 4,740 (95% CrI 3,863, 5,691), for schools remaining closed versus reopening, respectively, with no other community-based nonpharmaceutical intervention; 714 (95%, CrI: 568, 908) and 780 (95% CrI 580, 993) for schools remaining closed versus reopening, respectively, with community-based nonpharmaceutical interventions implemented; 777 (95% credible CrI: 621, 993) and 803 (95% CrI 617, 990) for schools remaining closed versus reopening, respectively, applied to the observed case numbers in Ontario in early October 2020. Contrasting the scenarios with implementation of community-based interventions versus not doing so yielded a mean difference of 39,355 cumulative COVID-19 cases by October 31, 2020, while keeping schools closed versus reopening them yielded a mean difference of 2,040 cases. Conclusions and relevance Our simulations suggest that the majority of COVID-19 infections in schools were due to acquisition in the community rather than transmission within schools and that the effect of school reopening on COVID-19 case numbers is relatively small compared to the effects of community-based nonpharmaceutical interventions. KEY POINTS Question With resurgence of COVID-19, reinstitution of school closure remains a possibility. Given the harm that closures can cause to children and families, the expected quantitative effect of school reopening or closure on incident and cumulative COVID-19 case numbers is an important consideration. Finding Relative to community-based nonpharmaceutical interventions, school closure resulted in a small change in COVID-19 incidence trajectories and cumulative case counts. Meaning Community-based interventions should take precedence over school closure.