Australian Health Protection Principal Committee (AHPPC) met on Tuesday 17 March to consider the issue of school closures in relation to the community transmission of COVID‑19. The Committee’s advice is that pre-emptive closures are not proportionate or effective as a public health intervention to prevent community transmission of COVID-19 at this time.
There is currently limited information on the contribution of children to transmission of COVID-19. The WHO-China Joint Mission noted the primary role of household transmission and observed that children tended to be infected by adults in the household. In China, 2.4% of total reported cases were under the age of 19 years old. Worldwide, of those cases under 19 years of age, very few were severe or critical. This contrasts distinctly with the severity pattern observed with other respiratory viruses, where young children are particularly at risk of severe disease.
Previous studies suggest that the potential reduction in community transmission from pre‑emptive school closures may be offset by the care arrangements that are in place for children who are not at school. Children may require care from older carers who are more vulnerable to severe disease, or may continue to associate (and transmit infection) outside of school settings.
Broadly, the health evidence on school closures from previous respiratory epidemics shows the costs are often underestimated and the benefits are overestimated. This may be even more so in relation to COVID-19 as, unlike influenza, the impact on otherwise healthy children has been minimal to date.
School closure is associated with considerable costs. Studies have estimated that around 15% of the total workforce and 30% of the healthcare workforce may need to take time off work to care for children. This burden will be significant and will fall disproportionately on those in casual or tenuous work circumstances.
At this stage, the spread of COVID-19 in the community is at quite low levels. It may be many months before the level of Australian community infection is again as low as it is at the moment. For pre-emptive school closures to be effective, closure for at least several months is required and it would be unclear when they could be re-opened.
School closures for shorter defined periods may be considered as part of a suite of more stringent distancing measures later in the outbreak, in anticipation of a peak in infection rates.
Short term reactive school closure may also be warranted to allow cleaning and contact tracing to occur in response to an outbreak in a given school.
More than 70 countries around the world have implemented either nationwide or localised school closures, at different times in the evolution of the local COVID-19 epidemic, however it should be noted the majority of these have not been successful in controlling the outbreak. Some of these countries are now considering their position in relation to re-opening schools.
Singapore has had success in limiting the transmission of COVID-19 in the community without closing schools. Other countries are working in different contexts, including Northern Hemisphere countries making decisions at the end of winter with COVID-19 being accompanied by influenza in the community.
The advice in relation to school closures will continue to be reviewed at daily meetings of the AHPPC.
Schools should implement a range of other strategies to reduce transmission, including the promotion of personal hygiene measures (frequent handwashing, reducing face-to-face contact, cough etiquette), physical distancing, reducing public gatherings (e.g. face-to-face school assemblies), and reducing the mixing of students (e.g. reduced use of common areas, staggered lunchtimes, and reduced after-school activities and inter-school activities).
Schools should also reinforce existing policies to exclude students and staff who are unwell, and current policies requiring quarantine for those who have recently travelled overseas. It is also important that the learning needs of students who are excluded from school are met.