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Comment & Response
August 31, 2020

Debates Around the Role of School Closures in the Coronavirus 2019 Pandemic

Author Affiliations
  • 1Department of Health Sciences, Karlstad University, Karlstad, Sweden
  • 2Folkuniversitetet, Gothenburg, Sweden
JAMA Pediatr. 2021;175(1):107. doi:10.1001/jamapediatrics.2020.3549

To the Editor We read with interest the article by Esposito and Principi.1 The authors have provided several arguments against the benefits of school closures, which have been enacted by more than 90% of the European countries during the coronavirus disease 2019 (COVID-19) pandemic. However, some of the points made by the authors appeared to be debatable.

First, low transmissions between children do not necessarily suggest low transmissions between children and adults. Furthermore, the basic reproductive number (R0) can vary across different populations.2 Therefore, the low R0 among school-aged children in Taiwan may not be generalizable to other countries.3 As one of the few countries that had not enacted nationwide school closures as of May 19, 2020, Taiwan did extend the winter intersession by 2 weeks in February of 2020. The temporary school closures in the early phase after the outbreak might have provided opportunities for the government to plan tightened border controls and other screening and tracking measures to curb the spread of the virus. Therefore, it would be far-fetched to refute the role of school closures in slowing down the viral spread by using Taiwan, which implemented rapid and early response to COVID-19, as an example.

Second, the authors cited the modeling study by Ferguson et al4 that reports that the mortality rate can only be reduced by 2% to 4% with school closures. In fact, according to Ferguson et al,4 the strategy consisting of voluntary quarantine combined with home isolation and social distancing reduced mortality rates by 13%, while the strategy consisting of voluntary quarantine combined with home isolation and social distancing as well as school closures could reduce mortality rates by 29% when R0 is 2.4. The latter strategy thus contributes to a 2-fold reduction of mortality rates compared with the former strategy. Therefore, despite the limited role of any intervention in isolation, combining multiple interventions shall have a substantial effect on transmission of COVID-19 because these different measures do not merely exert additive joint effects on mortality rates.

The role of school closures is to break social contacts not only within schools but also between households. School closures also facilitate social distancing within occupational networks centered on schools. The precautionary principle, which dictates that “when human activities may lead to morally unacceptable harm that is scientifically plausible but uncertain, actions shall be taken to avoid or diminish that harm,”5 may provide the rationale for the decision of school closures during the COVID-19 pandemic.

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Article Information

Corresponding Author: Ping-I Lin, MD, PhD, Karlstad University, Sweden, Universitetsgatan 2, 65188 Karlstad, Sweden (daniel.lin@kau.se).

Published Online: August 31, 2020. doi:10.1001/jamapediatrics.2020.3549

Conflict of Interest Disclosures: None reported.

References
1.
Esposito  S, Principi  N.  School closure during the coronavirus disease 2019 (COVID-19) pandemic: an effective intervention at the global level?   JAMA Pediatr. Published online May 13, 2020. doi:10.1001/jamapediatrics.2020.1892PubMedGoogle Scholar
2.
Liu  Y, Gayle  AA, Wilder-Smith  A, Rocklöv  J.  The reproductive number of COVID-19 is higher compared to SARS coronavirus.   J Travel Med. 2020;27(2):taaa021. doi:10.1093/jtm/taaa021PubMedGoogle Scholar
3.
Wang  CJ, Ng  CY, Brook  RH.  Response to COVID-19 in Taiwan: big data analytics, new technology, and proactive testing.   JAMA. Published March 3, 2020. doi:10.1001/jama.2020.3151Google Scholar
4.
Ferguson  NM, Laydon  D, Nedjati-Gilani  G,  et al. Impact of non-pharmaceutical interventions (NPIs) to reduce COVID-19 mortality and healthcare demand. Published online March 16, 2020. https://www.imperial.ac.uk/media/imperial-college/medicine/sph/ide/gida-fellowships/Imperial-College-COVID19-NPI-modelling-16-03-2020.pdf
5.
Weiss  C.  Defining precaution: UNESCO’S world commission on the ethics of scientific knowledge and techonology report: the precautionary principle.   Environment. 2007.Google Scholar
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