School closure and management practices during coronavirus outbreaks including COVID-19: A rapid narrative systematic review

Abstract

Background: COVID-19 was declared a pandemic by the WHO on 12 March 2020 and UNESCO reported that day that 49 countries had implemented national or subnational school closures. Evidence for the effectiveness for school closures comes almost entirely from influenza outbreaks, where transmission tends to be driven by children. It is unknown whether school measures are effective in coronavirus outbreaks e.g. due to SARS, or MERS and COVID-19. Methods: We undertook a rapid systematic review of 2 electronic databases and a preprint server to identify what is known about the effectiveness of school closure and other social school social distancing practices on infection during coronavirus outbreaks. Results: We identified 498 articles, of which 13 are included in this review (9 published; 4 preprint articles considered sufficient quality to include). All published papers concerned the 2003 SARS outbreak and 3 preprints concerned COVID-19. School closures were deployed rapidly across China and Hong Kong for COVID-19, however there are no data on the relative contribution of school closure to control of transmission. Data from the SARS outbreak in China, Hong Kong and Singapore suggest that school transmission played no significant role in the outbreak and that school closures did not contribute to control of the epidemic. Modelling studies of SARS produced conflicting results. Conclusions: Available evidence is consistent with a broad range of impacts of school closures, from little benefit for reducing transmission through to more substantial effects. Yet the economic costs and potential harms of school closure are very high. Data from influenza outbreaks suggests that school closures have low benefits in outbreaks with high transmissibility as with COVID-19. Policymakers need to be aware of the equivocal evidence when proposing or implementing school closures for COVID-19, and consideration should be given to other less disruptive social distancing interventions in schools.