Departments of Medicine, Epidemiology & Biostatistics, and Philosophy, Western University, London, ON, Canada.
Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
Clin Trials. 2021 Jun;18(3):371-376. doi: 10.1177/1740774520984860. Epub 2021 Jan 21.
The COVID-19 pandemic has highlighted the challenges of evidence-based health policymaking, as critical precautionary decisions, such as school closures, had to be made urgently on the basis of little evidence. As primary and secondary schools once again close in the face of surging infections, there is an opportunity to rigorously study their reopening. School-aged children appear to be less affected by COVID-19 than adults, yet schools may drive community transmission of the virus. Given the impact of school closures on both education and the economy, schools cannot remain closed indefinitely. But when and how can they be reopened safely? We argue that a cluster randomized trial is a rigorous and ethical way to resolve these uncertainties. We discuss key scientific, ethical, and resource considerations both to inform trial design of school reopenings and to prompt discussion of the merits and feasibility of conducting such a trial.
新冠疫情凸显了循证卫生决策面临的挑战，因为必须在几乎没有证据的情况下紧急做出关键的预防决策，例如关闭学校。随着感染人数的激增，中小学校再次关闭，现在有机会对学校重新开放进行严格的研究。儿童似乎比成年人受新冠疫情的影响小，但学校可能会推动病毒在社区传播。鉴于学校关闭对教育和经济的影响，学校不能无限期关闭。但是，学校何时以及如何才能安全重新开放呢？我们认为，整群随机试验是解决这些不确定性的严格且合乎伦理的方法。我们讨论了关键的科学、伦理和资源方面的考虑因素，既为学校重新开放的试验设计提供信息，也为讨论开展此类试验的优点和可行性提供了依据。
