Bilinski Alyssa, Salomon Joshua A, Giardina John, Ciaranello Andrea, Fitzpatrick Meagan C
Interfaculty Initiative in Health Policy, Harvard Graduate School of Arts and Sciences.
Center for Health Policy & Center for Primary Care and Outcomes Research, Stanford University School of Medicine.
medRxiv. 2021 Jan 29:2021.01.27.21250388. doi: 10.1101/2021.01.27.21250388.
The COVID-19 pandemic has induced historic educational disruptions. In December 2020, at least two-thirds of US public school students were not attending full-time in-person education. The Biden Administration has expressed that reopening schools is a priority.
To compare risks of SARS-COV-2 transmission in schools across different school-based prevention strategies and levels of community transmission.
We developed an agent-based network model to simulate transmission in elementary and high school communities, including home, school, and inter-household interactions.
We parameterized school structure based on average US classrooms, with elementary schools of 638 students and high schools of 1,451 students. We varied daily community incidence from 1 to 100 cases per 100,000 population. Patients (or Participants). We simulated students, faculty/staff, and adult household members.
We evaluated isolation of symptomatic individuals, quarantine of an infected individual's contacts, reduced class sizes, alternative schedules, staff vaccination, and weekly asymptomatic screening.
We projected transmission among students, staff and families during one month following introduction of a single infection into a school. We also calculated the number of infections expected for a typical 8-week quarter, contingent on community incidence rate.
School transmission risk varies according to student age and community incidence and is substantially reduced with effective, consistent mitigation measures. Nevertheless, when transmission occurs, it may be difficult to detect without regular, frequent testing due to the subclinical nature of most infections in children. Teacher vaccination can reduce transmission to staff, while asymptomatic screening both improves understanding of local circumstances and reduces transmission, facilitating five-day schedules at full classroom capacity.
There is uncertainty about susceptibility and infectiousness of children and low precision regarding the effectiveness of specific prevention measures, particularly with emergence of new variants.
With controlled community transmission and moderate school-based prevention measures, elementary schools can open with few in-school transmissions, while high schools require more intensive mitigation. Asymptomatic screening can both reduce transmission and provide useful information for decision-makers.
新冠疫情引发了历史性的教育中断。2020年12月，至少三分之二的美国公立学校学生未接受全日制面授教育。拜登政府表示，重新开放学校是一项优先事项。
比较不同学校预防策略和社区传播水平下学校中新冠病毒传播的风险。
我们开发了一个基于主体的网络模型，以模拟小学和高中社区中的传播情况，包括家庭、学校和家庭间的互动。
我们根据美国教室的平均规模对学校结构进行参数化，小学有638名学生，高中有1451名学生。我们将每日社区发病率从每10万人1例到100例进行了变化。患者（或参与者）。我们模拟了学生、教职员工和成年家庭成员。
我们评估了有症状个体的隔离、感染者接触者的检疫、班级规模的缩小、替代日程安排、工作人员接种疫苗以及每周无症状筛查。
我们预测了在学校引入一例感染后的一个月内学生、教职员工和家庭之间的传播情况。我们还根据社区发病率计算了一个典型的8周学季预期的感染人数。
学校传播风险因学生年龄和社区发病率而异，通过有效、持续的缓解措施可大幅降低。然而，当传播发生时，由于儿童中大多数感染具有亚临床性质，如果没有定期、频繁的检测，可能很难发现。教师接种疫苗可减少向教职员工的传播，而无症状筛查既能增进对当地情况的了解，又能减少传播，有助于实现满教室容量的五日制课程安排。
儿童的易感性和传染性存在不确定性，特定预防措施的有效性的精确性较低，尤其是随着新变种的出现。
在社区传播得到控制且采取适度的学校预防措施的情况下，小学可以在学校内传播很少的情况下开放，而高中则需要更严格的缓解措施。无症状筛查既能减少传播，又能为决策者提供有用信息。
