Zimmerman Frederick J, Anderson Nathaniel W
Center for Health Advancement, Department of Health Policy and Management, Fielding School of Public Health at University of California, Los Angeles.
JAMA Pediatr. 2021 May 1;175(5):501-509. doi: 10.1001/jamapediatrics.2020.6371.
The consequences of school closures for children's health are profound, but existing evidence on their effectiveness in limiting severe acute respiratory syndrome coronavirus 2 transmission is unsettled.
To determine the independent associations of voluntary behavioral change, school closures, and bans on large gatherings with the incidence and mortality due to coronavirus disease 2019 (COVID-19).
DESIGN, SETTING, AND PARTICIPANTS: This population-based, interrupted-time-series analysis of lagged independent variables used publicly available observational data from US states during a 60-day period from March 8 to May 18, 2020. The behavioral measures were collected from anonymized cell phone or internet data for individuals in the US and compared with a baseline of January 3 to February 6, 2020. Estimates were also controlled for several state-level characteristics.
Days since school closure, days since a ban on gatherings of 10 or more people, and days since residents voluntarily conducted a 15% or more decline in time spent at work via Google Mobility data.
The natural log of 7-day mean COVID-19 incidence and mortality.
During the study period, the rate of restaurant dining declined from 1 year earlier by a mean (SD) of 98.3% (5.2%) during the study period. Time at work declined by a mean (SD) of 40.0% (7.9%); time at home increased by a mean (SD) of 15.4% (3.7%). In fully adjusted models, an advance of 1 day in implementing mandatory school closures was associated with a 3.5% reduction (incidence rate ratio [IRR], 0.965; 95% CI, 0.946-0.984) in incidence, whereas each day earlier that behavioral change occurred was associated with a 9.3% reduction (IRR, 0.907; 95% CI, 0.890-0.925) in incidence. For mortality, each day earlier that school closures occurred was associated with a subsequent 3.8% reduction (IRR, 0.962; 95% CI, 0.926-0.998), and each day of advance in behavioral change was associated with a 9.8% reduction (IRR, 0.902; 95% CI, 0.869-0.936). Simulations suggest that a 2-week delay in school closures alone would have been associated with an additional 23 000 (95% CI, 2000-62 000) deaths, whereas a 2-week delay in voluntary behavioral change with school closures remaining the same would have been associated with an additional 140 000 (95% CI, 65 000-294 000) deaths.
In light of the harm to children of closing schools, these findings suggest that policy makers should consider better leveraging the public's willingness to protect itself through voluntary behavioral change.
学校关闭对儿童健康的影响深远，但关于其在限制严重急性呼吸综合征冠状病毒2传播方面有效性的现有证据尚无定论。
确定自愿行为改变、学校关闭和禁止大型集会与2019冠状病毒病（COVID-19）发病率和死亡率之间的独立关联。
设计、设置和参与者：这项基于人群的滞后自变量中断时间序列分析使用了2020年3月8日至5月18日60天期间美国各州公开可用的观察数据。行为测量数据从美国个人匿名手机或互联网数据中收集，并与2020年1月3日至2月6日的基线进行比较。估计值还对几个州层面的特征进行了控制。
学校关闭后的天数、禁止10人或以上集会后的天数，以及居民通过谷歌移动数据自愿减少工作时间15%或更多后的天数。
7天COVID-19平均发病率和死亡率的自然对数。
在研究期间，餐厅就餐率较上一年同期下降，研究期间平均（标准差）下降98.3%（5.2%）。工作时间平均（标准差）下降40.0%（7.9%）；在家时间平均（标准差）增加15.4%（3.7%）。在完全调整模型中，强制学校关闭提前1天与发病率降低3.5%（发病率比[IRR]，0.965；95%置信区间，0.946 - 0.984）相关，而行为改变提前每一天与发病率降低9.3%（IRR，0.907；95%置信区间，0.890 - 0.925）相关。对于死亡率，学校关闭提前每一天与随后降低3.8%（IRR，0.962；95%置信区间，0.926 - 0.998）相关，行为改变提前每一天与降低9.8%（IRR，0.902；95%置信区间，0.869 - 0.936）相关。模拟表明，仅学校关闭延迟2周就可能导致额外23000例（95%置信区间，2000 - 62000）死亡，而在学校关闭不变的情况下，自愿行为改变延迟2周可能导致额外140000例（95%置信区间，65000 - 294000）死亡。
鉴于学校关闭对儿童的危害，这些发现表明政策制定者应考虑更好地利用公众通过自愿行为改变来自我保护的意愿。
