Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.
Toronto Health Economics and Technology Assessment Collaborative, University Health Network, Toronto, Canada.
JAMA Netw Open. 2021 Mar 1;4(3):e213793. doi: 10.1001/jamanetworkopen.2021.3793.
Resurgent COVID-19 cases have resulted in the reinstitution of nonpharmaceutical interventions, including school closures, which can have adverse effects on families. Understanding the associations of school closures with the number of incident and cumulative COVID-19 cases is critical for decision-making.
To estimate the association of schools being open or closed with the number of COVID-19 cases compared with community-based nonpharmaceutical interventions.
DESIGN, SETTING, AND PARTICIPANTS: This decision analytical modelling study developed an agent-based transmission model using a synthetic population of 1 000 000 individuals based on the characteristics of the population of Ontario, Canada. Members of the synthetic population were clustered into households, neighborhoods, or rural districts, cities or rural regions, day care facilities, classrooms (ie, primary, elementary, or high school), colleges or universities, and workplaces. Data were analyzed between May 5, 2020, and October 20, 2020.
School reopening on September 15, 2020, vs schools remaining closed under different scenarios for nonpharmaceutical interventions.
Incident and cumulative COVID-19 cases between September 1, 2020, and October 31, 2020.
Among 1 000 000 simulated individuals, the percentage of infections among students and teachers acquired within schools was less than 5% across modeled scenarios. Incident COVID-19 case numbers on October 31, 2020, were 4414 (95% credible interval [CrI], 3491-5382) cases in the scenario with schools remaining closed and 4740 (95% CrI, 3863-5691) cases in the scenario for schools reopening, with no other community-based nonpharmaceutical intervention. In scenarios with community-based nonpharmaceutical interventions implemented, the incident case numbers on October 31 were 714 (95% CrI, 568-908) cases for schools remaining closed and 780 (95% CrI, 580-993) cases for schools reopening. When scenarios applied the case numbers observed in early October in Ontario, the cumulative case numbers were 777 (95% CrI, 621-993) cases for schools remaining closed and 803 (95% CrI, 617-990) cases for schools reopening. In scenarios with implementation of community-based interventions vs no community-based interventions, there was a mean difference of 39 355 cumulative COVID-19 cases by October 31, 2020, while keeping schools closed vs reopening them yielded a mean difference of 2040 cases.
This decision analytical modeling study of a synthetic population of individuals in Ontario, Canada, found that most COVID-19 cases in schools were due to acquisition in the community rather than transmission within schools and that the changes in COVID-19 case numbers associated with school reopenings were relatively small compared with the changes associated with community-based nonpharmaceutical interventions.
新冠病例再次出现，导致非药物干预措施重新实施，包括学校关闭，这可能对家庭产生不利影响。了解学校关闭与新冠病例数量之间的关联对于决策至关重要。
估计与社区非药物干预相比，学校开放或关闭与新冠病例数量的关联。
设计、地点和参与者：本决策分析模型研究使用基于加拿大安大略省人口特征的 100 万个体的综合人群，开发了基于代理的传播模型。综合人群中的成员被聚类到家庭、社区或农村地区、城市或农村地区、日托设施、教室（即小学、初中或高中）、学院或大学以及工作场所。数据分析时间为 2020 年 5 月 5 日至 2020 年 10 月 20 日。
2020 年 9 月 15 日重新开放学校与不同非药物干预措施下学校继续关闭的情况。
2020 年 9 月 1 日至 10 月 31 日期间的新冠感染病例。
在 100 万例模拟个体中，在建模场景中，学生和教师在学校内获得的感染比例均低于 5%。2020 年 10 月 31 日，在学校继续关闭的情况下，情景中的新冠病例数为 4414 例（95%可信区间[CrI]，3491-5382），在学校重新开放的情况下，情景中的新冠病例数为 4740 例（95%CrI，3863-5691），无其他社区非药物干预措施。在实施社区非药物干预措施的情况下，10 月 31 日的新冠病例数分别为 714 例（95%CrI，568-908）和 780 例（95%CrI，580-993），学校继续关闭和学校重新开放。当在安大略省实施的情况下应用 10 月初观察到的病例数时，10 月 31 日的累积病例数分别为 777 例（95%CrI，621-993）和 803 例（95%CrI，617-990），学校继续关闭和学校重新开放。在实施社区干预措施与不实施社区干预措施的情况下，到 2020 年 10 月 31 日，累积新冠病例数平均相差 39355 例，而保持学校关闭与重新开放相比，平均相差 2040 例。
本项针对加拿大安大略省个体的综合人群的决策分析模型研究发现，学校中大多数新冠病例是由于社区内获得而不是校内传播所致，与社区非药物干预措施相关的新冠病例数量变化与学校重新开放相关的变化相比相对较小。
