Institute for Medical Information Processing, Biometry, and Epidemiology - IBE, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany.
Pettenkofer School of Public Health, Munich, Germany.
Cochrane Database Syst Rev. 2022 Jun 6;6(6):CD015397. doi: 10.1002/14651858.CD015397.
With the emergence of SARS-CoV-2 in late 2019, governments worldwide implemented a multitude of non-pharmaceutical interventions in order to control the spread of the virus. Most countries have implemented measures within the school setting in order to reopen schools or keep them open whilst aiming to contain the spread of SARS-CoV-2. For informed decision-making on implementation, adaptation, or suspension of such measures, it is not only crucial to evaluate their effectiveness with regard to SARS-CoV-2 transmission, but also to assess their unintended consequences.
To comprehensively identify and map the evidence on the unintended health and societal consequences of school-based measures to prevent and control the spread of SARS-CoV-2. We aimed to generate a descriptive overview of the range of unintended (beneficial or harmful) consequences reported as well as the study designs that were employed to assess these outcomes. This review was designed to complement an existing Cochrane Review on the effectiveness of these measures by synthesising evidence on the implications of the broader system-level implications of school measures beyond their effects on SARS-CoV-2 transmission.
We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, four non-health databases, and two COVID-19 reference collections on 26 March 2021, together with reference checking, citation searching, and Google searches.
We included quantitative (including mathematical modelling), qualitative, and mixed-methods studies of any design that provided evidence on any unintended consequences of measures implemented in the school setting to contain the SARS-CoV-2 pandemic. Studies had to report on at least one unintended consequence, whether beneficial or harmful, of one or more relevant measures, as conceptualised in a logic model. DATA COLLECTION AND ANALYSIS: We screened the titles/abstracts and subsequently full texts in duplicate, with any discrepancies between review authors resolved through discussion. One review author extracted data for all included studies, with a second review author reviewing the data extraction for accuracy. The evidence was summarised narratively and graphically across four prespecified intervention categories and six prespecified categories of unintended consequences; findings were described as deriving from quantitative, qualitative, or mixed-method studies.
Eighteen studies met our inclusion criteria. Of these, 13 used quantitative methods (3 experimental/quasi-experimental; 5 observational; 5 modelling); four used qualitative methods; and one used mixed methods. Studies looked at effects in different population groups, mainly in children and teachers. The identified interventions were assigned to four broad categories: 14 studies assessed measures to make contacts safer; four studies looked at measures to reduce contacts; six studies assessed surveillance and response measures; and one study examined multiple measures combined. Studies addressed a wide range of unintended consequences, most of them considered harmful. Eleven studies investigated educational consequences. Seven studies reported on psychosocial outcomes. Three studies each provided information on physical health and health behaviour outcomes beyond COVID-19 and environmental consequences. Two studies reported on socio-economic consequences, and no studies reported on equity and equality consequences.
AUTHORS' CONCLUSIONS: We identified a heterogeneous evidence base on unintended consequences of measures implemented in the school setting to prevent and control the spread of SARS-CoV-2, and summarised the available study data narratively and graphically. Primary research better focused on specific measures and various unintended outcomes is needed to fill knowledge gaps and give a broader picture of the diverse unintended consequences of school-based measures before a more thorough evidence synthesis is warranted. The most notable lack of evidence we found was regarding psychosocial, equity, and equality outcomes. We also found a lack of research on interventions that aim to reduce the opportunity for contacts. Additionally, study investigators should provide sufficient data on contextual factors and demographics in order to ensure analyses of such are feasible, thus assisting stakeholders in making appropriate, informed decisions for their specific circumstances.
2019 年末出现 SARS-CoV-2 后，全球各国政府实施了多项非药物干预措施，以控制病毒的传播。大多数国家在学校环境中采取了措施，以重新开放或保持学校开放，同时旨在控制 SARS-CoV-2 的传播。为了对实施、调整或暂停这些措施做出明智的决策，不仅要评估这些措施在 SARS-CoV-2 传播方面的有效性，还要评估其意外后果。
全面识别和绘制预防和控制 SARS-CoV-2 传播的基于学校的措施的意外健康和社会后果的证据。我们旨在生成一份描述性的概述，说明所报告的意外（有益或有害）后果的范围，以及用于评估这些结果的研究设计。这项综述旨在通过综合更广泛的系统层面上学校措施的影响的证据来补充关于这些措施有效性的现有 Cochrane 综述，这些影响超出了对 SARS-CoV-2 传播的影响。
我们于 2021 年 3 月 26 日在 Cochrane 对照试验中心注册库（CENTRAL）、MEDLINE、Embase、四个非健康数据库和两个 COVID-19 参考收藏中进行了检索，同时进行了参考文献核对、引文搜索和谷歌搜索。
我们纳入了定量（包括数学建模）、定性和混合方法研究，这些研究设计提供了有关遏制 SARS-CoV-2 大流行的学校环境中实施的措施的任何意外后果的证据。研究必须报告至少一个意外后果，无论是有益的还是有害的，这些后果是在所构想的逻辑模型中对一个或多个相关措施的概念化。
我们对标题/摘要进行了双重筛选，然后对全文进行了筛选，如果审查员之间存在任何差异，则通过讨论解决。一名审查员对所有纳入的研究进行了数据提取，第二名审查员对数据提取的准确性进行了审查。证据以图形和文字的形式在四个预先确定的干预类别和六个预先确定的意外后果类别中进行了总结；研究结果描述为来自定量、定性或混合方法研究。
符合纳入标准的有 18 项研究。其中，13 项使用了定量方法（3 项实验/准实验；5 项观察性研究；5 项建模研究）；4 项使用了定性方法；1 项使用了混合方法。研究着眼于不同人群群体的影响，主要是儿童和教师。确定的干预措施被分为四大类：14 项研究评估了使接触更安全的措施；4 项研究着眼于减少接触的措施；6 项研究评估了监测和应对措施；1 项研究检查了多种措施的组合。研究涉及广泛的意外后果，其中大多数被认为是有害的。11 项研究调查了教育方面的影响。7 项研究报告了社会心理方面的结果。3 项研究分别提供了 COVID-19 以外的身心健康和健康行为方面的信息，以及环境方面的影响。2 项研究报告了社会经济方面的影响，没有研究报告公平和平等方面的影响。
我们确定了一个关于在学校环境中预防和控制 SARS-CoV-2 传播的措施的意外后果的异质证据基础，并以图形和文字的形式对现有研究数据进行了总结。需要更好地关注具体措施和各种意外结果的初级研究，以填补知识空白，并更全面地了解学校措施的各种意外后果，然后再进行更全面的证据综合。我们发现最显著的知识空白是关于社会心理、公平和平等方面的影响。我们还发现，旨在减少接触机会的干预措施研究不足。此外，研究调查人员还应提供关于背景因素和人口统计学的足够数据，以确保分析是可行的，从而帮助利益相关者为其特定情况做出适当、明智的决策。
