20. January 2021

 – Policy Brief

Assessment of measures in schools​

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Assessment of the Science Task Force mandated by the FDHA (January 2021)

The issue of operating schools in the pandemic is very complex. From kindergarten and primary school through higher education, the risks of transmission of SARS-CoV-2 vary widely, as do educational, social, and health-related (both physical and mental) concerns. To address this complexity, we conducted a scientific assessment that accounts for differences in the epidemiological situation, level of schooling, positive and negative effects of control measures, and confidence in the evidence.

Results are presented below in two tables for each school level: an overview of the relative advantages or disadvantages of particular control measures, depending on the epidemiological situation, as well as a detailed matrix on which the overview is based. The assessments themselves do not constitute recommendations. Consequently, it is not a contradiction if school policy does not align precisely with the scientific assessment of advantages and disadvantages of control measures. Feasibility, acceptance, and other pandemic control measures (apart from schools) must be considered as a whole.

Our findings indicate that there is a wide range of control measures, some of which have been underutilized, and that the choice of measures depends on the epidemiological situation and school level. The Ciao Corona study of 2500 Zurich schoolchildren serves as a guide for decisions regarding additional measures. This study shows that with the package of measures implemented in schools by the end of October (which remain ongoing), outbreaks in schools are uncommon. If the situation worsens, a number of measures can still be implemented in a stepwise manner and coordinated across cantons. (A comprehensive selection can be found here; the tables include various measures.)

It is important to note that owing to the short time available to complete this assessment, not every measure could be definitively assessed and referenced. This document will therefore be further refined after 18/1/2021. Note also that the next version will include control measures for vocational and higher education.

For the convenience of decision-makers, key results of the Science Task Force’s overall assessment by school level are presented first. A detailed description of the approach and a detailed analysis of the control measures follow.

The following examples show how to interpret the assessments in the overview:

The advantages and disadvantages of a measure are balanced (circle on a balanced scale). Confidence in the evidence is low (red), so the balance of advantages and disadvantages is likely to change with additional evidence.

The advantages of a measure slightly outweigh the disadvantages (one circle). Confidence in the evidence is moderate (yellow), so the balance of advantages and disadvantages may change with additional evidence.

The disadvantages of a measure moderately outweigh the advantages (two circles). Confidence in the evidence is high (green), so the balance of advantages and disadvantages is unlikely to change with additional evidence.

The advantages of a measure strongly outweigh the disadvantages (three circles). Confidence in the evidence is moderate (yellow), so the balance of advantages and disadvantages may change with additional evidence.

Overview of advantages and disadvantages of individual control measures for primary schools

 Epidemiological situation in a specific region or canton
Control measuresUnder controlSeriousVery serious
General measures a

Sick teachers and sick children stay at home

Masks for teachers

Masks for pupils b

No mixing of classes c  

Testing and quarantine of close contacts or classes d

Regular testing in schools

Reduced class size

Distance learning e

Notes

a General measures: Hand hygiene, no handshaking, teachers keep 1.5 meters distance from pupils, good ventilation, clean toilets and surfaces, outdoor classes, no camps or field trips, no events with non-school personnel (e.g. parents). HEPA filters should be used when adequate ventilation is not possible.

b The assessment differs slightly between primary school pupils and >12-year-olds because of possible negative effects (see detailed table) in an epidemiological situation under control.

c This includes no mixing of classes in school; staggered arrival, canteen, and break times; staggered lunchtimes; additional activities and noncontact sports outdoors (possibly with masks); and other control measures, depending on the epidemiological situation.

d The extent of testing in schools with cases and instructions for quarantine should depend on the epidemiological situation (e.g. whole classes or schools if the situation is very serious, only close contacts when the situation is under control).

e As distance learning is not possible for all pupils (e.g. lack of infrastructure, no place to study, or other social problems), arrangements should always be made to teach these pupils on-site.

 

Note for all school levels: Parents may request home schooling to better protect family members at high risk. This topic was deliberately excluded among control measures in the table, because attitudes toward it vary widely and science can make only a very limited contribution. Decision-makers, however, may wish to consider this issue.

Overview of advantages and disadvantages of individual control measures for secondary level I

 Epidemiological situation in a specific region or canton
Control measures Unter KontrolleGefährlichSehr gefährlich
General measures a

Sick teachers and sick children stay at home

Masks for teachers

Masks for pupils

No mixing of classes b  

Testing and quarantine of close contacts or classes c

Regular testing in schools

Reduced class size

Distance learning d

Notes

a General measures: Hand hygiene, no handshaking, teachers keep 1.5 meters distance from pupils, good ventilation, clean toilets and surfaces, outdoor classes, no camps or field trips, no events with non-school personnel (e.g. parents). HEPA filters should be used when adequate ventilation is not possible.

b This includes no mixing of classes in school; staggered arrival, canteen, and break times; staggered lunchtimes; additional activities and noncontact sports outdoors (possibly with masks); and other control measures, depending on the epidemiological situation.

c The extent of testing in schools with cases and instructions for quarantine should depend on the epidemiological situation (e.g. whole classes or schools if the situation is very serious, only close contacts when the situation is under control).

d As distance learning is not possible for all pupils (e.g. lack of infrastructure, no place to study, or other social problems), arrangements should always be made to teach these pupils on-site.

Overview of advantages and disadvantages of individual control measures for secondary level II

 Epidemiological situation in a specific region or canton
Control measuresUnder controlSeriousVery serious
General measures a

Sick teachers and sick children stay at home

Masks for teachers

Masks for pupils

No mixing of classes b  

Testing and quarantine of close contacts or classes c

Regular testing in schools

Reduced class size

Distance learning d

Notes

a General measures: Hand hygiene, no handshaking, teachers keep 1.5 meters distance from pupils, good ventilation, clean toilets and surfaces, outdoor classes, no camps or field trips, no events with non-school personnel (e.g. parents). HEPA filters should be used when adequate ventilation is not possible.

b This includes no mixing of classes in school; staggered arrival, canteen, and break times; staggered lunchtimes; additional activities and noncontact sports outdoors (possibly with masks); and other control measures, depending on the epidemiological situation.

c The extent of testing in schools with cases and instructions for quarantine should depend on the epidemiological situation (e.g. whole classes or schools if the situation is very serious, only close contacts when the situation is under control).

d As distance learning is not possible for all pupils (e.g. lack of infrastructure, no place to study, or other social problems), arrangements should always be made to teach these pupils on-site.

 

Description of the approach to assessing control measures in schools:

  • Primary, lower secondary, and upper secondary school levels have been considered separately. This is particularly important for secondary schools. With the transition here to adolescence and young adulthood, these pupils are regarded epidemiologically as adults (see the policy brief on children).
  • The same effects were assessed for each control measure and school level, namely, reduction of SARS-CoV-2 transmission as a positive consequence of control measures versus impaired learning progress, social development, and mental health as negative
  • For reasons of simplicity, we distinguished between three epidemiological situations: “Under control,” “Serious,” and “Very serious.” The epidemiological situation cannot be adequately described by a single indicator (e.g. cases per week per 100,000 inhabitants). Consequently, the situation for a canton as a whole should be assessed using a combination of indicators (e.g. case numbers, change in case numbers, hospitalizations, the value of Re, development of new mutations), as the Task Force does in its assessment of the epidemiological situation. A situation “Under control” has sporadic outbreaks but no general increase in local transmission (e.g. as was the case in July–August 2020 in many cantons). In a “Serious” situation there is increased local transmission, and in a “Very serious” situation there is both increased local transmission and risk posed by new mutations.
  • Evidence available for children and young people outside the school setting is detailed in the policy brief on children. We therefore base transmission assessments on evidence that children and adolescents are being infected at similar rates to adults, and that infectivity is higher in adolescents and young adults (>12 years) than in children, and similar to adults. Moreover, adolescents and young adults have greater mobility and travel farther to school than children.
  • We distinguished three levels of confidence in the evidence: low confidence when it is based primarily on expert opinion and no scientific evidence exists; moderate confidence when scientific evidence is available but is contradictory or of low quality, or only indirect evidence from outside the school setting exists; and high confidence when scientific evidence is consistent and of moderate to high quality.

 

Explanation of symbols used

It is nearly impossible to quantify the relative advantages and disadvantages of the effects of control measures. Consequently, we assessed them using simplified categories. The confidence in the evidence and the balance of advantages and disadvantages are indicated by color coding:

Detailed analysis for primary schools

Measures

 

Epidemiological situation

Reduced transmission in

 

Negative effects on

Balance of advantages and disadvantages

Community / Region

Families

Learning progress

Social development

Mental health

General measures a

Under control

Serious

Very serious

+

++

+++

+

++

Advantage

Advantage ●●

Advantage ●●●

Sick teachers and sick children stay at home

Under control

Serious

Very serious

+

++

+++

+

++

+++

Advantage

Advantage ●●

Advantage ●●●

Masks for teachers

Under control

Serious

Very serious

+

++

++

+

++

Advantage ●

Advantage ●●

Masks for pupils

Under control

Serious

Very serious

+

++

+

++

Advantage ●

Advantage ●●

No mixing of classes b

Under control

Serious

Very serious

+

++

+

Advantage ●

Testing and quarantine of close contacts or classes c

Under control

Serious

Very serious

+

++

+++

+

+

+

d

d

d

Advantage

Advantage ●●

Advantage ●●

Regular testing in schools

Under control

Serious

Very serious

+

+

+

+

Advantage

Advantage

Reduced class size

Under control

Serious

Very serious

+

+

Advantage

Distance learning

Under control

Serious

Very serious

+

++

+

++

− − −

− −

Disadvantages ●●●

Disadvantages ●●

Notes  

a General measures: Hand hygiene, no handshaking, teachers keep 1.5 meters distance from pupils, good ventilation, clean toilets and surfaces, outdoor classes, no camps or field trips, no events with non-school personnel (e.g. parents). HEPA filters should be used when adequate, regular ventilation is not possible.

b This includes no mixing of classes in school, staggered arrivals and breaks, staggered lunchtimes, and other measures depending on the epidemiological situation. Additional activities and sports may be held as long as there is no mixing of classes.

c The extent of testing in schools with cases and instructions for quarantine should depend on the epidemiological situation (e.g. whole classes or schools if the situation is very serious, only close contacts when the situation is under control).

d  Very serious situations may lead to repeated quarantines, which can have negative effects.

Detailed analysis for secondary level I

Measures

Epidemiological situation

Reduced transmission in

 

Negative effects on

Balance of advantages and disadvantages

Community / Region

Families

Learning progress

Social development

Mental health

General measures a

Under control

Serious

Very serious

+

++

+++

+

++

Vorteile

Vorteile ●●

Vorteile ●●●

Sick teachers and sick children stay at home

Under control

Serious

Very serious

+

++

+++

+

++

+++

Vorteile

Vorteile ●●

Vorteile ●●●

Masks for teachers

Under control

Serious

Very serious

+

++

++

+

++

Vorteile ●●

Vorteile ●●

Masks for pupils

Under control

Serious

Very serious

+

++

+

++

Vorteile

Vorteile ●●

No mixing of classes b

 

Under control

Serious

Very serious

+

++

+

Vorteile

Vorteile ●●

Testing and quarantine of close contacts or classes c

Under control

Serious

Very serious

+

++

+++

+

+

+

d

d

d

Vorteile

Vorteile ●●

Vorteile ●●

Regular testing in schools

Under control

Serious

Very serious

+

+

+

+

Vorteile

Vorteile ●●

Vorteile ●●●

Reduced class size

Under control

Serious

Very serious

+

+

Vorteile

Distance learning

Under control

Serious

Very serious

+

++

+

++

− −

− −

Nachteile ●●

Vorteile

Notes

a General measures: Hand hygiene, no handshaking, teachers keep 1.5 meters distance from pupils, good ventilation, clean toilets and surfaces, outdoor classes, no camps or field trips, no events with non-school personnel (e.g. parents). HEPA filters should be used when adequate, regular ventilation is not possible.

b This includes no mixing of classes at school, staggered arrivals and breaks, staggered lunchtimes, and other measures depending on the epidemiological situation. Additional activities and sports may be held as long as there is no mixing of classes.

c The extent of testing in schools with cases and instructions for quarantine should depend on the epidemiological situation (e.g. whole classes or schools if the situation is very serious, only close contacts when the situation is under control).

d  Very serious situations may lead to repeated quarantines, which can have negative effects.

 

Detailed analysis for secondary level II

MeasuresEpidemiological situationReduced transmission in Negative effects onBalance of advantages and disadvantages
Community / RegionFamiliesLearning progressSocial developmentMental health
General measures a

Under control

Serious

Very serious

+

++

+++

+

++

Advantage

Advantage ●●

Advantage ●●●

Sick teachers and sick children stay at home

Under control

Serious

Very serious

+

++

+++

+

++

+++

Advantage

Advantage ●●

Advantage ●●●

Masks for teachers

Under control

Serious

Very serious

+

++

++

+

++

Advantage ●●

Advantage ●●

Masks for pupils

Under control

Serious

Very serious

+

++

+

++

Advantage ●

Advantage ●●

No mixing of classes b

Under control

Serious

Very serious

+

++

+

Advantage ●

Advantage ●●

Testing and quarantine of close contacts or classes c

Under control

Serious

Very serious

+

++

+++

+

+

+

d

d

d

Advantage

Advantage ●●

Advantage ●●

Regular testing in schools

Under control

Serious

Very serious

+

+

+

+

Advantage ●

Advantage ●●

Advantage ●●●

Reduced class size

Under control

Serious

Very serious

+

+

Advantage

Distance learning

Under control

Serious

Very serious

+

++

+

++

 e

Advantage

Advantage

Advantage ●●

Notes

a General measures: Hand hygiene, no handshaking, teachers keep 1.5 meters distance from pupils, good ventilation, clean toilets and surfaces, outdoor classes, no camps or field trips, no events with non-school personnel (e.g. parents). HEPA filters should be used when adequate ventilation is not possible.

b This includes no mixing of classes at school, staggered arrivals and breaks, staggered lunchtimes, and other measures depending on the epidemiological situation. Additional activities and sports may be held as long as there is no mixing of classes.

c The extent of testing in schools with cases and instructions for quarantine should depend on the epidemiological situation (e.g. whole classes or schools if the situation is very serious, only close contacts when the situation is under control).

d  Very serious situations may lead to repeated quarantines, which can have negative effects.

e A slightly smaller negative effect can be assumed for gymnasiums than at secondary level I.

 

References on SARS-CoV-2 and schools

 

General reviews and recommendations

ECDC review from 12/2020 (includes description of a wide range of mitigation measures in European countries) 1
CDC recommendations 2
Review in school guidelines in other countries 3

Risk reduction in schools, Harvard School of Public Health 4

Transmission clusters review (few schools among clusters) 5

 

Transmission in households and schools

Viner review 6

Madewell review 7

Krishnaratne 8

Hyde 9

Individual studies 10–12

 

Case studies on outbreaks

Outbreaks in camps 13

Outbreak in Israel, 14 Chile, 15 France 16

Sweden 17

New Zealand 18

 

Contact tracing, overall prevalence, and modeling effect of closure on incidence

UK 19

Germany 20
Italy 21

Ireland 22

Australia 23

Singapore 24

US 25–27

South Korea 28,29
Japan 30

Finland 31
Netherlands 32

 

Specific measures in schools

In-person learning not associated with increased cases in US 33

Preprints of modeling effect of specific school NPIs in US 34,35

Modeling: reopening with reduction of contacts is safe 36

 

Other important studies
Gargle study in Austria 37
Point-prevalence monitoring studies in UK (includes children and schools) 38,39
Ecological studies of NPI effect 40–43
Modeling of UK tiered lockdown and school closures 44

 

Impact of school closures
UNESCO position 45
European Commission brief on educational inequalities 46
Modeling of lifetime impact in US 47,48

Maltreatment and domestic violence 49,50
Mental health (see references in this article) 51

Academic achievement 48,52

Comments and reviews 53

Social and economic impact 54

Downstream effects 55

Risk of obesity, 56 physical inactivity, sleep 57,58

 

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53          Wang G, Zhang Y, Zhao J, Zhang J, Jiang F. Mitigate the effects of home confinement on children during the COVID-19 outbreak. Lancet. 2020; 395: 945–7.

54          Chen WC, Huang AS, Chuang JH, Chiu CC, Kuo HS. Social and economic impact of school closure resulting from pandemic influenza A/H1N1. J Infect 2011; 62: 200–3.

55          Thomas J, Kneale D, O’Mara-Eves A, Rees R. School closure in response to epidemic outbreaks: Systems-based logic model of downstream impacts. F1000Research 2020; 9. DOI:10.12688/f1000research.23631.1.

56          Rundle AG, Park Y, Herbstman JB, Kinsey EW, Wang YC. COVID-19–related school closings and risk of weight gain among children. Obesity. 2020; 28: 1008–9.

57          Weaver RG, Beets MW, Perry M, et al. Changes in children’s sleep and physical activity during a 1-week versus a 3-week break from school: a natural experiment. Sleep 2019; 42. DOI:10.1093/sleep/zsy205.

58          Moore SA, Faulkner G, Rhodes RE, et al. Impact of the COVID-19 virus outbreak on movement and play behaviours of Canadian children and youth: a national survey. Int J Behav Nutr Phys Act 2020; 17: 85.

 

Evidence from Switzerland

Studies in schools

Ciao Corona Testing in summer 1

Ciao Corona Testing in Autumn 2

Ciao Corona Acute testing in Autumn 3

 

Studies in households, random samples

Geneva study 4

Geneva study – household transmission less likely from children 5

Contact tracing in families with children 6

 

Testing criteria for children

BAG 7

 

Other

Learning outcomes – worse in primary than secondary schools and individual variation 8

Survey on compliance with NPI in young people (largely compliant) 9

 

1             Ulyte A, Radtke T, Abela IA, et al. Variation in SARS-CoV-2 seroprevalence in school-children across districts, schools and classes. medRxiv 2020. DOI:10.1101/2020.09.18.20191254.

2             Ulyte A, Radtke T, Abela IA, et al. Clustering and longitudinal change in SARS-CoV-2 seroprevalence in school-children: prospective cohort study of 55 schools in Switzerland. medRxiv 2020. DOI:10.1101/2020.12.19.20248513.

3             Kriemler S, Ulyte A, Ammann P, et al. Surveillance of acute SARS-CoV-2 infections in school children and point-prevalence during a time of high community transmission in Switzerland. medRxiv 2020. DOI:10.1101/2020.12.24.20248558.

4             Stringhini S, Wisniak A, Piumatti G, et al. Seroprevalence of anti-SARS-CoV-2 IgG antibodies in Geneva, Switzerland (SEROCoV-POP): a population-based study. Lancet 2020. DOI:10.1016/S0140-6736(20)31304-0.

5             Bi Q, Lessler J, Eckerle I, Lauer SA, Kaiser L. Household transmission of SARS-COV-2: insights from a population-based serological survey. Silvia Stringhini 2020; 10: 12.

6             Posfay-Barbe KM, Wagner N, Gauthey M, et al. COVID-19 in children and the dynamics of infection in families. Pediatrics 2020; 146. DOI:10.1542/peds.2020-1576.

7             Bundesamt für Gesundheit. Testkriterien Kinder. https://www.bag.admin.ch/dam/bag/de/dokumente/mt/k-und-i/aktuelle-ausbrueche-pandemien/2019-nCoV/testkriterien-kinder.pdf.download.pdf/Testkriterien_Kinder.pdf (accessed Jan 16, 2021).

8             Tomasik MJ, Helbling LA, Moser U. Educational gains of in‐person vs. distance learning in primary and secondary schools: a natural experiment during the COVID‐19 pandemic school closures in Switzerland. Int J Psychol 2020. DOI:10.1002/ijop.12728.

9             Nivette A, Ribeaud D, Murray A, et al. Non-compliance with COVID-19-related public health measures among young adults in Switzerland: Insights from a longitudinal cohort study. Soc Sci Med 2021; 268: 113370.


Date of request: January 2021
Date of response: EDI

Comment on planned updates: at the end of January we plan to have an updated Policy Brief on the role of children and adolescents in the transmission of SARS-CoV-2

Expert groups involved:  Milo Puhan, Roman Stocker, Marcel Tanner and Public Health group, with input from multiple groups

Contact persons:  Milo Puhan