- Schools closed for 2 weeks right after the peak of the influenza outbreak 
- Examining the attack rates before and after closure showed that this was an effective strategy to lower the spread, but after a peak, there is going to be a reduction in cases anyway. 
- Taking a closer look, researchers found no significant effect of the closure of schools on the spread of the outbreak. 

Santa Clara University

- Australia

- Denmark

- Japan

- England

- Israel

- Hong Kong  

- Mainland China

- Taiwan

- UK

Outcomes of School Closures & Subsequent Re-opening/ Maintaining Open Schools by Country

Historical instances of school closures—ranging from scheduled holidays and teacher strikes to reactive shutdowns across different regions—provide valuable data on their effectiveness in mitigating viral transmission. Analyzing these cases during various influenza pandemics and SARS outbreaks helps to assess the overall impact of school closures on disease spread.

Past School Closures and Their Impacts on Viral Outbreaks and Pandemics

Cauchemez, S., Ferguson N.M., Wachtel C., Tegnell A., Saour G., Duncan B., Nicoll A. (2009, August). Closure of schools during an influenza pandemic. The Lancet Infectious Diseases, 9(473-81). 

Closure of schools during an influenza pandemic

A study of the spread of COVID-19 within New South Wales schools (10 high school, 5 primary) from March- mid April 2020 reveals that of a total of 6 initial cases in the primary schools (one student and five staff), only one of 168 close contacts was infected. Thus, there was a small outcome of infection among children and no instances of children infecting teachers.


Outcomes of Open Schools In Australia Amidst the COVID-19 Pandemic

On April 15, 2020, the Government of Denmark decided to send children under 11 back to school. School activities have been adapted to minimize transmission of the virus, and after a month of safety measures such as the creation of small groups of children for lessons and for playtime, frequent hand washing, 6-feet spacing of student’s desks and, when feasible, outdoor classes, the method seemed to be effective.


Outcomes of Re-opening Schools in Denmark Amidst the COVID-19 Pandemic

Local governments made the decision of whether they would reopen schools based on the number of COVID-19 cases in that area, with the national government recommending first- and sixth-graders be given priority. Schools have followed guidelines outlined by the Ministry of Health, such as daily temperature checks, maintenance of social distancing, and the wearing of face masks. 

Outcomes of Re-opening Schools in Japan Amidst the COVID-19 Pandemic

Israel declared complete closure of educational facilities on March 13, 2020 as a control measure for SARS-CoV-2 transmission. Limited reopening was permitted after May 3 for kindergartens and grades 1-3 and 11-12. All schools reopened on May 17, with public health requirements including daily health reports, good hygiene practices, facemask usage, social distancing, and minimal interactions. The first COVID-19 school outbreak emerged in a high school (Gymnasia Rehavia) on May 26, resulting in at least 130 cases among students and staff. The spike in cases in Israel following school re-opening has also been observed in South Korea and France. 

Outcomes of Open Schools In Israel Amidst the COVID-19 Pandemic

Hong Kong school closure in March 2008 

- 4-week school closure was initiated across the city on February 1, 2020, which was approximately 1 week after the first cases of COVID-19 were identified in Hong Kong. 
- School closures coincided with other stringent social distancing measures, and school closures that were initially until March 2020 were extended to April 2020.
- Collectively these measures were considered to have reduced the R below 1, thus controlling the spread of the outbreak. 
- A preprint observational study by Cowling and colleagues noted that "social distancing measures implemented during the COVID-19 outbreak reduced community transmission by 44%, which was much greater than the estimated 10-15% reduction in influenza transmission" attributed to school closures during the 2009 H1N1 pandemic in Hong Kong. 
- There was no data available from the papers on the effect of school closures separate from other measures.



Outcomes of School Closures in Hong Kong due to the COVID-19 Pandemic

- As of April 3, 2020, Taiwan has been recognized to have effectively minimized the spread of COVID-19.
- Widespread planned school closures was avoided by mandating local class closures, and subsequently local temporary school closures, based on low thresholds for infected cases within individual schools.

Outcomes of School Closures and School Re-Openings in Taiwan during the COVID-19 Pandemic

- 2 preprint studies reported that school closures were initiated nationally across mainland China in late January 2020 after delaying the restart of schools following Chinese New year holidays. School closures were part of a broader series of control measures during the COVID-19 pandemic. 
- However, there is no data available on the effectiveness of school closures because there was little variation in the timing of closures (closures were reportedly applied in all Chinese cities uniformly) and school closures were part of a broad range of quarantine and social distancing measures.
- These studies concluded that a combination of quarantine and social distancing measures was effective in reducing the epidemic in Mainland China.
- Relative contribution of school closures was not assessed. 


Outcomes of School Closures in Mainland China during the COVID-19 Pandemic 

- Outcomes of School Closure and Management Practices during Coronavirus Outbreaks in the UK: A Systematic REVIEW 
- Outcome Prediction of Open Schools in England Amidst the COVID-19 Pandemic

Outcomes of School Closures & Reopening during the COVID-19 Pandemic in the UK

- 21 years of surveillance data on influenza related illnesses in France found on average, children reduce their contact with others by 25% during school holidays, and holidays prevent about 1 in 6 seasonal influenza cases each year. 


School holidays in France


- In most cases, school closure was delayed until about 50-75% of the students became ill 
- Local decisions rather than national, which made local schools reluctant to close.
- Overall, the school closure was ineffective in reducing cases because school closure decisions were made too late. 

School closure in France during the 1957 pandemic

- Interventions: school closure, closing churches, banning mass gatherings, case isolation, disinfection and hygiene strategies, required masks
- However, the type and timing of these interventions was different across cities. 
- Interventions that were prolonged and implemented early resulted in positive health benefits, with an estimated reduction in mortality by 10-30% and up to 50% reduction in peak mortality. 


1918 influenza pandemic in US cities 

- During an influenza outbreak, the teacher strike caused a closure of schools. Looking at the number of cases 2 weeks before the strike and 2 weeks of the strike, a significant reduction in physician and emergency department visits, as well as respiratory tract infection diagnoses, was observed during the strike. 
- When the strike ended and students returned to school amidst the outbreak, doctor visits and cases of respiratory tract infections rebounded. 

Teacher strike in Israel in 2000

- 2003 SARS Outbreak
- 2009 H1N1 Pandemic 


Past school closures from viral outbreaks in Taiwan

- A review of the 2003 SARS outbreak in Singapore noted that containment measures included a twice daily mandatory temperature screening of all children aged 6-16 years in schools. 
- Although there were children diagnosed with SARS in Singapore, none were identified through daily temperature screenings at school. 
- All educational facilities were closed for 3 weeks along with the suspension other activities to prevent the congregation of large groups of children. 


2003 SARS Outbreak in Singapore

- Schools in Beijing were closed approximately 6 weeks after the beginning of the outbreak, and remained closed for over 2 months. 
- Pang and colleagues concluded that school closures made very little difference in preventing the spread of SARS in Beijing, due to the fact that there were low attack rates in schools before closure and low prevalence of SARS in children. 
- Cowling and colleagues estimated the effective R for each day of the Beijing SARS outbreak, noting that school closures occurred after the R had dropped below 1 and school closures did not significantly contribute to the control of the outbreak. 
- Class cancellation strategies were used in upper high school and colleges where students would stay on campus but did not attend classes. 
- There were no recorded transmission of SARS in schools during the outbreak in mainland China. 



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