- The positive effects of social distancing stop when they are lifted
- A second peak was seen in many US cities during the 1918 influenza pandemic when social distancing measures were lifted. 

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- Impacts of lessened social distancing 
- Criteria for reopening schools 
- Difficulties in creating consistent national policy
- The age-specific transmission rate of the virus

Important aspects to consider in reopening schools during a pandemic 

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

- Lifting of social distancing measures requires some assurance that herd-immunity has been reached (through immunization or natural infection) 
- The author believes cross-sectional seroprevalence surveys are the best way to determine the level of population immunity. 
- Or, reopen schools only when children have been immunized

Criteria for reopening schools

Impacts of lessened social distancing 

- Establishing national policies on school closure can be difficult, and the example of 1957 school closure in France that was based on local decisions rather than a synchronized national decision demonstrated how unorganized school closure had no significant effect on reduction of cases.

Difficulties in creating consistent national policy

- Different viruses have different attack rates among age groups. Because most of the virus transmission of the 1957 influenza example in France occurred among children, school closure would have been an effective policy. However, school closure would have had a less significant effect in 1968 when the attack rates were similar among children and adults. Therefore, the costly strategy of school closure should be based on age-specific estimates of severity and morbidity in cases of the virus. 

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