School closings: How student behavior can limit their effectiveness during outbreaks

 
school closure coronavirus effectiveness students
(Wikimedia Commons/Brinacor)
By

April 21, 2020

Last week, celebrity talk show host Dr. Mehmet Oz faced an immediate backlash after suggesting school closings are not a very effective way to prevent coronavirus deaths and that re-opening schools “may only cost us 2 to 3% in terms of total mortality.”

During a guest appearance on Fox News, Oz cited a new paper in The Lancet medical journal that examines the role school closures play in stopping the spread of infectious disease. Researchers have estimated that school closings in the United Kingdom would, on their own, prevent 2% to 4% of COVID-19 deaths — considerably less than other social distancing efforts, according to the journal article.

For years, researchers have said that the impact of shuttering schools is linked to how closely children adhere to authorities’ recommendations to stay home and avoid contact with other people. Scholars have studied school closings that took place in 2009 amid a pandemic of influenza A — the H1N1 virus — as well as closings prompted by earlier outbreaks of influenza B.

Mathematical models have indicated school closings “may help to reduce transmission during an influenza pandemic, but such models require assumptions about student and family behavior during closures,” researchers from the Harvard School of Public Health wrote in a study published in the PLoS ONE academic journal in 2010.

So how do students actually behave during school closures? Keep reading. We’ve gathered and summarized multiple studies focusing on children’s reactions to a pandemic or infectious outbreak in the U.S., Japan and Australia.

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U.S. student behavior

Student Behavior during a School Closure Caused by Pandemic Influenza A/H1N1
Miller, Joel C.; et al. PLoS ONE, May 2010.

Researchers surveyed students and parents to find out how they behaved during the temporary closure of a Boston school during an H1N1 outbreak in 2009. What they learned: “During the closure, students were advised to avoid contacts with other students and with the community, but our surveys show that they remained active, unless they became symptomatic.”

The study focuses on a private girls’ school serving grades 5-12 that had closed for a week in May. Nearly 200 students in grades 9-12 as well as 63 parents of students in grades 5-8 completed surveys consisting of 19 multiple-choice questions.

The authors find that closing the school reduced the frequency of contacts among school-age children. However, kids — especially older ones — continued to participate in out-of-school activities such as shopping, eating out and visiting friends. “Contacts substantially increased for grades 11 and 12 on Friday and Saturday [of that week],” the researchers write. “Grade 12 had significantly more contacts than the other grades, particularly late in the week.”

The authors hypothesize that students might not have complied with the school’s advice because they were either unaware of it or did not understand the reasons behind it. They also explain that “instructions may have been interpreted as instructions for protecting individual students rather than protecting others from the students. Instructions that include information about incubation time and infectiousness during incubation time, and the possible consequences for students with pre-existing conditions may achieve better adherence to social distancing measures.”

Household Effects of School Closure during Pandemic (H1N1) 2009, Pennsylvania, USA
Gift, Thomas L.; et al. Emerging Infectious Diseases, August 2010.

About 20% of Pennsylvania parents who responded to a survey about a pandemic-related school closing said they took time off work to care for their kids during the closure, according to this paper. Meanwhile, 69% of children whose parents took the survey did not comply with social distancing recommendations — they went on unnecessary outings during the week in 2009 when their elementary school was shuttered to prevent the spread of H1N1.

Researchers also discovered that children who exhibited symptoms of an influenza-like illness were as likely as healthy kids to go on excursions that week. “Most students left the home at least once during the closure period to visit routine venues (stores, locations of sports events or practices, restaurants),” the authors write. “This behavior, particularly by students who reported ILI [influenza-like illness], may increase the risk for onward transmission.”

Adults from 214 households located in the semirural area served by the school participated in the study. Their children comprise 59% of enrolled students.

Household Responses to School Closure Resulting from Outbreak of Influenza B, North Carolina
Johnson, April J.; et al. Emerging Infectious Diseases, July 2008.

This study looks at how North Carolina families responded to the weeklong closure of all nine public schools in one county during an influenza outbreak in 2006. At the time, an estimated 18,421 people lived in the county and 1,750 households had children enrolled in public schools.

Researchers found that most children in the 220 households surveyed did not stay home the entire week schools were closed. Almost half traveled outside the county and many went to grocery stores, church, parties and fast-food restaurants.

Children who were ill were more likely to visit some public places that week than children who were not, according to survey responses. For example, 37% of children who were ill went to church that week compared with 31% of children who were not, although researchers determined the difference was not statistically significant.

The paper notes that 22% of kids in the households surveyed reportedly had received the influenza vaccine for that season by Nov. 15, 2006. Schools were closed Nov. 2-12. Among those who received the vaccine, 81% got it after schools closed.

Student behavior in other countries

Contact Behavior of Children and Parental Employment Behavior During School Closures Against the Pandemic Influenza A (H1N1-2009) in Japan
Mizumoto, Kenji; Yamamoto, Taro; Nishiura, Hiroshi. Journal of International Medical Research, June 2013.

When schools in Japan closed during the H1N1 influenza pandemic in 2009, most Japanese students whose families participated in this study followed social distancing recommendations, according to this paper. More than 60% of children “strictly stayed at home, with a minority leaving the house for essential or nonessential purposes,” the authors explain.

Researchers analyzed data collected via surveys of 882 Japanese families with children to better understand the factors that influenced the behaviors of children and parents during the H1N1 pandemic in 2009. A commercial research company in Tokyo invited parents to participate.

The study finds that the youngest kids were most likely to leave home unnecessarily amid school closings — for example, 53.2% of kindergarteners left their homes at least once compared with 30.3% of junior high school students and 33.2% of high school students.

“Primary school pupils were most likely to leave the home to visit a supermarket or convenience store, followed by high school pupils,” the authors write. “Junior high school pupils and primary school pupils were more likely to leave the home to attend extracurricular studies (including prep-school and English school) compared with pupils in other school categories.”

The researchers also find that children were less likely to leave home if their parents believed school closings were an appropriate response to the pandemic, compared with kids from households that believed it was not an appropriate response. In addition, students from households that had to make special childcare arrangements during school closure were more likely to leave home unnecessarily than those who were independent and able to care for themselves.

Recommendations For and Compliance With Social Restrictions During Implementation of School Closures in the Early Phase of the Influenza A (H1N1) 2009 Outbreak in Melbourne, Australia
McVernon, Jodie; et al. BMC Infectious Diseases, September 2011.

This study was the first large-scale examination of household behavior during school closures caused by an infectious disease, according to the authors. They surveyed families across Melbourne, Australia whose children attended 33 schools that had either shut down completely or closed some classrooms to prevent the spread of H1N1 in 2009. A key finding: “Individual compliance with the recommendation to stay at home was high, with respondents reporting that individuals stayed at home for more than 94% of the days they were advised to be in quarantine.”

Of the 314 households that took the survey, completed online and via telephone, 51 had at least one confirmed case of an H1N1 infection.

The researchers write that the high rate of compliance with stay-at-home recommendations is likely because school and classroom closures occurred during the early days of the outbreak, when the public was unsure of its severity and there was considerable media attention. “These estimates likely reflect a ‘best case’ scenario, fueled by high levels of public awareness and anxiety at the time the measures were imposed,” they write.

Check out our other coronavirus-related resources, including research on online schooling and how infectious disease outbreaks affect mental health.

 

This image was obtained from Wikimedia Commons and is being used under a Creative Commons license. No changes were made.

 

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