key: cord-277936-0ytk77fm
authors: Rauscher, E.
title: Lower State COVID-19 Deaths and Cases with Earlier School Closure in the U.S.
date: 2020-05-13
journal: nan
DOI: 10.1101/2020.05.09.20096594
sha: 
doc_id: 277936
cord_uid: 0ytk77fm

This study quantifies the relationship between school closure timing and COVID-19 deaths and cases in the general population in all U.S. states. COVID-19 has higher symptomatic infection rates among the elderly, suggesting school closures could be unrelated to transmission. However, predicting daily cumulative COVID-19 deaths by state, earlier school closure is related to fewer deaths per capita and slower growth in deaths per capita. Results are similar for COVID-19 cases per capita.

Evidence is mixed on the extent to which spread of novel coronavirus or influenza strains slows with public school closure. 1,2 Reviews find early school closures can slow influenza transmission when infection rates are higher among children than adults. 3, 4 Unlike most previous influenza outbreaks such as H1N1, 5 COVID-19 causes higher symptomatic infection rates at older ages. 6 School closures may therefore not slow the spread of COVID-19. To examine whether health benefits of closing schools outweigh the economic and social costs 5 , this study quantifies the relationship between state school closure timing and COVID-19 deaths and cases in the U.S.

Using daily cumulative COVID-19 deaths and cases by state from The New York Times, this study examines dates after the first 100 cases in each state until April 27, 2020. prevalence is logged number of deaths (and cases) per 100,000 residents. Time period is days since the state reached 100 cases.

Using state-ordered school closure dates for each state from EdWeek, time to school closure is the number of days from when the state reached 100 cases until schools were closed. All states closed schools within 11 days after President Trump declared a national state of emergency on March 13. Variation in state prevalence rates on March 13 (zero to 6.6 cases/100,000) allows examination of the relationship between COVID-19 spread and school closure timing.

. CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)

The copyright holder for this preprint this version posted May 13, 2020. clustering. Figure 1 shows cumulative state COVID-19 deaths per 100,000 residents by school closure timing. The bivariate correlation is 0.5 (p<0.001). Model 1 in Table 1 finds that deaths per 100,000 residents are predicted to be 12% higher for each additional day before schools closed (p<0.01). Controlling for lagged deaths (Model 3), state deaths increase by 1.3% for each . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

The copyright holder for this preprint this version posted May 13, 2020. . https://doi.org/10.1101/2020.05.09.20096594 doi: medRxiv preprint additional day before schools closed (p<0.01). Estimates of both prevalence and growth are higher when including controls (Models 2 and 4). EdWeek. The trend is similar excluding seven states that recommended rather than ordered school closure.

. CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

The copyright holder for this preprint this version posted May 13, 2020. Predicted cases per 100,000 are 2.7% higher and increase by 0.3% for each additional day before schools closed (p<0.01). Sensitivity analyses yield consistent results without applying weights, when limited to one observation per state (predicting maximum cumulative deaths or cases on April 27), or when excluding states that recommended rather than ordered schools closed.

. CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

The copyright holder for this preprint this version posted May 13, 2020. . https://doi.org/10.1101/2020.05.09.20096594 doi: medRxiv preprint

This study quantifies the relationship between school closure timing and COVID-19 deaths and cases in the general population in all U.S. states. Although COVID-19 has higher symptomatic infection rates among the elderly 6 , earlier school closure is still related to fewer deaths per capita and slower growth in deaths per capita.

. CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

The copyright holder for this preprint this version posted May 13, 2020. 

School closure and management practices during coronavirus outbreaks including COVID-19: A rapid systematic review

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Closure of schools during an influenza epidemic

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