• Alyssa Bilinski, Joshua A Salomon, John Giardina, Andrea Ciaranello, and Meagan C Fitzpatrick.
• Interfaculty Initiative in Health Policy, Harvard Graduate School of Arts and Sciences, Cambridge, Massachusetts (A.B.).
• Ann. Intern. Med. 2021 Aug 1; 174 (8): 109011001090-1100.

BackgroundThe COVID-19 pandemic has induced historic educational disruptions. In April 2021, about 40% of U.S. public school students were not offered full-time in-person education.ObjectiveTo assess the risk for SARS-CoV-2 transmission in schools.DesignAn agent-based network model was developed to simulate transmission in elementary and high school communities, including home, school, and interhousehold interactions.SettingSchool structure was parametrized to reflect average U.S. classrooms, with elementary schools of 638 students and high schools of 1451 students. Daily local incidence was varied from 1 to 100 cases per 100 000 persons.ParticipantsStudents, faculty, staff, and adult household members.InterventionIsolation of symptomatic individuals, quarantine of an infected individual's contacts, reduced class sizes, alternative schedules, staff vaccination, and weekly asymptomatic screening.MeasurementsTransmission was projected among students, staff, and families after a single infection in school and over an 8-week quarter, contingent on local incidence.ResultsSchool transmission varies according to student age and local incidence and is substantially reduced with mitigation measures. Nevertheless, when transmission occurs, it may be difficult to detect without regular testing because of the subclinical nature of most children's infections. Teacher vaccination can reduce transmission to staff, and asymptomatic screening improves understanding of local circumstances and reduces transmission.LimitationUncertainty exists about the susceptibility and infectiousness of children, and precision is low regarding the effectiveness of specific countermeasures, particularly with new variants.ConclusionWith controlled community transmission and moderate mitigation, elementary schools can open safety, but high schools require more intensive mitigation. Asymptomatic screening can facilitate reopening at higher local incidence while minimizing transmission risk.Primary Funding SourceCenters for Disease Control and Prevention through the Council of State and Territorial Epidemiologists, National Institute of Allergy and Infectious Diseases, National Institute on Drug Abuse, and Facebook.

17 keywords...

hide…