Epidemiology: Protocols for the safe reopening of schools

Strategies to safely open schools after lockdown while trying to control the spread of COVID-19 should prioritize the gradual reopening of pre-school and primary schools, suggests a modelling study of French data published in Nature Communications. The study, using data from the north central region of France during the first wave of COVID-19 in Spring 2020, indicates that reopening all school levels at the same time may overwhelm the healthcare system.

The role of children in the spread of COVID-19 is not fully understood, and this remains a key challenge when assessing the risk that school reopening may have on transmission. Research has suggested that children are less susceptible to COVID-19 than adults, but some studies have shown that adolescents may be more likely than children under 10 years old to catch and spread the illness.

Vittoria Colizza and colleagues assess protocols by which schools in France can be safely opened without overwhelming the healthcare system, based on data from the Île-de-France region during France’s first lockdown before its end in May. The authors run simulations of the reopening of schools on 11 May through different scenarios: gradual or immediate reopening at full or partial attendance, differentiated for type of schools (pre-school, primary, middle, and high school). They test different hypotheses on children’s transmissibility, distinguishing between younger children and adolescents.

Although the authors find that reopening schools would lead to an increase in the number of COVID-19 cases, the results indicate that such increase would still be manageable if targeted protocols are adopted. Under a scenario where only pre-schools and primary schools reopen immediately at full attendance on May 11, and other school levels reopen gradually with a one-month delay, the authors predict that intensive care unit occupation would remain below maximum capacity (at most 76% capacity). Whether these projections could apply to more-recent time periods and in different countries remains to be tested, but the various school-reopening strategies assessed in this study may help tailor interventions and inform decisions on the opening or closure of schools, the authors conclude.

The full paper is available at: https://www.nature.com/articles/s41467-021-21249-6