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Closure of schools during an influenza pandemic
Abstract
In response to WHO raising the influenza pandemic alert level from phase five to phase six, health officials around the world are carefully reviewing pandemic mitigation protocols. School closure (also called class dismissal in North America) is a non-pharmaceutical intervention that is commonly suggested for mitigating influenza pandemics. Health officials taking the decision to close schools must weigh the potential health benefits of reducing transmission and thus case numbers against high economic and social costs, difficult ethical issues, and the possible disruption of key services such as health care. Also, if schools are expected to close as a deliberate policy option, or just because of high levels of staff absenteeism, it is important to plan to mitigate the negative features of closure. In this context, there is still debate about if, when, and how school closure policy should be used. In this Review, we take a multidisciplinary and holistic perspective and review the multiple aspects of school closure as a public health policy. Implications for the mitigation of the swine-origin influenza A H1N1 pandemic are also discussed.
... These may be 'unprecedented times' for us but not for our forebearers. We can trace the history of pandemics in the twentieth and twenty-first centuries through the pandemics of 1918-1919, to 1957-1958, to 1968-1969(WHO, 2009. The most recent pandemics have resulted in a greater recognition of the complexity of the effects of pandemics on the population. ...
... There are different nuances to school closures as outlined by Cauchemez et. al. (2009). The first type is a school closure in which all staff and students are sent home. This can be a Proactive closure or a Reactive closure. A Proactive closure occurs when the staff and students, or a particular class, are sent home to prevent the spread of the infection. A Reactive closure occurs when a significant number of staff or pup ...
... After the 2009 pandemic, there were calls for the development of 'pandemic mitigation protocols' (Cauchemez et. al., 2009). One of these protocols would be the formulation of a rationale for school closures. This would encompass an understanding of the 'trigger point' or 'thresholds' for school closures -the evidence that would be required for a school closure and at what point in the progress of the pandemic would school closures be judged to be effective ...
... Closure of schools is considered an effective strategy to contain an influenza pandemic 4 , based on both model calculations and observational studies of the influence of school holidays on the spread of influenza 5,6 . The reasons for this are the high contact rates in young age groups 7 and the susceptibility of children and young people to the influenza virus. ...
... Interventions for different school ages. Next we investigated the impact of targeting interventions at different age groups, starting from the situation in November 2020 with the effective reproduction number being about 1 ( Supplementary Fig. 4d). Figure 7a-c shows R e as a function of the reduction of school contacts in age groups of [0, 5), [5,10), and [10, 20) y.o., respectively. In each panel, we varied the number of school contacts in one age group while keeping the number of school contacts in the other two age groups constant. ...
... We used age-specific contact rates with ten age groups (ages [0, 5), [5,10), [10,20), [20,30), [30,40), [40,50), [50, 60), [60, 70), [70, 80) and 80+). Due to the low number of hospitalizations in young persons, we assumed that hospitalization rates in the first three age groups (ages [0, 5), [5,10), [10,20)) were equal; therefore, only eight hospitalization rates were estimated. ...
The role of school-based contacts in the epidemiology of SARS-CoV-2 is incompletely understood. We use an age-structured transmission model fitted to age-specific seroprevalence and hospital admission data to assess the effects of school-based measures at different time points during the COVID-19 pandemic in the Netherlands. Our analyses suggest that the impact of measures reducing school-based contacts depends on the remaining opportunities to reduce non-school-based contacts. If opportunities to reduce the effective reproduction number (Re) with non-school-based measures are exhausted or undesired and Re is still close to 1, the additional benefit of school-based measures may be considerable, particularly among older school children. As two examples, we demonstrate that keeping schools closed after the summer holidays in 2020, in the absence of other measures, would not have prevented the second pandemic wave in autumn 2020 but closing schools in November 2020 could have reduced Re below 1, with unchanged non-school-based contacts. The role of school-based contacts in the epidemiology of SARS-CoV-2 is incompletely understood. Here, the authors use an age-structured transmission model fitted to age-specific seroprevalence and hospital admission data to assess the effects of school-based measures during the COVID-19 pandemic in the Netherlands.
... The 2009 influenza pandemic caused disruption to schools, businesses, and governmental entities. Numerous reports from US CDC and European countries document the central role of school-aged children in community-wide transmission of pandemic virus [1][2][3][4][5][6][7][8][9][10]. In the United States and Australia, the onset of pandemic influenza incidence was linked to school opening dates [11]. ...
... Pre-emptive, school closures are recommended as a countermeasure during severe influenza pandemics [23], but are associated with significant educational, social and economic impacts [24]. Prior studies of the impact of school closures on respiratory viral transmission have focused on observations around planned and unplanned closures [4,6,25], but none have characterized grade specific differences or half-day attendance. Further work is required to assess the efficacy of a half-day attendance regime in nonkindergarten grades and in other school populations on influenza infection and transmission. ...
Background
Information on the etiology and age-specific burden of respiratory viral infections among school-aged children remains limited. Though school aged children are often recognized as driving the transmission of influenza as well as other respiratory viruses, little detailed information is available on the distribution of respiratory infections among children of different ages within this group. Factors other than age including gender and time spent in school may also be important in determining risk of infection but have been little studied in this age group.
Methods
We conducted a cohort study to determine the etiology of influenza like illness (ILI) among 2519 K–12 students during the 2012–13 influenza season. We obtained nasal swabs from students with ILI-related absences. Generalized linear mixed-effect regressions determined associations of outcomes, including ILI and laboratory-confirmed respiratory virus infection, with school grade and other covariates.
Results
Overall, 459 swabs were obtained from 552 ILI–related absences. Respiratory viruses were found in 292 (63.6%) samples. Influenza was found in 189 (41.2%) samples. With influenza B found in 134 (70.9%). Rates of influenza B were significantly higher in grades 1 (10.1, 95% CI 6.8–14.4%), 2 (9.7, 6.6–13.6%), 3 (9.3, 6.3–13.2%), and 4 (9.9, 6.8–13.8%) than in kindergarteners (3.2, 1.5–6.0%). After accounting for grade, sex and self-reported vaccination status, influenza B infection risk was lower among kindergarteners in half-day programs compared to kindergarteners in full-day programs (OR = 0.19; 95% CI 0.08–0.45).
Conclusions
ILI and influenza infection is concentrated in younger schoolchildren. Reduced infection by respiratory viruses is associated with a truncated school day for kindergarteners but this finding requires further investigation in other grades and populations.
... When the research was conducted, more than 124 countries around the world, including Indonesia, have closed their schools and universities. Closing schools is one of the effective ways to prevent the spread of the epidemics, in particular, to prevent the virus spread among students (Cauchemez et al., 2009;Cowling et al., 2010;Wu et al., 2010;Jackson et al., 2013). ...
... In term of this policy, teachers teach from home during this pandemic by optimizing the use of information and communication technology (ICT) to ensure students can still observe the learning process from home. The closing of schools is based on evidence and observations from previous outbreaks by the social interaction among students deemed acceptable (Barclay et al., 2014;Cauchemez et al., 2009;Jackson et al., 2016;Potter et al., 2012;Viner et al., 2020). ...
This study investigates the distance learning process of teachers during school closure due to COVID-19's impact. This research focuses on the introduction of distance learning, the obstacles faced by teachers and approaches to addressing different hurdles in the implementation of distance learning. This study collected data from mathematics and science teachers spread in junior and senior high schools in Aceh Province, Indonesia. Data were collected through a questionnaire from 353 teachers and interview from 6 teachers to get in-depth information related to the focus of this study. The results of the study revealed that teachers could not directly utilize various Information and Communication Technology (ICT) devices and online learning platforms that are widely available in supporting distance implementation, either due to the ability of teachers, parents’ economic factors, limited internet access, and the absence of guidance. However, over time, the teacher can independently adapt to environmental conditions and the characteristics of students in carrying out distance learning.
... In nations' agendas, school closures have been one of the non-pharmaceutical interventions to mitigate a pandemic (Cauchemez et al., 2009), but it has never been planned to be applied at such a large scale until the outbreak of COVID-19; namely, a disease caused by the new coronavirus. School closures, among many other implications, were discussed to have caused ethical and social justice concerns for disadvantaged populations (Berkman, 2008), mental health problems for students (Lee, 2020) and an increase in related costs, creating economic problems (Lempel, Epstein, & Hammond, 2009;Sadique, Adams, & Edmunds, 2008). ...
... Gonzales, Calarc and Lynch (2018, p.2) found out that in a sample taken in the USA, roughly 20 percent of the 748 respondents in their study, "had difficulty due to broken hardware, data limits, connectivity problems, etc.) and students of lower socioeconomic status and students of color disproportionately experienced hardships, and reliance on poorly functioning laptops was associated with lower grade point averages. " Cauchemez et al. (2009) highlight similar concerns. In essence, the disadvantage of school closures broadens the gap between rich and poor as families and students from disadvantaged backgrounds are likely to be disproportionately affected by the implementation of digital learning. ...
When COVID-19, with its contagious properties and fatal signs, was detected, the reactions of human communities were interesting and weird at the same time. First came the denial; that COVID-19 was just another ordinary flu. However, denial was soon replaced by denunciations, and when people were busy blaming others for the situation, only within a few weeks the virus had spread itself
everywhere. COVID-19 had not been taken seriously until the pandemic situation was finally announced; then, the world was in chaos. It felt like a world war that had sparked out of ignorance and negligence. Some said that it happened owing to lack of foresight; others argued that it would have never happened had science not been politicized in our modern world. Whatever its real culprit might have been, the pandemic was real, and within only 15 months, it had silently taken over two million human lives. A couple of years ago, it would be bizarre to believe that soon we would see a day when social distancing, now the norm almost everywhere, would be encouraged and mandated. Like a world war, the COVID-19 Pandemic put the human community in a worldwide state of confusion. However, the confusion was worsened by the fact that in a war, comrades know their visible enemy. Nevertheless, during the pandemic, an infected friend turns into a potential foe instantly after diagnosis. This quickly created some social stigmatization for the infected individuals and worsened the situation because many cases infected did not report themselves, which, in turn, expedited the spread of the virus. The pandemic had numerous social implications. Therefore, besides all the miseries it had brought along, again, much like most wars, it also created a unique opportunity for social science researchers. Many researchers suddenly became interested in investigating this new phenomenon in relation to many other variables. This book attempts to present concepts and empirical research findings related to the COVID-19 Pandemic in human societies worldwide. In general, the purpose of this book is to examine the social effects of the COVID-19 Pandemic. It will hopefully help us understand the changes in society once the pandemic is over. The COVID-19 Pandemic has affected every aspect of social life around the globe, from individual relationships to institutional operations at local and global levels. As people do their best to mitigate transmission through strict restrictions on people's movement, connections, and interactions, the disease continues to decimate families, upend governments, crush economies, affect migrants, and tear through the social and economic sector. These social changes and transformations also brought psychosocial health problems. During this time, modern societies should be studied from different fields of social sciences. Authors in this book tried to examine, collect and report the social effects of the COVID-19 Pandemic in different parts of the world. Our contributors are academics working in social sciences who share their country's COVID-19 Pandemic experience with us. Our contributors have addressed diverse topics related to social sciences and the COVID-19 Pandemic. More specifically, the issues that are addressed by the chapters include: the relationship between the pandemic and gender, the effect of digitization and social distancing on sociology and philosophical or political ways of thinking, the pandemic and globalization or nationalization, psychosocial effects of the pandemic, adaptation to masks and social distancing, macroeconomic effects of the pandemic, local copying strategies, technology leadership, challenges for disadvantaged groups, educational procedures, and assessment practices during the pandemic. Our contributors, who come from diverse parts of the world such as Brazil, China, India, Indonesia, Italy, Malaysia, Turkey and Ukraine report the impact of this phenomenon on their local social circles. We believe the book is very timely as it creates new literature on the COVID- 19 Pandemic. The outcomes and results of the researches in this book will help policymakers for a healthy management of the pandemic. Not only in the pandemic but also after the pandemic, this book will shed light for the researchers, professionals, and policymakers. One of the strong sides of this book is being internationally contributed and edited from multidisciplinary perspectives. Several international authors worked together for their joint papers. More than 30 scholars worked for a total of 17 chapters published in this book. Since there is not much literature on the COVID -19 Pandemic from a social science perspective, it will be a unique book in its area and will have an essential contribution to the area. We hope that our readers will find this book a valuable source that views the social influences of the pandemic in various parts of the world.
The Editorial Team:
Hakan Gulerce, Harran University
Vahid Nimehchisalem, Universiti Putra Malaysia
Veysel Bozkurt, Istanbul University
Glenn Dawes, James Cook University
Shameem Rafik-Galea, SEGI University Malaysia
May 2021
... Though school closure is intended to control the spread of the virus within schools, prevent carriage to other vulnerable individuals, and sustain public health, these closures have had widespread socioeconomic impacts (Lindzon, 2020;Wren-Lewis, 2020;Cauchemez et al., 2009). Furthermore, the far-reaching effects of social/physical distancing and the associated lockdown measures, as well as school closures, have thwarted the education sector and are expected to leave an indelible mark on the education system (Impey, 2020;Yinka & Adebayo, 2020;Nicola et al., 2020). ...
... It is estimated that more than 1,576, 021, 858, which constitute about 91.3% of all the learners across the globe, have been affected by the closure of educational institutions (Fong et al., 2020;Nicola et al., 2020;Sadique Adams & Edmunds, 2008;Brown et al., 2011;UNESCO, 2020). Apart from the impact on learners, school closures have high economic, health and social costs (Cauchemez et al., 2009;Brown et al., 2011;Wu et al., 2010). ...
Education is among the sectors with devastating impact of COVID-19 pandemic. Before the pandemic, the Nigerian education system has adopted purely, face-to-face approached to teaching and learning in primary and secondary schools. Primary and secondary school learners were not allowed to own any digital gadget such as phone or computer, neither were they allowed to be seen with such in the schools. With the emergence of the lockdown condition and school closure, following the COVID-19 pandemic, both teachers and learners were helpless about how to continue learning in the face of the pandemic. This study investigated the challenges posed by, and the impacts of COVID-19 on Education in Nigeria. A sequential exploratory mixed method design was adopted for the study. Results showed that the challenges of education during the COVID-19 pandemic include school closure, poor learning, unequal access to education opportunities and poor skills. Further, the pandemic negatively impacts education, causing poor school enrollment, inequality in education, poor achievement, poor school health and challenges in school assessment and transition. It was concluded that COVID-19 has negatively affected education in Nigeria. Implications for practice policy and practice of electronic learning (e-learning) were discussed.
... Studies have shown that children attending day care are at higher risk of infections [17À19], and children are thought to play an important role in infection transmission [20]. School closures have been a non-pharmaceutical intervention in previous influenza pandemics [3,20], and therefore reducing close contacts of children in day care centres and schools was a reasonable strategy to diminish the spread of SARS-CoV-2. ...
... Studies have shown that children attending day care are at higher risk of infections [17À19], and children are thought to play an important role in infection transmission [20]. School closures have been a non-pharmaceutical intervention in previous influenza pandemics [3,20], and therefore reducing close contacts of children in day care centres and schools was a reasonable strategy to diminish the spread of SARS-CoV-2. According to our study, the restrictions, including the closure of schools and day care centres, were effective in reducing the spread of all respiratory pathogens, although the reduction of SARS-CoV-2 cases began later than for other respiratory pathogens. ...
Background
Nationwide restrictions started in Finland in March to prevent the spread of COVID-19, leading to school and day care closures. The aim of this study is to describe the effect of closures and re-openings on the respiratory pathogen epidemiology.
Methods
Laboratory-confirmed cases of SARS-CoV-2; respiratory syncytial virus (RSV); influenza (A & B); parainfluenza-, adeno-, and rhinoviruses; Mycoplasma pneumoniae; and Streptococcus pneumoniae in children were collected from the National Infectious Disease Register over the period of 2017–2020. Weekly incidences (weeks 1 to 35) with 95% confidence intervals (CIs) were calculated per 100 000 children in 2020 and compared by incidence rate ratios (IRRs) to corresponding periods in 2017−2019.
Findings
The lockdown had immediate impact on the incidences of respiratory pathogens except SARS-CoV-2. Week after the lockdown began IRR was 0•3 (CI 0•3–0•4) and next week the IRR was 0•1 (0•1–0•2). The incidence of SARS-CoV-2 started to decline eight weeks after the lockdown began. The highest recorded weekly incidence of SARS-CoV-2 was 7•2/100 000 children. The effect of the lockdown lasted until late summer. Rhinovirus and SARS-CoV-2 began to increase before the schools or day cares opened in August. The re-opening of schools seemed to have no impact on the incidence of any pathogen.
Interpretation
Our results suggest that general social distancing, including school and day care closures, played a crucial role in reducing infections, and the effect lasted for several weeks. The re-opening of schools and day care centres seems to have had no immediate impact on the incidences of any respiratory pathogens.
Funding
This study had no funding source.
... Schools have previously been described as a focal point for contact and transmission events for respiratory viruses [23][24][25]. School closure has been shown to reduce influenza transmissionwhether done so for holidays or in response to an outbreak [26][27][28]. However, the implementation of reactive school closures is challenging, and comes at a social and economic cost [28]. ...
... School closure has been shown to reduce influenza transmissionwhether done so for holidays or in response to an outbreak [26][27][28]. However, the implementation of reactive school closures is challenging, and comes at a social and economic cost [28]. Adaption of schools to accommodate physical and social distancing is a promising alternative [29]. ...
Background:
Describing contact patterns is crucial to understanding infectious disease transmission dynamics and guiding targeted transmission mitigation interventions. Data on contact patterns in Africa, especially South Africa, are limited. We measured and compared contact patterns in a rural and urban community, South Africa. We assessed participant and contact characteristics associated with differences in contact rates.
Methods:
We conducted a cross-sectional study nested in a prospective household cohort study. We interviewed participants to collect information on persons in contact with for one day. We described self-reported contact rates as median number people contacted per day, assessed differences in contact rates based on participant characteristics using quantile regression, and used a Poisson model to assess differences in contact rates based on contact characteristics within age groups. We also calculated cumulative person hours in contact within age groups at different locations.
Results:
We conducted 535 interviews (269 rural, 266 urban), with 17,252 contacts reported. The overall contact rate was 14 (interquartile range (IQR) 9-33) contacts per day. Those ≤18 years had higher contact rates at the rural site (coefficient 17, 95% confidence interval (95%CI) 10-23) compared to the urban site, for those aged 14-18 years (13, 95%CI 3-23) compared to < 7 years. No differences were observed for adults. There was a strong age-based mixing, with age groups interacting more with similar age groups, but also interaction of participants of all ages with adults. Children aged 14-18 years had the highest cumulative person hours in contact (116.3 rural and 76.4 urban).
Conclusions:
Age played an important role in the number and duration of contact events, with children at the rural site having almost double the contact rate compared to the urban site. These contact rates can be utilized in mathematical models to assess transmission dynamics of infectious diseases in similar communities.
... Several studies examined the impact of school closure strategies [1][2][3][4][5][6]. However, the strategies evaluated in many of these studies were implemented for a limited time window, after which a complete reopening occurred with minor variations. ...
This article examines the impact of partial/full reopening of school/college campuses on the spread of a pandemic using COVID-19 as a case study. The study uses an agent-based simulation model that replicates community spread in an urban region of U.S.A. via daily social mixing of susceptible and infected individuals. Data representing population demographics, SARS-CoV-2 epidemiology, and social interventions guides the model's behavior, which is calibrated and validated using data reported by the government. The model indicates a modest but significant increase (8.15%) in the total number of reported cases in the region for a complete (100%) reopening compared to keeping schools and colleges fully virtual. For partial returns of 75% and 50%, the percent increases in the number of reported cases are shown to be small (2.87% and 1.26%, respectively) and statistically insignificant. The AB model also predicts that relaxing the stringency of the school safety protocol for sanitizing, use of mask, social distancing, testing, and quarantining and thus allowing the school transmission coefficient to double may result in a small increase in the number of reported infected cases (2.14%). Hence for pandemic outbreaks from viruses with similar characteristics as for SARS-CoV-2, keeping the schools and colleges open with a modest campus safety protocol and in-person attendance below a certain threshold may be advisable.
... In the USA, unpublished estimates suggested that 29% of healthcare workers had childcare obligations. UK national gross domestic product (GDP) per annum for school closure for 12-13 weeks was estimated at 0·2-1% (Cauchemez, Ferguson, Wachtel, Tegnell, Saour, Duncan, & Nicoll, 2009). ...
... Several other studies, primarily from Asian countries, have reported an effect of nonpharmaceutical public health measures, including a broad range of interventions and behavioural changes, on influenza epidemiology (12)(13)(14)(15)(16)(17). In previous reviews of nonpharmaceutical interventions for influenza control, reactive school closures (as those in Canada in response to the COVID-19 pandemic) reportedly decreased influenza transmission by 7% to 15% (2,18). Broad working-from-home approaches have been shown to reduce transmission by 20%-30%, while travel restrictions (>50%) may delay influenza peak transmission (2). ...
Background: The first coronavirus disease 2019 (COVID-19) case was reported in Canada on January 25, 2020. In response to the imminent outbreak, many provincial and territorial health authorities implemented nonpharmaceutical public health measures to curb the spread of disease. "Social distancing" measures included restrictions on group gatherings; cancellation of sports, cultural and religious events and gatherings; recommended physical distancing between people; school and daycare closures; reductions in non-essential services; and closures of businesses.
Objectives: To evaluate the impact of the combined nonpharmaceutical interventions imposed in March 2020 on influenza A and B epidemiology by comparing national laboratory surveillance data from the intervention period with 9-year historical influenza season control data.
Methods: We obtained epidemiologic data on laboratory influenza A and B detections and test volumes from the Canadian national influenza surveillance system for the epidemiologic period December 29, 2019 (epidemiologic week 1) through May 2, 2020 (epidemiologic week 18). COVID-19-related social distancing measures were implemented in Canada from epidemiologic week 10 of this period. We compared influenza A and B laboratory detections and test volumes and trends in detection during the 2019–20 influenza season with those of the previous nine influenza seasons for evidence of changes in epidemiologic trends.
Results: While influenza detections the week prior to the implementation of social distancing measures did not differ statistically from the previous nine seasons, a steep decline in positivity occurred between epidemiologic weeks 10 and 14 (March 8–April 4, 2020). Both the percent positive on week 14 (p≤0.001) and rate of decline between weeks 10 and 14 (p=0.003) were significantly different from mean historical data.
Conclusion: The data show a dramatic decrease in influenza A and B laboratory detections concurrent with social distancing measures and nonpharmaceutical interventions in Canada. The impact of these measures on influenza transmission may be generalizable to other respiratory viral illnesses during the study period, including COVID-19.
... Plusieurs autres études, menées principalement dans des pays asiatiques, ont fait état d'un effet des mesures de santé publique non pharmaceutiques, y compris un large éventail d'interventions et de changements de comportement, sur l'épidémiologie de l'influenza (12)(13)(14)(15)(16)(17). Dans des études antérieures sur les interventions non pharmaceutiques de lutte contre l'influenza, les fermetures réactives d'écoles (comme celles qui ont eu lieu au Canada en réponse à la pandémie de COVID-19) auraient réduit la transmission de l'influenza de 7 à 15 % (2,18). Il a été démontré que les approches générales de travail à domicile réduisent la transmission de 20 à 30 %, tandis que les restrictions de voyage (plus de 50 %) peuvent retarder le pic de transmission de l'influenza (2). ...
Contexte : Le premier cas de maladie à coronavirus 2019 (COVID-19) a été signalé au Canada
le 25 janvier 2020. En réponse à l’imminence d’une éclosion, de nombreuses autorités
sanitaires provinciales et territoriales ont mis en oeuvre des mesures de santé publique non
pharmaceutiques pour freiner la propagation de la maladie. Les mesures de « distanciation
sociale » comprenaient des restrictions sur les rassemblements de groupes, l’annulation
d’événements et de rassemblements sportifs, culturels et religieux, la recommandation du
maintien d’une distance physique entre les personnes, la fermeture d’écoles et de garderies, la
réduction des services non essentiels et la fermeture d’entreprises.
Objectifs : Évaluer l’incidence des interventions non pharmaceutiques combinées imposées
en mars 2020 sur l’épidémiologie de l’influenza (grippe) A et B en comparant les données
de surveillance des laboratoires nationaux de la période d’intervention avec les données
historiques de contrôle de la saison grippale sur 9 ans.
Méthodes : Nous avons obtenu des données épidémiologiques sur les détections de
l’influenza A et B en laboratoire et les volumes de tests du système national canadien de
surveillance de l’influenza pour la période épidémiologique allant du 29 décembre 2019
(semaine épidémiologique 1) au 2 mai 2020 (semaine épidémiologique 18). Des mesures de
distanciation sociale liées à la COVID-19 ont été mises en oeuvre au Canada à partir de la
semaine épidémiologique 10 de cette période. Nous avons comparé les seuils de détection
de l’influenza A et B en laboratoire et les volumes de tests et les tendances en matière
de détection pendant la saison grippale 2019–2020 avec ceux des neuf saisons grippales
précédentes afin de mettre en évidence les changements de tendances épidémiologiques.
Résultats : Les détections de l’influenza la semaine précédant la mise en oeuvre des mesures de distanciation sociale ne diffèrent pas statistiquement des neuf saisons précédentes; toutefois, une forte baisse de la positivité s’est produite entre les semaines épidémiologiques 10 et 14 (du 8 mars au 4 avril 2020). Le pourcentage de cas positif à la semaine 14 (p ≤ 0,001) et le taux de diminution entre les semaines 10 et 14 (p = 0,003) étaient tous deux significativement différents des données historiques moyennes.
Conclusion : Les données montrent une diminution spectaculaire des détections de l’influenza
A et B en laboratoire, parallèlement aux mesures de distanciation sociale et aux interventions
non pharmaceutiques au Canada. L’incidence de ces mesures sur la transmission de l’influenza
peut être généralisable à d’autres maladies virales respiratoires pendant la période d’étude, y
compris la COVID-19.
... The policy of symptom monitoring, which isolates contacts after onset of symptoms, has been examined computationally and shown to be sufficient for controlling certain outbreaks (Peak et al., 2017). Several studies also modeled non-pharmaceutical interventions such as closures but not absenteeism policies (Andreasen & Frommelt, 2005;Milne et al., 2008;Cauchemez et al., 2009;Sasaki et al., 2009;Rhodes & Hollingsworth, 2009;Bansal et al., 2010;Lee et al., 2010;Christensen et al., 2010;Stebbins et al., 2011;Araz et al., 2012;Jackson et al., 2013;Diedrichs, Isihara & Buursma, 2014;Eames, 2014). We retrieved all studies that evaluated isolation policies by using a broad search on PubMed and found that many modeling studies assumed isolation for a fixed interval following diagnosis but not in a symptom-dependent way (Halloran et al., 2008). ...
Background
Non-pharmaceutical interventions such as social distancing, school closures and travel restrictions are often implemented to control outbreaks of infectious diseases. For influenza in schools, the Center of Disease Control (CDC) recommends that febrile students remain isolated at home until they have been fever-free for at least one day and a related policy is recommended for SARS-CoV-2 (COVID-19). Other authors proposed using a school week of four or fewer days of in-person instruction for all students to reduce transmission. However, there is limited evidence supporting the effectiveness of these interventions.
Methods
We introduced a mathematical model of school outbreaks that considers both intervention methods. Our model accounts for the school structure and schedule, as well as the time-progression of fever symptoms and viral shedding. The model was validated on outbreaks of seasonal and pandemic influenza and COVID-19 in schools. It was then used to estimate the outbreak curves and the proportion of the population infected (attack rate) under the proposed interventions.
Results
For influenza, the CDC-recommended one day of post-fever isolation can reduce the attack rate by a median (interquartile range) of 29 (13–59)%. With 2 days of post-fever isolation the attack rate could be reduced by 70 (55–85)%. Alternatively, shortening the school week to 4 and 3 days reduces the attack rate by 73 (64–88)% and 93 (91–97)%, respectively. For COVID-19, application of post-fever isolation policy was found to be less effective and reduced the attack rate by 10 (5–17)% for a 2-day isolation policy and by 14 (5–26)% for 14 days. A 4-day school week would reduce the median attack rate in a COVID-19 outbreak by 57 (52–64)%, while a 3-day school week would reduce it by 81 (79–83)%. In both infections, shortening the school week significantly reduced the duration of outbreaks.
Conclusions
Shortening the school week could be an important tool for controlling influenza and COVID-19 in schools and similar settings. Additionally, the CDC-recommended post-fever isolation policy for influenza could be enhanced by requiring two days of isolation instead of one.
... This is well described for other viral infections, including influenza, in which children are the main drivers of infection. 7,8 In previous coronavirus outbreaks, school closure did not con trib ute to the control of these epi demics. 3 School closure affects educational attainment as well as the physical, social, and mental wellbeing of children, 3 especially among those from vulnerable and disadvantaged backgrounds. ...
Background
Little is known about the risk of SARS-CoV-2 infection and transmission in educational settings. Public Health England initiated a study, COVID-19 Surveillance in School KIDs (sKIDs), in primary schools when they partially reopened from June 1, 2020, after the first national lockdown in England to estimate the incidence of symptomatic and asymptomatic SARS-CoV-2 infection, seroprevalence, and seroconversion in staff and students.
Methods
sKIDs, an active, prospective, surveillance study, included two groups: the weekly swabbing group and the blood sampling group. The swabbing group underwent weekly nasal swabs for at least 4 weeks after partial school reopening during the summer half-term (June to mid-July, 2020). The blood sampling group additionally underwent blood sampling for serum SARS-CoV-2 antibodies to measure previous infection at the beginning (June 1–19, 2020) and end (July 3–23, 2020) of the summer half-term, and, after full reopening in September, 2020, and at the end of the autumn term (Nov 23–Dec 18, 2020). We tested for predictors of SARS-CoV-2 antibody positivity using logistic regression. We calculated antibody seroconversion rates for participants who were seronegative in the first round and were tested in at least two rounds.
Findings
During the summer half-term, 11 966 participants (6727 students, 4628 staff, and 611 with unknown staff or student status) in 131 schools had 40 501 swabs taken. Weekly SARS-CoV-2 infection rates were 4·1 (one of 24 463; 95% CI 0·1–21·8) per 100 000 students and 12·5 (two of 16 038; 1·5–45·0) per 100 000 staff. At recruitment, in 45 schools, 91 (11·2%; 95% CI 7·9–15·1) of 816 students and 209 (15·1%; 11·9–18·9) of 1381 staff members were positive for SARS-CoV-2 antibodies, similar to local community seroprevalence. Seropositivity was not associated with school attendance during lockdown (p=0·13 for students and p=0·20 for staff) or staff contact with students (p=0·37). At the end of the summer half-term, 603 (73·9%) of 816 students and 1015 (73·5%) of 1381 staff members were still participating in the surveillance, and five (four students, one staff member) seroconverted. By December, 2020, 55 (5·1%; 95% CI 3·8–6·5) of 1085 participants who were seronegative at recruitment (in June, 2020) had seroconverted, including 19 (5·6%; 3·4–8·6) of 340 students and 36 (4·8%; 3·4–6·6) of 745 staff members (p=0·60).
Interpretation
In England, SARS-CoV-2 infection rates were low in primary schools following their partial and full reopening in June and September, 2020.
Funding
UK Department of Health and Social Care.
... In Italy, schools have been closed for half of the 2019À2020 school year and, during the second COVID-19 wave, high schools have been closed again, students switching to "integrated digital learning" nationwide since November 6, 2020. The rationale for such a NPI has mostly been drawn from the reported beneficial effect of school closure during influenza pandemics [1], even if the debate was still open [2]. However, while children's immune system is naïve to influenza antigens, making them a known reservoir of influenza infection, they do not appear to be as affected by COVID-19 as adults, representing a small fraction of documented COVID-19 cases. ...
Background:
During COVID-19 pandemic, school closure has been mandated in analogy to its effect against influenza, but it is unclear whether schools are early COVID-19 amplifiers.
Methods:
We performed a cross-sectional and prospective cohort study in Italy during the second COVID-19 wave (from September 30, 2020 until at least February 28, 2021). We used databases from the Italian Ministry of Education, the Veneto region systems of SARS-CoV-2 cases notification and of schools' secondary cases tracing to compare SARS-CoV-2 incidence in students/school staff and general population and incidence across age groups. Number of tests, secondary infections by type of index case and ratio cases/ tests per school were estimated using an adjusted multivariable generalized linear regression model. Regional reproduction numbers Rt were estimated from Italian Civil Protection daily incidence data with a method of posterior distribution using a Markov Chain Monte Carlo algorithm.
Findings:
SARS-CoV-2 incidence among students was lower than in the general population. Secondary infections at school were <1%, and clusters of ≥2 secondary cases occurred in 5-7% of the analysed schools. Incidence among teachers was comparable to the population of similar age (P = 0.23). Secondary infections among teachers were rare, occurring more frequently when the index case was a teacher than a student (37% vs. 10%, P = 0.007). Before and around the date of school opening in Veneto, SARS-CoV-2 incidence grew maximally in 20-29- and 45-49-years old individuals, not among students. The lag between school opening dates in Italian regions and the increase in the regional COVID-19 Rt was not uniform. Finally, school closures in two regions where they were implemented before other measures did not affect Rt decrease.
Interpretation:
This analysis does not support a role for school opening as a driver of the second COVID-19 wave in Italy, a large European country with high SARS-CoV-2 incidence.
Funding:
Fondazione MITE.
... En las últimas tres décadas, las catástrofes ocasionadas por epidemias virales han sido cada vez más recurrentes en distintas partes del mundo (Esparza, 2016), por ejemplo, el síndrome respiratorio agudo grave (SARS-CoV) en el año 2002, la gripe aviar (H5N1) en el año 2003, la gripe porcina (H1N1) en el 2009, el síndrome respiratorio de oriente medio (MERS-COV) en el 2012, el ébola (EVE) en el 2013 y, de manera reciente, el brote de SARS-CoV-2, virus que causa la enfermedad Ante el brote de nuevas epidemias, la Organización Mundial de la Salud (OMS) recomienda a los gobiernos adoptar políticas de distanciamiento social para frenar la propagación del virus entre la población. Las investigaciones previas han demostrado que el cierre de espacios públicos en una etapa temprana de la epidemia reduce los índices de contagio y ayuda a retrasar el pico de una epidemia (Ahmed et al., 2018;Baum et al., 2009;Bell et al., 2006;Carlo y Chung, 2009;Cauchemez et al., 2009). ...
La propagación del virus SARS-CoV-2 es una emergencia de escala mundial con grandes repercusiones en todos los sistemas educativos. Ante dicho escenario, las universidades han implementado diversas acciones para mitigar el impacto de la pandemia sobre la formación de sus estudiantes. El propósito de esta investigación fue identificar los me- canismos de respuesta implementados por 35 universidades mexicanas. Teniendo como referencia el método de teoría fundamentada, se analizaron los sitios Web oficiales de las universidades y, a partir de la naturaleza de los propios datos, se propusieron categorías conceptuales para caracterizar las acciones, estrategias y programas implementados ante la emergencia. Como parte de los resultados se identificaron 22 categorías conceptuales que se agruparon en cuatro rubros: i) medidas de preparación en una etapa temprana de la emergencia, ii) respuesta y apoyo para la implementación de la modalidad educativa en línea; iii) medidas para el cuidado y bienestar personal y iv) canales de comunicación dirigidos a la comunidad educativa. A partir de las fortalezas identificadas en las univer- sidades se sugiere aprovechar la experiencia acumulada, especialmente los casos exito- sos de tres universidades públicas, y pasar de la simple prescripción de pautas para la continuidad académica a la elaboración amplia de planes educativos para la emergencia.
... Several studies examined the impact of school closure strategies [1][2][3][4][5][6]. However, the strategies evaluated in many of these studies were implemented for a limited time window, after which a complete reopening occurred with minor variations. ...
This article examines the impact of partial/full reopening of school/college campuses on the spread of a pandemic using COVID-19 as a case study. The study uses an agent-based simulation model that replicates community spread in an urban region of U.S.A. via daily social mixing of susceptible and infected individuals. Data representing population demographics, SARS-CoV-2 epidemiology, and social interventions guides the model's behavior, which is calibrated and validated using data reported by the government. The model indicates a modest but significant increase (8.15 %) in the total number of reported cases in the region for a complete (100%) reopening compared to keeping schools and colleges fully virtual. For partial returns of 75% and 50%, the percent increases in the number of reported cases are shown to be small (2.87% and 1.26%, respectively) and statistically insignificant. The AB model also predicts that relaxing the stringency of the school safety protocol for sanitizing, use of mask, social distancing, testing, and quarantining and thus allowing the school transmission coefficient to double may result in a small increase in the number of reported infected cases (2.14%). Hence for pandemic outbreaks from viruses with similar characteristics as for SARS-CoV-2, keeping the schools and colleges open with a modest campus safety protocol and in-person attendance below a certain threshold may be advisable.
... United Nations Educational, Scientific, and Cultural Organisation (UNESCO 2020a) estimated that 107 countries have temporarily closed their educational institutions nationwide, impacting over 861.7 million children and youth, i.e., 90% of the world's student population. 2 The Government in India, like most of the governments worldwide, has decided on temporary shutdown of the Educational Institutions as a precautionary attempt to prevent the spread of However, the closure of educational institutes as a part of safety measures severely compromises the ethics of social equality. The article by Cauchemez et al. (2009) points out that school closure raises a range of ethical and social issues, particularly since families from underprivileged backgrounds are likely to be disproportionately affected by this intervention. The pace of development for certain groups of people has been low, and the pandemic acts as the catalyst to magnify the pre-existing constraints of development. ...
Education is the guiding light to development, climbing up the social ladder, and having perspectives about how the world can change for good. With time people on earth have felt the need for education, emphasizing education as a right and considering it a Sustainable Development Goal. This paper explores how the COVID-19 pandemic has come as a blow to the education system and sector; the rights, Sustainable goals are being jeopardized due to the sudden closure of the educational institutions and shift in teaching methods from paper to digital. All three education sectors, primary, secondary, and tertiary, are severely affected by the pandemic. While the government had started stressing on the quality of education, the access once again has been put into question. There are a revisiting and framing of new initiatives by India’s government to take up digital measures of education for the students. While the future of education and students in India still remain unclear with examinations getting canceled and new academic calendars are being prepared and relooked at, the concern is about the changes that shall come in the education post-pandemic to build better.
... The COVID-19 pandemic negatively affected the mental health and social, emotional, psychological, and educational wellbeing of young people (Golberstein et al., 2020). When other research results are examined, it has been stated that schools have various effects that can help alleviate this process in outbreaks (Sadique et al., 2008;Cauchemez et al., 2009;Demir Öztürk et al., 2020). It is normal for outbreaks to cause anxiety and fear in society (Güngör et al., 2020), but the anxiety and fear caused by the pandemics may make it difficult for individuals to combat the results of the outbreak. ...
The purpose of the current study was to investigate the effects of COVID-19 on high school students’ psychological symptoms and to understand how ready counselors and school counseling services are. Therefore, this research is designed under two different studies: A) Study 1: Effects of COVID-19 pandemic on students’ psychological symptoms and B) Study 2: Views and expectations of students and school counselors about school counseling services. The first study was a quantitative study and included 549 high school students (398 females, 151 males). A Structural Equation Model (SEM) was created to examine the effects of COVID-19 pandemic on participants’ psychological symptoms. The Impact of Event Scale-Revised (IES-R) scores showed that 107 (19.50%) individuals had a score of 50 and above pointing out that individuals in this group had severe impact of event/ trauma symptomologies. The SEM analysis indicated that IES-R scores had a total effect of .79 on anxiety, .75 on depression, .74 on negative self-concept, .68 on somatization, and .66 on hostility scores. Furthermore, female students had significantly higher scores on anxiety, depression, negative self-concept, somatization, hostility, and impact of events variables than male students. Study 2 was a qualitative design and consisted of five school counselors and five students from different schools. The results indicated that students' difficulties during the COVID-19 outbreak were educational, cognitive, emotional, physiological, relational, technological and related to routines. Academic, social, emotional and behavioral issues came to the fore among the difficulties that can be experienced if students start face-to-face education. On the other hand, the school counselors listed that family relations, personal-social, emotional and academic themes were the difficulties experienced by the students at the beginning of the COVID-19. In addition, when COVID-19 started, the services offered by school counselors were discussed under: 1) services for the student, 2) services for the family, and 3) services for the teacher. Finally, according to the opinions of the school counselors, if students start face-to-face education, they may experience emotional, academic and relational difficulties. In summary, it is vital that student personality services be prepared and implemented by school counseling services for schools based on the results
... If 60% of infections are symptomatic, contact tracing and isolation can slow down the epidemic to around 15 days, but they cannot control it, even if there is no diagnosis delay and all non-household contacts are traced. [38,39]. However, social distancing can never be complete, as healthcare workers and doctors have to continue their work, but also personnel of supermarkets, public transport employees, and others will have contact outside their households. ...
SARS-CoV-2 has established itself in all parts of the world, and many countries have implemented social distancing as a measure to prevent overburdening of health care systems. Here we evaluate whether and under which conditions containment of SARS-CoV-2 is possible by isolation and contact tracing in settings with various levels of social distancing. To this end we use a branching process model in which every person generates novel infections according to a probability distribution that is affected by the incubation period distribution, distribution of the latent period, and infectivity. The model distinguishes between household and non-household contacts. Social distancing may affect the numbers of the two types of contacts differently, for example while work and school contacts are reduced, household contacts may remain unchanged. The model allows for an explicit calculation of the basic and effective reproduction numbers, and of exponential growth rates and doubling times. Our findings indicate that if the proportion of asymptomatic infections in the model is larger than 30%, contact tracing and isolation cannot achieve containment for a basic reproduction number ( ℛ 0 ) of 2.5. Achieving containment by social distancing requires a reduction of numbers of non-household contacts by around 90%. If containment is not possible, at least a reduction of epidemic growth rate and an increase in doubling time may be possible. We show for various parameter combinations how growth rates can be reduced and doubling times increased by contact tracing. Depending on the realized level of contact reduction, tracing and isolation of only household contacts, or of household and non-household contacts are necessary to reduce the effective reproduction number to below 1. In a situation with social distancing, contact tracing can act synergistically to tip the scale toward containment. These measures can therefore be a tool for controlling COVID-19 epidemics as part of an exit strategy from lock-down measures or for preventing secondary waves of COVID-19.
... Research studies have documented evidence showing positive effects on virus spread from school closures based on earlier pandemics. (Cauchemez et al. 2009), for example, This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=3776366 ...
... School closures also change children's social environment with potentially negative social consequences: closures due to the Ebola epidemic increased dropouts, child labor, violence against children, and teen pregnancies (UNDP, 2015). These negative outcomes disproportionately affect disadvantaged populations (Berkman, 2008;Cauchemez et al., 2009;Entwisle et al., 1997). ...
... In education, COVID-19 pandemic could engender the quality education decline because distance learning requires new skills, both for students and teachers, especially for special education schools in front most, outermost and disadvantaged areas (Yarrow, 2020). Moreover, educational institutions closure also raised ethical and social issues, especially because they tend to disproportionately affect the underprivileged households (Cauchemez et al., 2009). ...
This study used a mixed methods approach to capture key findings on COVID-19 impacts on education and challenges that hinder continued education particularly in disadvantaged and rural areas. The respondents were 900 parents, 943 children, 15 teachers and education officials in 594 villages in 9 provinces of Indonesia. The results showed that 1 out of 3 children stopped learning and children learned less. Children had limited access to widely supported online learning. While the offline method was more applicable, still it had some challenges. Children’s mental health was affected and they experienced excessive emotions of fear and anxiety. Many parents were not ready to support children in learning school subjects while doing livelihood activities at the same time. Some children experienced domestic violence. Parents did not have a spare budget to provide distance learning facilities and had to sacrifice education over basic needs. The risk of drop out of school was heightened.
... School closures can be an effective mitigation tool to slow the transmission of an infectious disease (Jackson et al. 2013), but they are best used in combination with other strategies (Markel et al. 2007;Viner et al. 2020). Further, school closures are often initiated too late, in a reactive manner after the peak of infections have passed (Cauchemez et al. 2009). Key considerations in deciding whether to close schools include the case fatality rate 4 and the infection rate among youth (Cauchemez et al. 2014;UK DOH 2014). ...
The COVID-19 pandemic has seen an unprecedented shutdown of society. Among the various safety measures taken, much attention has been given to school closure as a non-pharmaceutical mitigation tool to curb the spread of the disease through ensuring “social” (physical) distancing. Nearly 1.725 billion children in over 95% of countries worldwide have been affected by school closures implemented in April 2020 as the virus continued to spread. In the field of education, policymakers’ attention has been directed at keeping students on board through remote learning and addressing the immediate needs of schools upon reopening. The study presented in this article focuses on who remains absent after schools resume. Using publicly available survey data from the USAID Demographic Health Surveys Program and the UNICEF Multiple Indicator Cluster Survey from before and after the 2013–2016 Ebola pandemic in Guinea and Sierra Leone in West Africa, the author examined changes in school enrolment and dropout patterns, with targeted consideration given to traditionally marginalised groups. At the time, schools closed for between seven to nine months in the two countries; this length and intensity makes this Ebola pandemic the only health crisis in the recent past to come close to the pandemic-related school closures experienced in 2020. The author’s findings suggest that post-Ebola, youth in the poorest households saw the largest increase in school dropout. Exceeding expected pre-Ebola dropout rates, an additional 17,400 of the poorest secondary-age youth were out of school. This evidence is important for minimising the likely post-COVID-19 expansion in inequality. The author’s findings point to the need for sustainable planning that looks beyond the reopening of educational institutions to include comprehensive financial support packages for groups most likely to be affected.
... Cauchemez et al. stated that school closure is a nonpharmaceutical intervention that is commonly suggested for mitigating influenza pandemics. 6 Based on this philosophy, closure of educational institutions was implemented to delay the transmission of COVID-19. ...
... In nations' agendas, school closures have been one of the non-pharmaceutical interventions to mitigate a pandemic (Cauchemez et al., 2009), but it has never been planned to be applied at such a large scale until the outbreak of COVID-19; namely, a disease caused by the new coronavirus. School closures, among many other implications, were discussed to have caused ethical and social justice concerns for disadvantaged populations (Berkman, 2008), mental health problems for students (Lee, 2020) and an increase in related costs, creating economic problems (Lempel, Epstein, & Hammond, 2009;Sadique, Adams, & Edmunds, 2008). ...
The outbreak of the COVID-19 pandemic in 2019-2020 academic year has resulted in universal school closures, which is a rare event in education history. States enacted various measures to protect students and teachers from the new pandemic and employed initiatives ranging from radio-based teaching, TV solutions to online learning programs to compensate for educational losses. With its experience in infusing digital education into its schools before the pandemic, Ministry of National Education in Turkey has employed online and broadcasting options in response to the nationwide school closure. This paper, based on a case study design within a qualitative research format, aims to examine the technology leadership, challenges, and opportunities that Turkish schools facing in implementing online and broadcasting options. The participants in the study, most of whom mainly serve in disadvantaged regions were composed of twelve teachers,
one academician, and one education coordinator. The findings based on interviews were grouped under technology leadership, challenges for disadvantaged groups, expectations, and scenarios regarding the pandemic, and opportunities. In general, the results signified the vitality of technologically competent leaders from central management to the schools, a need for a coordinated focus on disadvantaged groups’ challenges, a well-prepared strategy for post-pandemic cases, and a swift paradigm change to transform teachers in regard to their pedagogical and technological leadership competences.
... On the other hand, social dynamics can favor or hinder potential transmission channels: a typical example for the latter relies on risk perception and spread of awareness 3,[5][6][7] , determining the choice to take individual actions-such as social distancing and wearing masks-or mid-scale non-pharmaceutical interventions-such as school or workplace closure and household quarantine-and have the direct effect of reducing the probability that a pathogen is transmitted from one infectious individual to susceptible ones in their social neighborhood. Convincing evidence for the role of human behavior in the spreading of several infectious diseases has been reported in the last decades for Foot-and-mouth disease 8 , Influenza and its strains [9][10][11][12][13] , SARS 14,15 , Ebola 16 , Dengue 17,18 , Zika 19 and, very recently, for COVID-19 [20][21][22][23][24] . ...
The spread of an infectious disease is well approximated by metapopulation networks connected by human mobility flow and upon which an epidemiological model is defined. In order to account for travel restrictions or cancellation we introduce a model with a parameter that explicitly indicates the ratio between the time scales of the intervening processes. We study the critical properties of the epidemic process and its dependence on such a parameter. We find that the critical threshold separating the absorbing state from the active state depends on the scale parameter and exhibits a critical behavior itself: a metacritical point – a critical value in the curve of critical points – reflected in the behavior of the attack rate measured for a wide range of empirical metapopulation systems. Our results have potential policy implications, since they establish a non-trivial critical behavior between temporal scales of reaction (epidemic spread) and diffusion (human mobility) processes.
... The assessment of non-pharmaceutical interventions and prediction by simulation has to be based on reliable models; cf. [4][5][6][7][8][9][10][11] for the spread of SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) and other infectious diseases. Only then, the most effective interventions can be determined as a basis for informed political decisions. ...
Non-pharmaceutical interventions (NPIs) are important to mitigate the spread of infectious diseases as long as no vaccination or outstanding medical treatments are available. We assess the effectiveness of the sets of non-pharmaceutical interventions that were in place during the course of the Coronavirus disease 2019 (Covid-19) pandemic in Germany. Our results are based on hybrid models, combining SIR-type models on local scales with spatial resolution. In order to account for the age-dependence of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), we include realistic prepandemic and recently recorded contact patterns between age groups. The implementation of non-pharmaceutical interventions will occur on changed contact patterns, improved isolation, or reduced infectiousness when, e.g., wearing masks. In order to account for spatial heterogeneity, we use a graph approach and we include high-quality information on commuting activities combined with traveling information from social networks. The remaining uncertainty will be accounted for by a large number of randomized simulation runs. Based on the derived factors for the effectiveness of different non-pharmaceutical interventions over the past months, we provide different forecast scenarios for the upcoming time.
... We found that the most effective NPI was school closing. This NPI has been widely used since the beginning of the pandemic due to its effectiveness against influenza outbreaks [50][51][52]. However, school closing carries a heavy socioeconomical burden, hindering education and social interactions for children and causing additional child-care obligations for parents, linked to work absenteeism [53]. ...
Objectives
To evaluate which non-pharmaceutical interventions (NPIs) have been more and less effective in controlling the COVID-19 pandemic.
Methods
We performed a systematic review of published and unpublished empirical studies, either observational or interventional, analysing the comparative effectiveness of NPIs against the COVID-19 pandemic. We searched Embase/Medline and medRxiv to identify the relevant literature.
Results
We identified 34 studies. During the first wave of the COVID-19 pandemic, school closing was the most effective NPI, followed by workplace closing, business and venue closing and public event bans. Public information campaigns and mask wearing requirements were also effective in controlling the pandemic while being less disruptive for the population than other NPIs. There was no evidence on the effectiveness of public transport closure, testing and contact tracing strategies and quarantining or isolation of individuals. Early implementation was associated with a higher effectiveness in reducing COVID-19 cases and deaths, while general stringency of the NPIs was not.
Conclusions
In this systematic review, we found that school closing, followed by workplace closing, business and venue closing and public event bans were the most effective NPIs in controlling the spread of COVID-19. An early response and a combination of specific social distancing measures are effective at reducing COVID-19 cases and deaths. Continuous monitoring of NPIs effectiveness is needed in order to adapt decision making.
... Epidemiological strategies to control the spread of infectious respiratory diseases include contact, droplet and/or aerosol precautions, asymptomatic screening, contact tracing, case isolation, ring containment and social distancing [1][2][3][4][5][6][7]. While the specific set of strategies employed depends on the aetiological agent, the use of microbiological and molecular testing to identify disease cases is a crucially important element. ...
Rapid and widespread implementation of infectious disease surveillance is a critical component in the response to novel health threats. Molecular assays are the preferred method to detect a broad range of viral pathogens with high sensitivity and specificity. The implementation of molecular assay testing in a rapidly evolving public health emergency, such as the ongoing COVID-19 pandemic, can be hindered by resource availability or technical constraints. We present a screening strategy that is easily scaled up to support a sustained large volume of testing over long periods of time. This non-adaptive pooled-sample screening protocol employs Bayesian inference to yield a reportable outcome for each individual sample in a single testing step (no confirmation of positive results required). The proposed method is validated using clinical specimens tested using a real-time reverse transcription polymerase chain reaction test for SARS-CoV-2. This screening protocol has substantial advantages for its implementation, including higher sample throughput, faster time to results, no need to retrieve previously screened samples from storage to undergo retesting, and excellent performance of the algorithm's sensitivity and specificity compared with the individual test's metrics.
... The COVID-19 Impact Survey built on previous waves of data collection and a rapid review of pandemic-related literature and government priorities. [14][15][16][17][18][19][20][21][22] Topic areas were prioritized in consultation with research experts and community groups who had worked with the All Our Families team over the past 12 years. Research experts included pediatricians, psychologists, epidemiologists, members of the COVID-19 Immunity Task Force, nurses and public health experts. ...
Background:
Acceptance of a vaccine against SARS-CoV-2 is critical to achieving high levels of immunization. The objectives of this study were to understand mothers' SARS-CoV-2 vaccine intentions to explore reasons for and against SARS-CoV-2 vaccination.
Methods:
Participants from the All Our Families pregnancy longitudinal cohort whose children had reached ages 9-12 years were invited in May-June 2020 to complete a survey on the impact of COVID-19. The survey covered topics about the impact of the pandemic and included 2 specific questions on mothers' intentions to vaccinate their child against SARS-CoV-2. Current responses were linked to previously collected data, including infant vaccine uptake. Multinomial regression models were run to estimate associations between demographic factors, past vaccination status and vaccination intention. Qualitative responses regarding factors affecting decision-making were analyzed thematically.
Results:
The response rate was 53.8% (1321/2455). A minority of children of participants had partial or no vaccinations at age 2 (n = 200, 15.1%). A total of 60.4% of mothers (n = 798) intended to vaccinate their children with the SARS-CoV-2 vaccine, 8.6% (n = 113) did not intend to vaccinate and 31.0% (n = 410) were unsure. Lower education, lower income and incomplete vaccination history were inversely associated with intention to vaccinate. Thematic analysis of qualitative responses showed 10 themes, including safety and efficacy, long-term effects and a rushed process.
Interpretation:
Within a cohort with historically high infant vaccination, a third of mothers remained unsure about vaccinating their children against SARS-CoV-2. Given the many uncertainties about future SARS-CoV-2 vaccines, clear communication regarding safety will be critical to ensuring vaccine uptake.
... La literatura existente sobre otras crisis sanitarias mundiales, han revelado que el cierre de las escuelas tiene fuertes costos económicos y sociales en las familias en torno a su seguridad laboral, ya que los padres deben ausentarse en sus trabajos, y pasar al cuidado de los niños y personas dependientes en el hogar, y a la interrupción de beneficios sociales de niñas y niños más vulnerables, como los programas de alimentación o participación en actividades sociales extraeducativas (Cauchemez, et al., 2009). A su vez, ya se ha investigado acerca de las potenciales pérdidas acumulativas en los estudiantes a lo largo de su trayectorias vitales -producto de las pérdidas de aprendizaje-por el cierre de las escuelas; en términos generales, cada año escolar cursado se asocia con un promedio de ingresos un 10% más alto en muchos países, por lo que estas estimaciones de pérdida generalizada en los alumnos impactarán más fuertemente en los hogares de los estudiantes más desfavorecidos (Hanusheck y Woessmann, 2020). ...
Este artículo reflexiona acerca de las experiencias educativas del aprendizaje en casa de niñas, niños y adolescentes confinados por la pandemia COVID-19 en Chile. A partir de los datos de una encuesta en línea dirigida a madres, padres y apoderados de menores entre 4 y 18 años, aplicada durante el mes de septiembre del 2020 (N=4.912), se evaluaron las condiciones de educabilidad, sociales y de aprendizaje de los escolares y sus familias en este contexto de crisis. El análisis de este estudio amplía la definición de lo que se entiende por experiencia educativa, reconociendo que las oportunidades de aprendizaje en casa incluyen también las experiencias no formales experimentadas en la convivencia diaria y la vida cotidiana. Los resultados señalan una fuerte profundización de las desigualdades socioeconómicas, evidenciando los desafíos de equidad que aún mantiene pendientes la educación remota. En las reflexiones finales del artículo exploramos las posibilidades futuras de la “escuela pandémica”, la importancia del rol de la escuela como espacio de socialización y la fragilidad de esta experiencia vital para niñas y niños
... Online schooling preserved the continuity of the academic year, although this solution created some problems for families' well-being. Evidence of the effect of distance learning on preventing a virus' diffusion is lacking from previous pandemics [3], whereas a few evaluations were carried out for the COVID-19 pandemic [4][5][6]. The severe consequences of school closures were not justified by the clinical picture of Italian children [7]. ...
Background
School closure created difficulties for parents, who were asked to care for their children and help them with schooling, while working at home. We aimed to explore the experiences in organising school for children at home and its implications on children’s psychological well-being and educational progress during the quarantine for the COVID-19 pandemic.
Methods
A nationwide online survey of mothers of primary and middle school students was conducted during the COVID-19 pandemic. Demographic data and information on distance learning organisation and children’s attitudes and behavioural changes were collected.
Results
2149 mothers completed the survey, with a final sample of 1601 subjects. Large differences between primary and middle school emerged: lessons were less organised and routines were more instable for the youngest, who could not pay attention for more than 20 min (28.3%) and needed breaks every 10 min (21.6%), with lower quality of learning (40.6%), increased restlessness (69.1%), and aggressiveness (33.3%). A large use of screens was reported, with an abuse in screen time in 2%. Two thirds of mothers did not approve of distance learning (72.2%) because of their role in replacing teachers (77.8%), the effort required (66%), and the great commitment required (78.3%).
Conclusions
Distance learning increased educational deprivation and social inequalities, especially for the youngest children, who lost almost one year of school. The situation was even worse for children with disabilities, who were neglected by the institutions. This period should be considered as an opportunity to correct the weaknesses of our school system.
... Due to the rapid spread of the SARS-CoV-2 virus, most governments worldwide took the decision to close all school levels. This decision was also based on the pandemic spread model of the Influenza A and B virus, where children seem to be most frequently affected and responsible for transmission in the majority of cases [2], even though the issue is still under debate [87]. ...
The COVID-19 pandemic has led to an unprecedented closure of schools in terms of duration. The option of school closure, SARS-CoV-2 initially being poorly known, was influenced by the epidemiological aspects of the influenza virus. However, school closure is still under debate and seems unsupported by sure evidence of efficacy in the COVID-19 era. The aim of our narrative review is to discuss the available literature on SARS-CoV-2 spread among children and adolescents, in the school setting, trying to explain why children appear less susceptible to severe disease and less involved in viral spreading. We also tried to define the efficacy of school closure, through an overview of the effects of the choices made by the various countries, trying to identify which preventive measures could be effective for a safe reopening. Finally, we focused on the psychological aspects of such a prolonged closure for children and adolescents. SARS-CoV-2, children, COVID-19, influenza, and school were used as key words in our literature research, updated to 29 March 2021. To our knowledge, this is the first review summarizing the whole current knowledge on SARS-CoV-2 spreading among children and adolescents in the school setting, providing a worldwide overview in such a pandemic context.
... The former has been noted by sequences of the following influenza pandemics including H2N3 in 1957 and 1968 and Avian Flu during 1997 and 2004 and H5N2 in 2009. 5,6 As far as non-health impacts, the 1918 influenza pandemic had been long postulated to be highly associated with 1929 Great Depression worldwide with the implementation of very strict containment measurements such as isolation and lockdown polices. 7,8 There is a continental transition of influenza pandemic, shifting from the preponderance of the 1918 pandemic in Western countries (the United States and Europe) to the emergence of its viral variants in Asian countries of those subsequent influenza pandemics after 1918 pandemic. ...
The spread of the emerging pathogen, named as SARS-CoV-2, has led to a unprecedented COVID-19 pandemic since 1918 influenza pandemic. This review first sheds light om the similarity on global transmission, surges of pandemics, and the disparity of prevention between two pandemics. Such a brief comparison also provides an insight into the potential sequelae of COVID-19 based on an inference drawn from the fact that a cascade of successive influenza pandemic occurred after 1918 and also the previous experience on the epidemic of SARS and MERS occurring in 2003 and 2015, respectively. We then propose a systematic framework for elucidating emerging infectious disease (EID) such as COVID-19 with a panorama viewpoint from natural infection and disease process, public health interventions (NPIs and vaccine), clinical treatments and therapies (antivirals), until global aspects of health and economic loss and economic evaluation of interventions with emphasis on mass vaccination. This review not only concisely delves for evidence-based scientific literatures from the origin of outbreak, the spread of SARS-CoV-2 to three surges of pandemic, and NPIs and vaccine uptakes but also provides a new insight into how to apply big data analytics to identify unprecedented discoveries through COVID-19 pandemic scenario embracing from biomedical to economic viewpoints.
... Although there is evidence that they may be infected (Liu et al. 2020), it appears that their symptoms are milder than those of adults and that they recover more quickly (Castagnoli et al. 2020;Gudbjartsson et al. 2020). Tracking studies conducted in several countries also suggest that children play a lesser role in transmission (RIVM 2020) and that transmission in schools, compared to that in families, is limited (Cauchemez et al. 2009; National Centre for Immunisation Research and Surveillance 2020; Viner et al. 2020). However, because adults in schools are more important vectors of contagion, they must observe strict physical distancing measures (RIVM 2020). ...
Education is going through a period of crisis related to the SARS-CoV-2 pandemic that most probably will follow a continuum organized into distinct phases: emergency, recovery, reconstruction, development, and institutionalization. This article analyzes the response of curriculum to an unpredictable, chaotic, and recursive crisis situation. The article also highlights the role of important, but often forgotten, actors in a formal education system—parents—and examines the stresses the pandemic has placed on them. Finally, in the light of the continuum of the educational crisis and the impacts of Covid-19 on certain curricular dimensions, the article concludes with reflections on the need to rethink curricula, even in education systems that considered themselves robust in their institutionalization.
Purpose
During the 2020 COVID-19 pandemic, schools closed in haste and were expected to create virtual learning opportunities for their students while they waited to see when and how they might re-open. National governments issued reopening guidance at varying speeds. The purpose of this study was to invite health and education professionals to share what was happening in their country about school reopening in terms of the features and implications of the guidance issued.
Design/methodology/approach
A qualitative study. Initial interviews informed a semi-structured questionnaire distributed through the global community of UNESCO Chair ‘Global Health and Education’ and partner organisations. Its aim was to collect, analyse and share globally relevant knowledge and practices about school reopening.
Findings
There were 192 useable responses from 43 countries and territories and 1 multi-country region. 20 of these, mainly in the Global North, had received reopening guidance, 23 were still waiting and 1 had not closed its schools. Guidance prioritised public health measures like social distancing, with less emphasis on education impacts. Success came from partnerships between schools, families and local authorities, consistent guidance and enough time and resources for implementation. Fear of infection led to significant absenteeism among students and staff. Respondents waiting for guidance, mainly in the Global South, shared similar concerns and expectations.
Originality/value
Describing first-hand practices and perspectives of health and education professionals from diverse countries and territories about reopening schools.
School closures during the coronavirus disease (COVID-19) pandemic have been outlined in studies from different disciplines, including economics, sociology, mathematical modeling, epidemiology, and public health. In this review, we discuss the implications of school closures in the context of the current COVID-19 pandemic. Modeling studies of the effects of school closures, largely derived from the pandemic influenza model, on severe acute respiratory syndrome coronavirus 2 produced conflicting results. Earlier studies assessed the risk of school reopening by modeling transmission across schools and communities; however, it remains unclear whether the risk is due to increased transmission in adults or children. The empirical findings of the impact of school closures on COVID-19 outbreaks suggest no clear effect, likely because of heterogeneity in community infection pressure, differences in school closure strategies, or the use of multiple interventions. The benefits of school closings are unclear and not readily quantifiable; however, they must be weighed against the potential high social costs, which can also negatively affect the health of this generation.
In this chapter we show the results of simulations of two widely adopted measures that were taken in order to stop the spreading of the Covid-19 virus, namely closing of schools and working from home. We take these two measures together because in practice they are often instated together and at least parents with young children will have to stay at home if the children cannot go to school. We will simulate different scenarios in order to separately examine the effects of closed schools and people working from home on the number of infections, hospitalisations and social contacts, and the effect of the combination of the two measures. Although we expected a positive impact to come from people working from home, we see that closing of schools has the best results on decreasing the number of infected people. Working remotely has a negative effect as infections and hospitalisations are higher when people work from home. We will look into where and how many social contacts take place and how this results in the transmission of the virus. We will see that a decrease in physical social interaction is not enough to suppress infections by imposing these measures. The behaviour of people will change in such a way that smaller gatherings at busy locations cause almost as many infections as without the imposed measures.
This study aimed to analyze what university students in Indonesia liked and disliked about the emergency remote learning process, which was implemented due to the COVID-19 pandemic. The case of Indonesia revealed what the majority of higher education institutions in developing countries faced during the COVID-10 period. This research used a qualitative phenomenological approach. There were 80 education students from the Faculty of Education state university in Jakarta, Indonesiawho participated in the study. The inquiry consisted of a thorough study of participants' diaries of day-today learning and reflective essays and an online focus group of discussions. The results revealed what the students liked about learning from home during the COVID-19 crisis, which was grouped into three overarching themes of flexibility and efficiency, self-care and self-development, and learning new technology. What they disliked was grouped into three main themes: lack of structure, technological difficulties, and financial barriers. By knowing what students liked and disliked, we can try to reduce obstacles to their learning experience, and further improve the activities and features they liked. As a result, the quality of remote learning in this pandemic could be enhanced, and students' ability to study in any circumstances could be increased.
Background
To suppress the COVID-19 outbreak, the Norwegian government closed all schools on March 13, 2020. The kindergartens reopened on April 20, and the schools on April 27 and May 11 of 2020. The effect of these measures is largely unknown since the role of children in the spread of the SARS-CoV-2 virus is still unclear. There are only a few studies of school closures as a separate intervention to other social distancing measures, and little research exists on the effect of school opening during a pandemic.
Objective
This study aimed to model the effect of opening kindergartens and the schools in Norway in terms of a change in the reproduction number ( R ). A secondary objective was to assess if we can use the estimated R after school openings to infer the rates of transmission between children in schools.
Methods
We used an individual-based model (IBM) to assess the reopening of kindergartens and schools in two Norwegian cities, Oslo, the Norwegian capital, with a population of approximately 680 000, and Tromsø, which is the largest city in Northern Norway, with a population of approximately 75 000. The model uses demographic information and detailed data about the schools in both cities. We carried out an ensemble study to obtain robust results in spite of the considerable uncertainty that remains about the transmission of SARS-CoV-2.
Results
We found that reopening of Norwegian kindergartens and schools are associated with a change in R of 0.10 (95%CI 0.04–0.16) and 0.14 (95%CI 0.01–0.25) in the two cities under investigation if the in-school transmission rates for the SARS-CoV-2 virus are equal to what has previously been estimated for influenza pandemics.
Conclusion
We found only a limited effect of reopening schools on the reproduction number, and we expect the same to hold true in other countries where nonpharmaceutical interventions have suppressed the pandemic. Consequently, current R -estimates are insufficiently accurate for determining the transmission rates in schools. For countries that have closed schools, planned interventions, such as the opening of selected schools, can be useful to infer general knowledge about children-to-children transmission of SARS-CoV-2.
Public perceptions and behaviors in relation to COVID-19 have been at the forefront of public health policy to mitigate the transmission of the infection and reduce the burden on healthcare infrastructure. This study assesses people’s perspectives towards COVID-19, especially concerning disease risk, adherence to protective measures, and the effectiveness of the imposed prevention and control measures. An explorative study based on Q-method was conducted in Erbil, the Kurdistan Region. The study involved a purposively selected sample of 40 persons representing different educational, social, and economic levels. 41 statements were extracted that covered various aspects of the impact of COVID-19 on the lives of people and their perspectives about these experiences, using 41 statements answerable with a nine-point Likert scale, with responses ranging from ‘least agree’ to ‘most agree’. Data analysis involved a by-person factor analysis using PQMethod 2.35. Three distinct viewpoints and one consensus perspective were identified. Viewpoint 1, confidence and adherence to protective measures, centers on compliance with the main protective measures, the seriousness of COVID-19, and the effectiveness of the public health preventive measures. Viewpoint 2, apprehensiveness and noncompliance, focuses on extreme apprehension from the disease and concerns about the public health policies against COVID-19. Viewpoint 3, inattentive, emphasizes the lack of awareness and adherence to protective measures by the people and the ineffectiveness of the public health preventive measures. The primary aspects distinguishing the three viewpoints included risk perception, protective behavioral response, and public health preventive measures. Risk perception can potentially guide appropriate protective behavior. To strengthen preventive measures and comply with protective behaviors, different approaches that can address the needs of different groups of people are required. The focus should be on increasing risk awareness, reducing anxiety, and explaining the justification and effectiveness of public health policy preventive measures.
Aims
This observational study examines the effect of the COVID-19 pandemic upon the paediatric trauma burden of a district general hospital. We aim to compare the nature and volume of the paediatric trauma during the first 2020 UK lockdown period with the same period in 2019.
Methods
Prospective data was collected from 23 March 2020 to 14 June 2020 and compared with retrospective data collected from 23 March 2019 to 14 June 2019. Patient demographics, mechanism of injury, nature of the injury, and details of any surgery were tabulated and statistically analyzed using the independent-samples t-test for normally distributed data and the Mann-Whitney-U test for non-parametric data. Additionally, patients were contacted by telephone to further explore the mechanism of injury where required, to gain some qualitative insight into the risk factors for injury.
Results
The 2020 lockdown resulted in 30% fewer paediatric trauma presentations (441 vs 306), but no significant change in the number of patients requiring surgery (47 vs 51; p = 0.686). Trampolining injuries increased in absolute numbers by 168% (p < 0.001), almost four times more common when considered as percentage of all injuries observed in 2020 vs 2019. There was a decrease in high energy trauma from road traffic accidents and falls from height (21.5% decrease, p < 0.001). Despite a shift towards more conservative treatment options, trampolining injuries continued to require surgery in similar proportions (19.4 vs 20%; p = 0.708). Qualitative investigation revealed that the most common risk factor for trampolining injury was concurrent usage, especially with an older child.
Conclusion
COVID-19 lockdown has resulted in a decrease in paediatric orthopaedic presentations and high energy trauma. However, due to a marked increase in home trampolining injuries, and their unchanged requirement for surgery, there has been no change in the requirement for surgery during the lockdown period. As home exercise becomes more prevalent, a duty of public health falls upon clinicians to advise parents against trampoline usage. Cite this article: Bone Jt Open 2021;2(2):86–92.
Mixed evidence on the relationship between school closure and COVID-19 prevalence could reflect focus on large-scale levels of geography, limited ability to address endogeneity, and demographic variation. Using county-level Centers for Disease Control and Prevention (CDC) COVID-19 data through June 15, 2020, two matching strategies address potential heterogeneity: nearest geographic neighbor and propensity scores. Within nearest neighboring pairs in different states with different school closure timing, each additional day from a county’s first case until state-ordered school closure is related to 1.5 to 2.4 percent higher cumulative COVID-19 deaths per capita (1,227–1,972 deaths for a county with median population and deaths/capita). Results are consistent using propensity score matching, COVID-19 data from two alternative sources, and additional sensitivity analyses. School closure is more strongly related to COVID-19 deaths in counties with a high concentration of Black or poor residents, suggesting schools play an unequal role in transmission and earlier school closure is related to fewer lives lost in disadvantaged counties.
Background
The impact of school closures/reopening on transmission of SARS-CoV-2 in the wider community remains contested.
Methods
Outbreak data from Colorado, USA (2020), alongside data on implemented public health measures were analyzed.
Results
There were three waves (n = 3169 outbreaks; 61 650 individuals). The first was led by healthcare settings, the second leisure/entertainment and the third workplaces followed by other settings where the trajectory was equally distributed amongst essential workplaces, non-essential workplaces, schools and non-essential healthcare.
Non-acute healthcare, essential and non-essential workplace experienced more outbreaks compared to education, entertainment, large-group-living and social gatherings.
Schools experienced 11% of identified outbreaks, yet involved just 4% of total cases. Conversely, adult-education outbreaks (2%) had disproportionately more cases (9%).
Conclusion
Our findings suggest schools were not the key driver of the latest wave in infections. School re-opening coinciding with returning to work may have accounted for the parallel rise in outbreaks in those settings suggesting contact-points outside school being more likely to seed in-school outbreaks than contact points within school as the wave of outbreaks in all other settings occurred either prior to or simultaneously with the schools wave.
School re-opening is a priority but requires mitigation measures to do so safely including staggering opening of different settings whilst maintaining low levels of community transmission.
Sewer overflow (SO), which has attracted global attention, poses serious threat to public health and ecosystem. SO impacts public health via consumption of contaminated drinking water, aerosolization of pathogens, food-chain transmission, and direct contact with fecally-polluted rivers and beach sediments during recreation. However, no study has attempted to map the linkage between SO and public health including Covid-19 using scientometric analysis and systematic review of literature. Results showed that only few countries were actively involved in SO research in relation to public health. Furthermore, there are renewed calls to scale up environmental surveillance to safeguard public health. To safeguard public health, it is important for public health authorities to optimize water and wastewater treatment plants and improve building ventilation and plumbing systems to minimize pathogen transmission within buildings and transportation systems. In addition, health authorities should formulate appropriate policies that can enhance environmental surveillance and facilitate real-time monitoring of sewer overflow. Increased public awareness on strict personal hygiene and point-of-use-water-treatment such as boiling drinking water will go a long way to safeguard public health. Ecotoxicological studies and health risk assessment of exposure to pathogens via different transmission routes is also required to appropriately inform the use of lockdowns, minimize their socio-economic impact and guide evidence-based welfare/social policy interventions. Soft infrastructures, optimized sewer maintenance and prescreening of sewer overflow are recommended to reduce stormwater burden on wastewater treatment plant, curtail pathogen transmission and marine plastic pollution. Comprehensive, integrated surveillance and global collaborative efforts are important to curtail on-going Covid-19 pandemic and improve resilience against future pandemics.
The study is an attempt to enquire into the preference of undergraduate students, after a considerable and over a year-long experience with Online Teaching and Learning (OTL), under the emergency preventive measure of switching from the traditional face-to-face classes to online. The study followed an exploratory approach, with a quantitative survey followed by a qualitative one, and a convenient sampling method to collect responses from a substantial sample size. The study is positioned after more than a year of remote classes by the undergraduate student, and hence represents highly experienced reflections and preferences from these students, as compared to other studies conducted last year. The study has profound implications in considering, and questioning, the importance of on-campus classes, and significance of the physical presence of a tutor in the class, and its effect on the learning experience of undergraduate students.
Ndikimi i pandemisë COVID-19 në arsim dhe mirëqenie shqyrton ndikimin e masave të pandemisë COVID-19 në mirëqenien dhe arsimin e nxënësve të arsimit parauniversitar dhe të studentëve të arsimit të lartë, si dhe punën e mësimdhënësve të rregullt dhe të stafit mbështetës. Për më tepër, libri siguron prova të hollësishme të ndryshimeve të shkaktuara nga distancimi fizik, mbyllja e shkollave dhe karantina në angazhimet e prindër-fëmijë me theks ndikimin e ngjarjeve të mëparshme stresuese të jetës në stresin e prindërve dhe praktikat e prindërimit gjatë periudhës pandemike. Kjo punë ka për qëllim ta avancojë kërkimin dhe ta përmirësojë praktikën aktuale në mënyrë që mësimdhënësit dhe punonjësit e shëndetit mendor të mund të planifikojnë nivele të përshtatshme të mbështetjes dhe ndërhyrjes si gjatë një pandemie ashtu edhe pas saj.
Since March 2020, families across the United States have faced challenges due to the novel coronavirus (COVID-19) pandemic and its subsequent restrictions. Although some experts have voiced concern over the impact of COVID-19 on family well-being, few studies have been conducted thus far. This study utilized n = 250 responses from an online survey that was administered between May and June 2020 to gauge family stress and resilience among mothers of children ages 0 to 5 during the pandemic. Adverse childhood experiences were negatively associated with parental resilience among this sample. Furthermore, frequency of child care was positively linked to protective factors and resilience. Implications for practice, policy, and research are discussed, with a particular focus on the role of child care and school openings during the pandemic.
Background:
On April 15 and April 17, 2009, novel swine-origin influenza A (H1N1) virus (S-OIV) was identified in specimens obtained from two epidemiologically unlinked patients in the United States. The same strain of the virus was identified in Mexico, Canada, and elsewhere. We describe 642 confirmed cases of human S-OIV infection identified from the rapidly evolving U.S. outbreak.
Methods:
Enhanced surveillance was implemented in the United States for human infection with influenza A viruses that could not be subtyped. Specimens were sent to the Centers for Disease Control and Prevention for real-time reverse-transcriptase-polymerase-chain-reaction confirmatory testing for S-OIV.
Results:
From April 15 through May 5, a total of 642 confirmed cases of S-OIV infection were identified in 41 states. The ages of patients ranged from 3 months to 81 years; 60% of patients were 18 years of age or younger. Of patients with available data, 18% had recently traveled to Mexico, and 16% were identified from school outbreaks of S-OIV infection. The most common presenting symptoms were fever (94% of patients), cough (92%), and sore throat (66%); 25% of patients had diarrhea, and 25% had vomiting. Of the 399 patients for whom hospitalization status was known, 36 (9%) required hospitalization. Of 22 hospitalized patients with available data, 12 had characteristics that conferred an increased risk of severe seasonal influenza, 11 had pneumonia, 8 required admission to an intensive care unit, 4 had respiratory failure, and 2 died. The S-OIV was determined to have a unique genome composition that had not been identified previously.
Conclusions:
A novel swine-origin influenza A virus was identified as the cause of outbreaks of febrile respiratory infection ranging from self-limited to severe illness. It is likely that the number of confirmed cases underestimates the number of cases that have occurred.
The early phases of an epidemic present decision makers with predictable challenges. Marc Lipsitch and colleagues write that the combination of urgency, uncertainty, and the costs of interventions makes the effort to control infectious diseases especially difficult.
A novel influenza A (H1N1) virus has spread rapidly across the globe. Judging its pandemic potential is difficult with limited data, but nevertheless essential to inform appropriate health responses. By analyzing the outbreak in Mexico, early data on international spread, and viral genetic diversity, we make an early assessment of transmissibility and severity. Our estimates suggest that 23,000 (range 6000 to 32,000) individuals had been infected in Mexico by late April, giving an estimated case fatality ratio (CFR) of 0.4% (range: 0.3 to 1.8%) based on confirmed and suspected deaths reported to that time. In a community outbreak in the small community of La Gloria, Veracruz, no deaths were attributed to infection, giving an upper 95% bound on CFR of 0.6%. Thus, although substantial uncertainty remains, clinical severity appears less than that seen in the 1918 influenza pandemic but comparable with that seen in the 1957 pandemic. Clinical attack rates in children in La Gloria were twice that in adults (<15 years of age: 61%; >/=15 years: 29%). Three different epidemiological analyses gave basic reproduction number (R0) estimates in the range of 1.4 to 1.6, whereas a genetic analysis gave a central estimate of 1.2. This range of values is consistent with 14 to 73 generations of human-to-human transmission having occurred in Mexico to late April. Transmissibility is therefore substantially higher than that of seasonal flu, and comparable with lower estimates of R0 obtained from previous influenza pandemics.
In winter 2008, kindergartens and primary schools in Hong Kong were closed for 2 weeks after media coverage indicated that 3 children had died, apparently from influenza. We examined prospective influenza surveillance data before, during, and after the closure. We did not find a substantial effect on community transmission.
During an influenza pandemic, public health staff may not report to work due to illness, transport disruptions or care responsibilities, including care of children if school closures occur. A survey was conducted in a population health unit to estimate the impact of closure of schools and day care facilities on staff ability to work at their usual workplace or at home, and determine their access to the Internet for communication. Staff were also asked about concerns associated with working from home. Eighty-seven staff completed a paper based survey. Thirty-eight per cent (33/87) of staff may be absent from work due to the impact of childcare and school closure, however 24 (73%) of these staff would be able to work from home with most having access to dial-up (87%) and broadband Internet access (71%). Staff reported concerns about potential exposure to pandemic influenza, the need for personal protection and clearly defined roles and training, availability of adequate equipment and technology to work from home, and sick leave provisions during a pandemic. While school and childcare closures will have a significant impact on public health agency staff, they have the capacity and willingness to work from home. Their practical concerns should be addressed to optimise their participation.
The effect of community hygienic measures during the outbreak of severe acute respiratory syndrome in Hong Kong was studied by comparing the proportion of positive specimens of various respiratory viruses in 2003 with those from 1998 to 2002. Community hygienic measures significantly reduced the incidence of various respiratory viral infections.
The World Health Organization's recommended pandemic influenza interventions, based on limited data, vary by transmission pattern, pandemic phase, and illness severity and extent. In the pandemic alert period, recommendations include isolation of patients and quarantine of contacts, accompanied by antiviral therapy. During the pandemic period, the focus shifts to delaying spread and reducing effects through population-based measures. Ill persons should remain home when they first become symptomatic, but forced isolation and quarantine are ineffective and impractical. If the pandemic is severe, social distancing measures such as school closures should be considered. Nonessential domestic travel to affected areas should be deferred. Hand and respiratory hygiene should be routine; mask use should be based on setting and risk, and contaminated household surfaces should be disinfected. Additional research and field assessments during pandemics are essential to update recommendations. Legal authority and procedures for implementing interventions should be understood in advance and should respect cultural differences and human rights.
Recent human deaths due to infection by highly pathogenic (H5N1) avian influenza A virus have raised the specter of a devastating pandemic like that of 1917–1918, should this avian virus evolve to become readily transmissible among humans. We introduce and use a large-scale stochastic simulation model to investigate the spread of a pandemic strain of influenza virus through the U.S. population of 281 million individuals for R 0 (the basic reproductive number) from 1.6 to 2.4. We model the impact that a variety of levels and combinations of influenza antiviral agents, vaccines, and modified social mobility (including school closure and travel restrictions) have on the timing and magnitude of this spread. Our simulations demonstrate that, in a highly mobile population, restricting travel after an outbreak is detected is likely to delay slightly the time course of the outbreak without impacting the eventual number ill. For R 0 < 1.9, our model suggests that the rapid production and distribution of vaccines, even if poorly matched to circulating strains, could significantly slow disease spread and limit the number ill to <10% of the population, particularly if children are preferentially vaccinated. Alternatively, the aggressive deployment of several million courses of influenza antiviral agents in a targeted prophylaxis strategy may contain a nascent outbreak with low R 0, provided adequate contact tracing and distribution capacities exist. For higher R 0, we predict that multiple strategies in combination (involving both social and medical interventions) will be required to achieve similar limits on illness rates.
• antiviral agents
• infectious diseases
• simulation modeling
• social network dynamics
• vaccines
Development of strategies for mitigating the severity of a new influenza pandemic is now a top global public health priority. Influenza prevention and containment strategies can be considered under the broad categories of antiviral, vaccine and non-pharmaceutical (case isolation, household quarantine, school or workplace closure, restrictions on travel) measures. Mathematical models are powerful tools for exploring this complex landscape of intervention strategies and quantifying the potential costs and benefits of different options. Here we use a large-scale epidemic simulation to examine intervention options should initial containment of a novel influenza outbreak fail, using Great Britain and the United States as examples. We find that border restrictions and/or internal travel restrictions are unlikely to delay spread by more than 2-3 weeks unless more than 99% effective. School closure during the peak of a pandemic can reduce peak attack rates by up to 40%, but has little impact on overall attack rates, whereas case isolation or household quarantine could have a significant impact, if feasible. Treatment of clinical cases can reduce transmission, but only if antivirals are given within a day of symptoms starting. Given enough drugs for 50% of the population, household-based prophylaxis coupled with reactive school closure could reduce clinical attack rates by 40-50%. More widespread prophylaxis would be even more logistically challenging but might reduce attack rates by over 75%. Vaccine stockpiled in advance of a pandemic could significantly reduce attack rates even if of low efficacy. Estimates of policy effectiveness will change if the characteristics of a future pandemic strain differ substantially from those seen in past pandemics.
Targeted social distancing to mitigate pandemic influenza can be designed through simulation of influenza's spread within local community social contact networks. We demonstrate this design for a stylized community representative of a small town in the United States. The critical importance of children and teenagers in transmission of influenza is first identified and targeted. For influenza as infectious as 1957-58 Asian flu (=50% infected), closing schools and keeping children and teenagers at home reduced the attack rate by >90%. For more infectious strains, or transmission that is less focused on the young, adults and the work environment must also be targeted. Tailored to specific communities across the world, such design would yield local defenses against a highly virulent strain in the absence of vaccine and antiviral drugs.
We studied nonpharmaceutical interventions used to mitigate the second, and most deadly, wave of the 1918-1920 influenza pandemic in the United States. We conclude that several small communities implemented potentially successful attempts at preventing the introduction of influenza.
In an influenza pandemic, the benefit of vaccines and antiviral medications will be constrained by limitations on supplies and effectiveness. Non-pharmaceutical public health interventions will therefore be vital in curtailing disease spread. However, the most comprehensive assessments of the literature to date recognize the generally poor quality of evidence on which to base non-pharmaceutical pandemic planning decisions. In light of the need to prepare for a possible pandemic despite concerns about the poor quality of the literature, combining available evidence with expert opinion about the relative merits of non-pharmaceutical interventions for pandemic influenza may lead to a more informed and widely accepted set of recommendations. We evaluated the evidence base for non-pharmaceutical public health interventions. Then, based on the collective evidence, we identified a set of recommendations for and against interventions that are specific to both the setting in which an intervention may be used and the pandemic phase, and which can be used by policymakers to prepare for a pandemic until scientific evidence can definitively respond to planners' needs.
Building on reviews of past pandemics and recent historical inquiries, we evaluated the relative merits of non-pharmaceutical interventions by combining available evidence from the literature with qualitative and quantitative expert opinion. Specifically, we reviewed the recent scientific literature regarding the prevention of human-to-human transmission of pandemic influenza, convened a meeting of experts from multiple disciplines, and elicited expert recommendation about the use of non-pharmaceutical public health interventions in a variety of settings (healthcare facilities; community-based institutions; private households) and pandemic phases (no pandemic; no US pandemic; early localized US pandemic; advanced US pandemic).
The literature contained a dearth of evidence on the efficacy or effectiveness of most non-pharmaceutical interventions for influenza. In an effort to inform decision-making in the absence of strong scientific evidence, the experts ultimately endorsed hand hygiene and respiratory etiquette, surveillance and case reporting, and rapid viral diagnosis in all settings and during all pandemic phases. They also encouraged patient and provider use of masks and other personal protective equipment as well as voluntary self-isolation of patients during all pandemic phases. Other non-pharmaceutical interventions including mask-use and other personal protective equipment for the general public, school and workplace closures early in an epidemic, and mandatory travel restrictions were rejected as likely to be ineffective, infeasible, or unacceptable to the public.
The demand for scientific evidence on non-pharmaceutical public health interventions for influenza is pervasive, and present policy recommendations must rely heavily on expert judgment. In the absence of a definitive science base, our assessment of the evidence identified areas for further investigation as well as non-pharmaceutical public health interventions that experts believe are likely to be beneficial, feasible and widely acceptable in an influenza pandemic.
Local epidemic curves during the 1918-1919 influenza pandemic were often characterized by multiple epidemic waves. Identifying the underlying cause(s) of such waves may help manage future pandemics. We investigate the hypothesis that these waves were caused by people avoiding potentially infectious contacts-a behaviour termed 'social distancing'. We estimate the effective disease reproduction number and from it infer the maximum degree of social distancing that occurred during the course of the multiple-wave epidemic in Sydney, Australia. We estimate that, on average across the city, people reduced their infectious contact rate by as much as 38%, and that this was sufficient to explain the multiple waves of this epidemic. The basic reproduction number, R0, was estimated to be in the range of 1.6-2.0 with a preferred estimate of 1.8, in line with other recent estimates for the 1918-1919 influenza pandemic. The data are also consistent with a high proportion (more than 90%) of the population being initially susceptible to clinical infection, and the proportion of infections that were asymptomatic (if this occurs) being no higher than approximately 9%. The observed clinical attack rate of 36.6% was substantially lower than the 59% expected based on the estimated value of R0, implying that approximately 22% of the population were spared from clinical infection. This reduction in the clinical attack rate translates to an estimated 260 per 100000 lives having been saved, and suggests that social distancing interventions could play a major role in mitigating the public health impact of future influenza pandemics.
To systematically review evidence for the effectiveness of physical interventions to interrupt or reduce the spread of respiratory viruses.
Search strategy of the Cochrane Library, Medline, OldMedline, Embase, and CINAHL, without language restriction, for any intervention to prevent transmission of respiratory viruses (isolation, quarantine, social distancing, barriers, personal protection, and hygiene). Study designs were randomised trials, cohort studies, case-control studies, and controlled before and after studies.
Of 2300 titles scanned 138 full papers were retrieved, including 49 papers of 51 studies. Study quality was poor for the three randomised controlled trials and most of the cluster randomised controlled trials; the observational studies were of mixed quality. Heterogeneity precluded meta-analysis of most data except that from six case-control studies. The highest quality cluster randomised trials suggest that the spread of respiratory viruses into the community can be prevented by intervening with hygienic measures aimed at younger children. Meta-analysis of six case-control studies suggests that physical measures are highly effective in preventing the spread of SARS: handwashing more than 10 times daily (odds ratio 0.45, 95% confidence interval 0.36 to 0.57; number needed to treat=4, 95% confidence interval 3.65 to 5.52); wearing masks (0.32, 0.25 to 0.40; NNT=6, 4.54 to 8.03); wearing N95 masks (0.09, 0.03 to 0.30; NNT=3, 2.37 to 4.06); wearing gloves (0.43, 0.29 to 0.65; NNT=5, 4.15 to 15.41); wearing gowns (0.23, 0.14 to 0.37; NNT=5, 3.37 to 7.12); and handwashing, masks, gloves, and gowns combined (0.09, 0.02 to 0.35; NNT=3, 2.66 to 4.97). The incremental effect of adding virucidals or antiseptics to normal handwashing to decrease the spread of respiratory disease remains uncertain. The lack of proper evaluation of global measures such as screening at entry ports and social distancing prevent firm conclusions being drawn.
Routine long term implementation of some physical measures to interrupt or reduce the spread of respiratory viruses might be difficult but many simple and low cost interventions could be useful in reducing the spread.
Planning a response to an outbreak of a pandemic strain of influenza is a high public health priority. Three research groups using different individual-based, stochastic simulation models have examined the consequences of intervention strategies chosen in consultation with U.S. public health workers. The first goal is to simulate the effectiveness of a set of potentially feasible intervention strategies. Combinations called targeted layered containment (TLC) of influenza antiviral treatment and prophylaxis and nonpharmaceutical interventions of quarantine, isolation, school closure, community social distancing, and workplace social distancing are considered. The second goal is to examine the robustness of the results to model assumptions. The comparisons focus on a pandemic outbreak in a population similar to that of Chicago, with ≈8.6 million people. The simulations suggest that at the expected transmissibility of a pandemic strain, timely implementation of a combination of targeted household antiviral prophylaxis, and social distancing measures could substantially lower the illness attack rate before a highly efficacious vaccine could become available. Timely initiation of measures and school closure play important roles. Because of the current lack of data on which to base such models, further field research is recommended to learn more about the sources of transmission and the effectiveness of social distancing measures in reducing influenza transmission.
• influenza antiviral agents
• mitigation
• prophylaxis
• social distancing
• transmission
The threat posed by the highly pathogenic H5N1 influenza virus requires public health authorities to prepare for a human pandemic. Although pre-pandemic vaccines and antiviral drugs might significantly reduce illness rates, their stockpiling is too expensive to be practical for many countries. Consequently, alternative control strategies, based on non-pharmaceutical interventions, are a potentially attractive policy option. School closure is the measure most often considered. The high social and economic costs of closing schools for months make it an expensive and therefore controversial policy, and the current absence of quantitative data on the role of schools during influenza epidemics means there is little consensus on the probable effectiveness of school closure in reducing the impact of a pandemic. Here, from the joint analysis of surveillance data and holiday timing in France, we quantify the role of schools in influenza epidemics and predict the effect of school closure during a pandemic. We show that holidays lead to a 20-29% reduction in the rate at which influenza is transmitted to children, but that they have no detectable effect on the contact patterns of adults. Holidays prevent 16-18% of seasonal influenza cases (18-21% in children). By extrapolation, we find that prolonged school closure during a pandemic might reduce the cumulative number of cases by 13-17% (18-23% in children) and peak attack rates by up to 39-45% (47-52% in children). The impact of school closure would be reduced if it proved difficult to maintain low contact rates among children for a prolonged period.
School closure is a key component of many countries' plans to mitigate the effect of an influenza pandemic. Although a number of studies have suggested that such a policy might reduce the incidence, there are no published studies of the cost of such policies. This study attempts to fill this knowledge gap
School closure is expected to lead to significant work absenteeism of working parents who are likely to be the main care givers to their dependent children at home. The cost of absenteeism due to school closure is calculated as the paid productivity loss of parental absenteeism during the period of school closure. The cost is estimated from societal perspective using a nationally representative survey.
The results show that overall about 16% of the workforce is likely to be the main caregiver for dependent children and therefore likely to take absenteeism. This rises to 30% in the health and social care sector, as a large proportion of the workforce are women. The estimated costs of school closure are significant, at 0.2 pounds bn - 1.2 pounds bn per week. School closure is likely to significantly exacerbate the pressures on the health system through staff absenteeism.
The estimates of school closure associated absenteeism and the projected cost would be useful for pandemic planning for business continuity, and for cost effectiveness evaluation of different pandemic influenza mitigation strategies.
We report the results of a national survey conducted to help public health officials understand the public's response to community mitigation interventions for a severe outbreak of pandemic influenza. Survey results suggest that if community mitigation measures are instituted, most respondents would comply with recommendations but would be challenged to do so if their income or job were severely compromised. The results also indicate that community mitigation measures could cause problems for persons with lower incomes and for racial and ethnic minorities. Twenty-four percent of respondents said that they would not have anyone available to take care of them if they became sick with pandemic influenza. Given these results, planning and public engagement will be needed to encourage the public to be prepared.
School closure is a proposed strategy for reducing influenza transmission during a pandemic. Few studies have assessed how families respond to closures, or whether other interactions during closure could reduce this strategy's effect. Questionnaires were administered to 220 households (438 adults and 355 children) with school-age children in a North Carolina county during an influenza B virus outbreak that resulted in school closure. Closure was considered appropriate by 201 (91%) households. No adults missed work to solely provide childcare, and only 22 (10%) households required special childcare arrangements; 2 households incurred additional costs. Eighty-nine percent of children visited at least 1 public location during the closure despite county recommendations to avoid large gatherings. Although behavior and attitudes might differ during a pandemic, these results suggest short-term closure did not cause substantial hardship for parents. Pandemic planning guidance should address the potential for transmission in public areas during school closure.
Data augmentation and Gibbs sampling are two closely related, sampling-based approaches to the calculation of posterior moments. The fact that each produces a sample whose constituents are neither independent nor identically distributed complicates the assessment of convergence and numerical accuracy of the approximations to the expected value of functions of interest under the posterior. In this paper methods from spectral analysis are used to evaluate numerical accuracy formally and construct diagnostics for convergence. These methods are illustrated in the normal linear model with informative priors, and in the Tobit-censored regression model. Keywords and phrases: Data augmentation, Gibbs sampling, Mixed estimation, Monte Carlo integration, Tobit model This paper was prepared as an invited presentation at the Fourth Valencia International Meeting on Bayesian Statistics, Peiscola, Spain, April 15-20, 1991. Financial support from National Science Foundation Grant SES-8908365 and re...
Objectives: To project the potential economic impact of pandemic influenza mitigation strategies from a societal perspective in the United States. Methods: We use a stochastic agent-based model to simulate pandemic influenza in the community. We compare 17 strategies: targeted antiviral prophylaxis (TAP) alone and in combination with school closure as well as prevaccination. Results: In the absence of intervention, we predict a 50% attack rate with an economic impact of $187 per capita as loss to society. Full TAP (FTAP) is the most effective single strategy, reducing number of cases by 54% at the lowest cost to society ($127 per capita). Prevaccination reduces number of cases by 48% and is the second least costly alternative ($140 per capita). Adding school closure to FTAP or prevaccination further improves health outcomes but increases total cost to society by approximately $2700 per capita. Conclusion: FTAP is an effective and cost-saving measure for mitigating pandemic influenza. © 2008, International Society for Pharmacoeconomics and Outcomes Research (ISPOR).
The World Health Organization's recommended pan- demic influenza interventions, based on limited data, vary by transmission pattern, pandemic phase, and illness severity and extent. In the pandemic alert period, recom- mendations include isolation of patients and quarantine of contacts, accompanied by antiviral therapy. During the pan- demic period, the focus shifts to delaying spread and reducing effects through population-based measures. Ill persons should remain home when they first became symptomatic, but forced isolation and quarantine are inef- fective and impractical. If the pandemic is severe, social distancing measures such as school closures should be considered. Nonessential domestic travel to affected areas should be deferred. Hand and respiratory hygiene should be routine; mask use should be based on setting and risk, and contaminated household surfaces should be disinfec- ted. Additional research and field assessments during pan- demics are essential to update recommendations. Legal authority and procedures for implementing interventions should be understood in advance and should respect cul- tural differences and human rights.
Objectives:
To project the potential economic impact of pandemic influenza mitigation strategies from a societal perspective in the United States.
Methods:
We use a stochastic agent-based model to simulate pandemic influenza in the community. We compare 17 strategies: targeted antiviral prophylaxis (TAP) alone and in combination with school closure as well as prevaccination.
Results:
In the absence of intervention, we predict a 50% attack rate with an economic impact of $187 per capita as loss to society. Full TAP (FTAP) is the most effective single strategy, reducing number of cases by 54% at the lowest cost to society ($127 per capita). Prevaccination reduces number of cases by 48% and is the second least costly alternative ($140 per capita). Adding school closure to FTAP or prevaccination further improves health outcomes but increases total cost to society by approximately $2700 per capita.
Conclusion:
FTAP is an effective and cost-saving measure for mitigating pandemic influenza.
Development of strategies for mitigating the severity of a new influenza pandemic is now a top global public health priority. Influenza prevention and containment strategies can be considered under the broad categories of antiviral, vaccine and non-pharmaceutical (case isolation, household quarantine, school or workplace closure, restrictions on travel) measures. Mathematical models are powerful tools for exploring this complex landscape of intervention strategies and quantifying the potential costs and benefits of different options. Here we use a large-scale epidemic simulation to examine intervention options should initial containment of a novel influenza outbreak fail, using Great Britain and the United States as examples. We find that border restrictions and/or internal travel restrictions are unlikely to delay spread by more than 2-3 weeks unless more than 99% effective. School closure during the peak of a pandemic can reduce peak attack rates by up to 40%, but has little impact on overall attack rates, whereas case isolation or household quarantine could have a significant impact, if feasible. Treatment of clinical cases can reduce transmission, but only if antivirals are given within a day of symptoms starting. Given enough drugs for 50% of the population, household-based prophylaxis coupled with reactive school closure could reduce clinical attack rates by 40-50%. More widespread prophylaxis would be even more logistically challenging but might reduce attack rates by over 75%. Vaccine stockpiled in advance of a pandemic could significantly reduce attack rates even if of low efficacy. Estimates of policy effectiveness will change if the characteristics of a future pandemic strain differ substantially from those seen in past pandemics.
Davis, L E., G. G. Caldwell, R. E. Lynch, R. E. Bailey and T. D. Y. Chin (Ecological Investigations Program, NCDC, 2002 W. 39 St., Kansas City, Kans. 66103). Hong Kong influenza: the epidemiologic features of a high school family study analyzed and compared with a similar study during the 1957 Asian influenza epidemic. Amer. J. Epid., 1970, 92; 240-247.-A retrospective questionnaire survey of 6, 994 students from a high school in Kansas City, Mo. and their families, for histories of influenza-like illness was conducted during the 1968-1969 epidemic of Hong Kong influenza. The overall clinical attack rate was 39%. The age-specific attack rates of all age groups were similar. The secondary age-specific attack rate curve also had a flat configuration, possibly indicating that all age ranges were equally susceptible to Hong Kong influenza. These results were compared with those of a similar survey at the same high school following the 1957 Asian influenza epidemic. In contrast, school children in the 1957 epidemic experienced significantly higher clinical attack rates than adults. In 1957, the epidemic spread primarily within schools; a school child was flve times as likely as an adult to have introduced the illness into the family. In the Hong Kong influenza epidemic, however, the virus appeared to have spread initially both in schools and in the community; an adult was as likely as a school child to have been the first family case. This dual mode of primary spread weakens the suggestion that vaccination of school children would abort an influenza epidemic.
We evaluated the effect of school closure on the occurrence of respiratory infection among children ages 6-12 years and its impact on health care services. During this period, there were significant decreases in the diagnoses of respiratory infections (42%), visits to physician (28%) and emergency departments (28%) and medication purchases (35%). The present study provides quantitative data to support school closure during an influenza pandemic.
The threat of an influenza pandemic has alarmed countries around the globe and given rise to an intense interest in disease mitigation measures. This article reviews what is known about the effectiveness and practical feasibility of a range of actions that might be taken in attempts to lessen the number of cases and deaths resulting from an influenza pandemic. The article also discusses potential adverse second- and third-order effects of mitigation actions that decision makers must take into account. Finally, the article summarizes the authors' judgments of the likely effectiveness and likely adverse consequences of the range of disease mitigation measures and suggests priorities and practical actions to be taken.
Nonpharmaceutical interventions (NPIs) intended to reduce infectious contacts between persons form an integral part of plans to mitigate the impact of the next influenza pandemic. Although the potential benefits of NPIs are supported by mathematical models, the historical evidence for the impact of such interventions in past pandemics has not been systematically examined. We obtained data on the timing of 19 classes of NPI in 17 U.S. cities during the 1918 pandemic and tested the hypothesis that early implementation of multiple interventions was associated with reduced disease transmission. Consistent with this hypothesis, cities in which multiple interventions were implemented at an early phase of the epidemic had peak death rates ≈50% lower than those that did not and had less-steep epidemic curves. Cities in which multiple interventions were implemented at an early phase of the epidemic also showed a trend toward lower cumulative excess mortality, but the difference was smaller (≈20%) and less statistically significant than that for peak death rates. This finding was not unexpected, given that few cities maintained NPIs longer than 6 weeks in 1918. Early implementation of certain interventions, including closure of schools, churches, and theaters, was associated with lower peak death rates, but no single intervention showed an association with improved aggregate outcomes for the 1918 phase of the pandemic. These findings support the hypothesis that rapid implementation of multiple NPIs can significantly reduce influenza transmission, but that viral spread will be renewed upon relaxation of such measures.
• mitigation
• nonpharmaceutical interventions
• closures
During the 1918 influenza pandemic, the U.S., unlike Europe, put considerable effort into public health interventions. There was also more geographic variation in the autumn wave of the pandemic in the U.S. compared with Europe, with some cities seeing only a single large peak in mortality and others seeing double-peaked epidemics. Here we examine whether differences in the public health measures adopted by different cities can explain the variation in epidemic patterns and overall mortality observed. We show that city-specific per-capita excess mortality in 1918 was significantly correlated with 1917 per-capita mortality, indicating some intrinsic variation in overall mortality, perhaps related to sociodemographic factors. In the subset of 23 cities for which we had partial data on the timing of interventions, an even stronger correlation was found between excess mortality and how early in the epidemic interventions were introduced. We then fitted an epidemic model to weekly mortality in 16 cities with nearly complete intervention-timing data and estimated the impact of interventions. The model reproduced the observed epidemic patterns well. In line with theoretical arguments, we found the time-limited interventions used reduced total mortality only moderately (perhaps 10–30%), and that the impact was often very limited because of interventions being introduced too late and lifted too early. San Francisco, St. Louis, Milwaukee, and Kansas City had the most effective interventions, reducing transmission rates by up to 30–50%. Our analysis also suggests that individuals reactively reduced their contact rates in response to high levels of mortality during the pandemic.
• epidemic model
• public health interventions
A critical question in pandemic influenza planning is the role nonpharmaceutical interventions might play in delaying the temporal effects of a pandemic, reducing the overall and peak attack rate, and reducing the number of cumulative deaths. Such measures could potentially provide valuable time for pandemic-strain vaccine and antiviral medication production and distribution. Optimally, appropriate implementation of nonpharmaceutical interventions would decrease the burden on health care services and critical infrastructure.
To examine the implementation of nonpharmaceutical interventions for epidemic mitigation in 43 cities in the continental United States from September 8, 1918, through February 22, 1919, and to determine whether city-to-city variation in mortality was associated with the timing, duration, and combination of nonpharmaceutical interventions; altered population susceptibility associated with prior pandemic waves; age and sex distribution; and population size and density.
Historical archival research, and statistical and epidemiological analyses. Nonpharmaceutical interventions were grouped into 3 major categories: school closure; cancellation of public gatherings; and isolation and quarantine.
Weekly excess death rate (EDR); time from the activation of nonpharmaceutical interventions to the first peak EDR; the first peak weekly EDR; and cumulative EDR during the entire 24-week study period.
There were 115,340 excess pneumonia and influenza deaths (EDR, 500/100,000 population) in the 43 cities during the 24 weeks analyzed. Every city adopted at least 1 of the 3 major categories of nonpharmaceutical interventions. School closure and public gathering bans activated concurrently represented the most common combination implemented in 34 cities (79%); this combination had a median duration of 4 weeks (range, 1-10 weeks) and was significantly associated with reductions in weekly EDR. The cities that implemented nonpharmaceutical interventions earlier had greater delays in reaching peak mortality (Spearman r = -0.74, P < .001), lower peak mortality rates (Spearman r = 0.31, P = .02), and lower total mortality (Spearman r = 0.37, P = .008). There was a statistically significant association between increased duration of nonpharmaceutical interventions and a reduced total mortality burden (Spearman r = -0.39, P = .005).
These findings demonstrate a strong association between early, sustained, and layered application of nonpharmaceutical interventions and mitigating the consequences of the 1918-1919 influenza pandemic in the United States. In planning for future severe influenza pandemics, nonpharmaceutical interventions should be considered for inclusion as companion measures to developing effective vaccines and medications for prophylaxis and treatment.
Pandemic influenza response plans have placed a significant emphasis on school closures as a community mitigation strategy. However, school closures raise serious ethical concerns, many of which have been largely overlooked. First, evidence of this intervention's efficacy has not yet been firmly established, calling into question whether it will be useful against the threat. Second, school closures have the potential to create serious adverse consequences, which will disproportionately affect vulnerable populations. Thus, policy makers should focus on gathering more evidence about the efficacy of school closures and on strengthening communication and transparency about the strengths and weaknesses of any school-closure plan that they decide to adopt. Policy makers should also consider intermediate options, such as partial school closures, which might provide ways to reap many of the benefits of school closings, while minimizing the costs. Finally, policy makers must labor to ensure that the benefits and the burdens of any interventions are distributed equitably.
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