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Background: Nonpharmaceutical interventions (NPIs) may be considered as part of national pandemic preparedness as a first line defense against influenza pandemics. Preemptive school closures (PSCs) are an NPI reserved for severe pandemics and are highly effective in slowing influenza spread but have unintended consequences. Methods: We used results of simulated PSC impacts for a 1957-like pandemic (i.e., an influenza pandemic with a high case fatality rate) to estimate population health impacts and quantify PSC costs at the national level using three geographical scales, four closure durations, and three dismissal decision criteria (i.e., the number of cases detected to trigger closures). At the Chicago regional level, we also used results from simulated 1957-like, 1968-like, and 2009-like pandemics. Our net estimated economic impacts resulted from educational productivity costs plus loss of income associated with providing childcare during closures after netting out productivity gains from averted influenza illness based on the number of cases and deaths for each mitigation strategy. Results: For the 1957-like, national-level model, estimated net PSC costs and averted cases ranged from $7.5 billion (2016 USD) averting 14.5 million cases for two-week, community-level closures to $97 billion averting 47 million cases for 12-week, county-level closures. We found that 2-week school-by-school PSCs had the lowest cost per discounted life-year gained compared to county-wide or school district–wide closures for both the national and Chicago regional-level analyses of all pandemics. The feasibility of spatiotemporally precise triggering is questionable for most locales. Theoretically, this would be an attractive early option to allow more time to assess transmissibility and severity of a novel influenza virus. However, we also found that county-wide PSCs of longer durations (8 to 12 weeks) could avert the most cases (31–47 million) and deaths (105,000–156,000); however, the net cost would be considerably greater ($88-$103 billion net of averted illness costs) for the national-level, 1957-like analysis. Conclusions: We found that the net costs per death averted ($180,000-$4.2 million) for the national-level, 1957-like scenarios were generally less than the range of values recommended for regulatory impact analyses ($4.6 to 15.0 million). This suggests that the economic benefits of national-level PSC strategies could exceed the costs of these interventions during future pandemics with highly transmissible strains with high case fatality rates. In contrast, the PSC outcomes for regional models of the 1968-like and 2009-like pandemics were less likely to be cost effective; more targeted and shorter duration closures would be recommended for these pandemics. [ABSTRACT FROM AUTHOR]

As part of a multiyear project that monitored illness-related school closures, we conducted systematic daily online searches during July 27, 2020-June 30, 2022, to identify public announcements of COVID-19-related school closures (COVID-SCs) in the United States lasting >1 day. We explored the temporospatial patterns of COVID-SCs and analyzed associations between COVID-SCs and national COVID-19 surveillance data. COVID-SCs reflected national surveillance data: correlation was highest between COVID-SCs and both new PCR test positivity (correlation coefficient [r] = 0.73, 95% CI 0.56-0.84) and new cases (r = 0.72, 95% CI 0.54-0.83) during 2020-21 and with hospitalization rates among all ages (r = 0.81, 95% CI 0.67-0.89) during 2021-22. The numbers of reactive COVID-SCs during 2020-21 and 2021-22 greatly exceeded previously observed numbers of illness-related reactive school closures in the United States, notably being nearly 5-fold greater than reactive closures observed during the 2009 influenza (H1N1) pandemic. [ABSTRACT FROM AUTHOR]

Introduction: Schools close in reaction to seasonal influenza outbreaks and, on occasion, pandemic influenza. The unintended costs of reactive school closures associated with influenza or influenza-like illness (ILI) has not been studied previously. We estimated the costs of ILI-related reactive school closures in the United States over eight academic years. Methods: We used prospectively collected data on ILI-related reactive school closures from August 1, 2011 to June 30, 2019 to estimate the costs of the closures, which included productivity costs for parents, teachers, and non-teaching school staff. Productivity cost estimates were evaluated by multiplying the number of days for each closure by the state- and year-specific average hourly or daily wage rates for parents, teachers, and school staff. We subdivided total cost and cost per student estimates by school year, state, and urbanicity of school location. Results: The estimated productivity cost of the closures was $476 million in total during the eight years, with most (90%) of the costs occurring between 2016–2017 and 2018–2019, and in Tennessee (55%) and Kentucky (21%). Among all U.S. public schools, the annual cost per student was much higher in Tennessee ($33) and Kentucky ($19) than any other state ($2.4 in the third highest state) or the national average ($1.2). The cost per student was higher in rural areas ($2.9) or towns ($2.5) than cities ($0.6) or suburbs ($0.5). Locations with higher costs tended to have both more closures and closures with longer durations. Conclusions: In recent years, we found significant heterogeneity in year-to-year costs of ILI-associated reactive school closures. These costs have been greatest in Tennessee and Kentucky and been elevated in rural or town areas relative to cities or suburbs. Our findings might provide evidence to support efforts to reduce the burden of seasonal influenza in these disproportionately impacted states or communities. [ABSTRACT FROM AUTHOR]

Widespread school closures and other non‐pharmaceutical interventions (NPIs), used to limit the spread of SARS‐CoV‐2, significantly disrupted transmission patterns of seasonal respiratory viruses. As NPIs were relaxed, populations were vulnerable to resurgence. This study within a small community assessed acute respiratory illness among kindergarten through grade 12 students as they returned to public schools from September through December 2022 without masking and distancing requirements. The 277 specimens collected demonstrated a shift from rhinovirus to influenza. With continued circulation of SARS‐CoV‐2 and return of seasonal respiratory viruses, understanding evolving transmission patterns will play an important role in reducing disease burden. [ABSTRACT FROM AUTHOR]

Introduction: Outside of pandemics, there is little information about occurrence of prolonged unplanned K-12 school closures (PUSC). We describe here the reasons, characteristics, and patterns of PUSC in the United States during 8 consecutive inter-pandemic academic years, 2011–2019. Methods: From August 1, 2011 through June 30, 2019, daily systematic online searches were conducted to collect data on publicly announced unplanned school closures lasting ≥1 school days in the United States. Closures were categorized as prolonged when schools were closed for ≥5 unplanned days (approximating one full workweek), excluding weekends and scheduled days off per school calendars. Results: During the eight academic years, a total of 22,112 PUSCs were identified, affecting over 800,000 teachers and 13 million students that resulted in 91.5 million student-days lost. A median of 62.9% of students in PUSC-affected schools were eligible for subsidized school meals. Most affected schools were in cities (35%) and suburban areas (33%). Natural disasters (47%), adverse weather conditions (35%), and budget/teacher strikes (15%) were the most frequently cited reasons for PUSC; illness accounted for 1%, and building/facility issues, environmental issues and violence together accounted for the remaining 2%. The highest number of PUSCs occurred in Health and Human Services Regions 2, 3, 4, and 6 encompassing areas that are frequently in the path of hurricanes and tropical storms. The majority of PUSCs in these regions were attributed to a handful of hurricanes during the fall season, including hurricanes Sandy, Irma, Harvey, Florence, and Matthew. Conclusions: PUSCs occur annually in the United States due to a variety of causes and are associated with a substantive loss of student-days for in-school learning. Both these prior experiences with PUSCs and those during the current COVID-19 pandemic illustrate a need for creating sustainable solutions for high-quality distance learning and innovative supplemental feeding programs nationwide, especially in disaster-prone areas. [ABSTRACT FROM AUTHOR]

Pre-emptive school closures are frontline community mitigation measures recommended by the US Centers for Disease Control and Prevention (CDC) for implementation during severe pandemics. This study describes the spatiotemporal patterns of publicly announced school closures implemented in response to the coronavirus disease 2019 (COVID-19) pandemic and assesses how public K-12 districts adjusted their methods of education delivery and provision of subsidized meals. During February 18–June 30, 2020, we used daily systematic media searches to identify publicly announced COVID-19–related school closures lasting ≥1 day in the United States (US). We also collected statewide school closure policies from state government websites. Data on distance learning and subsidized meal programs were collected from a stratified sample of 600 school districts. The first COVID-19–associated school closure occurred on February 27, 2020 in Washington state. By March 30, 2020, all but one US public school districts were closed, representing the first-ever nearly synchronous nationwide closure of public K-12 schools in the US. Approximately 100,000 public schools were closed for ≥8 weeks because of COVID-19, affecting >50 million K-12 students. Of 600 districts sampled, the vast majority offered distance learning (91.0%) and continued provision of subsidized meal programs (78.8%) during the closures. Despite the sudden and prolonged nature of COVID-19–associated school closures, schools demonstrated flexibility by implementing distance learning and alternate methods to continue subsidized meal programs. [ABSTRACT FROM AUTHOR]

Introduction: School closures, while an effective measure against the spread of disease during a pandemic, may carry unintended social and economic consequences for students and families. We evaluated these costs and consequences following a 4-day school closure in Mississippi’s Harrison County School District (HCSD). Methods: In a survey of all households with students enrolled in HCSD, we collected information on difficulties related to the school closure, including interruption of employment and pay, loss of access to subsidized school meals, and arrangement of alternative childcare. We analyzed this information in the context of certain demographic characteristics of the survey respondents and households, such as race, level of education, and income. We also estimated the average number of lost work days and documented the childcare alternatives chosen by households affected by the school closure. Results: We received 2,229 (28.4%) completed surveys from an estimated 7,851 households eligible to participate. About half (1,082 [48.5%]) of the households experienced at least some difficulty during the closure, primarily in three areas: uncertainty about duration of the closure, lost income, and the effort of arranging alternate childcare. Adults working outside the home, particularly the major wage earner in the household, were more likely to suffer lost income while schools were closed, an effect mitigated by paid leave benefits. Difficulty arranging childcare was reported most frequently by respondents with lower levels of education and households with younger children. Beyond the top three concerns expressed by households in HCSD, the survey also shed light on the issue of food insecurity when subsidized school meals are not available. Reported by 17.9% of households participating in the subsidized school lunch program, difficulty providing meals during the closure was associated with higher numbers of dependent children, selection of “other” as the race of the household respondent, and lower levels of education. Conclusion: To help prevent undue financial hardship in families of school children, public health authorities and school administrators should provide recommendations for childcare alternatives and paid leave or remote work options during prolonged school closures, particularly to households in which all adults work outside of the home. [ABSTRACT FROM AUTHOR]

Background. School closures may delay the epidemic peak of the next influenza pandemic, but whether school closure can delay the peak until pandemic vaccine is ready to be deployed is uncertain. Methods. To study the effect of school closures on the timing of epidemic peaks, we built a deterministic susceptibleinfected- recovered model of influenza transmission. We stratified the U.S. population into 4 age groups (0-4, 5-19, 20-64, and ⩾65 years), and used contact matrices to model the average number of potentially disease transmitting, nonphysical contacts. Results. For everyweek of school closure at day 5 of introduction and a 30% clinical attack rate scenario, epidemic peak would be delayed by approximately 5 days. For a 15% clinical attack rate scenario, 1 week closure would delay the peak by 9 days. Closing schools for less than 84 days (12 weeks) would not, however, reduce the estimated total number of cases. Conclusions. Unless vaccine is available early, school closure alone may not be able to delay the peak until vaccine is ready to be deployed. Conversely, if vaccination begins quickly, school closure may be helpful in providing the time to vaccinate school-aged children before the pandemic peaks. [ABSTRACT FROM AUTHOR]

Introduction: We describe characteristics of unplanned school closures (USCs) in the United States over two consecutive academic years during a non-pandemic period to provide context for implementation of school closures during a pandemic. Methods: From August 1, 2011 through June 30, 2013, daily systematic internet searches were conducted for publicly announced USCs lasting ≥1 day. The reason for closure and the closure dates were recorded. Information on school characteristics was obtained from the National Center for Education Statistics. Results: During the two-year study period, 20,723 USCs were identified affecting 27,066,426 students. Common causes of closure included weather (79%), natural disasters (14%), and problems with school buildings or utilities (4%). Only 771 (4%) USCs lasted ≥4 school days. Illness was the cause of 212 (1%) USCs; of these, 126 (59%) were related to respiratory illnesses and showed seasonal variation with peaks in February 2012 and January 2013. Conclusions: USCs are common events resulting in missed school days for millions of students. Illness causes few USCs compared with weather and natural disasters. Few communities have experience with prolonged closures for illness. [ABSTRACT FROM AUTHOR]

Background School closure is a non-pharmaceutical intervention that was considered in many national pandemic plans developed prior to the start of the influenza A(H1N1)pdm09 pandemic, and received considerable attention during the event. Here, we retrospectively review and compare national and local experiences with school closures in several countries during the A(H1N1)pdm09 pandemic. Our intention is not to make a systematic review of country experiences; rather, it is to present the diversity of school closure experiences and provide examples from national and local perspectives. Methods Data were gathered during and following a meeting, organized by the European Centres for Disease Control, on school closures held in October 2010 in Stockholm, Sweden. A standard data collection form was developed and sent to all participants. The twelve participating countries and administrative regions (Bulgaria, China, France, Hong Kong Special Administrative Region (SAR), Italy, Japan, New Zealand, Serbia, South Africa, Thailand, United Kingdom, and United States) provided data. Results Our review highlights the very diverse national and local experiences on school closures during the A(H1N1)pdm09 pandemic. The processes including who was in charge of making recommendations and who was in charge of making the decision to close, the school-based control strategies, the extent of school closures, the public health tradition of responses and expectations on school closure varied greatly between countries. Our review also discusses the many challenges associated with the implementation of this intervention and makes recommendations for further practical work in this area. Conclusions The single most important factor to explain differences observed between countries may have been the different public health practises and public expectations concerning school closures and influenza in the selected countries. [ABSTRACT FROM AUTHOR]