Association of in-person vs virtual education with community COVID-19 case incidence following school reopenings in the first year of the COVID-19 pandemic.
Open accessAbstract
Importance: The variability in timing of middle and secondary school reopenings during the 2020 to 2021 school year in the US presents an opportunity to examine the associations of different approaches to in-person education with changes in community COVID-19 incidence. Early studies on this topic have reached mixed conclusions and may be biased by unmeasured confounders. Objective: To estimate the association of in-person vs virtual instruction for students at the sixth grade level or above with county-level COVID-19 incidence in the first year of the COVID-19 pandemic. Design, Setting, and Participants: This cohort study included matched pairs of counties resuming school programs with in-person vs virtual instruction, drawn from 229 US counties that contained a single public school district and with county populations exceeding 100 000 residents. Counties that contained 1 single public school district and reopened in-person schooling for students at the sixth grade level or above during the fall of 2020 were matched 1-to-1 with counties whose school district reopened with only virtual instruction, based on geographic proximity, population-level demographic factors, the resumption of school district-level fall sports activity, and baseline county COVID-19 incidence rates. Data were analyzed from November 2021 to November 2022. Exposures: In-person instruction for students at the sixth grade level or above resuming between August 1 and October 31, 2020. Main Outcomes and Measures: County-level daily COVID-19 incidence per 100 000 residents. Results: The inclusion criteria and subsequent matching algorithm led to the identification of 51 pairs of matched counties among 79 total unique counties. Exposed counties had a median (IQR) of 141 840 (81 441-241 910) residents each, and unexposed counties had a median (IQR) of 131 412 (89 011-278 666) residents each. County schools with in-person vs virtual instruction had similar daily COVID-19 case incidence within the first 4 weeks after in-person reopening, but counties with in-person instruction had higher daily incidence beyond 4 weeks. Daily case incidence per 100 000 residents among counties with in-person instruction, compared with counties with virtual instruction, was higher at 6 weeks (adjusted incidence rate ratio, 1.24 [95% CI, 1.00-1.55]) and at 8 weeks after (adjusted incidence rate ratio, 1.31 [95% CI, 1.06-1.62]). This outcome was also concentrated in counties where schools provided full rather than hybrid instructional models. Conclusions and Relevance: In a cohort study of matched pairs of counties that reopened with in-person vs virtual instruction at the secondary school level in the 2020 to 2021 academic year, counties with in-person school instructional models early in the COVID-19 pandemic experienced increases in county-level COVID-19 incidence at 6 and 8 weeks after in-person reopening, compared with counties with virtual instructional models.
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Evidence suggests that aggregate COVID-19 infection rates are lower in areas with more virtual instruction.
“Second, evidence suggests that aggregate COVID-19 infection rates are lower in areas with more virtual instruction.22”
From Virtual Learning in Kindergarten Through Grade 12 During the COVID-19 Pandemic and Chronic Absenteeism (2024) · cites this paper as [22]
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Richardson, S., Hirsch, J. S., Narasimhan, M., Crawford, J. M., McGinn, T., Davidson, K. W., and the Northwell COVID-19 Research Consortium, Barnaby, D. P., Becker, L. B., Chelico, J. D., et al. (2020) · JAMA · doi:10.1001/jama.2020.6775 · Cited by 9,254 · see citing works
National Center for Education Statistics
Carlson, C. L. (2008) · Encyclopedia of Educational Psychology · doi:10.4135/9781412963848.n192 · Cited by 4,546 · see citing works
Learning loss due to school closures during the COVID-19 pandemic
Engzell, P., Frey, A., & Verhagen, M. D. (2021) · Proceedings of the National Academy of Sciences · doi:10.1073/pnas.2022376118 · Cited by 1,848 · see citing works
Learning loss due to school closures during the COVID-19 pandemic
Engzell, P., Frey, A., & Verhagen, M. D. (2020) · doi:10.31235/osf.io/ve4z7 · Cited by 1,739 · see citing works
A New Framework and Software to Estimate Time-Varying Reproduction Numbers During Epidemics
Cori, A., Ferguson, N. M., Fraser, C., & Cauchemez, S. (2013) · American Journal of Epidemiology · doi:10.1093/aje/kwt133 · Cited by 1,530 · see citing works
Association Between Statewide School Closure and COVID-19 Incidence and Mortality in the US
Auger, K. A., Shah, S. S., Richardson, T., Hartley, D., Hall, M., Warniment, A., Timmons, K. M., Bosse, D., Ferris, S. A., Brady, P. W., et al. (2020) · JAMA · doi:10.1001/jama.2020.14348 · Cited by 464 · see citing works
Li, Y., Campbell, H. J., Kulkarni, D., Harpur, A., Nundy, M., Wang, X., & Nair, H. (2020) · The Lancet Infectious Diseases · doi:10.1016/s1473-3099(20)30785-4 · Cited by 428 · see citing works
Verlenden, J., Pampati, S., Rasberry, C. N., Liddon, N. C., Hertz, M. F., Kilmer, G., Viox, M. H., Lee, S., Cramer, N. K., Barrios, L. C., et al. (2021) · MMWR Morbidity and Mortality Weekly Report · doi:10.15585/mmwr.mm7011a1 · Cited by 179 · see citing works
Walsh, S., Chowdhury, A., Braithwaite, V., Russell, S., Birch, J. M., Ward, J., Waddington, C. S., Brayne, C., Bonell, C. P., Viner, R., et al. (2021) · BMJ Open · doi:10.1136/bmjopen-2021-053371 · Cited by 145 · see citing works
Remote or Removed: Predicting Successful Engagement with Online Learning during COVID-19
Domina, T., Renzulli, L. A., Murray, B., Garza, A. N., & Perez, L. (2021) · Socius Sociological Research for a Dynamic World · doi:10.1177/2378023120988200 · Cited by 143 · see citing works
Rubin, D. M., Huang, J. Y., Fisher, B. T., Gasparrini, A., Tam, V. W., Song, L., Wang, X., Kaufman, J., Fitzpatrick, K., Jain, A., et al. (2020) · JAMA Network Open · doi:10.1001/jamanetworkopen.2020.16099 · Cited by 136 · see citing works
Data and Policy to Guide Opening Schools Safely to Limit the Spread of SARS-CoV-2 Infection
Honein, M. A., Barrios, L. C., & Brooks, J. T. (2021) · JAMA · doi:10.1001/jama.2021.0374 · Cited by 110 · see citing works
Determinants of Ethnic Differences in School Modality Choices During the COVID-19 Crisis
Camp, A. M., & Zamarro, G. (2021) · Educational Researcher · doi:10.3102/0013189x211057562 · Cited by 76 · see citing works
The impact of school reopening on the spread of COVID-19 in England
Keeling, M. J., Tildesley, M. J., Atkins, B. D., Penman, B. S., Southall, E., Guyver‐Fletcher, G., Holmes, A., McKimm, H., Gorsich, E. E., Hill, E. M., et al. (2021) · Philosophical Transactions of the Royal Society B Biological Sciences · doi:10.1098/rstb.2020.0261 · Cited by 72 · see citing works
Budzyn, S. E., Panaggio, M. J., Parks, S. E., Papazian, M., Magid, J., Eng, M., & Barrios, L. C. (2021) · MMWR Morbidity and Mortality Weekly Report · doi:10.15585/mmwr.mm7039e3 · Cited by 71 · see citing works
Chernozhukov, V., Kasahara, H., & Schrimpf, P. (2021) · Proceedings of the National Academy of Sciences · doi:10.1073/pnas.2103420118 · Cited by 62 · see citing works
Roy, A. K., Breaux, R., Sciberras, E., Patel, P. R., Ferrara, E., Shroff, D. M., Cash, A. R., Dvorsky, M. R., Langberg, J. M., Quach, J., et al. (2022) · School Psychology · doi:10.1037/spq0000465 · Cited by 52 · see citing works
Atherstone, C., Siegel, M., Schmitt-Matzen, E. N., Sjoblom, S., Jackson, J., Blackmore, C., & Neatherlin, J. C. (2021) · MMWR Morbidity and Mortality Weekly Report · doi:10.15585/mmwr.mm7004e4 · Cited by 46 · see citing works
Theuring, S., Thielecke, M., van Loon, W., Hommes, F., Hülso, C., von der Haar, A., Körner, J., Schmidt, M., Böhringer, F., Mall, M. A., et al. (2021) · Eurosurveillance · doi:10.2807/1560-7917.es.2021.26.34.2100184 · Cited by 42 · see citing works
Huang, J. Y., Fisher, B. T., Tam, V. W., Wang, Z., Song, L., Shi, J., Rochelle, C. L., Wang, X., Morris, J. S., Coffin, S. E., et al. (2022) · Health Affairs · doi:10.1377/hlthaff.2021.01072 · Cited by 41 · see citing works
Operational Strategy for K-12 Schools through Phased Prevention
Control, C. F. D. (2021) · Cited by 29 · see citing works
Bosslet, G. T., Pollak, M., Jang, J. H., Roll, R. L., Sperling, M., & Khan, B. A. (2021) · Clinical Infectious Diseases · doi:10.1093/cid/ciab306 · Cited by 5 · see citing works
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Evans, W. N., Muchnick, K., & Rosenlund, O. (2024) · JAMA Network Open · doi:10.1001/jamanetworkopen.2024.29569 · Cited by 7 · see citing works
Renzi, E., Baccolini, V., Covelli, A., Siena, L. M., Sciurti, A., Migliara, G., Massimi, A., Marzuillo, C., Vito, C. D., Casini, L., et al. (2024) · PLoS ONE · doi:10.1371/journal.pone.0301215 · Cited by 3 · see citing works
Kile, S. (2025) · Chapman University Digital Commons (Chapman University) · doi:10.36837/chapman.000683
School opening associated with lower test-adjusted COVID-19 case rates in children
Chandra, A., & Høeg, T. B. (2025) · International Journal of Epidemiology · doi:10.1093/ije/dyaf113
School masking and COVID-19 community transmission: a synthetic control study
Luan, X., Fisher, B. T., Coffin, S. E., Rubin, D., Matone, M., & Huang, J. Y. (2025) · Health Affairs Scholar · doi:10.1093/haschl/qxaf233
- Authors
- Matone, M., Wang, X., Marshall, D., Huang, J., Worsley, D., Filograna, C., & Rubin, D.
- Affiliations
- Children's Hospital of Philadelphia (US)
- Merck & Co., Inc., Rahway, NJ, USA (United States) (US)
- Corresponding author
- Matone, Meredith
- Venue
- JAMA Network Open
- Publisher
- American Medical Association (AMA)
- Published
- 2023-04-14
- Volume
- 6
- Issue
- 4
- Pages
- e238300
- ISSN
- 2574-3805 (ISSN-L)
- PMC
- PMC10105309
- OpenAlex
- W4365478877
- Cited by
- 5
- References
- 21
- Citations by year
- 2025: 3 · 2024: 2
- FWCI
- 1.05
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- JAMA Network Open (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Funders
- Centers for Disease Control and Prevention (U01CK000674)
- Topics
- Physical Sciences › Mathematics › Modeling and Simulation › COVID-19 epidemiological studies
- Social Sciences › Education › Education during COVID-19 pandemic
- Health Sciences › Medicine › Infectious Diseases › SARS-CoV-2 and COVID-19 Research
- Keywords
- COVID-19 pandemic, school reopening, face-to-face teaching, virtual instruction, distance education, school closures, county-level incidence, 2020-2021 pandemic, United States counties, public school districts, COVID-19 mitigation measures
- MeSH terms
- COVID-19, Humans, Schools, Cohort Studies, Incidence, Pandemics
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