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Cited by 233COVID-19 epidemiological studiesEducation during COVID-19 pandemicSARS-CoV-2 and COVID-19 Research

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Household COVID-19 risk and in-person schooling

Open access
Lessler, Justin, Grabowski, M. Kate, Grantz, Kyra H., Badillo-Goicoechea, Elena, Metcalf, C. Jessica E., Lupton-Smith, Carly, Azman, Andrew S., Stuart, Elizabeth A.·2021·Science
DOI 10.1126/science.abh2939PMC PMC8168618

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Abstract

Back to school—safely: Severe COVID-19 in children is rare, but many schools remain closed because the transmission risk that school contact poses to adults and the wider community is unknown. Observing the heterogeneity of approaches taken among U.S. school districts, Lessler et al. investigated how different strategies influence COVID-19 transmission rates in the wider community using COVID-19 Symptom Survey data from Carnegie Mellon and Facebook. The authors found that when mitigation measures are in place, transmission within schools is limited and infection rates mirror that of the surrounding community. Science , abh2939, this issue p. 1092

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Figures

Fig. 1 Spatial distribution of survey responses. (A) Number of survey respondents reporting a school-aged student in the household by county. (B) Percentage of households with school-aged children reporting any in-person schooling by county, excluding counties with fewer than 10 responses (excluded counties are shown in dark gray). (C) Percentage of households reporting a child in in-person schooling who report full-time in-person schooling, excluding counties with fewer than 10 reporting in-person schooling. (D) Average number of school-based mitigation measures reported for children with in-person schooling, excluding counties with fewer than 10 reporting in-person schooling.
Fig. 1 Spatial distribution of survey responses. (A) Number of survey respondents reporting a school-aged student in the household by county. (B) Percentage of households with school-aged children reporting any in-person schooling by county, excluding counties with fewer than 10 responses (excluded counties are shown in dark gray). (C) Percentage of households reporting a child in in-person schooling who report full-time in-person schooling, excluding counties with fewer than 10 reporting in-person schooling. (D) Average number of school-based mitigation measures reported for children with in-person schooling, excluding counties with fewer than 10 reporting in-person schooling.CC BY · PubMed Central
Fig. 2 Risk from in-person schooling and distribution of mitigation measures by grade. (A) Odds ratio of COVID-19–related outcomes associated with full- and part-time in-person schooling by outcome and grade level compared with individuals with children in their household not attending in-person schooling and adjusted for individual- and county-level covariates (but not number of mitigation measures), which indicates that the strength of the association increases with grade level. K, kindergarten. (B) Distribution of mitigation measures by grade level and full- versus part-time in-person status across all grades. Test+, positive SARS-CoV-2 test result.
Fig. 2 Risk from in-person schooling and distribution of mitigation measures by grade. (A) Odds ratio of COVID-19–related outcomes associated with full- and part-time in-person schooling by outcome and grade level compared with individuals with children in their household not attending in-person schooling and adjusted for individual- and county-level covariates (but not number of mitigation measures), which indicates that the strength of the association increases with grade level. K, kindergarten. (B) Distribution of mitigation measures by grade level and full- versus part-time in-person status across all grades. Test+, positive SARS-CoV-2 test result.CC BY · PubMed Central
Fig. 3 Impact of individual mitigation measures. (A) Relationship between number of mitigation measures and percent reporting COVID-19–related outcomes using a log-linear (solid lines) and spline (dashed lines) model. (B) Odds ratio of COVID-19–related outcomes by mitigation measure in multivariable model including all measures versus the reduction resulting from a generic mitigation measure (dashed line).
Fig. 3 Impact of individual mitigation measures. (A) Relationship between number of mitigation measures and percent reporting COVID-19–related outcomes using a log-linear (solid lines) and spline (dashed lines) model. (B) Odds ratio of COVID-19–related outcomes by mitigation measure in multivariable model including all measures versus the reduction resulting from a generic mitigation measure (dashed line).CC BY · PubMed Central
Fig. 4 Risk of in-person schooling by strata of number of reported mitigation measures. (A) Estimated risk associated with full- and part-time in-person schooling by outcome and number of mitigation measures implemented, adjusted for individual- and county-level covariates. (B) Distribution of mitigation measures by total number of measures implemented.
Fig. 4 Risk of in-person schooling by strata of number of reported mitigation measures. (A) Estimated risk associated with full- and part-time in-person schooling by outcome and number of mitigation measures implemented, adjusted for individual- and county-level covariates. (B) Distribution of mitigation measures by total number of measures implemented.CC BY · PubMed Central
Fig. 5 Subgroup analysis of association between in-person schooling and COVID-19–related outcomes. (A to C) Estimated odds ratios (versus those in strata not reporting in-person schooling) of COVID-19–related outcomes from full-time (circles and dashed lines) and part-time (triangles and dotted lines) in-person schooling, when data are stratified by county population size and relation to metropolitan areas (metropolitan area, nonmetropolitan area, or adjacent to metropolitan area) (A); quintile of incidence [quintile 1 (Q1) is lowest and Q5 is highest] (B); and propensity to report in-person schooling (Q5, most likely to have in-person schooling; Q1, least likely) (C). Horizontal dashed and dotted lines show overall point estimates for full-time and part-time in-person instruction, respectively.
Fig. 5 Subgroup analysis of association between in-person schooling and COVID-19–related outcomes. (A to C) Estimated odds ratios (versus those in strata not reporting in-person schooling) of COVID-19–related outcomes from full-time (circles and dashed lines) and part-time (triangles and dotted lines) in-person schooling, when data are stratified by county population size and relation to metropolitan areas (metropolitan area, nonmetropolitan area, or adjacent to metropolitan area) (A); quintile of incidence [quintile 1 (Q1) is lowest and Q5 is highest] (B); and propensity to report in-person schooling (Q5, most likely to have in-person schooling; Q1, least likely) (C). Horizontal dashed and dotted lines show overall point estimates for full-time and part-time in-person instruction, respectively.CC BY · PubMed Central

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Metadata

Authors
Lessler, J., Grabowski, M. K., Grantz, K. H., Badillo-Goicoechea, E., Metcalf, C. J. E., Lupton-Smith, C., Azman, A. S., & Stuart, E. A.
Affiliations
  • Johns Hopkins University (US)
  • Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
  • Princeton University (US)
  • Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
  • University of Geneva (CH)
Corresponding author
Lessler, Justin
ORCID
Venue
Science
Publisher
American Association for the Advancement of Science (AAAS)
Published
2021-06-04
Volume
372
Issue
6546
Pages
1092-1097
ISSN
  • 0036-8075 (ISSN-L)
  • 1095-9203
DOI
10.1126/science.abh2939
PMC
PMC8168618
OpenAlex
W3157264684
Cited by
233
References
21
Citations by year
2026: 14 · 2025: 15 · 2024: 28 · 2023: 42 · 2022: 61 · 2021: 73
FWCI
19.72
Type
journal article
Language
en
Open access
Licence
Locations
  • Science (publishedVersion, cc-by)
  • medRxiv (acceptedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Archive ouverte UNIGE (University of Geneva) (submittedVersion, cc-by)
Funders
  • U.S. Department of Health and Human Services
  • Johns Hopkins University
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, in-person schooling, household transmission, symptom screening, extracurricular activities, teachers, occupational risk, SARS-CoV-2
MeSH terms
School Teachers, Physical Distancing, COVID-19, Adolescent, Child, Child, Preschool, Communicable Disease Control, Family Characteristics, Humans, Masks, Surveys and Questionnaires, Schools, Students, United States, Risk Assessment

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