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. 2020 Dec 17;12(12):CD013812.
doi: 10.1002/14651858.CD013812.

Measures implemented in the school setting to contain the COVID-19 pandemic: a scoping review

Shari Krishnaratne  1   2   3 , Lisa M Pfadenhauer  1   2 , Michaela Coenen  1   2 , Karin Geffert  1   2 , Caroline Jung-Sievers  1   2 , Carmen Klinger  1   2 , Suzie Kratzer  1   2 , Hannah Littlecott  1   2   4 , Ani Movsisyan  1   2 , Julia E Rabe  1   2 , Eva Rehfuess  1   2 , Kerstin Sell  1   2 , Brigitte Strahwald  1   2 , Jan M Stratil  1   2 , Stephan Voss  1   2 , Katharina Wabnitz  1   2 , Jacob Burns  1   2
Affiliations

Measures implemented in the school setting to contain the COVID-19 pandemic: a scoping review

Shari Krishnaratne et al. Cochrane Database Syst Rev. .

Abstract

Background: In response to the spread of SARS-CoV-2 and the impact of COVID-19, national and subnational governments implemented a variety of measures in order to control the spread of the virus and the associated disease. While these measures were imposed with the intention of controlling the pandemic, they were also associated with severe psychosocial, societal, and economic implications on a societal level. One setting affected heavily by these measures is the school setting. By mid-April 2020, 192 countries had closed schools, affecting more than 90% of the world's student population. In consideration of the adverse consequences of school closures, many countries around the world reopened their schools in the months after the initial closures. To safely reopen schools and keep them open, governments implemented a broad range of measures. The evidence with regards to these measures, however, is heterogeneous, with a multitude of study designs, populations, settings, interventions and outcomes being assessed. To make sense of this heterogeneity, we conducted a rapid scoping review (8 October to 5 November 2020). This rapid scoping review is intended to serve as a precursor to a systematic review of effectiveness, which will inform guidelines issued by the World Health Organization (WHO). This review is reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist and was registered with the Open Science Framework.

Objectives: To identify and comprehensively map the evidence assessing the impacts of measures implemented in the school setting to reopen schools, or keep schools open, or both, during the SARS-CoV-2/COVID-19 pandemic, with particular focus on the types of measures implemented in different school settings, the outcomes used to measure their impacts and the study types used to assess these.

Search methods: We searched the Cochrane COVID-19 Study Register, MEDLINE, Embase, the CDC COVID-19 Research Articles Downloadable Database for preprints, and the WHO COVID-19 Global literature on coronavirus disease on 8 October 2020.

Selection criteria: We included studies that assessed the impact of measures implemented in the school setting. Eligible populations were populations at risk of becoming infected with SARS-CoV-2, or developing COVID-19 disease, or both, and included people both directly and indirectly impacted by interventions, including students, teachers, other school staff, and contacts of these groups, as well as the broader community. We considered all types of empirical studies, which quantitatively assessed impact including epidemiological studies, modelling studies, mixed-methods studies, and diagnostic studies that assessed the impact of relevant interventions beyond diagnostic test accuracy. Broad outcome categories of interest included infectious disease transmission-related outcomes, other harmful or beneficial health-related outcomes, and societal, economic, and ecological implications.

Data collection and analysis: We extracted data from included studies in a standardized manner, and mapped them to categories within our a priori logic model where possible. Where not possible, we inductively developed new categories. In line with standard expectations for scoping reviews, the review provides an overview of the existing evidence regardless of methodological quality or risk of bias, and was not designed to synthesize effectiveness data, assess risk of bias, or characterize strength of evidence (GRADE).

Main results: We included 42 studies that assessed measures implemented in the school setting. The majority of studies used mathematical modelling designs (n = 31), while nine studies used observational designs, and two studies used experimental or quasi-experimental designs. Studies conducted in real-world contexts or using real data focused on the WHO European region (EUR; n = 20), the WHO region of the Americas (AMR; n = 13), the West Pacific region (WPR; n = 6), and the WHO Eastern Mediterranean Region (EMR; n = 1). One study conducted a global assessment and one did not report on data from, or that were applicable to, a specific country. Three broad intervention categories emerged from the included studies: organizational measures to reduce transmission of SARS-CoV-2 (n = 36), structural/environmental measures to reduce transmission of SARS-CoV-2 (n = 11), and surveillance and response measures to detect SARS-CoV-2 infections (n = 19). Most studies assessed SARS-CoV-2 transmission-related outcomes (n = 29), while others assessed healthcare utilization (n = 8), other health outcomes (n = 3), and societal, economic, and ecological outcomes (n = 5). Studies assessed both harmful and beneficial outcomes across all outcome categories.

Authors' conclusions: We identified a heterogeneous and complex evidence base of measures implemented in the school setting. This review is an important first step in understanding the available evidence and will inform the development of rapid reviews on this topic.

PubMed Disclaimer

Conflict of interest statement

All authors (ShK, LMP, MC, KG, CJS, CK, SK, HL, AM, JR, ER, KS, BS, JMS, SV, KW, JB) declare being part of the scientific secretariat that supports the development of a living interdisciplinary, evidence‐based and consensus‐based guideline on measures to prevent and control SARS‐CoV‐2 transmission in schools, recently registered with the Association of the Scientific Medical Societies (AWMF) in Germany (www.awmf.org/en/clinical-practice-guidelines/detail/anmeldung/1/ll/027-076.html).

CJS, MC and ER are involved in the conduct of an ongoing study that, after completion, is likely to be eligible for inclusion in the review (COVID Kids Bavaria, funded by the State of Bavaria, Germany).

ER is a member of the scientific advisory board of the Bavarian Health and Food Safety Authority that has issued guidance on schooling during COVID‐19, but has not been involved with developing this guidance. She is a member of the WHO Regional Office for Europe's Technical Advisory Group on Schooling during COVID‐19 and, in this role, is involved with advising the WHO Regional Office for Europe on the issue.

Figures

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The system‐based logic model visualizes our a priori conceptualization of measures implemented in the school setting, following the PICO (population, intervention, comparison and outcome) scheme. The impact of measures implemented in the school setting is also dependent on measures implemented in the wider community (e.g. mask regulations) or on a national level (e.g. travel bans)
2
2
The review flowchart showing an overview of our searching and screening procedures
3
3
The system‐based logic model, an updated version of the a priori logic model, visualizes our posteriori conceptualization of measures implemented in the school setting, following the PICO (population, intervention, comparison and outcome) scheme. The impact of measures implemented in the school setting is also dependent on measures implemented in the wider community (e.g. mask regulations) or on a national level (e.g. travel bans)
4
4
Evidence gap map in which each square represents the case in which a single included study evaluated a type of school measure (rows) against an outcome category (columns); additionally, the study type is provided (colour).
5
5
The geographical distribution of where studies occurred or from where data were drawn, categorized using the WHO world region categorization. Abbreviations: AFRO: African Region; EMRO: Eastern Mediterranean Region; EURO: European Region; PAHO: Region of the Americas; SEARO: South‐East Asian Region; WPRO: Western Pacific Region. Note: total number of studies included is 42; one study conducted a global assessment (Buonsenso 2020); one study did not report on a country from which data were use to validate the model or to which the findings are applicable (Keeling 2020)
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References

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