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Comparative Study
. 2021 Mar 1;4(3):e213793.
doi: 10.1001/jamanetworkopen.2021.3793.

Simulation-Based Estimation of SARS-CoV-2 Infections Associated With School Closures and Community-Based Nonpharmaceutical Interventions in Ontario, Canada

David Naimark  1   2   3   4   5 , Sharmistha Mishra  1   4   5   6   7 , Kali Barrett  1   2   8 , Yasin A Khan  1   2   8 , Stephen Mac  1   2 , Raphael Ximenes  2   6   9 , Beate Sander  1   2   5   8   10   11
Affiliations
Comparative Study

Simulation-Based Estimation of SARS-CoV-2 Infections Associated With School Closures and Community-Based Nonpharmaceutical Interventions in Ontario, Canada

David Naimark et al. JAMA Netw Open. .

Abstract

Importance: Resurgent COVID-19 cases have resulted in the reinstitution of nonpharmaceutical interventions, including school closures, which can have adverse effects on families. Understanding the associations of school closures with the number of incident and cumulative COVID-19 cases is critical for decision-making.

Objective: To estimate the association of schools being open or closed with the number of COVID-19 cases compared with community-based nonpharmaceutical interventions.

Design, setting, and participants: This decision analytical modelling study developed an agent-based transmission model using a synthetic population of 1 000 000 individuals based on the characteristics of the population of Ontario, Canada. Members of the synthetic population were clustered into households, neighborhoods, or rural districts, cities or rural regions, day care facilities, classrooms (ie, primary, elementary, or high school), colleges or universities, and workplaces. Data were analyzed between May 5, 2020, and October 20, 2020.

Exposures: School reopening on September 15, 2020, vs schools remaining closed under different scenarios for nonpharmaceutical interventions.

Main outcomes and measures: Incident and cumulative COVID-19 cases between September 1, 2020, and October 31, 2020.

Results: Among 1 000 000 simulated individuals, the percentage of infections among students and teachers acquired within schools was less than 5% across modeled scenarios. Incident COVID-19 case numbers on October 31, 2020, were 4414 (95% credible interval [CrI], 3491-5382) cases in the scenario with schools remaining closed and 4740 (95% CrI, 3863-5691) cases in the scenario for schools reopening, with no other community-based nonpharmaceutical intervention. In scenarios with community-based nonpharmaceutical interventions implemented, the incident case numbers on October 31 were 714 (95% CrI, 568-908) cases for schools remaining closed and 780 (95% CrI, 580-993) cases for schools reopening. When scenarios applied the case numbers observed in early October in Ontario, the cumulative case numbers were 777 (95% CrI, 621-993) cases for schools remaining closed and 803 (95% CrI, 617-990) cases for schools reopening. In scenarios with implementation of community-based interventions vs no community-based interventions, there was a mean difference of 39 355 cumulative COVID-19 cases by October 31, 2020, while keeping schools closed vs reopening them yielded a mean difference of 2040 cases.

Conclusions and relevance: This decision analytical modeling study of a synthetic population of individuals in Ontario, Canada, found that most COVID-19 cases in schools were due to acquisition in the community rather than transmission within schools and that the changes in COVID-19 case numbers associated with school reopenings were relatively small compared with the changes associated with community-based nonpharmaceutical interventions.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Barrett reported receiving personal fees from Xenios outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Mean of 100 Model Repetitions for Scenarios in Which Schools Reopened or Remained Closed on September 15, 2020
Modeled counts subjected to Gaussian kernel smoothing with a bandwidth of 2 days. Scenario 1 indicates no public health interventions restricting contacts or reducing the probability of transmission of COVID-19 between contacts implemented (ie, if the trends in the rise of new cases in September had been allowed to persist through October); scenario 2, implementation of public health interventions restricting contacts and reducing the probability of transmission of COVID-19 between contacts implemented (ie, if the trends in the increase of new cases in September had not been allowed to persist through October); scenario 3, the slowing of the rate of growth of cases observed from October 1 to 15, 2020, to 0.8% per day, persisted until October 31, 2020.
Figure 2.
Figure 2.. Comparison of Model Simulations for the Estimated Cumulative Number of COVID-19 Cases in Ontario Between September 1 and October 31, 2020, Among 6 Modeled Scenarios
Modeled counts subjected to Gaussian kernel smoothing with a bandwidth of 2 days.
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