The impact of school closure intervention during the third wave of the COVID-19 pandemic in Italy: Evidence from the Milan area

Abstract

Background: In February 2021, the spread of a new variant of SARS-CoV-2 in the Lombardy Region, Italy caused concerns about school-aged children as a source of contagion, leading local authorities to adopt an extraordinary school closure measure. This generated a debate about the usefulness of such an intervention in light of the trade-off between its related benefits and costs (e.g. delays in educational attainment, impact on children and families' psycho-physical well-being). This article analyses the epidemiological impact of the school closure intervention in the Milan metropolitan area.

Methods: Data from the Agency for Health Protection of the Metropolitan City of Milan allowed analysing the trend of contagion in different age classes before and after the intervention, adopting an interrupted times series design, providing a quasi-experimental counterfactual scenario. Segmented Poisson regression models of daily incident cases were performed separately for the 3-11-year-old, the 12-19-year-old, and the 20+-year-old age groups, examining the change in the contagion curves after the intervention, adjusting for time-varying confounders. Kaplan-Meier survival curves and Cox regression were used to assess the equality of survival curves in the three age groups before and after the intervention.

Results: Net of time-varying confounders, the intervention produced a daily reduction of the risk of contagion by 4% in those aged 3-11 and 12-19 (IRR = 0·96) and by 3% in those aged 20 or more (IRR = 0·97). More importantly, there were differences in the temporal order of contagion decrease between the age groups, with the epidemic curve lowering first in the school-aged children directly affected by the intervention, and only subsequently in the adult population, which presumably indirectly benefitted from the reduction of contagion among children.

Conclusion: Though it was not possible to completely discern the effect of school closures from concurrent policy measures, a substantial decrease in the contagion curves was clearly detected after the intervention. The extent to which the slowdown of infections counterbalanced the social costs of the policy remains unclear.

Fig 1. Scatter plot and fractional polynomial line (degree = 2) with 95% confidence intervals of daily incident COVID-19 cases in the ATS territory (without Bollate) in individuals aged 3–11, 12–19, and 20+ years old or more.

Fig 2. Interrupted time series of daily incident COVID-19 cases in the ATS territory (without Bollate) in individuals aged 3–11, 12–19, and 20+ years old or more.

Solid line: predicted trend based on the covariate-adjusted segmented Poisson regression model. Dashed line: unadjusted trend.

Fig 3. Kaplan-Meier survival curves of daily incident COVID-19 cases in the three age groups.