Shutting schools during COVID-19 lockdowns might have helped reduce transmission of SARS-CoV-2 but the measure also hurt children's education, health, and wellbeing, a study of international evidence concluded.
Researchers at the University of Oxford conducted a systematic overview of reviews to assess the benefits and drawbacks of school closures and in-school mitigations during the pandemic. The study, published in BMJ Evidence-Based Medicine, found that school closures were associated with reduced COVID transmission, morbidity, and mortality in the community but came at the cost of reduced learning and increased anxiety and obesity among schoolchildren affected. However, they found that the overall quality of evidence was weak, particularly with regard to the impact that in-school mitigations, such as mask wearing, might have had on transmission of the SARS-CoV-2 virus or on children's health, wellbeing, and learning.
Researchers at the Nuffield Department of Primary Care Health Sciences initially identified 578 reports for possible analysis, but those were whittled down to 26 systematic reviews that answered at least 1 of 4 specific questions about the efficacy and drawbacks of school closures for pupils aged 5-18.
The authors looked at the quality of the systematic reviews and made a formal evaluation of the evidence base. One of the systematic reviews was classed as being of 'high' quality, none were 'moderate', 10 were 'low', and 15 were categorised as of 'critically low' quality.
Reduced Transmission was Accompanied by Harms to Schoolchildren
Senior author, Kamal Mahtani, a GP and professor of evidence-based healthcare at the Nuffield, said: "Our comprehensive review, which systematically included over 132 unique studies, highlights some of the global impacts of COVID-19 related school closures. While there may be some association with reduced community transmission, there is also notable associations of harm, including worsening physical and mental health, loss of learning, and increased domestic violence."
The authors highlighted specific difficulties with the data available to assess. For instance, many of the studies of school closures they analysed were carried out under different circumstances and throughout different waves of COVID-19, including pre- and post-vaccination campaigns). Also, different countries approached mitigation measures in different ways, making it difficult to unpick the specific effects of school closures on COVID transmission, illness, and death in wider society with high certainty. There were no studies assessing the effects of in-school mitigations, such as masking or social distancing, they added.
However, the authors concluded that "our findings suggest that the benefits of school closures in reducing community transmission of COVID-19 should be considered in the context of the harms on children’s education, health and well-being" and that the analysis "may inform future planning for school closures during pandemic outbreaks". Prof Mahtani said: "Healthcare leaders must deeply consider the balance of benefits and harms when implementing future policies on behalf of such a vulnerable part of our society."
This study received no project-specific funding. KRM has received funding from the NIHR SPCR Evidence Synthesis Working Group. The authors declared no conflicts of interest.