COVID-19-Related School Closures, United States, July 27, 2020-June 30, 2022.

As part of a multiyear project that monitored illness-related school closures, we conducted systematic daily online searches during July 27, 2020-June 30, 2022, to identify public announcements of COVID-19-related school closures (COVID-SCs) in the United States lasting >1 day. We explored the temporospatial patterns of COVID-SCs and analyzed associations between COVID-SCs and national COVID-19 surveillance data. COVID-SCs reflected national surveillance data: correlation was highest between COVID-SCs and both new PCR test positivity (correlation coefficient [r] = 0.73, 95% CI 0.56-0.84) and new cases (r = 0.72, 95% CI 0.54-0.83) during 2020-21 and with hospitalization rates among all ages (r = 0.81, 95% CI 0.67-0.89) during 2021-22. The numbers of reactive COVID-SCs during 2020-21 and 2021-22 greatly exceeded previously observed numbers of illness-related reactive school closures in the United States, notably being nearly 5-fold greater than reactive closures observed during the 2009 influenza (H1N1) pandemic.

Cost effectiveness of preemptive school closures to mitigate pandemic influenza outbreaks of differing severity in the United States.

BACKGROUND: Nonpharmaceutical interventions (NPIs) may be considered as part of national pandemic preparedness as a first line defense against influenza pandemics. Preemptive school closures (PSCs) are an NPI reserved for severe pandemics and are highly effective in slowing influenza spread but have unintended consequences. METHODS: We used results of simulated PSC impacts for a 1957-like pandemic (i.e., an influenza pandemic with a high case fatality rate) to estimate population health impacts and quantify PSC costs at the national level using three geographical scales, four closure durations, and three dismissal decision criteria (i.e., the number of cases detected to trigger closures). At the Chicago regional level, we also used results from simulated 1957-like, 1968-like, and 2009-like pandemics. Our net estimated economic impacts resulted from educational productivity costs plus loss of income associated with providing childcare during closures after netting out productivity gains from averted influenza illness based on the number of cases and deaths for each mitigation strategy. RESULTS: For the 1957-like, national-level model, estimated net PSC costs and averted cases ranged from $7.5 billion (2016 USD) averting 14.5 million cases for two-week, community-level closures to $97 billion averting 47 million cases for 12-week, county-level closures. We found that 2-week school-by-school PSCs had the lowest cost per discounted life-year gained compared to county-wide or school district-wide closures for both the national and Chicago regional-level analyses of all pandemics. The feasibility of spatiotemporally precise triggering is questionable for most locales. Theoretically, this would be an attractive early option to allow more time to assess transmissibility and severity of a novel influenza virus. However, we also found that county-wide PSCs of longer durations (8 to 12 weeks) could avert the most cases (31-47 million) and deaths (105,000-156,000); however, the net cost would be considerably greater ($88-$103 billion net of averted illness costs) for the national-level, 1957-like analysis. CONCLUSIONS: We found that the net costs per death averted ($180,000-$4.2 million) for the national-level, 1957-like scenarios were generally less than the range of values recommended for regulatory impact analyses ($4.6 to 15.0 million). This suggests that the economic benefits of national-level PSC strategies could exceed the costs of these interventions during future pandemics with highly transmissible strains with high case fatality rates. In contrast, the PSC outcomes for regional models of the 1968-like and 2009-like pandemics were less likely to be cost effective; more targeted and shorter duration closures would be recommended for these pandemics.

Systematic review of empiric studies on lockdowns, workplace closures, and other non-pharmaceutical interventions in non-healthcare workplaces during the initial year of the COVID-19 pandemic: benefits and selected unintended consequences.

BACKGROUND: We conducted a systematic review aimed to evaluate the effects of non-pharmaceutical interventions within non-healthcare workplaces and community-level workplace closures and lockdowns on COVID-19 morbidity and mortality, selected mental disorders, and employment outcomes in workers or the general population. METHODS: The inclusion criteria included randomized controlled trials and non-randomized studies of interventions. The exclusion criteria included modeling studies. Electronic searches were conducted using MEDLINE, Embase, and other databases from January 1, 2020, through May 11, 2021. Risk of bias was assessed using the Risk of Bias in Non-Randomized Studies of Interventions (ROBINS-I) tool. Meta-analysis and sign tests were performed. RESULTS: A total of 60 observational studies met the inclusion criteria. There were 40 studies on COVID-19 outcomes, 15 on anxiety and depression symptoms, and five on unemployment and labor force participation. There was a paucity of studies on physical distancing, physical barriers, and symptom and temperature screening within workplaces. The sign test indicated that lockdown reduced COVID-19 incidence or case growth rate (23 studies, p < 0.001), reproduction number (11 studies, p < 0.001), and COVID-19 mortality or death growth rate (seven studies, p < 0.05) in the general population. Lockdown did not have any effect on anxiety symptoms (pooled standardized mean difference = -0.02, 95% CI: -0.06, 0.02). Lockdown had a small effect on increasing depression symptoms (pooled standardized mean difference = 0.16, 95% CI: 0.10, 0.21), but publication bias could account for the observed effect. Lockdown increased unemployment (pooled mean difference = 4.48 percentage points, 95% CI: 1.79, 7.17) and decreased labor force participation (pooled mean difference = -2.46 percentage points, 95% CI: -3.16, -1.77). The risk of bias for most of the studies on COVID-19 or employment outcomes was moderate or serious. The risk of bias for the studies on anxiety or depression symptoms was serious or critical. CONCLUSIONS: Empiric studies indicated that lockdown reduced the impact of COVID-19, but that it had notable unwanted effects. There is a pronounced paucity of studies on the effect of interventions within still-open workplaces. It is important for countries that implement lockdown in future pandemics to consider strategies to mitigate these unintended consequences. SYSTEMATIC REVIEW REGISTRATION: PROSPERO registration # CRD42020182660.

Community mitigation strategies for coronavirus disease 2019: An assessment of knowledge and adherence amongst residents of Benin City, Edo State, Nigeria.

BACKGROUND: In the absence of effective vaccines and definitive treatment, non-pharmaceutical interventions, also known as community mitigation strategies (CMS), are needed to reduce the transmission of respiratory virus infections such as coronavirus disease 2019 (COVID-19). However, the effectiveness of these strategies depends on a knowledgeable population cooperating and adhering strictly to recommended strategies. OBJECTIVE: The objective of the study was to determine the knowledge and adherence to CMS against COVID-19 in Benin City, the capital of Edo State, Nigeria. MATERIALS AND METHODS: A descriptive cross-sectional study was conducted amongst adult residents in Benin City using a self-administered questionnaire for data collection. Eighteen questions addressed knowledge of CMS, while adherence was assessed using 14 questions on a graded scale. Each correct answer was scored giving maximum and minimum scores of 18 and 0 for knowledge and 28 and 0 for adherence, respectively. Scores were converted to percentages with scores 70% and above adjudged as good knowledge of CMS and scores 50% and above adjudged as good adherence to CMS. Data were analysed with IBM SPSS version 25.0 software. The level of significance was set at P < 0.05. RESULTS: The mean age (standard deviation) of 577 respondents who participated in the study was 32.5 ± 11.7 years. Overall, 532 (92.2%) respondents had good knowledge, while only 165 (28.6%) demonstrated good compliance with CMS against COVID-19. Christianity was a statistically significant predictor of knowledge of CMS. Income was found to be a significant predictor of adherence to CMS amongst respondents. CONCLUSION: Respondents demonstrated good knowledge but poor adherence with CMS against COVID-19 in Benin City, Edo State. Behaviour change communication is advocated to ensure that mitigation strategies are effective.

Effectiveness of workplace social distancing measures in reducing influenza transmission: a systematic review.

BACKGROUND: Social distancing is one of the community mitigation measures that may be recommended during influenza pandemics. Social distancing can reduce virus transmission by increasing physical distance or reducing frequency of congregation in socially dense community settings, such as schools or workplaces. We conducted a systematic review to assess the evidence that social distancing in non-healthcare workplaces reduces or slows influenza transmission. METHODS: Electronic searches were conducted using MEDLINE, Embase, Scopus, Cochrane Library, PsycINFO, CINAHL, NIOSHTIC-2, and EconLit to identify studies published in English from January 1, 2000, through May 3, 2017. Data extraction was done by two reviewers independently. A narrative synthesis was performed. RESULTS: Fifteen studies, representing 12 modeling and three epidemiological, met the eligibility criteria. The epidemiological studies showed that social distancing was associated with a reduction in influenza-like illness and seroconversion to 2009 influenza A (H1N1). However, the overall risk of bias in the epidemiological studies was serious. The modeling studies estimated that workplace social distancing measures alone produced a median reduction of 23% in the cumulative influenza attack rate in the general population. It also delayed and reduced the peak influenza attack rate. The reduction in the cumulative attack rate was more pronounced when workplace social distancing was combined with other nonpharmaceutical or pharmaceutical interventions. However, the effectiveness was estimated to decline with higher basic reproduction number values, delayed triggering of workplace social distancing, or lower compliance. CONCLUSIONS: Modeling studies support social distancing in non-healthcare workplaces, but there is a paucity of well-designed epidemiological studies. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO registration # CRD42017065310.

School closures due to seasonal influenza: a prospective data collection-based study of eleven influenza seasons-United States, 2011-2022.

Background: While numerous studies explore pandemic-associated school closures, literature is scant regarding seasonal influenza-associated closures. We previously reported summaries on COVID-19 pandemic-related school closures in the United States (US), which affected virtually all schools in the nation. The current prospective study aims to address the knowledge gap for seasonal influenza-related closures in the United States. Methods: We conducted systematic daily online searches from August 1, 2011 to June 30, 2022, to identify public announcements of unplanned school closures in the US lasting ≥1 day, selecting those that mentioned influenza and influenza-like illness (ILI) as reason for school closure (ILI-SCs). We studied ILI-SC temporal patterns and compared them with reported outpatient ILI-related healthcare visits. Findings: We documented that ILI-SCs occurred annually, with yearly totals ranging from 11 ILI-SCs in both the 2013-2014 and 2020-2021 school years to 2886 ILI-SCs in the 2019-2020 school year among more than 100,000 kindergarten through twelfth grade schools in the US. ILI-SCs occurred concurrently with widespread illness and the strongest correlations were observed during influenza A (H3N2)-dominant seasons, most notably in the 2016-2017 (Spearman rank correlation (rs) = 0.83) and the 2017-2018 (rs = 0.84) school years. ILI-SCs were heavily centered in U.S. Department of Health and Human Services Region 4 (states of Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, and Tennessee) [60% (6040/9166, Region 4/Total school closures)] and disproportionately impacted rural and lower-income communities. Interpretation: Outside of a pandemic, disease-related school closures are extreme and generally rare events for US schools and communities. Timely compilation of publicly available ILI-SC announcements could enhance influenza surveillance, particularly in severe influenza seasons or pandemics when ILI-SCs are prevalent. Funding: This work was supported by the U.S. Centers for Disease Control and Prevention. Co-authors (NZ, YZ, HG, AU) were or are US CDC employees, and FJ was a contractor through Cherokee Nation Operational Solutions, LLC, which supported FJ's salary, but had no additional role in the study.

Effect of winter school breaks on influenza-like illness, Argentina, 2005-2008.

School closures are used to reduce seasonal and pandemic influenza transmission, yet evidence of their effectiveness is sparse. In Argentina, annual winter school breaks occur during the influenza season, providing an opportunity to study this intervention. We used 2005-2008 national weekly surveillance data of visits to a health care provider for influenza-like illness (ILI) from all provinces. Using Serfling-specified Poisson regressions and population-based census denominators, we developed incidence rate ratios (IRRs) for the 3 weeks before, 2 weeks during, and 3 weeks after the break. For persons 5-64 years of age, IRRs were <1 for at least 1 week after the break. Observed rates returned to expected by the third week after the break; overall decrease among persons of all ages was 14%. The largest decrease was among children 5-14 years of age during the week after the break (37% lower IRR). Among adults, effects were weaker and delayed. Two-week winter school breaks significantly decreased visits to a health care provider for ILI among school-aged children and nonelderly adults.

Community Mitigation of COVID-19 and Portrayal of Testing on TikTok: Descriptive Study.

BACKGROUND: COVID-19 testing remains an essential element of a comprehensive strategy for community mitigation. Social media is a popular source of information about health, including COVID-19 and testing information. One of the most popular communication channels used by adolescents and young adults who search for health information is TikTok-an emerging social media platform. OBJECTIVE: The purpose of this study was to describe TikTok videos related to COVID-19 testing. METHODS: The hashtag #covidtesting was searched, and the first 100 videos were included in the study sample. At the time the sample was drawn, these 100 videos garnered more than 50% of the views for all videos cataloged under the hashtag #covidtesting. The content characteristics that were coded included mentions, displays, or suggestions of anxiety, COVID-19 symptoms, quarantine, types of tests, results of test, and disgust/unpleasantness. Additional data that were coded included the number and percentage of views, likes, and comments and the use of music, dance, and humor. RESULTS: The 100 videos garnered more than 103 million views; 111,000 comments; and over 12.8 million likes. Even though only 44 videos mentioned or suggested disgust/unpleasantness and 44 mentioned or suggested anxiety, those that portrayed tests as disgusting/unpleasant garnered over 70% of the total cumulative number of views (73,479,400/103,071,900, 71.29%) and likes (9,354,691/12,872,505, 72.67%), and those that mentioned or suggested anxiety attracted about 60% of the total cumulative number of views (61,423,500/103,071,900, 59.59%) and more than 8 million likes (8,339,598/12,872,505, 64.79%). Independent one-tailed t tests (α=.05) revealed that videos that mentioned or suggested that COVID-19 testing was disgusting/unpleasant were associated with receiving a higher number of views and likes. CONCLUSIONS: Our finding of an association between TikTok videos that mentioned or suggested that COVID-19 tests were disgusting/unpleasant and these videos' propensity to garner views and likes is of concern. There is a need for public health agencies to recognize and address connotations of COVID-19 testing on social media.

Social approaches to COVID-19 pandemic response: effectiveness and practicality in sub-Saharan Africa.

INTRODUCTION: the threat of the coronavirus disease 2019 (COVID-19) pandemic to health systems and communities in sub-Saharan Africa (SSA) is enormous. Social approaches such as distancing measures are essential components of the public health response to respiratory-related infectious disease outbreaks. Due to socio-economic and broader peculiarities of SSA countries, social approaches that were effective elsewhere may have limited practicality in these contexts, and if practical; may yield different or even adverse results. We highlighted the effectiveness of these social approaches and their practicality in SSA. METHODS: we conducted a comprehensive literature search through multiple databases, to identify articles relevant to social distancing. Findings were thematically summarized. RESULTS: our review found emerging and varying empirical evidence on the effectiveness of social approaches in the control and mitigation of the COVID-19 pandemic; thus, limiting its applicability in SSA contexts. Nonetheless, our review demonstrates that the effectiveness and practicality of social approaches in SSA contexts will depend on available resources; timing, duration, and intensity of the intervention; and compliance. Weak political coordination, anti-science sentiments, distrust of political leaders and limited implementation of legal frameworks can also affect practicality. CONCLUSION: to overcome these challenges, tailoring and adaptation of these measures to different but unique contexts for maximum effectiveness, and investment in social insurance mechanisms, are vital.

COVID-19 and Bangladesh: Challenges and How to Address Them.

As the coronavirus outbreak quickly surges worldwide, many countries are adopting non-therapeutic preventive measures, which include travel bans, remote office activities, country lockdown, and most importantly, social distancing. However, these measures face challenges in Bangladesh, a lower-middle-income economy with one of the world's densest populations. Social distancing is difficult in many areas of the country, and with the minimal resources the country has, it would be extremely challenging to implement the mitigation measures. Mobile sanitization facilities and temporary quarantine sites and healthcare facilities could help mitigate the impact of the pandemic at a local level. A prompt, supportive, and empathic collaboration between the Government, citizens, and health experts, along with international assistance, can enable the country to minimize the impact of the pandemic.