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2.
J Infect Chemother ; 27(1): 62-64, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32896479

RESUMO

BACKGROUND: As countermeasures against the COVID-19 outbreak, sports and entertainment events were canceled (VEC) in Japan for two weeks from 26 February through 13 March. Moreover, most schools were closed (SC). OBJECTIVE: For this study, we estimated the basic reproduction number (R0) and SC and VEC effects. METHOD: After constructing a susceptible-infected-recovered model with three age classes, we used data of symptomatic patients in Japan for 14 January through 24 March. The SC and VEC effects were incorporated into the model through changes in contact patterns and contact frequencies among age classes. RESULTS: Results suggest R0 as 2.56, with 95% CI of [2.51, 2.96] before SC and VEC. The respective effects of SC and VEC were estimated as 0.4 (95% CI [0.3, 0.5]) and 0.5 (95% CI [0.3, 0.7]). CONCLUSION: The estimated R0 is similar to those found from other studies of China and Japan. Significant reduction of contact frequency has been achieved by SC and VEC. Nevertheless, its magnitude was insufficient to contain the outbreak.


Assuntos
Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Surtos de Doenças/prevenção & controle , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Instituições Acadêmicas/organização & administração , Adulto , Idoso , Número Básico de Reprodução , Betacoronavirus , Criança , Surtos de Doenças/estatística & dados numéricos , Humanos , Japão/epidemiologia , Modelos Estatísticos
3.
Cochrane Database Syst Rev ; 12: CD013812, 2020 12 17.
Artigo em Inglês | MEDLINE | ID: mdl-33331665

RESUMO

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.


Assuntos
/epidemiologia , Pandemias/prevenção & controle , Instituições Acadêmicas/organização & administração , Pessoal Administrativo , Humanos , Professores Escolares , Estudantes
4.
J Prim Care Community Health ; 11: 2150132720967503, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33146062

RESUMO

Teachers are vulnerable non-essential workers that continue to have significant misgivings about in-person school reopening. Dialogue around pandemic management has relatively neglected these concerns so far. This perspective offers a broad framework for risk assessment related to COVID-19 and in-person instruction. The accumulated general body of knowledge related to COVID-19 is particularized to the special dynamics of education. We highlight the impact of historic investments and underinvestment in education on the viability of adapting best practices to mitigate risk. Gaps in public health planning to supply educators with needed personal protective equipment and vaccination are explored. The challenges for low-income and minority-predominant districts receive special attention. We place these problems within the broader context of socioeconomic disparities and the societal consequences of the pandemic. The local level of community transmission, resources, and circumstances should dictate reopening dates. Without effective infection control, teachers are justified to fear infection. The transparency and scientific rigor that would allow teachers to assess their personal health risk and characterize the process for decision-making has been largely absent.


Assuntos
Infecções por Coronavirus/prevenção & controle , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Professores Escolares/psicologia , Instituições Acadêmicas/organização & administração , Infecções por Coronavirus/epidemiologia , Medo , Humanos , Pneumonia Viral/epidemiologia , Medição de Risco , Professores Escolares/estatística & dados numéricos , Estados Unidos/epidemiologia
5.
BMC Public Health ; 20(1): 1713, 2020 Nov 16.
Artigo em Inglês | MEDLINE | ID: mdl-33198707

RESUMO

BACKGROUND: Mathematical modeling studies have suggested that pre-emptive school closures alone have little overall impact on SARS-CoV-2 transmission, but reopening schools in the background of community contact reduction presents a unique scenario that has not been fully assessed. METHODS: We adapted a previously published model using contact information from Shanghai to model school reopening under various conditions. We investigated different strategies by combining the contact patterns observed between different age groups during both baseline and "lockdown" periods. We also tested the robustness of our strategy to the assumption of lower susceptibility to infection in children under age 15 years. RESULTS: We find that reopening schools for all children would maintain a post-intervention R0 < 1 up to a baseline R0 of approximately 3.3 provided that daily contacts among children 10-19 years are reduced to 33% of baseline. This finding was robust to various estimates of susceptibility to infection in children relative to adults (up to 50%) and to estimates of various levels of concomitant reopening in the rest of the community (up to 40%). However, full school reopening without any degree of contact reduction in the school setting returned R0 virtually back to baseline, highlighting the importance of mitigation measures. CONCLUSIONS: These results, based on contact structure data from Shanghai, suggest that schools can reopen with proper precautions during conditions of extreme contact reduction and during conditions of reasonable levels of reopening in the rest of the community.


Assuntos
Infecções por Coronavirus/transmissão , Pneumonia Viral/transmissão , Instituições Acadêmicas/organização & administração , Criança , China/epidemiologia , Busca de Comunicante , Infecções por Coronavirus/epidemiologia , Humanos , Modelos Teóricos , Pandemias , Pneumonia Viral/epidemiologia
7.
Child Adolesc Ment Health ; 25(4): 265-266, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33049100

RESUMO

The COVID-19 pandemic lockdown response has had a disproportionate and damaging effect on the lives, mental health and well-being of young people globally. They have been neglected in policy-making and their needs have been subjugated to those of adults which contravenes the UN Convention on the Rights of the Child. Here, I argue that the needs and rights of young people must come first to protect their health, mental health and futures. If we do not do this, we will let down a generation of children who will bear the brunt of the fallout of the economic burden of the global COVID-19 crisis.


Assuntos
Infecções por Coronavirus , Saúde Mental , Pandemias , Pneumonia Viral , Quarentena/psicologia , Instituições Acadêmicas/organização & administração , Estudantes/psicologia , Adolescente , Criança , Humanos , Aprendizagem , Transtornos do Neurodesenvolvimento/psicologia
8.
Child Adolesc Ment Health ; 25(4): 263-264, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33058519

RESUMO

The COVID-19 pandemic has illuminated preference of children with autism spectrum disorder of near average to above average intelligence (high functioning autism - HFA) for remote learning. While many children with HFA excel at the academic curriculum, the majority struggle with the so-called hidden curriculum, which includes such things as social rules and societal norms. Explicit teaching of the hidden curriculum is often lacking in mainstream education classes and can be a tremendous stumbling block for children with HFA. The result is often anxiety and depression which can be exacerbated or sometimes even caused by the intense demands for sociability and flexibility required in most mainstream educational settings. Remote learning, while not a legitimate option until now, has provided these children with an opportunity to flourish at home and improve not only their grades but also their mental health. While remote learning or hybrid models may continue to be appropriate for some children, understanding of the hidden curriculum is necessary beyond the school years. Both mental health and academic proficiency will flourish to the degree we are able to make the hidden curriculum more explicit to children with HFA.


Assuntos
Transtorno do Espectro Autista/psicologia , Infecções por Coronavirus , Pandemias , Pneumonia Viral , Instituições Acadêmicas/organização & administração , Adolescente , Criança , Currículo , Humanos , Aprendizagem , Masculino , Comportamento Social , Telecomunicações
9.
Child Adolesc Ment Health ; 25(4): 258-259, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33026141

RESUMO

The COVID-19 pandemic has highlighted existing gaps in school-based mental health services and created new and urgent needs to address student mental health. Evidence from early in the pandemic already suggests that preexisting educational and mental health disparities have increased under the stress of the current health crisis. School mental health professionals are essential to help address anxiety, to promote social adjustment in the 'new normal', and to address trauma, grief, and loss. Schools will also need to creatively support teachers during this unprecedented time. Such efforts will require adequate funding and advocacy for the inclusion of school-based mental health supports within governmental COVID-19 aid packages.


Assuntos
Infecções por Coronavirus/psicologia , Serviços de Saúde Mental/organização & administração , Saúde Mental , Pneumonia Viral/psicologia , Serviços de Saúde Escolar/organização & administração , Instituições Acadêmicas/organização & administração , Estudantes/psicologia , Adolescente , Serviços de Saúde do Adolescente , Criança , Serviços de Saúde da Criança , Feminino , Humanos , Masculino , Pandemias
11.
BMC Public Health ; 20(1): 1597, 2020 Oct 23.
Artigo em Inglês | MEDLINE | ID: mdl-33097011

RESUMO

BACKGROUND: Norway and Sweden have similar populations and health care systems, but different reactions to the COVID-19 pandemic. Norway closed educational institutions, and banned sports and cultural activities; Sweden kept most institutions and training facilities open. We aimed to compare peoples' attitudes towards authorities and control measures, and perceived impact of the pandemic and implemented control measures on life in Norway and Sweden. METHODS: Anonymous web-based surveys for individuals age 15 or older distributed through Facebook using the snowball method, in Norway and Sweden from mid-March to mid-April, 2020. The survey contained questions about perceived threat of the pandemic, views on infection control measures, and impact on daily life. We performed descriptive analyses of the responses and compared the two countries. RESULTS: 3508 individuals participated in the survey (Norway 3000; Sweden 508). 79% were women, the majority were 30-49 years (Norway 60%; Sweden 47%), and about 45% of the participants in both countries had more than 4 years of higher education. Participants had high trust in the health services, but differed in the degree of trust in their government (High trust in Norway 17%; Sweden 37%). More Norwegians than Swedes agreed that school closure was a good measure (Norway 66%; Sweden 18%), that countries with open schools were irresponsible (Norway 65%; Sweden 23%), and that the threat from repercussions of the mitigation measures were large or very large (Norway 71%; Sweden 56%). Both countries had a high compliance with infection preventive measures (> 98%). Many lived a more sedentary life (Norway 69%; Sweden 50%) and ate more (Norway 44%; Sweden 33%) during the pandemic. CONCLUSION: Sweden had more trust in the authorities, while Norwegians reported a more negative lifestyle during the pandemic. The level of trust in the health care system and self-reported compliance with preventive measures was high in both countries despite the differences in infection control measures.


Assuntos
Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Estilo de Vida , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Confiança , Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Noruega/epidemiologia , Medição de Risco , Instituições Acadêmicas/organização & administração , Inquéritos e Questionários , Suécia/epidemiologia , Adulto Jovem
13.
BMJ ; 371: m3588, 2020 10 07.
Artigo em Inglês | MEDLINE | ID: mdl-33028597

RESUMO

OBJECTIVE: To replicate and analyse the information available to UK policymakers when the lockdown decision was taken in March 2020 in the United Kingdom. DESIGN: Independent calculations using the CovidSim code, which implements Imperial College London's individual based model, with data available in March 2020 applied to the coronavirus disease 2019 (covid-19) epidemic. SETTING: Simulations considering the spread of covid-19 in Great Britain and Northern Ireland. POPULATION: About 70 million simulated people matched as closely as possible to actual UK demographics, geography, and social behaviours. MAIN OUTCOME MEASURES: Replication of summary data on the covid-19 epidemic reported to the UK government Scientific Advisory Group for Emergencies (SAGE), and a detailed study of unpublished results, especially the effect of school closures. RESULTS: The CovidSim model would have produced a good forecast of the subsequent data if initialised with a reproduction number of about 3.5 for covid-19. The model predicted that school closures and isolation of younger people would increase the total number of deaths, albeit postponed to a second and subsequent waves. The findings of this study suggest that prompt interventions were shown to be highly effective at reducing peak demand for intensive care unit (ICU) beds but also prolong the epidemic, in some cases resulting in more deaths long term. This happens because covid-19 related mortality is highly skewed towards older age groups. In the absence of an effective vaccination programme, none of the proposed mitigation strategies in the UK would reduce the predicted total number of deaths below 200 000. CONCLUSIONS: It was predicted in March 2020 that in response to covid-19 a broad lockdown, as opposed to a focus on shielding the most vulnerable members of society, would reduce immediate demand for ICU beds at the cost of more deaths long term. The optimal strategy for saving lives in a covid-19 epidemic is different from that anticipated for an influenza epidemic with a different mortality age profile.


Assuntos
Infecções por Coronavirus/mortalidade , Transmissão de Doença Infecciosa/estatística & dados numéricos , Previsões , Pneumonia Viral/mortalidade , Quarentena/tendências , Instituições Acadêmicas/organização & administração , Betacoronavirus , Simulação por Computador , Infecções por Coronavirus/transmissão , Feminino , Humanos , Unidades de Terapia Intensiva/tendências , Masculino , Irlanda do Norte/epidemiologia , Pandemias , Pneumonia Viral/transmissão , Quarentena/métodos , Reino Unido/epidemiologia
14.
Am J Public Health ; 110(11): 1635-1643, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32941069

RESUMO

In 2019, the National School Lunch Program and School Breakfast Program served approximately 15 million breakfasts and 30 million lunches daily at low or no cost to students.Access to these meals has been disrupted as a result of long-term school closures related to the COVID-19 pandemic, potentially decreasing both student nutrient intake and household food security. By the week of March 23, 2020, all states had mandated statewide school closures as a result of the pandemic, and the number of weekly missed breakfasts and lunches served at school reached a peak of approximately 169.6 million; this weekly estimate remained steady through the final week of April.We highlight strategies that states and school districts are using to replace these missed meals, including a case study from Maryland and the US Department of Agriculture waivers that, in many cases, have introduced flexibility to allow for innovation. Also, we explore lessons learned from the pandemic with the goal of informing and strengthening future school nutrition policies for out-of-school time, such as over the summer.


Assuntos
Infecções por Coronavirus/epidemiologia , Serviços de Alimentação/organização & administração , Inovação Organizacional , Pandemias , Pneumonia Viral/epidemiologia , Instituições Acadêmicas/organização & administração , Betacoronavirus , Desjejum , Serviços de Alimentação/estatística & dados numéricos , Abastecimento de Alimentos/economia , Humanos , Almoço , Maryland , Pobreza/economia , Estados Unidos/epidemiologia
16.
Rev. Rol enferm ; 43(9): 579-599, sept. 2020. ilus
Artigo em Espanhol | IBECS | ID: ibc-194389

RESUMO

El coronavirus SARS-CoV-2 causa COVID-19, una enfermedad cuyas manifestaciones clínicas varían desde una infección asintomática hasta cuadros clínicos graves, incluso con desenlace fatal. Este virus procede de China y en pocos meses se ha extendido por todo el planeta, lo que demuestra una alta capacidad de transmisión. Su transmisión es muy buena en entornos cerrados, poco ventilados, donde haya muchas personas, a poca distancia entre ellas y que no usen mascarillas. El estudio de las medidas preventivas frente a COVID-19 tiene una importancia capital en esta nueva enfermedad, que ha demostrado su agresividad y letalidad, sobre todo porque no se dispone de tratamientos efectivos específicos ni de vacunas comercializadas para su uso poblacional. Esto adquiere mayor importancia, si cabe, cuando se conoce, a través de diversos estudios, que la inmunidad poblacional es en todo el mundo baja o muy baja, a pesar de la agresividad del virus; también en España, como mostró un importante estudio longitudinal seroepidemiológico de base poblacional en el ámbito nacional. A pesar de la ausencia de tratamientos efectivos específicos y de vacunas comercializadas, la población debe convivir con el virus hasta que pueda ser vencido definitivamente. La sociedad no puede pararse indefinidamente y debe seguir adelante, aplicando las recomendaciones para prevenir la infección por el virus. En este contexto resulta clave poner en marcha el sistema educativo presencial y las residencias de mayores, dos actores imprescindibles en nuestra sociedad. Para su funcionamiento de la forma más segura posible, se requiere aplicar las medidas preventivas con efectividad y conocimiento. En este artículo se expone una aproximación a los factores de riesgo poblacional frente al virus y a las medidas preventivas de aplicación poblacional más significativas para reducir la transmisión del coronavirus SARS-CoV-2 basadas en la evidencia científica actual. Para ello se ha realizado una revisión de la bibliografía disponible en PubMed (inglés y castellano) sobre prevención de la infección por coronavirus SARS-CoV-2, sin limitación de rango temporal dado el reciente comienzo de la afectación humana conocida, y en instituciones y entidades de referencia. La ventilación con aire exterior, la higiene de manos frecuente (lavado o aplicación de gel hidroalcohólico), el distanciamiento social, evitar aglomeraciones, la limpieza y desinfección de objetos y superficies y el uso de mascarillas son las medidas preventivas de aplicación general que pueden considerarse de más impacto. No hay que olvidar otras como, por ejemplo, no fumar


Coronavirus SARS-CoV-2 causes COVID-19, a disease whose clinical manifestations can vary from an asymptomatic infection to a severe medical condition (including death). This virus comes from China and, in a few months, it has spread throughout the planet, proving to have a high transmission rate. A transmission which is excellent in closed, poorly ventilated environments, where there are many people with a short distance between them. Studying useful preventive measures against COVID-19 has a great importance in fighting this new disease, which has proved its high aggressiveness and lethality, especially since no specific treatments or vaccines are available on the market at the present. This becomes even more important when it is known that population immunity is low or very low over the world, including Spain, despite the aggressiveness of the virus, as an important population-based seroepidemiological longitudinal study showed at the national level. Despite the absence of specific effective treatments and marketed vaccines, the population must live with the virus until it can be definitively defeated. Society cannot stop indefinitely and must move forward, applying the recommendations to prevent the infection with the virus to the entire population. In this context, implementing these measures in an in-person education system and in the residences of the elderly (two essential actors in our society) is a key to fight the pandemic. To operate as safely as possible, preventive measures are required apply with effectiveness and knowledge. This article outlines an approximation of population risk factors against the virus and the most significant preventive measures of popular application to reduce the transmission of SARC-CoV-2 coronavirus based on current scientific evidence. To achieve this, a review of the available literature in PubMed (English and Spanish) on the prevention of coronarivus infection has been carried out, without limitation of temporal range given the recent beginning of known human involvement. Ventilation with outdoor air, frequent hands hygiene, social distancing, avoiding crowds, cleaning and disinfection of objects and surfaces and the use of masks are the preventive measures of general application that can be considered of the greatest impact. Do not forget others such as not smoking


Assuntos
Humanos , Infecções por Coronavirus/prevenção & controle , Transmissão de Doença Infecciosa/prevenção & controle , Controle de Doenças Transmissíveis/métodos , Precauções Universais/métodos , Síndrome Respiratória Aguda Grave/prevenção & controle , Vírus da SARS/patogenicidade , Instituição de Longa Permanência para Idosos/organização & administração , Instituições Acadêmicas/organização & administração , Centros de Saúde
17.
JAMA ; 324(9): 859-870, 2020 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-32745200

RESUMO

Importance: In the US, states enacted nonpharmaceutical interventions, including school closure, to reduce the spread of coronavirus disease 2019 (COVID-19). All 50 states closed schools in March 2020 despite uncertainty if school closure would be effective. Objective: To determine if school closure and its timing were associated with decreased COVID-19 incidence and mortality. Design, Setting, and Participants: US population-based observational study conducted between March 9, 2020, and May 7, 2020, using interrupted time series analyses incorporating a lag period to allow for potential policy-associated changes to occur. To isolate the association of school closure with outcomes, state-level nonpharmaceutical interventions and attributes were included in negative binomial regression models. States were examined in quartiles based on state-level COVID-19 cumulative incidence per 100 000 residents at the time of school closure. Models were used to derive the estimated absolute differences between schools that closed and schools that remained open as well as the number of cases and deaths if states had closed schools when the cumulative incidence of COVID-19 was in the lowest quartile compared with the highest quartile. Exposures: Closure of primary and secondary schools. Main Outcomes and Measures: COVID-19 daily incidence and mortality per 100 000 residents. Results: COVID-19 cumulative incidence in states at the time of school closure ranged from 0 to 14.75 cases per 100 000 population. School closure was associated with a significant decline in the incidence of COVID-19 (adjusted relative change per week, -62% [95% CI, -71% to -49%]) and mortality (adjusted relative change per week, -58% [95% CI, -68% to -46%]). Both of these associations were largest in states with low cumulative incidence of COVID-19 at the time of school closure. For example, states with the lowest incidence of COVID-19 had a -72% (95% CI, -79% to -62%) relative change in incidence compared with -49% (95% CI, -62% to -33%) for those states with the highest cumulative incidence. In a model derived from this analysis, it was estimated that closing schools when the cumulative incidence of COVID-19 was in the lowest quartile compared with the highest quartile was associated with 128.7 fewer cases per 100 000 population over 26 days and with 1.5 fewer deaths per 100 000 population over 16 days. Conclusions and Relevance: Between March 9, 2020, and May 7, 2020, school closure in the US was temporally associated with decreased COVID-19 incidence and mortality; states that closed schools earlier, when cumulative incidence of COVID-19 was low, had the largest relative reduction in incidence and mortality. However, it remains possible that some of the reduction may have been related to other concurrent nonpharmaceutical interventions.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Instituições Acadêmicas , Humanos , Incidência , Análise de Séries Temporais Interrompida , Pandemias , Política Pública , Instituições Acadêmicas/organização & administração , Governo Estadual , Estados Unidos/epidemiologia
18.
Lancet Child Adolesc Health ; 4(11): 817-827, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32758453

RESUMO

BACKGROUND: As lockdown measures to slow the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection begin to ease in the UK, it is important to assess the impact of any changes in policy, including school reopening and broader relaxation of physical distancing measures. We aimed to use an individual-based model to predict the impact of two possible strategies for reopening schools to all students in the UK from September, 2020, in combination with different assumptions about relaxation of physical distancing measures and the scale-up of testing. METHODS: In this modelling study, we used Covasim, a stochastic individual-based model for transmission of SARS-CoV-2, calibrated to the UK epidemic. The model describes individuals' contact networks stratified into household, school, workplace, and community layers, and uses demographic and epidemiological data from the UK. We simulated six different scenarios, representing the combination of two school reopening strategies (full time and a part-time rota system with 50% of students attending school on alternate weeks) and three testing scenarios (68% contact tracing with no scale-up in testing, 68% contact tracing with sufficient testing to avoid a second COVID-19 wave, and 40% contact tracing with sufficient testing to avoid a second COVID-19 wave). We estimated the number of new infections, cases, and deaths, as well as the effective reproduction number (R) under different strategies. In a sensitivity analysis to account for uncertainties within the stochastic simulation, we also simulated infectiousness of children and young adults aged younger than 20 years at 50% relative to older ages (20 years and older). FINDINGS: With increased levels of testing (between 59% and 87% of symptomatic people tested at some point during an active SARS-CoV-2 infection, depending on the scenario), and effective contact tracing and isolation, an epidemic rebound might be prevented. Assuming 68% of contacts could be traced, we estimate that 75% of individuals with symptomatic infection would need to be tested and positive cases isolated if schools return full-time in September, or 65% if a part-time rota system were used. If only 40% of contacts could be traced, these figures would increase to 87% and 75%, respectively. However, without these levels of testing and contact tracing, reopening of schools together with gradual relaxing of the lockdown measures are likely to induce a second wave that would peak in December, 2020, if schools open full-time in September, and in February, 2021, if a part-time rota system were adopted. In either case, the second wave would result in R rising above 1 and a resulting second wave of infections 2·0-2·3 times the size of the original COVID-19 wave. When infectiousness of children and young adults was varied from 100% to 50% of that of older ages, we still found that a comprehensive and effective test-trace-isolate strategy would be required to avoid a second COVID-19 wave. INTERPRETATION: To prevent a second COVID-19 wave, relaxation of physical distancing, including reopening of schools, in the UK must be accompanied by large-scale, population-wide testing of symptomatic individuals and effective tracing of their contacts, followed by isolation of diagnosed individuals. FUNDING: None.


Assuntos
Defesa Civil , Técnicas de Laboratório Clínico , Controle de Doenças Transmissíveis , Busca de Comunicante/métodos , Infecções por Coronavirus , Transmissão de Doença Infecciosa/prevenção & controle , Pandemias , Pneumonia Viral , Serviços de Saúde Escolar/organização & administração , Adolescente , Betacoronavirus , Criança , Defesa Civil/métodos , Defesa Civil/organização & administração , Técnicas de Laboratório Clínico/métodos , Técnicas de Laboratório Clínico/normas , Controle de Doenças Transmissíveis/métodos , Controle de Doenças Transmissíveis/organização & administração , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/transmissão , Surtos de Doenças/prevenção & controle , Humanos , Modelos Teóricos , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Pneumonia Viral/transmissão , Instituições Acadêmicas/organização & administração
19.
Can J Public Health ; 111(4): 462-465, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32767271

RESUMO

COVID-19 mitigation strategies have led to widespread school closures around the world. Initially, these were undertaken based on data from influenza outbreaks in which children were highly susceptible and important in community-wide transmission. An argument was made that school closures were necessary to prevent harm to vulnerable adults, especially the elderly. Although data are still accumulating, the recently described complication, pediatric multisystem inflammatory syndrome, is extremely rare and children remain remarkably unaffected by COVID-19. We also do not have evidence that children are epidemiologically important in community-wide viral spread. Previous studies have shown long-term educational, social, and medical harms from school exclusion, with very young children and those from marginalized groups such as immigrants and racialized minorities most affected. The policy and ethical implications of ongoing mandatory school closures, in order to protect others, need urgent reassessment in light of the very limited data of public health benefit.


Assuntos
Infecções por Coronavirus/prevenção & controle , Política de Saúde , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Prática de Saúde Pública/ética , Instituições Acadêmicas/organização & administração , Canadá/epidemiologia , Criança , Infecções por Coronavirus/epidemiologia , Humanos , Pneumonia Viral/epidemiologia
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