Randomised trials could help to return children safely to schools, says report

A research team led by the University of Birmingham says school reopening policies currently “lack a rigorous evidence base”

A research team led by scientists at the University of Birmingham have said staging randomised trials when pupils return could help clarify uncertainties around when to send children back to the classroom.

The team – which includes experts from Harvard University, the University of Pennsylvania and Western University, Canada – said school reopening policies currently “lack a rigorous evidence base”, leading to variation around the world.

Professor Karla Hemming from the University of Birmingham’s Institute of Applied Health Research said: “As Covid-19 cases and deaths ebb and flow around the world, the question of when and how to withdraw public health policies is pressing.

“Many regions face new waves of outbreaks and new lockdowns. Whether and when schools can reopen and stay open will continue to be a question of upmost importance, but policymakers are left to make such decisions in the absence of rigorous evidence.

Whether and when schools can reopen and stay open will continue to be a question of upmost importance, but policymakers are left to make such decisions in the absence of rigorous evidence – Professor Karla Hemming, University of Birmingham

“Given the impact of school closures on both education and the economy, schools cannot remain closed indefinitely. But when and how can they be reopened safely? A cluster randomised trial is a rigorous and ethical way to resolve these uncertainties.”

Hemming has published a new report with Charles Weijer, Spencer Phillips Hey and Holly Fernandez Lynch in Clinical Trials titled Reopening schools safely in the face of COVID-19: Can cluster randomized trials help?

The researchers noted that Swedish schools remained open for under-16s throughout the pandemic, whilst Denmark, Germany and Norway reopened schools after a period of closure.

Italy and Spain chose to keep schools closed until autumn last year, whilst schools in Austria, the Czech Republic and Russia have at times closed. Variability is seen within the United States at state and county level.

Some officials relied on local test positivity rates and others focused on numbers of new cases within schools.

Reopening primary schools in Quebec, Canada, was associated with relatively few new cases, yet opening primary and secondary schools in Israel was associated with several outbreaks and the reclosure of some schools.

Key aspects of the trials

  • Running such a study should only be considered when community transmission is under control and the health system has capacity.
  • As the main interest is community transmission of SARS-CoV-2, the study would have to include many municipalities or regions.
  • Entire regions (including all schools within) would be randomised to either remain closed or to reopen.
  • For schools reopening, this would mean operating under precautions, including social distancing, mask wearing and possibly testing. Teachers and children who are clinically extremely vulnerable should be allowed to remain at home.
  • For schools remaining closed, the burdens of keeping schools closed require careful consideration, especially for those who are more vulnerable at home.

In related news: Independent sector responds to roadmap for reopening schools

(Main image: Freepik)

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