"We didn't get much schooling because we were fishing all the time": Potential impacts of irregular school attendance on the spread of epidemics

Pandemics, past and present: The role of biological anthropology in interdisciplinary pandemic studies

Biological anthropologists are ideally suited for the study of pandemics given their strengths in human biology, health, culture, and behavior, yet pandemics have historically not been a major focus of research. The COVID‐19 pandemic has reinforced the need to understand pandemic causes and unequal consequences at multiple levels. Insights from past pandemics can strengthen the knowledge base and inform the study of current and future pandemics through an anthropological lens. In this paper, we discuss the distinctive social and epidemiological features of pandemics, as well as the ways in which biological anthropologists have previously studied infectious diseases, epidemics, and pandemics. We then review interdisciplinary research on three pandemics–1918 influenza, 2009 influenza, and COVID‐19–focusing on persistent social inequalities in morbidity and mortality related to sex and gender; race, ethnicity, and Indigeneity; and pre‐existing health and disability. Following this review of the current state of pandemic research on these topics, we conclude with a discussion of ways biological anthropologists can contribute to this field moving forward. Biological anthropologists can add rich historical and cross‐cultural depth to the study of pandemics, provide insights into the biosocial complexities of pandemics using the theory of syndemics, investigate the social and health impacts of stress and stigma, and address important methodological and ethical issues. As COVID‐19 is unlikely to be the last global pandemic, stronger involvement of biological anthropology in pandemic studies and public health policy and research is vital.

"We didn't get much schooling because we were fishing all the time": Potential impacts of irregular school attendance on the spread of epidemics

Objectives

Especially in traditional, rural, and low‐income areas, children attend school irregularly. School‐based interventions are common mitigation strategies for infectious disease epidemics, but if daily attendance is not the norm, the impact of schools on disease spread might be overestimated.

Methods

We use an agent‐based model of an early 20th century Newfoundland community to compare epidemic size and duration in three scenarios: (1) all school‐aged children attend school each weekday, (2) students aged 10–15 have a chance of engaging in adult activities each day, and (3) students aged 10–15 have a chance of being reassigned to adult roles at the start of each simulation and thus never attend school.

Results

As the probability of not attending school increases, epidemics become smaller and peak earlier. The change in final size is larger with permanent reassignment (35% at baseline, 18% at maximum reassignment) than with daily nonattendance (35% vs. 22%). For both scenarios, the peak occurs 3 days earlier with maximum absence compared to the baseline. Benefits extend beyond the reassigned agents, as all school‐aged agents are more likely to escape infection with increasing reassignment, and on average, 3–6 additional agents (2.6%–5.3%) escape infection compared to the baseline.

Conclusions

This study demonstrates that absenteeism can have important impacts on epidemic outcomes. Thus, socioeconomic and other reasons for nonattendance of school, as well as how rates vary in different contexts, must be considered in models predicting epidemic outcomes or evaluating public health interventions in the face of major pandemics.