Pandemic Preparedness Strategies for School Systems: Is Closure Really the Only Way?

A New Paradigm for Pandemic Preparedness

Purpose of Review

Preparing for pandemics requires a degree of interdisciplinary work that is challenging under the current paradigm. This review summarizes the challenges faced by the field of pandemic science and proposes how to address them.

Recent Findings

The structure of current siloed systems of research organizations hinders effective interdisciplinary pandemic research. Moreover, effective pandemic preparedness requires stakeholders in public policy and health to interact and integrate new findings rapidly, relying on a robust, responsive, and productive research domain. Neither of these requirements are well supported under the current system.

Summary

We propose a new paradigm for pandemic preparedness wherein interdisciplinary research and close collaboration with public policy and health practitioners can improve our ability to prevent, detect, and treat pandemics through tighter integration among domains, rapid and accurate integration, and translation of science to public policy, outreach and education, and improved venues and incentives for sustainable and robust interdisciplinary work.

Mental health and well-being during the COVID-19 pandemic in higher education: Evidence from G20 countries

Background: The spread of coronavirus (COVID-19) has resulted in a drastic alteration to billions of individuals' emotional, physical, mental, social, and financial status. As of July 21st, 2020, there had been 14.35 million confirmed cases of COVID-19, including 0.60 million deaths in 216 countries. Design and Methods: The study explores health and wellbeing in universities within the G20 countries (19 member countries and the European Union) during the COVID-19 pandemic. The sample selection of these countries was considered since it serves around 80% of the world's economic output, two-thirds of the global population (including more than half of the world's poor), and 75% of international trade. Specifically, due to this public health concern, schools' nationwide closures are impacting over 60% of the world's student population to promote their quality of life and well-being. Results: This study investigates the G20 policies and procedures within higher education regarding health and well-being measures during the COVID-19 epidemic. The findings reveal that the lockdown, social distancing, and self-isolation requirements are stressful and detrimental for many individuals and have caused students' health and well-being concerns. Conclusions: Several countries within the G20 have taken significant steps to support health and well-being issues for university students; however, numerous countries are far behind in addressing this issue. Hence, government leaders of G20 countries, policymakers, and health providers should promptly take the necessary measures to regulate the outbreak, improve safety measures to decrease disease transmission, and administer those who demand medical attention.

Social distancing and reopening universities after the COVID-19 pandemic: policy complexity in G20 countries

Background: The coronavirus disease (COVID-19) has affected the entire globe, and various mythologies argue about its diagnosis, cure, and prevention. Globally, as of September 18th, 2020, there have been 30.055 million confirmed cases, including 0.943 million deaths. The nationwide closures are impacting over 60% of the world's student population. This study aimed to explore the social distancing policies and universities' reopening after COVID-19 in G20 countries (19 member countries and the European Union). Design and Methods: The study is based on documentary analysis. G20 members represent around 80% of the world's economic output, two-thirds of the global population (including more than half of the world's poor), and 75% of international trade. Based on documentary analysis, the study revealed that there is a policy dilemma among G20 countries regarding school reopening and a variety of conflicting policies within each country. Results: Based on a sample of 838 universities in the USA, 66% of universities (552 of 838) plan for in-person instruction, while only 7% are planning for a completely online teaching mode in the fall 2020 semester. Conclusions: Interestingly, none of the private universities in this study are planning to implement an online teaching mode. Policymakers need an integrated set of policy guidelines for school reopening, considering the evaluation of current COVID- 19 pandemic circumstances and social distancing capacity.

School closure and management practices during coronavirus outbreaks including COVID-19: a rapid systematic review

In response to the coronavirus disease 2019 (COVID-19) pandemic, 107 countries had implemented national school closures by March 18, 2020. It is unknown whether school measures are effective in coronavirus outbreaks (eg, due to severe acute respiratory syndrome [SARS], Middle East respiratory syndrome, or COVID-19). We undertook a systematic review by searching three electronic databases to identify what is known about the effectiveness of school closures and other school social distancing practices during coronavirus outbreaks. We included 16 of 616 identified articles. School closures were deployed rapidly across mainland China and Hong Kong for COVID-19. However, there are no data on the relative contribution of school closures to transmission control. Data from the SARS outbreak in mainland China, Hong Kong, and Singapore suggest that school closures did not contribute to the control of the epidemic. Modelling studies of SARS produced conflicting results. Recent modelling studies of COVID-19 predict that school closures alone would prevent only 2-4% of deaths, much less than other social distancing interventions. Policy makers need to be aware of the equivocal evidence when considering school closures for COVID-19, and that combinations of social distancing measures should be considered. Other less disruptive social distancing interventions in schools require further consideration if restrictive social distancing policies are implemented for long periods.

School practices to promote social distancing in K-12 schools: review of influenza pandemic policies and practices

BACKGROUND

During an evolving influenza pandemic, community mitigation strategies, such as social distancing, can slow down virus transmission in schools and surrounding communities. To date, research on school practices to promote social distancing in primary and secondary schools has focused on prolonged school closure, with little attention paid to the identification and feasibility of other more sustainable interventions. To develop a list and typology of school practices that have been proposed and/or implemented in an influenza pandemic and to uncover any barriers identified, lessons learned from their use, and documented impacts.

METHODS

We conducted a review of the peer-reviewed and grey literature on social distancing interventions in schools other than school closure. We also collected state government guidance documents directed to local education agencies or schools to assess state policies regarding social distancing. We collected standardized information from each document using an abstraction form and generated descriptive statistics on common plan elements.

RESULTS

The document review revealed limited literature on school practices to promote social distancing, as well as limited incorporation of school practices to promote social distancing into state government guidance documents. Among the 38 states that had guidance documents that met inclusion criteria, fewer than half (42%) mentioned a single school practice to promote social distancing, and none provided any substantive detail about the policies or practices needed to enact them. The most frequently identified school practices were cancelling or postponing after-school activities, canceling classes or activities with a high rate of mixing/contact that occur within the school day, and reducing mixing during transport.

CONCLUSION

Little information is available to schools to develop policies and procedures on social distancing. Additional research and guidance are needed to assess the feasibility and effectiveness of school practices to promote social distancing.

Geographic prioritization of distributing pandemic influenza vaccines

Pandemic influenza is an international public health concern. In light of the persistent threat of H5N1 avian influenza and the recent pandemic of A/H1N1swine influenza outbreak, public health agencies around the globe are continuously revising their preparedness plans. The A/H1N1 pandemic of 2009 demonstrated that influenza activity and severity might vary considerably among age groups and locations, and the distribution of an effective influenza vaccine may be significantly delayed and staggered. Thus, pandemic influenza vaccine distribution policies should be tailored to the demographic and spatial structures of communities. Here, we introduce a bi-criteria decision-making framework for vaccine distribution policies that is based on a geospatial and demographically-structured model of pandemic influenza transmission within and between counties of Arizona in the Unites States. Based on data from the 2009-2010 H1N1 pandemic, the policy predicted to reduce overall attack rate most effectively is prioritizing counties expected to experience the latest epidemic waves (a policy that may be politically untenable). However, when we consider reductions in both the attack rate and the waiting period for those seeking vaccines, the widely adopted pro rata policy (distributing according to population size) is also predicted to be an effective strategy.

Controlling the spread of disease in schools

Pandemic and seasonal infectious diseases such as influenza may have serious negative health and economic consequences. Certain non-pharmaceutical intervention strategies--including school closures--can be implemented rapidly as a first line of defense against spread. Such interventions attempt to reduce the effective number of contacts between individuals within a community; yet the efficacy of closing schools to reduce disease transmission is unclear, and closures certainly result in significant economic impacts for caregivers who must stay at home to care for their children. Using individual-based computer simulation models to trace contacts among schoolchildren within a stereotypical school setting, we show how alternative school-based disease interventions have great potential to be as effective as traditional school closures without the corresponding loss of workforce and economic impacts.