The COVID-19 pandemic has highlighted the challenges of evidence-based health policymaking, as critical precautionary decisions, such as school closures, had to be made urgently on the basis of little evidence. As primary and secondary schools once again close in the face of surging infections, there is an opportunity to rigorously study their reopening. School-aged children appear to be less affected by COVID-19 than adults, yet schools may drive community transmission of the virus. 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? We argue that a cluster randomized trial is a rigorous and ethical way to resolve these uncertainties. We discuss key scientific, ethical, and resource considerations both to inform trial design of school reopenings and to prompt discussion of the merits and feasibility of conducting such a trial.
StarrP. Using controlled trials to resolve key unknowns about policy during the COVID-19 pandemic. JAMA2020; 323(23): 2369–2370.
3.
VenkataramaniASUnderhillKVolppKG. Moving toward evidence-based policy: the value of randomization for program and policy implementation. JAMA2020; 323(1): 21–22.
ZhangJLitvinovaMLiangY, et al. Changes in contact patterns shape the dynamics of the COVID-19 outbreak in China. Science2020; 368(6498): 1481–1486.
10.
LudvigssonJF. Children are unlikely to be the main drivers of the COVID-19 pandemic—a systematic review. Acta Paediatr2020; 109(8): 1525–1530.
11.
HeaveyLCaseyGKellyC, et al. No evidence of secondary transmission of COVID-19 from children attending school in Ireland, 2020. Euro Surveill2020; 25(21): 2000903.
12.
MunroAPSFaustSN. Children are not COVID-19 super spreaders: time to go back to school. Arch Dis Child2020; 105(7): 618–619.
TurnerELLiFGallisJA, et al. Review of recent methodological developments in group-randomized trials: part 1-design. Am J Public Health2017; 107(6): 907–915.
Goldhaber-FiebertJDStuddertDMMelloMM. School reopenings and the community during the COVID-19 pandemic. JAMA Health Forum. Epub ahead of print 28 October 2020. DOI: 10.1001/jamahealthforum.2020.1294
27.
JacksonCVynnyckyEHawkerJ, et al. School closures and influenza: systematic review of epidemiological studies. BMJ Open2013; 3(2): e002149.
28.
The Lancet Child Adolescent Health. Pandemic school closures: risks and opportunities. Lancet Child Adolesc Health2020; 4(5): 341.
29.
OrbenATomovaLBlakemoreSJ. The effects of social deprivation on adolescent development and mental health. Lancet Child Adolesc Health2020; 4(8): 634–640.
30.
HemmingKTaljaardM. Reflection on modern methods: when is a stepped-wedge cluster randomized trial a good study design choice?Int J Epidemiol2020; 49(3): 1043–1052.
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
