Study: in much of the U.S., virtual school did not lower COVID-19 case rates in surrounding communities

Analysis shows no difference in COVID-19 rates between U.S. counties where school was held in-person and those that had virtual school, except in the South

Since March 2020, parents, educators, and politicians have debated whether to send children to school in person during the COVID-19 pandemic. New research suggests that in most regions, with the exception of the South, opening schools for in-person learning was not associated with an increase in COVID-19 case rates in the community. The results of the nationwide study, published in Nature Medicine, included 895 school districts across the United States.

“The results suggest it is possible for schools to operate safely and in-person without increasing case rates in the community,” says Richard Nelson, Ph.D., associate professor of epidemiology at University of Utah Health and co-senior author with Westyn Branch-Elliman, M.D., of the VA Boston Healthcare System. “But the flip side is true, too. In some areas, in-person school did appear to be a source of community spread.”

The researchers analyzed data gathered during the 12 weeks from July to September 2020 by region, and categorized them as the Northeast, Midwest, South, and Mountain West. The Pacific West was not included because nearly all public schools were virtual. The study found that:

  • In every region analyzed, COVID-19 cases increased during the weeks following the start of school.
  • The South was the only region where case rates were higher in counties with in-person or hybrid school as compared to counties with virtual learning, after controlling for other contributing factors.
  • In all other regions, community case rates during the period following school opening were similar regardless of whether school was virtual, hybrid, or in-person.

“We know that cases increased substantially last fall throughout the country,” Nelson says. “In some areas of the country, school mode was a contributing factor to those increasing rates, whereas in other areas it was not.”

“The results suggest it is possible for schools to operate safely and in-person without increasing case rates in the community. But the flip side is true, too.”

In the South, which included 191 counties from Delaware to Texas, traditional in-person school was associated with an increase in community cases of COVID-19 beginning two weeks after the school reopened. The increase was chiefly among people between the ages of 0-9, or 20 and older. Data were not available for stratification that would allow the scientists to analyze impacts on different school-age groups (e.g. elementary, middle, and high school).

The researchers controlled for local policies, including closings of workplaces and public transportation, canceling of public events, COVID testing and contact tracing policies, and mask requirements.

However, because people follow policies imperfectly, another important piece of data the researchers considered was community mobility. This is data collected from Google location history that reflects how much people are actually moving around the community in four categories: residences, workplaces, grocery/pharmacy, and retail/recreation locations.

In communities where people are moving around more, there is more social interaction outside of school and thus more opportunity for infection to spread, Nelson explains. “Traditional school in an area where there’s lots of movement looks different than traditional school where there’s not much movement in the community, in terms of case rates,” Nelson says. “For this reason, it is important to take community-level mobility into account when evaluating the impact that schools had on cases.”

Together, the data suggest that the impact of traditional and hybrid school on community spread varied throughout the country, Nelson says. Further investigation into factors that may have contributed to community spread in the South could help determine the most effective mitigation measures for in-person school.

Branch-Elliman explains that it’s possible that regional differences in community-level and in-school mitigation strategies, or other factors such as environmental conditions, may have played a role. “It is important to appreciate that schools are not islands,” Branch-Elliman says. “They exist as part of a broader community network.”

At the time the study data were collected, vaccinations were not available and the Delta variant had not yet emerged in the U.S. Additional research will also need to investigate how these factors affect the spread of COVID-19.

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The research was published as “The Impact of School Opening Model on SARS-CoV-2 Community Incidence and Mortality” and was supported by the National Institutes of Health.

Additional centers that participated in the study include Binghamton University, Boston University School of Medicine, Brown University, Beth Israel Deaconess Medical Center, Iowa City VA Health Care System, University of Iowa, VA Salt Lake City Health Care System, and Harvard Medical School

Watching wastewater

The U is monitoring samples of municipal wastewater for signs of COVID-19 in a joint project started by the School of Medicine and the College of Engineering. Jennifer Weidhass, assistant professor in Civil and Environmental Engineering, and Jim Vanderslice, associate professor in Family & Preventive Medicine, lead the study to track the presence of the virus in sewage so that local health officials can recommend behavior changes—masking and social distancing—to slow the spread of COVID-19. After an initial pilot program, the state is funding a large-scale study of more than 40 facilities in Utah, covering about 80 percent of the population, in partnership with BYU, Utah State University, Utah Department of Environmental Quality, and the Utah Department of Health.

Find current data online.

COVID-19 and the metropolis

Many have assumed that densely populated areas like city centers are more conducive to the spread of COVID-19. A new study, published in the Journal of the American Planning Association, finds that the opposite may be true. Researchers from the University of Utah and the Johns Hopkins Bloomberg School of Public Health examined both infection and death rates in 913 U.S. metropolitan counties and found that population size, not density, corresponded to mortality rates. One possible explanation could be faster and more widespread adoption of social distancing practices and better quality of health care in areas of denser population.

“Our findings run counter to the recent narrative about escaping compact cities for sprawling suburbs as a way of staying safe from COVID-19,” said co-author Reid Ewing, distinguished professor in the Department of City & Metropolitan Planning at the University of Utah. “This is one more reason for urban planners and public officials to favor compact urban development over suburban sprawl. Compact places seem to promote better adherence to social distancing and provide better acute health care, so those contracting the coronavirus are less likely to die.”

A map of the 913 U.S. metropolitan counties included in the survey.

The three-member team chose to examine county data, not individual cities, between Jan. 20-May 25, 2020. Large cities alone have multiple unknown variables. Counties, on the other hand, have multiple known factors that allowed the team to find the “activity density” of each and make comparisons. Activity density = (population of a county + jobs in the county)/area of the county.

Activity density takes into account both the county residents and workers commuting within a given area. Other factors, such as population size, education levels, and demographic variables, including age and race and health care infrastructure (ICU bed capacity), were also considered.

“Our analysis shows that metropolitan size is more important than density,” said co-author Sadegh Sabouri, doctoral student in the Department of City & Metropolitan Planning at the U. “Take Dutchess County, New York, for example, being surrounded by one of the largest metropolitan areas—New York, Newark and New Jersey City. The activity density is 518.1 and death rate of 4.63 per 10,000. Salt Lake County, by comparison, is located in a metropolitan area that is one-twentieth the population and has a density four times higher at 2060.2 and a death rate of only 0.61.”

The analysis did not indicate a significant association with infection rates. However, higher activity density did have a significant and unexpected association with death rates. They found that after controlling for factors such as metropolitan size, education, race and age, doubling the activity density was associated with an 11.3% lower death rate.

They also conclude that counties with higher proportions of people ages 60 and older, lower proportions of college-educated people, and higher proportions of African Americans experienced greater infection and mortality rates.

The researchers have been updating the data as the pandemic has progressed and are finding that the associations uncovered in their study are becoming even stronger. The team is also conducting a longitudinal study that tracks the relationships among county density, infection and mortality rates and explanatory factors as they change over time. They have found consistent results regarding the inverse relationship between density and the COVID-19 mortality rate.

Find the full study here.

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Masks save lives and livelihoods

Statewide mask requirements not only reduce the transmission of COVID-19, but they also spur more economic activity, while countywide mask requirements actually depress economic activity, according to researchers at the Marriner S. Eccles Institute for Economics and Quantitative Analysis.

The thing that really pops out,” said lead research Nathan Seegert, assistant professor of finance at the Eccles School, “is that statewide mask mandates are much more effective at both saving lives and livelihoods.”

The statewide mask requirements signal that safety measures are being taken seriously, and that boosts consumer confidence.

“If people feel safe, they’re going to go out and spend more,” Seegert said.

The study showed that the positive effects of the statewide mask requirements were seen immediately after they were enacted and up to two months afterward. The economic impact of statewide mask requirements was directly measured, showing an average of about $24 more spent per person per month, which adds up to millions of dollars per month in increased sales.

In addition to Seegert, the research was conducted by Mac Gaulin, assistant professor of Accounting, Mu-Jeung Yang, visiting assistant professor of finance, and Francisco Navarro-Sanchez, a finance doctoral candidate.

The research findings were announced at a press conference on Monday, Nov. 23 with Taylor Randall, dean of the David Eccles School of Business, and Natalie Gochnour, assistant dean at the Eccles School and director of the Kem C. Gardner Policy Institute.

Randall addressed the protests happening in Utah around the country against mask requirements.

We’re all facing a set of tradeoffs here. If you choose to not wear masks, you’re causing the confidence of your community to decrease, which means you will see reduced economic activity,” Randall said. “If we want to push the boundary, meaning we want to have better health and a better economy during this really critical time, we really should wear masks.”

Randall pointed out the connection between health and the economy.

“At the core of this relationship is mask-wearing and consumer confidence,” Randall said.

Gochnour said that Utah’s economy is performing much better than the U.S. economy, and the unemployment rate is much lower in the Beehive State compared to the U.S. But she warned that rising case counts increase safety fears, which decreases consumer confidence and leads to people shopping less.

Wearing a mask “is part of controlling our destiny” by increasing economic confidence so “we can get back on our feet faster.”

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