Considering inequalities in the school closure response to COVID-19
Authors: Richard Armitage, Laura B Nellums
Journal: The Lancet Global Health (2020)

As COVID-19 is declared a pandemic and several countries declare nationwide school closures, these measures are affecting hundreds of millions of children.1Wang G Zhang Y Zhao J et al.Mitigate the effects of home confinement on children during the COVID-19 outbreak.Lancet. 2020; (published online March 4.)https://doi.org/10.1016/S0140-6736(20)30547-XSummary Full Text Full Text PDF Scopus (1123) Google Scholar More countries are entering delay and mitigation phases of pandemic control, with an urgent need for proactive and multifaceted responses addressing children's social, economic, and health needs to avoid widening disparities and honour commitments to the UN Convention on Child Rights and Sustainable Development Goals.2Clark H Coll-Seck AM Banerjee A et al.A future for the world's children? A WHO–UNICEF–Lancet Commission.Lancet. 2020; 395: 605-658Summary Full Text Full Text PDF PubMed Scopus (446) Google Scholar Children have milder symptoms of COVID-19, and their role in transmitting the disease remains unclear.3European Centre for Disease Prevention and ControlOutbreak of novel coronavirus disease 2019 (COVID-19): increased transmission globally—fifth update 02 March 2020.https://www.ecdc.europa.eu/sites/default/files/documents/RRA-outbreak-novel-coronavirus-disease-2019-increase-transmission-globally-COVID-19.pdfDate accessed: March 13, 2020Google Scholar While governments can implement proactive school closures to slow transmission (delay phase), reduce burden on health care, or protect at-risk populations (mitigate phase), both the benefits for transmission and the adverse community effects should be considered.3European Centre for Disease Prevention and ControlOutbreak of novel coronavirus disease 2019 (COVID-19): increased transmission globally—fifth update 02 March 2020.https://www.ecdc.europa.eu/sites/default/files/documents/RRA-outbreak-novel-coronavirus-disease-2019-increase-transmission-globally-COVID-19.pdfDate accessed: March 13, 2020Google Scholar School closures impede learning and compound inequities, disproportionately affecting disadvantaged children.3European Centre for Disease Prevention and ControlOutbreak of novel coronavirus disease 2019 (COVID-19): increased transmission globally—fifth update 02 March 2020.https://www.ecdc.europa.eu/sites/default/files/documents/RRA-outbreak-novel-coronavirus-disease-2019-increase-transmission-globally-COVID-19.pdfDate accessed: March 13, 2020Google Scholar School closures during the 2014–16 Ebola epidemic increased dropouts, child labour, violence against children, teen pregnancies, and persisting socioeconomic and gender disparities.4UN Development ProgrammeUNDP Africa policy note: confronting the gender impact of Ebola virus disease in Guinea, Liberia, and Sierra Leone.https://reliefweb.int/sites/reliefweb.int/files/resources/RBA%20Policy%20Note%20Vol%202%20No%201%202015_Gender.pdfDate: 2015Date accessed: March 3, 2020Google Scholar Access to distance learning through digital technologies is highly unequal, and subsidised meal programmes, vaccination clinics, and school nurses are essential to child health care, especially for marginalised communities. Schools provide safeguarding and supervision, and closures increase the economic burden of families using day care or their reliance on vulnerable older relatives. Working parents might leave children unsupervised or forgo employment to stay at home with them. The case for school closures is far from compelling. The UK's Influenza Pandemic Preparedness Strategy acknowledges that "the benefit of school closure in reducing clinically important outcomes needs to be balanced against secondary adverse effects."5Department of HealthImpact of school closures on an influenza pandemic: scientific evidence base review.https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/316203/School_Closures_Evidence_review.pdfDate: 2014Date accessed: March 9, 2020Google Scholar This position aligns with the WHO–UNICEF–Lancet Commission's emphasis on addressing health, social, and educational factors so that children "survive and thrive".2Clark H Coll-Seck AM Banerjee A et al.A future for the world's children? A WHO–UNICEF–Lancet Commission.Lancet. 2020; 395: 605-658Summary Full Text Full Text PDF PubMed Scopus (446) Google Scholar School closure measures should consider epidemiological evidence and avoid exacerbating inequities, providing learning without digital technologies, childcare alternatives, and health care, including nutritional programmes. Authorities should implement strategies to reduce transmission within schools before or instead of closures,3European Centre for Disease Prevention and ControlOutbreak of novel coronavirus disease 2019 (COVID-19): increased transmission globally—fifth update 02 March 2020.https://www.ecdc.europa.eu/sites/default/files/documents/RRA-outbreak-novel-coronavirus-disease-2019-increase-transmission-globally-COVID-19.pdfDate accessed: March 13, 2020Google Scholar including smaller class sizes, physical distancing, and hygiene and sanitation promotion. Countries in the initial stages of mitigation measures have an opportunity to be leaders in best practice, prioritising young people and establishing strategies to proactively ensure that children are at the centre of future responses. We call for transparent public discussion and research, incorporating the voices of children and their families on the feasibility, acceptability, and impact of closures to inform both our response now and future pandemic planning. We ask whether adequate evidence exists of transmission reduction due to school closures to outweigh the long-term risks of deepening social, economic, and health inequities for children. We must strike a balance, protecting those most at risk without sacrificing the next generation's future. We declare no competing interests.