Estimation of US Children’s Educational Attainment and Years of Life Lost Associated With Primary School Closures During the Coronavirus Disease 2019 Pandemic
Authors: Dimitri A. Christakis, Wil Van Cleve, Frederick J. Zimmerman
Journal: JAMA Network Open (2020)

<h3>Importance</h3> United States primary school closures during the 2020 coronavirus disease 2019 (COVID-19) pandemic affected millions of children, with little understanding of the potential health outcomes associated with educational disruption. <h3>Objective</h3> To estimate the potential years of life lost (YLL) associated with the COVID-19 pandemic conditioned on primary schools being closed or remaining open. <h3>Design, Setting, and Participants</h3> This decision analytical model estimated the association between school closures and reduced educational attainment and the association between reduced educational attainment and life expectancy using publicly available data sources, including data for 2020 from the US Centers for Disease Control and Prevention, the US Social Security Administration, and the US Census Bureau. Published peer-reviewed studies (2 US studies, 5 European studies) were identified that provided estimates of the relative risk (RR) of annual mortality related to educational attainment, which were weighted and applied to the most recent life table data to obtain YLL estimates across the life course. Direct COVID-19 mortality and potential increases in mortality that might have resulted if school opening led to increased transmission of COVID-19 were also estimated. <h3>Main Outcomes and Measures</h3> Years of life lost. <h3>Results</h3> A total of 24.2 million children aged 5 to 11 years attended public schools that were closed during the 2020 pandemic, losing a median of 54 (interquartile range, 48-62.5) days of instruction. Missed instruction was associated with a mean loss of 0.15 (95% credible interval [CI], 0.08-0.22) years of final educational attainment for boys and 0.12 (95% CI, 0.06-0.19) years for girls. Summed across the population, based on the RR from US studies, an estimated 13.8 million (95% CI, 2.5-42.1) YLL may be associated with school closures. Summed across the population, based on the RR from the European studies, an estimated 0.8 million (95% CI, 0.1 -2.4) YLL may be associated with school closures. The Centers for Disease Control and Prevention reported a total of 88 241 US deaths from COVID-19 through the end of May 2020, with an estimated 1.50 million (95% CI, 1.23-1.85 million) YLL as a result. Had schools remained open, an estimated 4.4 million (95% CI 2.29-6.41,) YLL could have been expected as a result, based on results of studies associating school closure with decreased pandemic spread. Comparing the full distributions of estimated YLL under both "schools open" and "schools closed" conditions, based on the US studies and the European studies, the analysis observed a 98.9% probability and a 26.3% probability, respectively, that school opening would have been associated with a lower total YLL than school closure. <h3>Conclusions and Relevance</h3> In this decision analytical model of years of life potentially lost under differing conditions of school closure, based on the US studies, the analysis favored schools remaining open. Future decisions regarding school closures during the pandemic should consider the association between educational disruption and decreased expected lifespan and give greater weight to the potential outcomes of school closure on children's health.