Household COVID-19 risk and in-person schooling

Abstract

In-person schooling has proved contentious and difficult to study throughout the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. Data from a massive online survey in the United States indicate an increased risk of COVID-19-related outcomes among respondents living with a child attending school in person. School-based mitigation measures are associated with significant reductions in risk, particularly daily symptoms screens, teacher masking, and closure of extracurricular activities. A positive association between in-person schooling and COVID-19 outcomes persists at low levels of mitigation, but when seven or more mitigation measures are reported, a significant relationship is no longer observed. Among teachers, working outside the home was associated with an increase in COVID-19-related outcomes, but this association is similar to that observed in other occupations (e.g., health care or office work). Although in-person schooling is associated with household COVID-19 risk, this risk can likely be controlled with properly implemented school-based mitigation measures.

Fig. 1. Spatial distribution of survey responses.

(A) Number of survey respondents reporting a school-aged student in the household by county. (B) Percentage of households with school-aged children reporting any in-person schooling by county, excluding counties with fewer than 10 responses (excluded counties are shown in dark gray). (C) Percentage of households reporting a child in in-person schooling who report full-time in-person schooling, excluding counties with fewer than 10 reporting in-person schooling. (D) Average number of school-based mitigation measures reported for children with in-person schooling, excluding counties with fewer than 10 reporting in-person schooling.

Fig. 2. Risk from in-person schooling and distribution of mitigation measures by grade.

(A) Odds ratio of COVID-19–related outcomes associated with full- and part-time in-person schooling by outcome and grade level compared with individuals with children in their household not attending in-person schooling and adjusted for individual- and county-level covariates (but not number of mitigation measures), which indicates that the strength of the association increases with grade level. K, kindergarten. (B) Distribution of mitigation measures by grade level and full- versus part-time in-person status across all grades. Test+, positive SARS-CoV-2 test result.

Fig. 3. Impact of individual mitigation measures.

(A) Relationship between number of mitigation measures and percent reporting COVID-19–related outcomes using a log-linear (solid lines) and spline (dashed lines) model. (B) Odds ratio of COVID-19–related outcomes by mitigation measure in multivariable model including all measures versus the reduction resulting from a generic mitigation measure (dashed line).

Fig. 4. Risk of in-person schooling by strata of number of reported mitigation measures.

(A) Estimated risk associated with full- and part-time in-person schooling by outcome and number of mitigation measures implemented, adjusted for individual- and county-level covariates. (B) Distribution of mitigation measures by total number of measures implemented.

Fig. 5. Subgroup analysis of association between in-person schooling and COVID-19–related outcomes.

(A to C) Estimated odds ratios (versus those in strata not reporting in-person schooling) of COVID-19–related outcomes from full-time (circles and dashed lines) and part-time (triangles and dotted lines) in-person schooling, when data are stratified by county population size and relation to metropolitan areas (metropolitan area, nonmetropolitan area, or adjacent to metropolitan area) (A); quintile of incidence [quintile 1 (Q1) is lowest and Q5 is highest] (B); and propensity to report in-person schooling (Q5, most likely to have in-person schooling; Q1, least likely) (C). Horizontal dashed and dotted lines show overall point estimates for full-time and part-time in-person instruction, respectively.