Association of Elementary School Reopening Status and County COVID-19 Incidence

Acad Pediatr. 2022 May-Jun;22(4):667-670. doi: 10.1016/j.acap.2021.09.006. Epub 2021 Sep 20.


Objective: To examine the association between elementary school opening status (ESOS) and changes in pediatric COVID-19 incidence.

Methods: We conducted a cross-sectional study of US counties with school districts with ≥500 elementary school students. The main exposure was ESOS in September, 2020. The outcome was county incidence of COVID-19. Age-stratified negative binomial regression models were constructed using county adult COVID-19 incidence.

Results: Among 3220 US counties, 618 (19.2%) were remote, 391 (12.1%) were hybrid, 2022 (62.8%) were in-person. In unadjusted models, COVID-19 incidence after school started was higher among children in hybrid or in-person counties compared with remote counties. After adjustment for local adult incidence, among children aged 0 to 9, the incidence rate ratio of COVID-19 (IRR) compared with remote counties was 1.01 (95% confidence interval [CI] 0.93-1.08) in hybrid counties and 0.79 (95% CI 0.75-0.84) in in-person counties.

Conclusions: Counties with in-person learning did not have higher rates of COVID-19 after adjustment for local adult rates.

Keywords: COVID-19; in-person learning; school reopening; school safety.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • COVID-19* / epidemiology
  • Child
  • Cross-Sectional Studies
  • Humans
  • Incidence
  • Schools
  • Students
  • United States / epidemiology