Nav: Home

The Lancet Public Health: US modelling study estimates impact of school closures for COVID-19 on US health-care workforce and associated mortality

April 03, 2020

US policymakers considering physical distancing measures to slow the spread of COVID-19 face a difficult trade-off between closing schools to reduce transmission and new cases, and potential health-care worker absenteeism due to additional childcare needs that could ultimately increase mortality from COVID-19, according to new modelling research published in The Lancet Public Health journal.

Using the latest data from the US Census Bureau's Current Population Survey to measure the childcare needs of health-care workers if schools are shut, researchers estimate that nationwide, at least one in seven medical workers may have to miss work to care for their children aged 3-12 years old, even after taking into account childcare provided by non-working adults and older siblings within the same household.

These additional childcare obligations could compromise the ability of the US healthcare system to respond to COVID-19 if alternative childcare arrangements are not made, researchers say.

However, the authors caution that the true impact of school closures on overall deaths from COVID-19 cannot be precisely predicted because of large uncertainties around estimates of transmission and infectivity, and to what extent a decline in the health-care workforce impacts the survival of patients with COVID-19.

"Closing schools comes with many trade-offs, and can create unintentional child-care shortages that put a strain on the health-care system", says Professor Eli Fenichel from Yale University in the USA who co-led the research. "Health-care workers spending less time providing patient care to look after their own children can directly influence the development of an epidemic and the survival of those patients. Understanding these trade-offs is vital when planning the public health response to COVID-19 because if the survival of infected patients is sufficiently sensitive to declines in the healthcare workforce, then school closures could potentially increase deaths from COVID-19." [1]

Support for mandatory school closures to reduce cases and mortality from COVID-19 comes from experience with influenza, or models that do not include the effect of school closure on the health-care workforce. Few studies have considered the trade-off between case reduction and disease burden and the potential loss of healthcare workers to childcare obligations.

In the study, researchers analysed data on more than 3 million individuals between January 2018 and January 2020 to assess family structure and probable within-household childcare options for health-care workers. They identified those most likely to require additional childcare for children aged 3-12 years old in the event of school closures by type of health-care occupation nationally and across different states, assuming that early childcare for children aged under 2 years remains open. They also modelled potential declines in the health-care workforce during school closures with estimates of case reductions from school closures to identify the point at which more lives are lost from school closures than are saved.

The analyses suggest that around 29% of US health-care workers need to provide care for children aged 3-12 years old. In households without a non-working adult or a sibling aged 13 years or older to provide care, the researchers estimate that 15% of health-care workers will require childcare--equivalent to around 2.3 million children nationwide--if schools close. However, the authors note that they were unable to account for health-care workers finding alternative methods of care for their children such as babysitters or friends.

School closures will be especially challenging for nurse practitioners (22% will need childcare), physician's assistants (21%), diagnostic technicians (19%), and physicians and surgeons (16%), as well as nearly 13% of the nursing and home health aids who are single parents and part of the group helping the elderly with infection control in nursing homes, researchers say.

The US states likely to have the greatest unmet childcare needs include South Dakota (21% of health-care workers will need childcare), Oregon (21%), and Missouri (21%). In contrast, Washington DC (9% health-care workers with unmet childcare needs), New Mexico (10%), and New Jersey (11%) are least likely to have health-care worker shortages if schools close.

Further analysis suggests that if the case fatality fraction (the share of people who die out of all those infected) rises from 2% to more than 2.4% when the health-care workforce declines by 15%, school closures could lead to a greater number of deaths than those they prevent. However, there is substantial variation across the country. For example, in South Dakota estimates suggest that the case fatality rate must not increase by more than 1.7% before school closures stop saving lives and start increasing overall mortality, whereas in Washington DC it is 4.1%--this is due to the low child care obligations in Washington DC relative to South Dakota.

"The US healthcare system appears disproportionately prone to labour shortages from school closures, particularly among those health-care workers providing infection control in nursing homes", says co-lead author Dr Jude Bayham from Colorado State University, USA. "These potential health-care workforce shortages should be a priority when assessing the potential benefits and costs of school closures, and alternative child care arrangements must be part of the school closure plan." [1]

According to Fenichel, "Closing schools and distancing in general is about bending the curve to stay below hospital capacity and reduce COVID-19 mortality, but how we distance in order to bend the curve can also influence the hospital capacity we need to stay below. We need to account for both."

The authors note some important limitations of the study, including that the authors informed their model based on the influenza virus, to which children are particularly vulnerable--however, early data on COVID-19 suggests children may be less vulnerable, so the benefits of school closures may be smaller than expected. On the other hand, the authors note that closing schools earlier in an outbreak could prevent more cases and lead to less health-care workers being infected and thus able to treat more patients. The study did not include mortality from other conditions that might occur if the health-care workforce declined, which should be taken into consideration when deciding about closing schools, the authors say.

It was conducted by researchers from Colorado State University, USA; and Yale University, USA.

The labels have been added to this press release as part of a project run by the Academy of Medical Sciences seeking to improve the communication of evidence. For more information, please see: if you have any questions or feedback, please contact The Lancet press office

[1] Quotes direct from authors and cannot be found in the text of the Article.

Peer-reviewed / Modelling study / People

The Lancet

Related Mortality Articles:

New analysis shows hydroxychloroquine does not lower mortality in COVID-19 patients, and is associated with increased mortality when combined with the antibiotic azithromycin
A new meta-analysis of published studies into the drug hydroxychloroquine shows that it does not lower mortality in COVID-19 patients, and using it combined with the antibiotic azithromycin is associated with a 27% increased mortality.
Hydroxychloroquine reduces in-hospital COVID-19 mortality
An Italian observational study contributes to the ongoing debate regarding the use of hydroxychloroquine in the current pandemic.
What's the best way to estimate and track COVID-19 mortality?
When used correctly, the symptomatic case fatality ratio (sCFR) and the infection fatality ratio (IFR) are better measures by which to monitor COVID-19 epidemics than the commonly reported case fatality ratio (CFR), according to a new study published this week in PLOS Medicine by Anthony Hauser of the University of Bern, Switzerland, and colleagues.
COVID-19: Bacteriophage could decrease mortality
Bacteriophage can reduce bacterial growth in the lungs, limiting fluid build-up.
COPD and smoking associated with higher COVID-19 mortality
Current smokers and people with chronic obstructive pulmonary disease (COPD) have an increased risk of severe complications and higher mortality with COVID-19 infection, according to a new study published May 11, 2020 in the open-access journal PLOS ONE by Jaber Alqahtani of University College London, UK, and colleagues.
Highest mortality risks for poor and unemployed
Large dataset shows that income, work status and education have a clear influence on mortality in Germany.
Addressing causes of mortality in Zambia
Despite the fact that people in sub-Saharan Africa are now living longer than they did two decades ago, their average life expectancy remains below that of the rest of the world population.
Examining the link between caste and under-five mortality in India
In India, children that belong to disadvantaged castes face a much higher likelihood of not living past their fifth birthday than their counterparts in non-deprived castes.
Mortality rates rising for Gens X and Y too
Declining life expectancies in the US include Gen X and Y Americans, in addition to the older Baby Boomers.
Trust in others predicts mortality in the United States
Do you trust other people? It may prolong your life.
More Mortality News and Mortality Current Events

Trending Science News

Current Coronavirus (COVID-19) News

Top Science Podcasts

We have hand picked the top science podcasts of 2020.
Now Playing: TED Radio Hour

Sound And Silence
Sound surrounds us, from cacophony even to silence. But depending on how we hear, the world can be a different auditory experience for each of us. This hour, TED speakers explore the science of sound. Guests on the show include NPR All Things Considered host Mary Louise Kelly, neuroscientist Jim Hudspeth, writer Rebecca Knill, and sound designer Dallas Taylor.
Now Playing: Science for the People

#576 Science Communication in Creative Places
When you think of science communication, you might think of TED talks or museum talks or video talks, or... people giving lectures. It's a lot of people talking. But there's more to sci comm than that. This week host Bethany Brookshire talks to three people who have looked at science communication in places you might not expect it. We'll speak with Mauna Dasari, a graduate student at Notre Dame, about making mammals into a March Madness match. We'll talk with Sarah Garner, director of the Pathologists Assistant Program at Tulane University School of Medicine, who takes pathology instruction out of...
Now Playing: Radiolab

Kittens Kick The Giggly Blue Robot All Summer
With the recent passing of Ruth Bader Ginsburg, there's been a lot of debate about how much power the Supreme Court should really have. We think of the Supreme Court justices as all-powerful beings, issuing momentous rulings from on high. But they haven't always been so, you know, supreme. On this episode, we go all the way back to the case that, in a lot of ways, started it all.  Support Radiolab by becoming a member today at