Reopening schools during the COVID-19 pandemic: governments must balance the uncertainty and risks of reopening schools against the clear harms associated with prolonged closure

Evidence to support the effectiveness of global school closures in controlling COVID-19 is sparse. There is continued uncertainty about the degree to which school children are susceptible to and transmit COVID-19. Balancing the potential benefits with harms involves explicit trade-offs for governments, but there has been little recognition that low-income and middle-income countries face a very different set of trade-offs around school reopening from those in wealthy countries. Both reopening schools and keeping them closed carry risks that actively require mitigation. Schools remain closed in many countries globally as part of efforts to control the COVID-19 pandemic.1 National governments face mounting dilemmas about when and how to reopen schools. We review the benefits and risks of school closures during the COVID-19 pandemic and outline key principles for reopening schools. Data from previous outbreaks suggest that schoolchildren may play only a relatively small role in the transmission of coronaviruses.2 Data from COVID-19 are sparse. Those under 20 years appear to be around half as susceptible as adults to severe acute respiratory syndrome coronavirus 23 4 and much less likely to be symptomatic.4 Yet data on viral load suggest that children may have COVID-19 viral load similar to that of adults.5 Data on transmission in schools are sparse. Population-based contact-tracing data on transmission in schools in Australia have identified almost no transmission.6 Given this uncertainty, the impact of reopening schools on transmission and the potential for a second pandemic wave is unclear. However, there is no evidence that children are more likely to transmit than adults, unlike in some respiratory viruses. When children do get COVID-19, there is also clear evidence that they are very unlikely to have severe illness or die.4 Together these data suggest that children, particularly primary schoolchildren, are likely to be …