Non-Pharmacological Interventions for Pandemic Mitigation: What you should know (Part 2)

School measures and closures

Background Information:

School closure: School is closed to all children and staff

Class dismissal: School campus remains open with administrative staff, but most children stay home.

Reactive closure or dismissal: School is closed after a substantial incidence of illness is reported among children or staff (or both) in that school.

Proactive closure or dismissal: School is closed before a substantial transmission among children and staff is reported.

School Measures: These include

  • Increasing desk distance between students
  • Cancelling or postponing after-school activities
  • Restricting access to common areas
  • Staggering the school schedule
  • Reducing mixing during transport to and from school
  • Dividing classes into smaller groups
  • Cancelling classes that bring students together from multiple classrooms
  • Increasing attention to students with symptoms of illness
  • Ensuring ill children either do not attend school, or are segregated from other students


A total of 101 epidemiological studies were included in the systematic review.

The effect of reactive school closure in reducing influenza transmission varied but was generally limited. Proactive closures and planned school holidays had a moderate impact on transmission.

The timing and duration of school closures is critical- mistimed closures could lack impact.

Although school closures alone may have an impact, combination with other interventions improved the effectiveness.

School closure is found to be potentially not cost-effective, with costs being:

  • 0.2-1% of GDP per week of proactive closure in the UK and Australia
  • 0.1-0.3% of GDP for 4 weeks’ proactive closure in the USA
  • >3% of GDP for 8 weeks’ reactive closure in the USA

School closure could have a major impact on the safety, health and nutrition of children in lower income families:

  • Missing work to take care of children could affect income
  • Lack of access to free school meals could be an additional concern

Parents may face challenges in making other arrangements for care or supervision of their children, especially if closures are prolonged.

If students do not have access to alternative learning strategies (like online classes); miss important exams or class work, their educational advancement may be jeopardized.

If schools remain open during a pandemic or epidemic, school measures can be considered to reduce transmission.

A class dismissal intervention could include a provision or children of low-income families or essential workers to attend school, and would be a more flexible measure than complete school closure.

Quality of evidence: There is a very low overall quality of evidence, and published studies reported or predicted that school measures and closures have a variable effect on transmission of influenza.

Overall strength of recommendation: Conditionally recommended

School measures are likely to be feasible in any epidemic or pandemic, and are conditionally recommended, with gradation of interventions based on severity.

The balance between the advantages and disadvantages of school closure is less certain, but closure may be considered in severe epidemics/ pandemics, and the timing and duration should be limited to a period that is judged to be optimal.

Useful Links:

Link to the previous article on Non-Pharmacological Interventions for Pandemic Mitigation:

Link to the related WHO document:

1 thought on “Non-Pharmacological Interventions for Pandemic Mitigation: What you should know (Part 2)

  1. Pingback: Non-Pharmacological Interventions for Pandemic Mitigation: What you should know (Part 3) | communitymedicine4all

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