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Impact of school closures for COVID-19 on the US health-care workforce and net mortality: a modelling study

Our take —

This study highlights an overlooked cost of school closures: possible increases in COVID-19 mortality associated with health care workers leaving work because of increased child care burden. The model ignores several potentially important dynamics, and is reliant on assumptions with considerable uncertainty, so its estimate of the critical parameter value should be interpreted with caution. It is nonetheless useful in calling attention to real-world tradeoffs.

Study design

Modeling/Simulation

Study population and setting

This modeling study considers the population of health care workers (HCWs) in the US, drawing on data from the US Current Population Survey on family structure to estimate child-care requirements. The study estimates the critical value of a parameter (the decrease in COVID-19 survival probability associated with a reduction in the health care workforce) at which school closures would “break even” in terms of overall mortality.

Summary of Main Findings

An estimated 29% of US HCWs provide care for children aged 3-12 years. Under model assumptions, a 17.6% increase in mortality probability per COVID-19 patient, occasioned by a reduction in the HCW labor force to meet child-care needs, would offset the benefits (in terms of reduced transmission and thus mortality) from nationwide school closures.

Study Strengths

The study draws on detailed data on household structure among HCWs from a large, nationwide, monthly survey.

Limitations

The model assumes that HCWs will find no alternative child care options upon school closures. The model ignores any effects of health care labor on non-COVID-19 mortality, which may be considerable. The model ignores the mortality benefits of removing HCWs from high-risk transmission environments. HCWs are treated homogeneously; the relationship between COVID-19 survival probability and health care labor is likely highly complex and spatially idiosyncratic.

Value added

This study addresses an overlooked aspect of school closures: namely, the fact that they impose a large child care burden on health care workers with real costs in terms of public health.