Measures implemented in the school setting to contain the COVID‐19 pandemic: a rapid review

Cochrane published a rapid review in January 2022 where the effectiveness of measures implemented in the school setting to safely reopen schools, or keep schools open, or both, during the COVID‐19 pandemic, with particular focus on the different types of measures implemented in school settings and the outcomes used to measure their impacts on transmission‐related outcomes, healthcare utilisation outcomes, other health outcomes as well as societal, economic, and ecological outcomes were assessed. The evidence current up to December 2020 found 38 relevant studies. Most of these were modelling studies (33 studies). Five studies used real‐world data. Twenty studies were conducted in North or South America, 16 in Europe and two in China. Measures in the school setting can be grouped into the following four broad categories.

1. Measures reducing the opportunity for contacts: by reducing the number of students in a class or a school, opening certain school types only (for example primary schools) or by creating a schedule by which students attend school on different days or in different weeks, the face‐to‐face contact between students can be reduced.
2. Measures making contacts safer: by putting measures in place such as face masks, improving ventilation by opening windows or using air purifiers, cleaning, hand washing, or modifying activities like sports or music, contacts can be made safer.
3. Surveillance and response measures: screening for symptoms or testing sick or potentially sick students, or teachers, or both, and putting them into isolation (for sick people) or quarantine (for potentially sick people).
4. Multicomponent measures: measures from categories 1, 2 and 3 are combined.

The review aimed to find out which measures implemented in the school setting allow schools to safely reopen, stay open, or both, during the COVID‐19 pandemic and searched for studies that looked at the impact of these types of measures in the school setting on the spread of the virus that causes COVID‐19, the impact on the healthcare system (i.e. how many hospital beds are needed), as well as important social aspects (i.e. how often students attended school). The studies could focus on students, teachers and other school staff, as well as on families and the whole community. They could use real‐life data (observational studies) or data from computer‐generated simulations (modelling studies). The confidence in the results of the review is limited. Most studies used models, that is, they estimated the effects of the interventions rather than observing outcomes. As the models are built on assumptions about how the virus spreads and how people behave, review lack real‐world evidence. Many studies were published as 'preprints' without undergoing rigorous checks of published studies, which further limits our confidence. Also, the studies were very different from each other (for example, with regards to the levels of transmission in the community).

Key messages

Reopening schools or keeping schools open while having a broad range of measures in place can reduce transmission of the virus that causes COVID‐19. Such measures can also reduce the number of people who will need to go to hospital due to developing COVID‐19. Very little is known about other consequences of these measures, such as those linked to education, resources, and physical or mental health, as this knowledge is mostly based on studies modelling the real world. More studies set in the real world using real‐world data are needed.

The review can be accessed at