{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T01:29:27Z","timestamp":1792114167653,"version":"4.4.0"},"update-to":[{"DOI":"10.1371\/journal.pmed.1004512","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2025,2,4]],"date-time":"2025-02-04T00:00:00Z","timestamp":1738627200000}}],"reference-count":32,"publisher":"Public Library of Science (PLoS)","issue":"1","license":[{"start":{"date-parts":[[2025,1,21]],"date-time":"2025-01-21T00:00:00Z","timestamp":1737417600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000925","name":"National Health and Medical Research Council","doi-asserted-by":"publisher","award":["GNT2025844"],"award-info":[{"award-number":["GNT2025844"]}],"id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000923","name":"Australian Research Council","doi-asserted-by":"publisher","award":["DE230100730"],"award-info":[{"award-number":["DE230100730"]}],"id":[{"id":"10.13039\/501100000923","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Medical Research Future Fund","award":["RRDHI000027"],"award-info":[{"award-number":["RRDHI000027"]}]}],"content-domain":{"domain":["www.plosmedicine.org"],"crossmark-restriction":false},"short-container-title":["PLoS Med"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>School closures have been a prominent component of the global Coronavirus Disease 2019 (COVID-19) response. However, their effect on viral transmission, COVID-19 mortality and health care system pressure remains incompletely understood, as traditional observational studies fall short in assessing such population-level impacts.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods and findings<\/jats:title>\n<jats:p>We used a mathematical model to simulate the COVID-19 epidemics of 74 countries, incorporating observed data from 2020 to 2022 and historical school closure timelines. We then simulated a counterfactual scenario, assuming that schools remained open throughout the study period. We compared the simulated epidemics in terms of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infections, deaths, and hospital occupancy pressure. We estimated that school closures achieved moderate to significant burden reductions in most settings over the period 2020 to 2022. They reduced peak hospital occupancy pressure in nearly all countries, with 72 out of 74 countries (97%) showing a positive median estimated effect, and median estimated effect ranging from reducing peak hospital occupancy pressure by 89% in Brazil to increasing it by 19% in Indonesia. The median estimated effect of school closures on COVID-19 deaths ranged from a 73% reduction in Thailand to a 7% increase in the United Kingdom. We estimated that school closures may have increased overall COVID-19 mortality (based on median estimates) in 9 countries (12%), including several European nations and Indonesia. This is attributed to changes in population-level immunity dynamics, leading to a concentration of the epidemic during the Delta variant period, alongside an upward shift in the age distribution of infections. While our estimates were associated with significant uncertainty, our sensitivity analyses exploring the impact of social mixing assumptions revealed robustness in our country-specific conclusions. The main study limitations include the fact that analyses were conducted at the national level, whereas school closure policies often varied by region. Furthermore, some regions, including Africa, were underrepresented due to insufficient data informing the model.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Our analysis revealed nuanced effects of school closures on COVID-19 dynamics, with reductions in COVID-19 impacts in most countries but negative epidemiological effects in a few others. We identified critical mechanisms for consideration in future policy decisions, highlighting the unpredictable nature of emerging variants and potential shifts in infection demographics associated with school closures.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pmed.1004512","type":"journal-article","created":{"date-parts":[[2025,1,21]],"date-time":"2025-01-21T18:27:11Z","timestamp":1737484031000},"page":"e1004512","update-policy":"https:\/\/doi.org\/10.1371\/journal.pmed.corrections_policy","source":"Crossref","is-referenced-by-count":8,"title":["Estimating the impact of school closures on the COVID-19 dynamics in 74 countries: A modelling analysis"],"prefix":"10.1371","volume":"22","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8520-2362","authenticated-orcid":true,"given":"Romain","family":"Ragonnet","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1543-1757","authenticated-orcid":true,"given":"Angus E.","family":"Hughes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-4663-1366","authenticated-orcid":true,"given":"David S.","family":"Shipman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael T.","family":"Meehan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9233-5059","authenticated-orcid":true,"given":"Alec S.","family":"Henderson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4878-2000","authenticated-orcid":true,"given":"Guillaume","family":"Briffoteaux","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nouredine","family":"Melab","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Tuyttens","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9570-9172","authenticated-orcid":true,"given":"Emma S.","family":"McBryde","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0991-1631","authenticated-orcid":true,"given":"James M.","family":"Trauer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,1,21]]},"reference":[{"key":"pmed.1004512.ref001","author":"Public Health England","year":"2014","journal-title":"Impact of School Closures on an Influenza Pandemic Scientific Evidence Base Review"},{"issue":"5","key":"pmed.1004512.ref002","doi-asserted-by":"crossref","first-page":"397","DOI":"10.1016\/S2352-4642(20)30095-X","article-title":"School closure and management practices during coronavirus outbreaks including COVID-19: a rapid systematic review","volume":"4","author":"RM Viner","year":"2020","journal-title":"Lancet Child Adolesc Health"},{"issue":"5","key":"pmed.1004512.ref003","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1016\/S2352-4642(20)30105-X","article-title":"Pandemic school closures: risks and opportunities.","volume":"4","author":"The Lancet Child Adolescent 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a global SARS-CoV-2 seroprevalence dashboard","volume":"21","author":"RK Arora","year":"2021","journal-title":"Lancet Infect Dis"},{"issue":"1","key":"pmed.1004512.ref013","doi-asserted-by":"crossref","first-page":"6266","DOI":"10.1038\/s41467-021-26558-4","article-title":"Understanding how Victoria, Australia gained control of its second COVID-19 wave.","volume":"12","author":"JM Trauer","year":"2021","journal-title":"Nat Commun."},{"key":"pmed.1004512.ref014","first-page":"100211","article-title":"Understanding COVID-19 dynamics and the effects of interventions in the Philippines: A mathematical modelling study","volume":"14","author":"JM Caldwell","year":"2021","journal-title":"Lancet Reg Health West Pac"},{"key":"pmed.1004512.ref015","doi-asserted-by":"crossref","first-page":"100517","DOI":"10.1016\/j.epidem.2021.100517","article-title":"Sustaining effective COVID-19 control in Malaysia through large-scale vaccination.","volume":"37","author":"P 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Available from: https:\/\/github.com\/idem-lab\/conmat [accessed: 13\/01\/2024]."},{"issue":"1","key":"pmed.1004512.ref019","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1038\/s41467-020-20544-y","article-title":"Inferring high-resolution human mixing patterns for disease modeling.","volume":"12","author":"D Mistry","year":"2021","journal-title":"Nat Commun."},{"key":"pmed.1004512.ref020","article-title":"Monash Epidemiological Modelling Unit","journal-title":"GitHub repository of the summer modelling package"},{"key":"pmed.1004512.ref021","article-title":"Monash Epidemiological Modelling Unit","journal-title":"GitHub repository for COVID-19 school closures modelling 2024"},{"issue":"27","key":"pmed.1004512.ref022","doi-asserted-by":"crossref","first-page":"13174","DOI":"10.1073\/pnas.1821298116","article-title":"Reactive school closure weakens the network of social interactions and reduces the spread of influenza","volume":"116","author":"M 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Munday","year":"2021","journal-title":"BMC Med."},{"issue":"1","key":"pmed.1004512.ref032","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1186\/s12916-020-01872-8","article-title":"The impact of non-pharmaceutical interventions on SARS-CoV-2 transmission across 130 countries and territories.","volume":"19","author":"Y Liu","year":"2021","journal-title":"BMC Med"}],"updated-by":[{"DOI":"10.1371\/journal.pmed.1004512","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2025,2,4]],"date-time":"2025-02-04T00:00:00Z","timestamp":1738627200000}}],"container-title":["PLOS 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