Impact of school closures for COVID-19 on the US health-care workforce and net mortality: a modelling study
Impact of school closures for COVID-19 on the US health-care workforce and net mortality: a modelling study
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DOI：
10.1016/s2468-2667(20)30082-7
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发表时间：
2020-05-01
影响因子：
50
通讯作者：
Fenichel, Eli P.
中科院分区：
文献类型：
--
作者：
Bayham, Jude;Fenichel, Eli P.
背景2019冠状病毒病（COVID-19）大流行导致全球（包括美国）采取社交（物理）距离政策。政府首先采取的一些行动是关闭学校。强制关闭学校减少了病例数，并最终减少了死亡率，这一证据来自流感方面的经验，或来自不包括关闭学校对保健劳动力影响的模型。关闭学校可能带来的好处需要与保健工作者因承担额外的托儿义务而缺勤的成本进行权衡。在这项研究中，我们的目的是衡量美国卫生保健工作者因学校关闭而产生的儿童保育义务，当这些被用作社交距离措施时。然后，我们评估了卫生保健工作者的贡献在降低因儿童保育义务而缺勤的死亡率方面的重要性，以消除学校关闭在减少病例数量方面的好处。我们使用美国当前人口调查每月发布的数据来分析美国健康的家庭结构和可能的家庭内儿童保育选择，护工我们占卫生保健部门，国家和家庭结构内的职业，以确定卫生保健劳动力的部分，最容易受到学校关闭的儿童保育义务。我们使用这些估计值来确定卫生保健劳动力供应在增加COVID-19患者生存概率方面的重要性将抵消学校关闭的好处并最终增加累积死亡率的临界水平。美国当前人口调查包括130万个家庭中310多万人的信息。我们发现，美国卫生保健部门的儿童保育义务是美国最高的，28.8%（95%CI 28.5-29.1）的卫生保健工作人员需要为3-12岁的儿童提供护理。假设没有工作的成年人或13岁或13岁以上的兄弟姐妹可以提供儿童保育，那么在学校关闭期间，15.0%（14.8-15.2）的卫生保健工作人员仍然需要儿童保育。我们观察到医疗保健系统内部存在很大差异。我们估计，结合COVID-19的合理参数，例如学校关闭病例减少15.0%和基线死亡率2.0%，医疗卫生劳动力减少15.0%需要将学校关闭的每百分比医疗卫生工作者的生存概率降低17.6%，以增加累积死亡率。我们的模型估计，如果COVID-19的感染死亡率从2. 00%上升到2. 35%，而卫生保健人员减少15. 0%，学校关闭可能导致更多的死亡人数比他们防止。解释学校关闭带来了许多权衡，并可能产生意想不到的儿童保育义务。我们的研究结果表明，在没有缓解措施的情况下，从降低COVID-19造成的累积死亡率的角度来看，需要仔细权衡学校关闭的潜在传染预防措施与卫生保健工作者的潜在损失。版权所有（C）2020作者。爱思唯尔有限公司出版
Background The coronavirus disease 2019 (COVID-19) pandemic is leading to social (physical) distancing policies worldwide, including in the USA. Some of the first actions taken by governments are the closing of schools. The evidence that mandatory school closures reduce the number of cases and, ultimately, mortality comes from experience with influenza or from models that do not include the effect of school closure on the health-care labour force. The potential benefits from school closures need to be weighed against costs of health-care worker absenteeism associated with additional child-care obligations. In this study, we aimed to measure child-care obligations for US health-care workers arising from school closures when these are used as a social distancing measure. We then assessed how important the contribution of health-care workers would have to be in reducing mortality for their absenteeism due to child-care obligations to undo the benefits of school closures in reducing the number of cases.Methods For this modelling analysis, we used data from the monthly releases of the US Current Population Survey to characterise the family structure and probable within-household child-care options of US health-care workers. We accounted for the occupation within the health-care sector, state, and household structure to identify the segments of the health-care workforce that are most exposed to child-care obligations from school closures. We used these estimates to identify the critical level at which the importance of health-care labour supply in increasing the survival probability of a patient with COVID-19 would undo the benefits of school closures and ultimately increase cumulative mortality.Findings Between January, 2018, and January, 2020, the US Current Population Survey included information on more than 3.1 million individuals across 1.3 million households. We found that the US health-care sector has some of the highest child-care obligations in the USA, with 28.8% (95% CI 28.5-29.1) of the health-care workforce needing to provide care for children aged 3-12 years. Assuming non-working adults or a sibling aged 13 years or older can provide child care, 15.0% (14.8-15.2) of the health-care workforce would still be in need of child care during a school closure. We observed substantial variation within the health-care system. We estimated that, combined with reasonable parameters for COVID-19 such as a 15.0% case reduction from school closings and 2.0% baseline mortality rate, a 15.0% decrease in the health-care labour force would need to decrease the survival probability per percent health-care worker lost by 17.6% for a school closure to increase cumulative mortality. Our model estimates that if the infection mortality rate of COVID-19 increases from 2.00% to 2.35% when the health-care workforce declines by 15.0%, school closures could lead to a greater number of deaths than they prevent.Interpretation School closures come with many trade-offs, and can create unintended child-care obligations. Our results suggest that the potential contagion prevention from school closures needs to be carefully weighted with the potential loss of health-care workers from the standpoint of reducing cumulative mortality due to COVID-19, in the absence of mitigating measures. Copyright (C) 2020 The Author(s). Published by Elsevier Ltd.