Effectiveness of isolation policies in schools: evidence from a mathematical model of influenza and COVID-19.
Effectiveness of isolation policies in schools: evidence from a mathematical model of influenza and COVID-19.
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作者：
Burns AAC;Gutfraind A
通常会实施社交距离、关闭学校和旅行限制等非药物干预措施来控制传染病的爆发。对于学校流感，疾病控制中心 (CDC) 建议发热学生在家中隔离，直到他们至少一天不再发烧，并建议针对 SARS-CoV-2 (COVID-19) 采取相关政策。其他作者建议在学校每周对所有学生进行四天或更少天的面对面教学，以减少传播。然而，支持这些干预措施有效性的证据有限。我们引入了考虑两种干预方法的学校疫情数学模型。我们的模型考虑了学校的结构和时间表，以及发烧症状和病毒脱落的时间进展。该模型在学校爆发的季节性流感和大流行性流感以及 COVID-19 中得到了验证。然后用它来估计拟议干预措施下的疫情曲线和感染人口比例（发病率）。对于流感，CDC 建议发烧后隔离一天可以将发病率中位数（四分位距）降低 29 (13–59)%。发烧后隔离 2 天，发病率可降低 70 (55–85)%。或者，将学校周缩短至 4 天和 3 天可分别将发病率降低 73 (64–88)% 和 93 (91–97)%。对于 COVID-19，应用发烧后隔离政策效果较差，2 天隔离政策可将发病率降低 10 (5–17)%，14 天隔离政策可将发病率降低 14 (5–26)%。每周 4 天的学校将使 COVID-19 爆发的中位发病率降低 57 (52–64)%，而每周 3 天的学校将降低 81 (79–83)%。在这两种感染中，缩短上课周数显着缩短了疫情爆发的持续时间。缩短上课周可能是在学校和类似环境中控制流感和 COVID-19 的重要工具。此外，疾病预防控制中心建议的流感发烧后隔离政策可以通过要求隔离两天而不是一天来加强。
Non-pharmaceutical interventions such as social distancing, school closures and travel restrictions are often implemented to control outbreaks of infectious diseases. For influenza in schools, the Center of Disease Control (CDC) recommends that febrile students remain isolated at home until they have been fever-free for at least one day and a related policy is recommended for SARS-CoV-2 (COVID-19). Other authors proposed using a school week of four or fewer days of in-person instruction for all students to reduce transmission. However, there is limited evidence supporting the effectiveness of these interventions. We introduced a mathematical model of school outbreaks that considers both intervention methods. Our model accounts for the school structure and schedule, as well as the time-progression of fever symptoms and viral shedding. The model was validated on outbreaks of seasonal and pandemic influenza and COVID-19 in schools. It was then used to estimate the outbreak curves and the proportion of the population infected (attack rate) under the proposed interventions. For influenza, the CDC-recommended one day of post-fever isolation can reduce the attack rate by a median (interquartile range) of 29 (13–59)%. With 2 days of post-fever isolation the attack rate could be reduced by 70 (55–85)%. Alternatively, shortening the school week to 4 and 3 days reduces the attack rate by 73 (64–88)% and 93 (91–97)%, respectively. For COVID-19, application of post-fever isolation policy was found to be less effective and reduced the attack rate by 10 (5–17)% for a 2-day isolation policy and by 14 (5–26)% for 14 days. A 4-day school week would reduce the median attack rate in a COVID-19 outbreak by 57 (52–64)%, while a 3-day school week would reduce it by 81 (79–83)%. In both infections, shortening the school week significantly reduced the duration of outbreaks. Shortening the school week could be an important tool for controlling influenza and COVID-19 in schools and similar settings. Additionally, the CDC-recommended post-fever isolation policy for influenza could be enhanced by requiring two days of isolation instead of one.
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影响因子：
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作者：
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DOI：
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