School Closures’ Impact on Health Care Workforce May Affect COVID-19 Mortality

The coronavirus disease 2019 (COVID-19) pandemic has made it necessary to implement social (physical) distancing policies in the United States, which required the closure of schools across the country. Evidence that school closures are an effective method of reducing mortality comes from experience with influenza, the spread of which has historically not resulted in absenteeism among the health care labor force due to child-care obligations.¹

Now, the decision to maintain school closures during the COVID-19 epidemic raises unique challenges regarding the benefits of closures weighed against the costs of resulting health care worker absenteeism. A study published in The Lancet Public Health addressed these challenges and found that at least 1 in 7 medical workers may have to miss work to care for their children aged 3 to 12 years, a number that takes into account childcare provided by non-working adults and older siblings within the same household.¹

“Closing schools comes with many trade-offs and can create unintentional child-care shortages that put a strain on the health care system,” said professor Eli Fenichel from Yale University, a co-author of the study, in a press release. “Health care workers spending less time providing patient care to look after their own children can directly influence the development of an epidemic and the survival of those patients. Understanding these tradeoffs is vital when planning the public health response to COVID-19 because if the survival of infected patients is sufficiently sensitive to declines in the health care workforce, then school closures could potentially increase deaths from COVID-19.”²

The authors used data from monthly releases between January 2018 and January 2020 of the US Current Population Survey to characterize the family structure and probable within-household childcare options of US health care workers.¹ The US health care sector has some of the highest childcare obligations in the United States, with 15% of the health care workforce still needing child care in the event of a school closure.¹

Notably, school closures will be especially challenging for nurse practitioners (22% will need childcare), physician's assistants (21%), diagnostic technicians (19%), and physicians and surgeons (16%), as well as nearly 13% of the nursing and home health aides who are single parents and helping the elderly with infection control in nursing homes.¹

“The US health care system appears disproportionately prone to labor shortages from school closures, particularly among those health care workers providing infection control in nursing homes,” said co-author Jude Bayham, PhD, from Colorado State University, in a press release. “These potential health care workforce shortages should be a priority when assessing the potential benefits and costs of school closures, and alternative child-care arrangements must be part of the school closure plan.”²

The results of the study showed that, when taking into account reasonable parameters for COVID-19, such as a 15% case reduction from school closings and 2% baseline mortality rate, a reduction in the health care labor force would need to decrease the survival probability per percent health care worker lost by 17.6% in order for a school closure to increase cumulative mortality.¹ However, the authors estimate that if the infection mortality rate of COVID-19 increases from 2% to 2.35% while the health care workforce simultaneously declines by 15%, school closures could lead to a greater number of deaths than they prevent.¹

References

• Bayham J, Fenichel E. Impact of school closures for COVID-19 on the US health-care workforce and net mortality: a modelling study. The Lancet Public Health. 2020. doi: 10.1016/S2468-2667(20)30082-7.
• US modelling study estimates impact of school closures for COVID-19 on US health-care workforce and associated mortality [news release]. ScienceDaily; April 4, 2020. http://sciencedaily.com/releases/2020/04/200404155613.htm. Accessed April 6, 2020.