During a pandemic, the World Health Organization (WHO) recommends school closures as an effective strategy to prevent any transmission of the virus. But, a recent U.S. modeling study estimates that school closures might result in the absenteeism of 29% of U.S. healthcare workers. The reason? They might need to stay at home to take care of their young children between the ages of 3 to 12 years old.

Nurses, in particular, might have to face the major brunt of school closures. Around 22% of nurse practitioners will find it challenging to arrange for child care. The study, published in the Lancet Public Health Journal, estimates that 21% of healthcare workers living in South Dakota, Oregon, and Missouri, are likely to have the highest unmet child care needs. 

The researchers, Eli Fenichel, associate professor of bioeconomics and ecosystem at Yale University, and Jude Bayham, assistant professor in the Department of Agriculture and Resource Economics at Colorado State University, observed in their study that school closures come with many trade-offs. On the one hand, it can add to the long list of responsibilities of already over-worked healthcare workers – which could result in absenteeism. But on the other hand, school closures prevent the coronavirus from spreading among children and school staff members. 

“In our study, we aren’t saying exactly what policies should or shouldn’t be enacted largely because there’s uncertainty around some of our estimates,” says Bayham. 

In the worst-case scenario, if schools remain closed, around 2.3 million children of healthcare workers across the U.S. might be left unattended if their parents don’t have a friend or a babysitter to take care of their little ones. In households without a stay-at-home adult or a sibling over the age of 13, the researchers estimate that 15% of healthcare workers will require to opt for alternative child care. By using data from the U.S. Current Population Survey, the researchers found that 6.8% of healthcare workers live in single-parent households. 

The researchers’ model estimates that if the mortality rate of COVID-19 infections increases from 2% to 2.35% while the healthcare workforce simultaneously declines by 15%, that is when school closures could lead to more deaths than they prevent.

“When it comes to our estimation of mortality rates increasing to 2.35%, we came to that conclusion from another study that was done in France a few years ago. That’s the best estimate that currently exists in the academic literature,” says Bayham.

“So, the point of our paper is we don’t exactly know where we are on these parameters. And that is what we’re trying to highlight to the rest of the academic community,” he adds.

The authors of the study were also not able to account for healthcare workers who can find a babysitter or someone else to supervise their children during working hours. Other than just nurse practitioners, 21% of physician’s assistants and 19% of diagnostic technicians will also face the same challenges. Similarly, 16% of physicians and surgeons might also need to skip work to take care of their children if schools continue to remain closed. 

Surprisingly, only 9% of healthcare workers living in Washington D.C. and 10% in New Mexico would face issues in finding a trusted adult to look after their young children. 

“What I’ve learned as the pandemic progresses is that it would probably make sense to do a targeted approach where schools are used child care centers for essential workers, especially from the healthcare industry,” says Bayham.

According to a 2009 study, closing all schools in the U.S. for just four weeks could cost anywhere between $10 and $47 billion. The researchers of the study also estimated that school closures might lead to a reduction of 6% to 19% in key healthcare workers. The coronavirus outbreak has resulted in many U.S. states struggling to arrange child care for essential workers.

Commenting on the recent Lancet Public Health study, Naom Ross, principal scientist of computational research at EcoHealth Alliance, says it is important for the general public to understand that such a study is in no way trying to predict the future.

“The value of having a study like this is it helps us understand what are the things that we need more certainty around and what we can control. For instance, there’s a lot we don’t know about the role that children and schools play in the transmission of the coronavirus,” says Ross.

But Meghan May, professor of microbiology and infectious diseases at the University of New England College of Osteopathic Medicine, points out that one of the many caveats of the study is the fact that the authors informed their model based on the influenza virus – to which children are more vulnerable. 

“With COVID-19, we know that children are not a major component of the patient population. But that being said, we also know that children can get infected with the coronavirus and not show any symptoms. It would be a mistake to assume that just because they don’t get sick, they are not playing some kind of role and transmission around the community,” says May. “Also, if the teachers and other school staff members come in and interact with each other, there’s still the risk of further transmission of the coronavirus.”

She argues that even if some healthcare workers have to stay home to take care of their young children, they could still work remotely by using telemedicine. “Just because a healthcare worker can’t be physically present at the hospital or clinic, doesn’t mean that they can’t treat patients,” she says.

But the academic community and general public cannot make blanket assumptions for all health care workers. “Someone like a diagnostic technician or a respiratory therapist cannot work remotely. School closures are going to affect some healthcare workers more than others,” explains May. 

May further observes that the study’s biggest limitation is that the authors did not simultaneously take into account the state-by-state disease burden in the U.S.

While the authors pointed out that D.C. is predicted to fare the best in terms of lesser absenteeism among healthcare workers, May says they also have a higher number of cases as compared to other American states. “There was a very careful state-by-state analysis for the healthcare workforce side. But not necessarily for the disease dynamic side. It means we have to be careful about how we interpret the implications of this study.”