Reopening Italy's schools in September 2020: a Bayesian estimation of the change in the growth rate of new SARS-CoV-2 cases.

OBJECTIVES: COVID-19's second wave started a debate on the potential role of schools as a primary factor in the contagion resurgence. Two opposite positions appeared: those convinced that schools played a major role in spreading SARS-CoV-2 infections and those who were not. We studied the growth rate of the total number of SARS-CoV-2 infections in all the Italian regions, before and after the school reopening (September-October 2020), investigating the hypothesis of an association between schools and the resurgence of the virus.
METHODS: Using a Bayesian piecewise linear regression to scrutinise the number of daily SARS-CoV-2 infections in each region, we looked for an estimate of a changepoint in the growth rate of those confirmed cases. We compared the changepoints with the school opening dates, for each Italian region. The regression allows to discuss the change in steepness of the infection curve, before and after the changepoint.
RESULTS: In 15 out of 21 Italian regions (71%), an estimated change in the rate of growth of the total number of daily SARS-CoV-2 infection cases occurred after an average of 16.66 days (95% CI 14.47 to 18.73) since the school reopening. The number of days required for the SARS-CoV-2 daily cases to double went from an average of 47.50 days (95% CI 37.18 to 57.61) before the changepoint to an average of 7.72 days (95% CI 7.00 to 8.48) after it.
CONCLUSION: Studying the rate of growth of daily SARS-CoV-2 cases in all the regions provides some evidence in favour of a link between school reopening and the resurgence of the virus. The number of factors that could have played a role is too many to give a definitive answer. Still, the temporal correspondence warrants further systematic experiments to investigate on potential confounders that could clarify how much reopening schools mattered. © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.