What strategies and approaches are countries implementing within schools both in response to COVID-19 and to localized outbreaks?

Cross-Country Analysis

What strategies and approaches are countries implementing within schools both in response to COVID-19 and to localized outbreaks?

Responses to COVID-19 within schools have varied significantly across the European Region.

While all governments throughout the region have implemented public health and social measures (PHSM) in response to COVID-19, the specific types, timing (initial date of implementation and length of implementation), degree of intensity, and scope have differed considerably. Closures of schools and other educational institutions are one type of public health measure that has been a tool in governmental response plans to COVID-19. As there is no available vaccine against COVID-19, school closures have been a widely used measure countries have utilized to minimize the risk of transmission amongst adult staff, children, adolescents and communities. While all 53 European Regional Member States have implemented some type of school closure measures in order to reduce COVID-19 transmission, individual approaches have been substantially different.

This analysis examines the strategies implemented by countries across the European Region both in approaches for reopening schools and responses to localized outbreaks both in school settings or local communities. Information was collected from open sources including media and government websites by the COVID-19 Incident Management Support Team of the WHO Regional Office for Europe and from the COVID-19 Health Systems Response Monitor (HSRM) (up to 5 August 2020). Selected country examples are provided for Austria, Belgium, Croatia, Cyprus, Denmark, Germany, Greece, Israel, Italy, Luxembourg, Norway, Turkey and the United Kingdom. This analysis can help to inform the development of school policies as Member States consider the modality for the reopening of educational institutions after the summer break. 

Following school closures earlier in 2020, countries are working to reopen schools safely to provide stability

Many countries recommended or required schools to close in early- to mid-March 2020. This was adapted through either a precautionary approach based on age (i.e., kindergarten, primary, secondary, university) or holistically with a full closure of all educational institutions. Variations regarding implementation of required or recommended school closures have differed significantly. According to various education ministers within the European Union, even with the reopening of schools prior to the summer break in the majority of countries in the Region, no major rises in COVID-19 cases were reported in 22 European Union Member States. However, at the time of writing, large school outbreaks have been detected and reported in Israel. In addition, several schools in the European Region have closed as a response to localized community outbreaks and sporadic cases observed in school settings.

As the pandemic continues, many children lack the stability provided by the school environment including: adequate nutrition, protection from domestic violence, access to proper resources, and consistent curricular engagement. To counter these effects, some Member States have endeavoured to reopen schools via a myriad of unique approaches with the intention to protect teachers, staff, students and communities at large.

Countries are taking a phased approach to reopen schools, but are also taking precautions in schools to protect against localized outbreaks

While a majority of countries in the region initially closed schools rapidly, a phased approach has been implemented when reopening educational establishments. Oftentimes, this has begun with kindergartens, day cares or to accommodate for students completing exams to move to their next educational level, i.e. the final year of primary or secondary school. 

In recent months, many Member States have also seen a sharp increase in localized outbreaks (i.e. in workplace settings, nursing homes etc.) often leading to local school measures in order to protect students, teachers and the surrounding community. Where localized outbreaks have occurred outside of school settings, precautionary approaches have been implemented including the immediate closure of schools often at local levels, testing of students and teachers for COVID-19, and quarantine when necessary. 

The models for reopening schools vary across Member States

While some countries have extended school closures until the Autumn Term, others readjusted their requirements and recommendations to allow for students to return to schools in the spring. Denmark was one of the first countries in the European Region to reopen schools after lifting their national lockdown in April. From July 2020, many schools across the European Region have begun their scheduled summer holidays. All Member States are planning to reopen pre-school, kindergarten, primary and secondary educational establishments in late August or early September 2020. Throughout the COVID-19 pandemic, countries have employed unique strategies using different approaches.

Distance Learning has been used to allow students to complete coursework

Towards the beginning of the pandemic many countries implemented distance learning with several countries not yet resuming in-person teaching. 

For example, Turkey implemented a nation-wide obligation for students to complete coursework via distance learning from March through their summer holidays or on weekends to make up for lost time during the regular academic year. As of July 2020, the Ministry of Education planned to reopen schools nationwide on 31 August under its initial “Plan A”: nation-wide return to in-person learning for students and staff. Under Plan A, teachers and administrators prepared onsite health precautions.

As of 17 August, the Ministry of Education shifted Plan A, allowing private schools to begin distance learning for their students at a nationwide level. From 31 August, public schools will also engage in distance learning, followed by a gradual re-matriculation of students and teachers to classrooms from 21 September depending on each region’s epidemiological situation and rates of daily infection. Universities will open with a hybrid educational model from 1 October which will allow each campus to decide on their own whether to continue education in person or online.

Italy garnered focus for many months as the epicentre of the Region’s outbreak, and schools were quickly closed starting in March. The closure was later extended through to September, with education continuing via distance learning for all levels until the end of the academic year. The Ministry of Health has announced a robust plan to test all teachers (~2 million) prior to their return in September 2020.

Rotational Systems allow for smaller “cohorts” of students to return to school at different times

By creating groups of students, or “cohorts”, schools minimize contacts and mixing between students and teachers which reduces the possibility of transmission of COVID-19. Additionally, if a student or teacher contracts COVID-19, the cohort can be sent home for quarantine or testing rather than the entire school population, lessening the amount of educational disruption for other pupils. Luxembourg and Greece created a rotational system in which students alternate days or weeks where they are either physically present in schools or engaging in distance learning from home. Cohorts of students have been determined based upon age, class or rank within school. This approach is then combined with additional safety measures in the classroom including infection prevention and control measures such as mask wearing, disinfection of surfaces and physical distancing

Traffic Light Systems indicate different responses relating to the relevant risk scenario

Norway implemented a traffic light system for schools which includes different rules depending on the epidemiological situations based on a safety indicator colour: red (severe), yellow (moderate) or green (normal). The alert level has remained at “red” (severe) since the COVID-19 crisis reached its peak in-country but has moved to “yellow” (moderate with safety precautions in place) as of June 2020. During ‘yellow’ infection periods, teachers and other schools continue to seek to avoid physical contact with one another, desks are cleaned every period and classes of students are kept apart from other cohorts as much as possible.

Belgium will resume onsite teaching for all schools in September 2020 following a traffic light system based on different risk scenarios which will apply to all class levels from kindergarten to secondary education. This also includes the use of face masks and physical distancing. Scenarios range between four colours: green, yellow, orange and red. In all scenarios, kindergartens and primary schools will remain open. In a green scenario, all students will attend school five days per week with only hand hygiene enforced. Yellow indicates a hybrid model for secondary students and requires that masks and social distancing be respected at all times. Orange is applicable when the virus’s spread accelerates and will implement a rotational system for all students except for kindergarten and primary pupils. Red is the highest risk scenario and will follow the same pattern as the orange scenario with stricter hygiene rules between teachers and pupils.

Austria has moved from a rotational system to a traffic light system for their new school year, dependent on the regional epidemiological situation. Whereas the green level indicates a “normal” level without stringent measures, the system requires infection prevention control to be implemented at the yellow level with mask-wearing outside of classrooms. When an orange level is reached, students will either transition to “flexible” home lessons or schools may also autonomously decide to continue teaching smaller groups face-to-face. If a red level is declared, schools will be locked down and distance learning will be compulsory except for kindergarten pupils.

A Hybrid Model combines in-person plus distance learning

Other countries, such as Croatia, opted for a hybrid model of reopening. Preschool education resumed with physical attendance, education for lower grades combined distance learning and in-person education, and higher grades learned via online-classes with the exception of vocational and laboratory courses.

Additionally, Bosnia and Herzegovina implemented a national closure of schools in mid-March. While kindergartens reopened in mid-May, primary and secondary schools were subject to only distance learning. It is expected that educators, students and parents who display symptoms do not come to school premises. The Sarajevo region has recommended the isolation of only possible COVID-positive cases rather than closing all schools.

For students in secondary education, Belgium will require them to attend in-person classes four days per week and to undertake distance-learning on Wednesdays. Only in the green scenario of the traffic light system will secondary students be allowed to attend school for five days per week.

Germany is also implementing a staggered approach for returning to classes with a hybrid model implemented in August. While the Ministry of Education prefers that students engage in face-to-face learning, distance learning will also be utilized where there is a shortage of teachers or for teachers who are considered high-risk for COVID-19. Additionally, classes have been reorganized into cohorts which will each have their own area in the school grounds. In the case of an infection, only the respective cohort will need to be quarantined rather than the entire school. This decision will be made by local health authorities.

Countries have responded to localized outbreaks by closing schools and other establishments

Even though alternative approaches have successfully been employed in some Member States, localized outbreaks either directly or indirectly linked to schools have manifested at the local or regional level in a number of countries including Cyprus, Israel, Austria, Germany, the United Kingdom and Denmark. Their responses to localized outbreaks have each been unique; Cyprus, Israel and Denmark have been the only outbreaks directly linked to schools identified at the end of August 2020.

Israel responded to outbreaks in schools through closures and by implementing testing

Israel began to reopen schools in early May with a staggered approach which allowed for smaller groups, or “capsules” of students to return, thus preventing a wider outbreak. As of mid-May, limitations on class sizes were lifted completely. During this time, infection prevention control measures such as mask-wearing and hand hygiene were recommended within school settings. However, a localized outbreak within a secondary school in Jerusalem caused many schools to close across the region, with entire grades of students and their teachers ordered to quarantine and be tested for COVID-19. 

From 1 June, all schools including higher education resumed operations under strict infection prevention control, including physical distancing, mask-wearing and practicing hand hygiene. If an area is declared to be a red zone due to its epidemiological situation, then the schools will be closed until further notice in that zone. If a case of COVID-19 is detected within a school, local health authorities will work with the school to actively isolate, quarantine, contact trace and verify the potential contacts of the patient. The school will remain open. Schools closed for the summer holidays on 27 July and were expected to open on 1 September.

Other countries have implemented school closures in response to outbreaks in the local community

Austria responded to a local outbreak by closing schools for a week

An outbreak in the Upper Austrian Region saw national COVID-19 cases rise above 100 in early July. The outbreak was linked to a cluster of the “Free Christian Community” in Linz, where community transmission was present in neighbouring districts originating from numerous large families of the religious community.

After consultation with the Ministry of Health, the federal state decided to take “drastic measures” by closing all schools, kindergartens and care facilities for a week in five districts around Linz from Friday, 3 July. This was due to an increasing number of reports of sick students in the area. As of Monday, 13 July, kindergartens and other childcare facilities in Linz and the surrounding districts, for which the closure had been ordered during the previous week, were reopened under strict hygiene requirements. 

Schools have not reopened due to the beginning of the summer holidays. Going forward, the Vienna school district has mandated that schools will not close if a case is detected, but instead the child and contacts of the child will be sent home to quarantine.

Germany’s regional closure originated in a meat processing plant

In mid-June, a severe outbreak of COVID-19 at the Rheda-Wiedenbrück meat processing plant in the Gütersloh district prompted local authorities to shut down the plant. They also closed all schools and day care centres in the region with immediate effect until the summer holidays which began 29 June.

From 3 August, different regions have begun their school year with in-person classes for students. Cohorts of pupils are divided into groups based on age and are not allowed to mingle with other groups. Furthermore, students and teachers must wear masks indoors and respect social distances of at least 1.5m. Parents also have the option to inform the school that their child will not be attending in-person lessons, but they must make arrangements for the student to engage in distance learning.

On 7 August, approximately 1,000 students were sent home from a secondary school in Ludwigslust after a teacher tested positive for COVID-19. The teacher had not conducted any classes at that point, but all members of staff needed to undergo testing. On the same day, an elementary school in Rostock was closed after a student tested positive for COVID-19. 

Denmark and Cyprus’s cluster outbreaks were contained via closing specific classes

Since the lifting of lockdown in April, Denmark saw its first COVID-19 cluster outbreak in northwest Jutland in mid-June. The municipality reacted rapidly, sending home all pupils and teachers connected with one class at a primary school, as well as all teachers and pupils from a kindergarten class and third grade class at a neighbouring school after pupils tested positive in all three classes. Other schools and classes remained on their normal schedule. The municipality followed up with testing of all care workers for older people, residents in the municipality’s care homes and all teachers at both schools affected by the outbreak. With the exception of one day care centre in Hillerød Municipality, additional detection of cases in other Danish regions have led to schools remaining open while students, teachers and close contacts are sent home to quarantine and be tested.

Cyprus detected a case of COVID-19 at a kindergarten via routine testing. Through an official statement, the Ministry of Health reported that the COVID-positive person had since been removed and contact tracing was underway. Infection prevention and control measures were also being undertaken as the school remained open for other pupils and staff.

Conclusions: The safe reopening of schools requires a flexible, risk- based approach 

Countries across the European Region have adopted a range of innovative approaches depending on the national and local school and epidemiological context. While the role of children in transmission still remains unclear and additional data is needed, rapid school responses to localized outbreaks in school and community settings have proven important to prevent exposure of students, teachers and the community and in preventing further transmission. In addition to school closures, these measures often include infection prevention and control measures, such as mask-wearing, physical distancing, hand hygiene and disinfection. 

The reopening of schools also prevents negative impacts from affecting students further (i.e. malnutrition, domestic violence, lack of psycho-social connection, etc.). It is also important to recognize community transmission as a key component to consider when reopening schools. Overall, the suppression of community transmission will provide a safer return to the school environment and community at large.  

As highlighted, the different school approaches are increasingly being defined at the national, regional and community levels, oftentimes allowing different regions to create approaches within their own timelines and at their own discretion. This has taken form in regions opting for a staggered return to schools based on different dates, how they handle confirmed cases in schools or even their criteria for moving students to distance learning versus in-person.

With the pandemic still unfolding national authorities will need to consider policy options for a range of school-based measures to ensure safe schooling. These will need to be continuously adapted according to the level of local transmission as well as the local educational context. 

Kayla King, Tanja Schmidt

Key References

Considerations for school-related public health measures in the context of COVID-19 (annex updated September 14).

Considerations in adjusting public health and social measures in the context of COVID-19: interim guidance

Schooling in the time of COVID-19 – Towards a consensus on schooling in the European Region during the COVID-19 pandemic.