Association of School Instructional Mode with Community COVID-19
Incidence During August -- December 2020 in Cuyahoga County, Ohio
Abstract
Remote and hybrid modes of instruction have been employed as
alternatives to in-person instruction as part of mitigation efforts in
response to the COVID-19 pandemic. Little is known about whether
instructional mode in a given school district may impact transmission in
the surrounding community. Utilizing weekly case counts by zip code from
August – December 2020, we employed a generalized estimating equations
approach to estimate the association between instructional mode of the
public school district and emergent COVID-19 cases in Cuyahoga County,
Ohio. Of 51 zip codes, 37 are contained largely within a single
district; of the 20 included school districts, 7 employed only remote
instruction (RI) and 13 used some non-remote instruction (NRI) (2-15
weeks). Districts attempting NRI had lower average Social Vulnerability
Index (SVI) (0.32 versus 0.73). Weekly incidence increased in all zip
codes from August to peaks in late November to early December before
declining. The zip code cumulative incidence within school districts
that employed some NRI was higher than in those offering only RI (risk
ratio = 1.12; risk difference = 519 per 100,000), a contrast to
relatively lower pre-study incidence in NRI zip codes (incidence rate
ratio of study: pre-study period = 6.12 (NRI) versus 3.59 (RI)). The
mean effect (incidence rate ratio) for NRI on emergent cases 2 weeks
after mode exposure, controlling for SVI was significant only for high
SVI zip codes 1.30 (p<0.001). NRI may be associated with
increased community COVID-19 incidence. Vulnerable communities may need
more resources to open schools safely.