Nicholas Irons (University of Oxford)

Title: US COVID-19 school closure was not cost-effective, but other measures were.

Abstract: Non-pharmaceutical interventions (NPIs) in response to the COVID-19 pandemic necessitated a trade-off between the health impacts of viral spread and the social and economic costs of restrictions. We conduct a cost-effectiveness analysis of NPI policies enacted at the state level in the United States in 2020. We find that NPIs were effective in substantially reducing SARS-CoV-2 transmission, averting 860,000 (95% CI: 560,000–1,190,000) COVID-19 deaths in the US in 2020. Although school closures reduced viral transmission, their social impact in terms of student learning loss was too costly, depriving the nation of $2 trillion (USD2020), conservatively, in future GDP. Moreover, this marginal trade-off between school closure and COVID deaths was not inescapable: a combination of other measures would have been enough to maintain similar or lower mortality rates without incurring such profound learning loss. Optimal policies involve consistent implementation of mask mandates, public test availability, contact tracing, social distancing orders, and reactive workplace closures, with no closure of schools beyond the usual 16 weeks of break per year. Their use would have reduced the gross impact of the pandemic in the US in 2020 from $4.6 trillion to $1.9 trillion and, with high probability, saved over 100,000 lives. Our results also highlight the need to address the substantial global learning deficit incurred during the pandemic.