School Reopening during COVID-19 Pandemic: Is It Safe? A Systematic Review

Main Article Content

Michelle Gunawan
Aurielle Annalicia Setiawan
Ivena Leonita


Introduction: School closures around the world during the COVID-19 pandemic has brought adverse impacts to students’ learning processes. School reopening has been implemented in some regions, accompanied with health protocols. Strict implementation of health measures and policies are keys in preventing outbreaks in school settings. It is also necessary to identify precipitating factors in outbreaks to design the most effective health policies. Objective: To review the most effective health policies to prevent outbreaks and to identify precipitating factors in outbreaks during school reopening. Methods: Studies were collected from PubMed, ScienceDirect, Cochrane and ResearchGate from 2020-2021 and were selected based on the inclusion criteria. This systematic review was reported according to the PRISMA (Preferred Reporting Items for Systematic Review and Meta Analyses) flow diagram. Quality of studies were assessed using the JBI (Joanna-Briggs Institute) checklist. Results: From 209 studies, 7 studies were eligible for qualitative analysis.  Current health measures implemented during the school reopening are sufficient to maintain low attack rates. Student attack rates are lower compared to staff (0.03% vs 4.4%) and students in higher levels of education are more likely to have higher attack rates (kindergarten vs high school: 17.5% vs 33.5%). Some effective health measures are physical distancing, hand hygiene, use of masks, bubbles and a mandatory 14-day quarantine before entering schools. Young adults and staffs tend to have lower compliance to health measures, which results in higher attack rates. Precipitating factors identified are frequency of school attendance, parents’ occupation as healthcare workers, older age, certain ethnic groups, and positive COVID-19 cases in households. Conclusion: It is safe to reopen schools, if proper health protocols are actualized, such as wearing masks, maintaining hand hygiene, physical distancing, and early restriction to attend school for suspects, while main precipitating factors are frequency of attendance, age, and parents’ occupation.

Article Details

How to Cite
Gunawan, M., Setiawan, A. A., Leonita, I. and Neville (2022) “School Reopening during COVID-19 Pandemic: Is It Safe? A Systematic Review”, Journal of Asian Medical Students’ Association. Kuala Lumpur, Malaysia. Available at: (Accessed: 3December2022).
Scientific Papers (EAMSC 2023 Nepal)


WHO Coronavirus (COVID-19) Dashboard [Internet]. 2021 [cited 14 November 2021]. Available from:

American Academy of Pediatrics. Children and COVID-19: State-Level Data Report [Internet]. 2021 [cited 14 November 2021]. Available from

Alsohime F, Temsah MH, Al-Nemri AM, Somily AM, Al-Subaie S. COVID-19 infection prevalence in pediatric population: Etiology, clinical presentation, and outcome. Journal of infection and public health. 2020 Oct 20.

Munro AP, Faust SN. Children are not COVID-19 super spreaders: time to go back to school. Archives of disease in childhood. 2020 Jul 1;105(7):618-9.

Viner RM, Russell SJ, Croker H, Packer J, Ward J, Stansfield C, Mytton O, Bonell C, Booy R. School closure and management practices during coronavirus outbreaks including COVID-19: a rapid systematic review. The Lancet Child & Adolescent Health. 2020 May 1;4(5):397-404.

Wang G, Zhang Y, Zhao J, Zhang J, Jiang F. Mitigate the effects of home confinement on children during the COVID-19 outbreak. The Lancet. 2020 Mar 21;395(10228):945-7.

Hasan N, Khan NH. ONLINE TEACHING-LEARNING DURING COVID-19 PANDEMIC: STUDENTS’ PERSPECTIVE. The Online Journal of Distance Education and e-Learning. 2020 Oct;8(4):202-13.

Spinelli M, Lionetti F, Pastore M, Fasolo M. Parents' stress and children's psychological problems in families facing the COVID-19 outbreak in Italy. Frontiers in psychology. 2020 Jul 3;11:1713.

Vermund SH, Pitzer VE. Asymptomatic transmission and the infection fatality risk for COVID-19: Implications for school reopening. Clinical Infectious Diseases. 2021 May 1;72(9):1493-6.

Hoang A, Chorath K, Moreira A, Evans M, Burmeister-Morton F, Burmeister F, Naqvi R, Petershack M, Moreira A. COVID-19 in 7780 pediatric patients: a systematic review. EClinicalMedicine. 2020 Jul 1;24:100433.

Gandini S, Rainisio M, Iannuzzo ML, Bellerba F, Cecconi F, Scorrano L. A cross-sectional and prospective cohort study of the role of schools in the SARS-CoV-2 second wave in Italy. The Lancet Regional Health-Europe. 2021 Jun 1;5:100092.

Gras-Le Guen C, Cohen R, Rozenberg J, Launay E, Levy-Bruhl D, Delacourt C. Reopening schools in the context of increasing COVID-19 community transmission: the French experience. Archives de Pédiatrie. 2021 Apr 1;28(3):178-85.

Ladhani SN, Baawuah F, Beckmann J, Okike IO, Ahmad S, Garstang J, Brent AJ, Brent B, Walker J, Andrews N, Ireland G. SARS-CoV-2 infection and transmission in primary schools in England in June–December, 2020 (sKIDs): an active, prospective surveillance study. The Lancet Child & Adolescent Health. 2021 Jun 1;5(6):417-27.

Buonsenso D, De Rose C, Moroni R, Valentini P. SARS-CoV-2 infections in Italian schools: preliminary findings after 1 month of school opening during the second wave of the pandemic. Frontiers in pediatrics. 2020;8.

Ismail SA, Saliba V, Bernal JL, Ramsay ME, Ladhani SN. SARS-CoV-2 infection and transmission in educational settings: a prospective, cross-sectional analysis of infection clusters and outbreaks in England. The Lancet Infectious Diseases. 2021 Mar 1;21(3):344-53.

Larosa E, Djuric O, Cassinadri M, Cilloni S, Bisaccia E, Vicentini M, Venturelli F, Rossi PG, Pezzotti P, Bedeschi E, Reggio Emilia Covid-19 Working Group. Secondary transmission of COVID-19 in preschool and school settings in northern Italy after their reopening in September 2020: a population-based study. Eurosurveillance. 2020 Dec 10;25(49):2001911.

Macartney K, Quinn HE, Pillsbury AJ, Koirala A, Deng L, Winkler N, Katelaris AL, O'Sullivan MV, Dalton C, Wood N, Brogan D. Transmission of SARS-CoV-2 in Australian educational settings: a prospective cohort study. The Lancet Child & Adolescent Health. 2020 Nov 1;4(11):807-16.

Siahaan AM, Lubis MP, Dalimunthe DA, Nasution MR, Lubis HP. Adherence to face mask and social distancing among residents in Medan during the COVID-19 pandemics. bmj. 2021;10:2414.

van Loenhout JA, Vanderplanken K, Scheen B, Van den Broucke S, Aujoulat I. Determinants of adherence to COVID-19 measures among the Belgian population: an application of the protection motivation theory. Archives of Public Health. 2021 Dec;79(1):1-5

Ng KW, Faulkner N, Cornish GH, Rosa A, Harvey R, Hussain S, Ulferts R, Earl C, Wrobel AG, Benton DJ, Roustan C. Preexisting and de novo humoral immunity to SARS-CoV-2 in humans. Science. 2020 Dec 11;370(6522):1339-43.

McElhaney JE, Kuchel GA, Zhou X, Swain SL, Haynes L. T-cell immunity to influenza in older adults: a pathophysiological framework for development of more effective vaccines. Frontiers in immunology. 2016 Feb 25;7:41.

Ludvigsson JF. Children are unlikely to be the main drivers of the COVID‐19 pandemic–a systematic review. Acta Paediatrica. 2020 Aug;109(8):1525-30.

Zhao H, Lu X, Deng Y, Tang Y, Lu J. COVID-19: asymptomatic carrier transmission is an underestimated problem. Epidemiology & Infection. 2020;148.

Dhawan S. Online learning: A panacea in the time of COVID-19 crisis. Journal of Educational Technology Systems. 2020 Sep;49(1):5-22.

Nambiar D. The impact of online learning during COVID-19: students’ and teachers’ perspective. The International Journal of Indian Psychology. 2020 Apr;8(2):783-93.

Dong C, Cao S, Li H. Young children’s online learning during COVID-19 pandemic: Chinese parents’ beliefs and attitudes. Children and youth services review. 2020 Nov 1;118:105440.