# Association of School Instructional Mode with Community COVID-19 Incidence during August–December 2020 in Cuyahoga County, Ohio

## TL;DR

This study found that school districts using in-person instruction had higher community COVID-19 cases, especially in vulnerable areas.

## Contribution

The study introduces a novel analysis linking school instructional mode to community-level COVID-19 incidence.

## Key findings

- School districts with non-remote instruction had a 12% higher risk ratio of community COVID-19 cases.
- The association was strongest in zip codes with high Social Vulnerability Index scores.
- Remote instruction was linked to lower incidence compared to in-person instruction.

## Abstract

Remote and hybrid modes of instruction were employed as alternatives to in-person instruction as part of early mitigation efforts in response to the COVID-19 pandemic. We investigated the impact of a public school district’s instructional mode on cumulative incidence and transmission in the surrounding community by employing a generalized estimating equations approach to estimate the association with weekly COVID-19 case counts by zip code in Cuyahoga County, Ohio, from August to December 2020. Remote instruction only (RI) was employed by 7 of 20 school districts; 13 used some non-remote instruction (NRI) (2–15 weeks). Weekly incidence increased in all zip codes from August to peak in late fall before declining. The zip code cumulative incidence within NRI school districts was higher than in those offering only RI (risk ratio = 1.12, p = 0.01; risk difference = 519 per 100,000, 95% confidence interval (123–519)). The mean effect for NRI on emergent cases 2 weeks after mode exposure, controlling for Social Vulnerability Index (SVI), was significant only for high SVI zip codes 1.30, p < 0.001. NRI may be associated with increased community COVID-19 incidence, particularly in communities with high SVI. Vulnerable communities may need more resources to open schools safely.