[Skip to Content]
[Skip to Content Landing]

Estimation of US Children’s Educational Attainment and Years of Life Lost Associated With Primary School Closures During the Coronavirus Disease 2019 Pandemic

Educational Objective
To identify the key insights or developments described in this article
1 Credit CME
Key Points

Question  Based on the current understanding of the associations between school disruption and decreased educational attainment and between decreased educational attainment and lower life expectancy, is it possible to estimate the association between school closure during the coronavirus disease 2019 pandemic and decreased life expectancy of publicly educated primary school–aged children in the United States?

Findings  This decision analytical model found that missed instruction during 2020 could be associated with an estimated 13.8 (95% CI 2.5-42.1) million years of life lost based on data from US studies and an estimated 0.8 (95% CI 0.1-2.4) million years of life lost based on data from European studies. This estimated loss in life expectancy was likely to be greater than would have been observed if leaving primary schools open had led to an expansion of the first wave of the pandemic.

Meaning  These findings suggest that the decision to close US public primary schools in the early months of 2020 may be associated with a decrease in life expectancy for US children.


Importance  United States primary school closures during the 2020 coronavirus disease 2019 (COVID-19) pandemic affected millions of children, with little understanding of the potential health outcomes associated with educational disruption.

Objective  To estimate the potential years of life lost (YLL) associated with the COVID-19 pandemic conditioned on primary schools being closed or remaining open.

Design, Setting, and Participants  This decision analytical model estimated the association between school closures and reduced educational attainment and the association between reduced educational attainment and life expectancy using publicly available data sources, including data for 2020 from the US Centers for Disease Control and Prevention, the US Social Security Administration, and the US Census Bureau. Published peer-reviewed studies (2 US studies, 5 European studies) were identified that provided estimates of the relative risk (RR) of annual mortality related to educational attainment, which were weighted and applied to the most recent life table data to obtain YLL estimates across the life course. Direct COVID-19 mortality and potential increases in mortality that might have resulted if school opening led to increased transmission of COVID-19 were also estimated.

Main Outcomes and Measures  Years of life lost.

Results  A total of 24.2 million children aged 5 to 11 years attended public schools that were closed during the 2020 pandemic, losing a median of 54 (interquartile range, 48-62.5) days of instruction. Missed instruction was associated with a mean loss of 0.15 (95% credible interval [CI], 0.08-0.22) years of final educational attainment for boys and 0.12 (95% CI, 0.06-0.19) years for girls. Summed across the population, based on the RR from US studies, an estimated 13.8 million (95% CI, 2.5-42.1) YLL may be associated with school closures. Summed across the population, based on the RR from the European studies, an estimated 0.8 million (95% CI, 0.1 -2.4) YLL may be associated with school closures. The Centers for Disease Control and Prevention reported a total of 88 241 US deaths from COVID-19 through the end of May 2020, with an estimated 1.50 million (95% CI, 1.23-1.85 million) YLL as a result. Had schools remained open, an estimated 4.4 million (95% CI 2.29-6.41,) YLL could have been expected as a result, based on results of studies associating school closure with decreased pandemic spread. Comparing the full distributions of estimated YLL under both “schools open” and “schools closed” conditions, based on the US studies and the European studies, the analysis observed a 98.9% probability and a 26.3% probability, respectively, that school opening would have been associated with a lower total YLL than school closure.

Conclusions and Relevance  In this decision analytical model of years of life potentially lost under differing conditions of school closure, based on the US studies, the analysis favored schools remaining open. Future decisions regarding school closures during the pandemic should consider the association between educational disruption and decreased expected lifespan and give greater weight to the potential outcomes of school closure on children’s health.

Sign in to take quiz and track your certificates

Buy This Activity

JN Learning™ is the home for CME and MOC from the JAMA Network. Search by specialty or US state and earn AMA PRA Category 1 Credit(s)™ from articles, audio, Clinical Challenges and more. Learn more about CME/MOC

CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.

Article Information

Accepted for Publication: October 14, 2020.

Published: November 12, 2020. doi:10.1001/jamanetworkopen.2020.28786

Correction: This article was corrected on January 8, 2021, to fix computational errors and an incorrect analysis.

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2020 Christakis DA et al. JAMA Network Open.

Corresponding Author: Dimitri A. Christakis, MD, MPH, Department of Pediatrics, Seattle Children’s Research Institute, 2001 Eighth Ave, Suite 400, Seattle, WA 98101 (dimitri.christakis@seattlechildrens.org).

Author Contributions: Dr Van Cleve had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: All authors.

Acquisition, analysis, or interpretation of data: Van Cleve, Zimmerman.

Drafting of the manuscript: All authors.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: All authors.

Administrative, technical, or material support: Christakis.

Supervision: Christakis, Zimmerman.

Conflict of Interest Disclosures: Dr Christakis reported serving as a member of the Children and Screens Advisory Board. No other disclosures were reported.

Shekerdemian  LS , Mahmood  NR , Wolfe  KK ,  et al; International COVID-19 PICU Collaborative.  Characteristics and outcomes of children with coronavirus disease 2019 (COVID-19) infection admitted to US and Canadian pediatric intensive care units.   JAMA Pediatr. 2020;174(9):868-873. doi:10.1001/jamapediatrics.2020.1948PubMedGoogle Scholar
Zachariah  P , Johnson  CL , Halabi  KC ,  et al; Columbia Pediatric COVID-19 Management Group.  Epidemiology, clinical features, and disease severity in patients with coronavirus disease 2019 (COVID-19) in a children’s hospital in New York City, New York.   JAMA Pediatr. 2020;e202430. doi:10.1001/jamapediatrics.2020.2430PubMedGoogle Scholar
Gudbjartsson  DF , Helgason  A , Jonsson  H ,  et al.  Spread of SARS-CoV-2 in the Icelandic population.   N Engl J Med. 2020;382(24):2302-2315. doi:10.1056/NEJMoa2006100PubMedGoogle Scholar
Park  YJ , Choe  YJ , Park  O ,  et al; COVID-19 National Emergency Response Center, Epidemiology and Case Management Team.  Contact tracing during coronavirus disease outbreak, South Korea, 2020.   Emerg Infect Dis. 2020;26(10):2465-2468. doi:10.3201/eid2610.201315PubMedGoogle Scholar
Christakis  DA .  School reopening: the pandemic issue that is not getting its due.   JAMA Pediatr. Published online May 13, 2020. doi:10.1001/jamapediatrics.2020.2068PubMedGoogle Scholar
US Department of Education Office of Planning, Evaluation, and Policy Development. Evaluation of evidence-based practices in online learning: a meta-analysis and review of online learning studies. Published 2010. Accessed October 19, 2020. https://www2.ed.gov/rschstat/eval/tech/evidence-based-practices/finalreport.pdf
Fitzpatrick  B , Berends  M , Ferrare  J , Waddington  R .  Virtual illusion: comparing student achievement and teacher and classroom characteristics in online and brick-and-mortar charter schools.   Educational Researcher. 2020;49(3)161-175. doi:10.3102/0013189X20909814Google Scholar
Freedberg L. Sal Khan says distance learning can't fully replace in-person instruction. EdSource. Published August 3, 2020. Accessed October 19, 2020. https://edsource.org/2020/sal-khan-says-distance-learning-cant-fully-replace-in-person-instruction/637541
Illinois State Board of Education. Remote learning recommendations during COVID-19 emergency. Published March 27, 2020. Accessed October 19, 2020. https://www.isbe.net/Documents/RL-Recommendations-3-27-20.pdf
Barnum M, Bryan C. America’s great remote-learning experiment: what surveys of teachers and parents tell us about how it went. Chalkbeat. Published June 26, 2020. Accessed October 19, 2020. https://www.chalkbeat.org/2020/6/26/21304405/surveys-remote-learning-coronavirus-success-failure-teachers-parents
Educators for Excellence. Voices from the virtual classroom: a survey of America’s teachers on COVID-19-related education issues. Accessed October 19, 2020. https://e4e.org/sites/default/files/voices_from_the_virtual_classroom_2020.pdf
Malkus  N , Christensen  C . School district responses to the covid-19 pandemic: round 5, plateauing services in America’s schools. American Enterprise Institute. Published May 22, 2020. Accessed October 19, 2020. https://www.aei.org/research-products/report/school-district-responses-to-the-covid-19-pandemic-round-5-plateauing-services-in-americas-schools/
 Reopening K-12 Schools During the COVID-19 Pandemic: Prioritizing Health, Equity, and Communities. Bond EC, Dibner K, Schweingruber H, eds. Washington, DC: The National National Academy of Science, Engineering, and Medicine; 2020.
Jaume  D , Willen  A .  The long-run effects of teacher strikes: evidence from Argentina.   J Labour Econ. 2019;37(4):1097-1139. doi:10.1086/703134Google Scholar
Belot  M , Webbink  D .  Do teacher strikes harm educational attainment of students?   Labour. 2010;24(4):391-406. doi:10.1111/j.1467-9914.2010.00494.xGoogle Scholar
Johnson  D .  Do strikes and work-to-rule campaigns change elementary school assessment results.   Canadian Public Policy. 2011;37.4:479-494. doi:10.3138/cpp.37.4.479Google Scholar
Caldwell  W , Jeffreys  L .  The effect of teacher strikes on student achievement: new evidence.   Government Union Review. 1983;4.1:40-58.Google Scholar
Hernandez  DJ . Double jeopardy: how third-grade reading skills and poverty influence high school graduation. The Annie E. Casey Foundation. Published January 1, 2012. Accessed October 19, 2020. https://www.aecf.org/resources/double-jeopardy
Conti  G , Heckman  J , Urzua  S .  The education-health gradient.   Am Econ Rev. 2010;100(2):234-238. doi:10.1257/aer.100.2.234PubMedGoogle Scholar
Conti  G , Heckman  JJ .  The developmental approach to child and adult health.   Pediatrics. 2013;131(suppl 2):S133-S141. doi:10.1542/peds.2013-0252dPubMedGoogle Scholar
Lleras-Muney  A .  The relationship between education and adult mortality in the United States.   Rev Econ Stud. 2005;72(1):189-221. doi:10.1111/0034-6527.00329Google Scholar
Mazumder  B .  Does education improve health? A reexamination of the evidence from compulsory schooling laws.   Economic Perspectives. 2008;32(2).Google Scholar
COVID-19 planning considerations: guidance for school re-entry. American Academy of Pediatrics. Updated August 19, 2020. Accessed October 19, 2020. https://services.aap.org/en/pages/2019-novel-coronavirus-covid-19-infections/clinical-guidance/covid-19-planning-considerations-return-to-in-person-education-in-schools/
Husereau  D , Drummond  M , Petrou  S ,  et al; CHEERS Task Force.  Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement.   BMJ. 2013;346:f1049. doi:10.1136/bmj.f1049PubMedGoogle Scholar
Arias  E .  United States life tables, 2017.   Natl Vital Stat Rep. 2019;68(7):1-66.PubMedGoogle Scholar
Clark  D , Royer  H .  The effect of education on adult mortality and health: evidence from Britain.   Am Econ Rev. 2013;103(6):2087-2120. doi:10.1257/aer.103.6.2087PubMedGoogle Scholar
Gathmann  C , Jürges  H , Reinhold  S .  Compulsory schooling reforms, education and mortality in twentieth century Europe.   Soc Sci Med. 2015;127:74-82. doi:10.1016/j.socscimed.2014.01.037PubMedGoogle Scholar
Grytten  J , Skau  I , Sørensen  R .  Who dies early? education, mortality and causes of death in Norway.   Soc Sci Med. 2020;245:112601. doi:10.1016/j.socscimed.2019.112601PubMedGoogle Scholar
Meghir  C , Palme  M , Simeonova  E .  Education and mortality: evidence from a social experiment.   American Economic Journal: Applied Economics. 2018;10(2):234-256. doi:10.1257/app.20150365Google Scholar
van Kippersluis  H , O’Donnell  O , van Doorslaer  E .  Long run returns to education: does schooling lead to an extended old age?   J Hum Resour. 2009;4:1-33.PubMedGoogle Scholar
Oliver  A .  A normative perspective on discounting health outcomes.   J Health Serv Res Policy. 2013;18(3):186-189. doi:10.1177/1355819613485671PubMedGoogle Scholar
Haacker  M , Hallett  TB , Atun  R .  On discount rates for economic evaluations in global health.   Health Policy Plan. 2020;35(1):107-114.PubMedGoogle Scholar
Heinzerling  L.   Regulatory costs of mythic proportions.   Yale Law J. 1998;107(7):1981-2070. doi:10.2307/797416Google Scholar
Landefeld  JS , Seskin  EP .  The economic value of life: linking theory to practice.   Am J Public Health. 1982;72(6):555-566. doi:10.2105/AJPH.72.6.555PubMedGoogle Scholar
Malcolm  D , Roseboom  J , Clark  C , Fazar  W.   Application of a technique for research and development program evaluation.   Oper Res. 1959;7(5):646-669. doi:10.1287/opre.7.5.646Google Scholar
New York City Department of Health and Mental Hygiene (DOHMH) COVID-19 Response Team.  Preliminary estimate of excess mortality during the COVID-19 outbreak—New York City, March 11-May 2, 2020.   MMWR Morb Mortal Wkly Rep. 2020;69(19):603-605. doi:10.15585/mmwr.mm6919e5PubMedGoogle Scholar
Auger  KA , Shah  SS , Richardson  T ,  et al.  Association between statewide school closure and COVID-19 incidence and mortality in the US.   JAMA. 2020;324(9):859-870. doi:10.1001/jama.2020.14348PubMedGoogle Scholar
Courtemanche  C , Garuccio  J , Le  A , Pinkston  J , Yelowitz  A .  Strong social distancing measures in the United States reduced the COVID-19 growth rate.   Health Aff (Millwood). 2020;39(7):1237-1246. doi:10.1377/hlthaff.2020.00608PubMedGoogle Scholar
Berchick  E .  Most uninsured were working-age adults.  US Bureau of the Census. Published September 12, 2018. Accessed December 23, 2020. https://www.census.gov/library/stories/2018/09/who-are-the-uninsured.html
Higgins  JPT , Thomas  J , Chandler  J , Cumpston  M , Li  T , Page  MJ , Welch  VA .  Cochrane Handbook for Systematic Reviews of Interventions. 2nd ed. John Wiley and Sons; 2019.
Hsiang  S , Allen  D , Annan-Phan  S ,  et al.  The effect of large-scale anti-contagion policies on the COVID-19 pandemic.   Nature. 2020;584(7820):262-267. doi:10.1038/s41586-020-2404-8PubMedGoogle Scholar
Dorn  E , Hancock  B , Sarakatsannis  J , Viruleg  E . COVID-19 and student learning in the United States: the hurt could last a lifetime. McKinsey & Co. Published June 1, 2020. Accessed July 21, 2020. https://www.mckinsey.com/industries/public-sector/our-insights/covid-19-and-student-learning-in-the-united-states-the-hurt-could-last-a-lifetime
Eubank  S , Eckstrand  I , Lewis  B , Venkatramanan  S , Marathe  M , Barrett  CL .  Commentary on Ferguson, et al., “Impact of Non-pharmaceutical Interventions (NPIs) to Reduce COVID-19 Mortality and Healthcare Demand”.   Bull Math Biol. 2020;82(4):52. doi:10.1007/s11538-020-00726-xPubMedGoogle Scholar
Ferguson  N , Laydon  D , Nedjati-Gilani  G , et al. Report 9: impact of non-pharmaceutical interventions (NPIs) to reduce COVID-19 mortality and healthcare demand. MRC Centre for Global Infectious Disease Analysis. Published March 16, 2020. Accessed October 19, 2020. https://www.imperial.ac.uk/mrc-global-infectious-disease-analysis/covid-19/report-9-impact-of-npis-on-covid-19/
Roser  M , Ortiz-Ospina  E . Global education. Our World in Data. 2020. Accessed December 8, 2020. https://ourworldindata.org/global-education
Nadworny  E . ‘Losing a generation’: fall college enrollment plummets for 1st-year students. NPR. Published December 17, 2020. Accessed December 21, 2020. https://www.npr.org/2020/12/17/925831720/losing-a-generation-fall-college-enrollment-plummets-for-first-year-students
Education Week staff. Coronavirus and learning: what’s happening in each state. Education Week. Published April 3, 2020. Accessed July 21, 2020. http://blogs.edweek.org/edweek/campaign-k-12/2020/04/coronavirus_and_schools_state_guide.html?cmp=SOC-SHR-FB
Viboud  C , Miller  M , Olson  D , Osterholm  M , Simonsen  L .  Preliminary estimates of mortality and years of life lost associated with the 2009 A/H1N1 pandemic in the US and comparison with past influenza seasons.   PLoS Curr. 2010;2:RRN1153-RRN1153. doi:10.1371/currents.RRN1153PubMedGoogle Scholar
AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

  • 1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
  • 1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
  • 1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
  • 1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
  • 1.00 credit toward the CME [and Self-Assessment requirements] of the American Board of Surgery’s Continuous Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.

Want full access to the AMA Ed Hub?
After you sign up for AMA Membership, make sure you sign in or create a Physician account with the AMA in order to access all learning activities on the AMA Ed Hub
Buy this activity
Want full access to the AMA Ed Hub?
After you sign up for AMA Membership, make sure you sign in or create a Physician account with the AMA in order to access all learning activities on the AMA Ed Hub
Buy this activity
With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
Education Center Collection Sign In Modal Right

Name Your Search

Save Search
With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience

Lookup An Activity


My Saved Searches

You currently have no searches saved.


My Saved Courses

You currently have no courses saved.