RT Journal Article SR Electronic T1 Closing schools for SARS-CoV-2: a pragmatic rapid recommendation JF BMJ Paediatrics Open JO BMJ Paediatrics Open FD BMJ Publishing Group Ltd SP e000971 DO 10.1136/bmjpo-2020-000971 VO 5 IS 1 A1 Bekkering, Geertruida A1 Delvaux, Nicolas A1 Vankrunkelsven, Patrik A1 Toelen, Jaan A1 Aertgeerts, Sigrid A1 Crommen, Sofie A1 Bruyckere, Pedro De A1 Devisch, Ignaas A1 Lernout, Tinne A1 Masschalck, Katrien A1 Milissen, Nore A1 Molenberghs, Geert A1 Pascal, Annelies A1 Plomteux, Oscar A1 Raes, Marc A1 Rans, Lise A1 Seghers, Alexandra A1 Sweldens, Lode A1 Vandenbussche, Jeroen A1 Vanham, Guido A1 Wollants, Elke A1 Aertgeerts, Bert YR 2021 UL http://bmjpaedsopen.bmj.com/content/5/1/e000971.abstract AB Background In Belgium, schools closed during the first lockdown in March 2020, with a partial reopening in May. They fully reopened in September. During the summer, infections started to increase in the general population, speeding up in September. Some measures were taken to limit social contacts but those were insufficient to mitigate the exponential rise of infections in October. Children were still receiving all lessons at school at that time and it was questioned whether this position was tenable. We systematically compared the benefits and harms of closing primary and secondary schools and developed a recommendation.Methods A multidisciplinary panel, including school pupils and teachers, educational experts, clinicians and researchers, produced this recommendation in compliance with the standards for trustworthy rapid guidelines. The recommendation is based on data collected through national surveillance or studies from Belgium, and supported by a rapid literature review.Results Closing schools during the first lockdown probably resulted in a large learning delay and possibly led to more cases of child abuse. We are uncertain about the effect on the infection rate, hospitalisations, transmission rates, mental health of children, teachers and parents. The panel concluded that the balance of benefits and harms of closing schools clearly shifts against closing schools. Detrimental effects are even worse for vulnerable children. This recommendation is affected by the local virus circulation.Conclusion The guideline panel issues a strong recommendation against closing schools when the virus circulation is low to moderate, and a weak recommendation against closing schools when the virus circulation is high. It does not apply when the school system cannot function due to lack of teachers, too many children who are at home or a shortage of support services. As the results of international studies are consistent with Belgian study results, this recommendation may also be relevant internationally.