School closures during the COVID-19 pandemic imposed enormous long-term costs while other measures delivered better health outcomes for far less money, according to new research led by Oxford University’s Department of Statistics and the Leverhulme Centre for Demographic Science analysing non-pharmaceutical interventions in the United States.

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The study, published in BMC Global and Public Health, examined policies implemented across US states during 2020, before vaccines became available. Researchers from Oxford and the University of Washington analysed eleven different non-pharmaceutical interventions, combining disease modelling with economic analysis to calculate both health benefits and costs to society.

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During this pre-vaccine period, policymakers relied entirely on non-pharmaceutical measures such as mask mandates, social distancing, testing, contact tracing, and facility closures to control the virus.

School closures

School closures prevented roughly 77,200 COVID-19 deaths and reduced transmission rates by 8.2% but created £1.6 trillion ($2 trillion) in future economic losses through damaged education. Students lost upwards of 0.35 schoolyears of learning, with some states keeping schools closed for nearly the entire 2020-2021 academic year.

In comparison, mask mandates cut transmission by 19%, making them more effective at preventing disease spread, while imposing minimal costs. Testing and contact tracing programmes also proved efficient compared to implementation costs.

Lead author Nicholas Irons said: “The pandemic posed unprecedented challenges to decision-makers at all levels. While our policy response was not optimal – and we could not have expected it to be – our study shows that many of the measures implemented mitigated economic damage in addition to suppressing transmission of the virus. School closures were a notable exception.”

Cutting pandemic impact

An optimal combination of interventions could have cut the pandemic’s total US impact from £3.7 trillion ($4.6 trillion) to £1.5 trillion ($1.9 trillion) while saving over 100,000 additional lives.

‘Our study shows how using statistical methods to analyse all the sources of data could improve health outcomes and vastly reduce costs to society,’ said co-author Adrian Raftery from the University of Washington. ‘Going forward, better national surveillance data needs to be collected regularly in the US, as was done in the UK during the pandemic.’

The findings provide a blueprint for future pandemic planning, offering concrete data on which interventions deliver the best health outcomes while minimising economic and social disruption. The research suggests rapid deployment of testing, contact tracing, mask mandates and social distancing, combined with targeted facility closures, could control similar future outbreaks without massive educational costs.

The full paper, ‘Optimal pandemic control strategies and cost‑effectiveness of COVID‑19 non‑pharmaceutical interventions in the United States,’ is available in the journal BMC Global and Public Health.

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