An evidence-based theory of change for reducing SARS-CoV-2 transmission in reopened schools

Schools have closed worldwide as part of measures to prevent SARS-CoV-2 transmission but are beginning to reopen in some countries. Various measures are being pursued to minimise transmission but existing guidance has not developed a comprehensive framework or theory of change. We present a framework informed by the occupational health hierarchy of control and a theory of change informed by realist approaches. We present measures focused on elimination, substitution, engineering, administration, education and personal protective equipment. We theorise that such measures offer a means of disrupting SARS-CoV-2 transmission via routes involving fomites, faeco-oral routes, droplets and aerosols.
Highlights • Schools have been closed worldwide as part of lock-down measures to prevent SARS-CoV-2 transmission but are beginning to reopen in a number of countries. • Various measures are being pursued to minimise transmission but existing guidance has not aimed to develop a comprehensive framework or theory of change. • We present a framework for measures informed by the occupational health hierarchy of control (elimination, substitution, engineering, administration, education and personal protective equipment) and a theory of change. • We theorise that, together, such measures offer a means of disrupting SARS-CoV-2 transmission via routes involving fomites, faeco-oral routes, droplets and aerosols.