COVID-19: Risk of Severe Disease Within Households of School Employees Interview with:
Thomas M. Selden

Director of the Division of Research and Modeling
Center for Financing, Access, and Cost Trends
Agency for Healthcare Research and Quality
Rockville, Maryland What is the background for this study?

Response: Across the United States, school districts are facing decisions about whether and how to reopen elementary and secondary schools.  We conducted this study to provide evidence on the risk of severe COVID-19 among adults who are connected to schools in some way – as teachers or other school workers or as household members of school-age children or school employees.

The Agency for Healthcare Research and Quality (AHRQ) collects the data we used in this study as part of its longstanding Medical Expenditure Panel Survey (MEPS), which is the nation’s most complete source of data on the cost and use of health care and health insurance coverage. What are the main findings?

Response: Between 42.0% and 51.4% of school employees have at least one underlying health issue identified by the Centers for Disease Control and Prevention (CDC) as putting them at increased risk of severe COVID-19 (   Moreover, we found that many school employees who are themselves at low risk of severe COVID-19 live in households with someone who is at increased risk.

Combining results, we find between 63.2% and 71.9% of all school employees either
(a) are at high risk themselves or (
b) live with someone who is high risk (so that the employee might not want to risk bringing the virus back to the home).

Similarly, 58.7% to 71.0% of school-age children live in households with at least one adult who is at increased risk for COVID-19. Between 33.9 million and 44.2 million adults who are in the increased risk group have a direct or within-household connection to schools, either as school employees or as household members living with school employees or school-age children.

The condition that most often places school-connected adults at increased risk of severe COVID-19 is obesity. What should readers take away from your report?

Response: Our study highlights the importance of considering not only the COVID-19 risks to school employees, but also to household members living with school employees or students.  Our study does not reach conclusions regarding any particular timetable or strategy for reopening schools, but rather offers nationally representative estimates as one piece of the puzzle. What recommendations do you have for future research as a result of this work?

Response: Our findings highlight the importance of improving our understanding regarding the combined health risk profiles of households and the rates of within-household transmission of COVID-19 if we are to inform policymaking surrounding this pandemic.

The views expressed in this interview are those of the authors and do not necessarily represent the views of the Department of Health and Human Services or the Agency for Healthcare Research and Quality. 


The Risk Of Severe COVID-19 Within Households Of School Employees And School-Age Children
Thomas M. Selden, Terceira A. Berdahl, and Zhengyi Fang
Health Affairs 0 0:0

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Last Updated on September 20, 2020 by Marie Benz MD FAAD