Are Teachers at a Decreased Risk for Hospitalization for COVID-19 Than the General Population?

An elementary school teacher sitting at her desk in the classroom during the covid-19 pandemic, wearing a face mask and shield. She is an mid adult African-American woman in her 30s.
A large case-control study conducted in Scotland assessed the risk for both hospitalization for COVID-19 and severe COVID-19 among teachers and their household members vs adults in the general population.

Teachers and their household members were found to not have an increased risk for hospitalization for treatment of COVID-19 and were at a decreased risk for developing severe COVID-19 compared with healthcare workers (HCW) and adults in the general population, according to results of a large study published in BMJ.

Investigators conducted a nested case-control study in Scotland to assess the risk for hospitalization for treatment of COVID-19 or severe COVID-19 among individuals working as teachers and their household members. The study occurred during defined periods of school closures and full openings in response to the COVID-19 pandemic.

Teachers were identified by the General Teaching Council for Scotland and comparator groups included adults in the general population and HCWs. The primary outcome was hospital admission for treatment of COVID-19.

The dataset of teachers included 66,710 individuals, of whom 25,687 were selected as either cases or controls. A total of 38,993 patient-facing HCWs and 2731 non–patient-facing HCWs were also enrolled in the study. Teachers and HCWs were similar in terms of age and ethnicity compared with the general population, but they were more likely to be women and to have fewer comorbidities.

During the study, the cumulative incidence of hospital admission with COVID-19 was less than 1% for adults of working age from the general population, including teachers and HCWs. After adjustment for age, sex, general practice, ethnicity, deprivation, number of comorbidities, and number of adults in the household, the risk for hospitalization was decreased among teachers (rate ratio, 0.77; 95% CI, 0.64-0.92) and their household members (rate ratio, 0.66; 95% CI, 0.56-0.80) compared with the general population. Teachers’ risk for severe COVID-19 (rate ratio, 0.56; 95% CI, 0.33-0.97) was also decreased compared with adults in the general population.

In autumn 2020, schools in Scotland reopened and the rate ratios for hospitalization for COVID-19 treatment and severe COVID-19 among the included study groups were calculated. The rate ratios among teachers were 1.20 (95% CI, 0.89-1.61) and 0.45 (95% CI, 0.13-1.55), respectively, and 0.91 (95% CI, 0.67-1.23) and 0.73 (95% CI, 0.37-1.44), respectively, for their household members. Among patient-facing HCWs, rate ratios were 2.08 (95% CI, 1.73-2.50) and 2.26 (95% CI, 1.43-3.59), respectively. In addition, the risk among teachers was similar during a second period of school reopening in summer 2021, and risk values were increased compared with those observed during periods of school closure.

Study limitations included the inability to link a small number of General Teaching Council for Scotland registrants to healthcare records; a low incidence of severe COVID-19; and a lack of specific data on the circumstances of individual teachers, such as class size and safety measures implemented at specific schools.

The investigators concluded that their findings “should reassure those who are engaged in face-to-face teaching.” Further, they noted that “[p]rompt uptake of [the COVID-19 vaccine] in teachers might have contributed to their protection during a period when the Delta variant was common.”

Disclosure: Some author(s) declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.


Fenton L, Gribben C, Caldwell D, et al. Risk of hospital admission with COVID-19 among teachers compared with healthcare workers and other adults of working age in Scotland, March 2020 to July 2021: Population based case-control study. BMJ. 2021;374:n2060. doi:10.1136/bmj.n2060