Amid speculations about a looming third wave of COVID-19 in India, experts are divided in their opinion on reopening schools.
Last week, Medanta Chairman, Dr Naresh Trehan, warned everyone about the risk of reopening schools and said that our country is "not prepared" to handle the possible surge in paediatric patients.
"We should learn from the USA. Their pediatric hospitalisations increased after schools opened," he was quoted as saying, according to reports.
India has not started vaccinating children yet. So far, only persons aged 18 years and above are being administered the COVID-19 vaccine.
While COVID-19 vaccines for kids is expected to be available in India soon, Dr Trehan was vocal about his reservation over schools sticking to safety protocols.
Meanwhile, several health experts say the opposition is based on an alarmist discourse over the possibility and intensity of a third wave, and that the benefits of resuming physical classes outweigh the risk of SARS-CoV-2.
Recently, The Indian Association of Preventive and Social Medicine (IAPSM), a group of public health experts, recommended urgent resumption of physical classes, based on extensive research and evidence on the risks and benefits.
The IAPSM document on school opening concluded that "it is safe to open schools for all age groups in India with appropriate precautions such as improved ventilation, physical distancing and masking."
Advisory for Reopening of Schools
The advisory applies to educational institutes across age-groups - starting from pre-school to professional institutions.
"The decisions to resume in-person activities should be decentralised, dynamic and based on local preparedness and SARS-CoV-2 epidemiology," it says.
Noting that education is essential for the overall growth and development of children, the advisory says that besides providing basic education, pre-schools and schools serve several other important functions:
Settings for early learning
Facilities for physical activities
Employment to teachers, staff & other caretakers
Initially, not much was known about Covid and our institutions were not prepared to handle the outbreak. But with the passage of time, we're realising the adverse effects of the prolonged closure, the experts say.
Experts noted that the closure of schools has exposed:
Socio-economic educational inequality
Interrupted learning of students
Restricted their opportunity for overall physical, social & emotional development
Are Your Concerns Valid? What Does Data Suggest?
The IAPSM highlights that there are mainly two concerns around sending children to schools:
Children getting infected & the risk of severe infection
Children transmitting the infection to family members, especially elderly
Allaying these fears, experts noted that the available evidence suggests that children do get infection at very similar rate as adults. However, a large proportion of children remain asymptomatic/mildly symptomatic.
Those infected with SARS-CoV-2 rarely need intensive care compared to adults, and the outcomes are usually good, especially those below 9 years.
Also, data from the latest sero survey, shows that children have already got Covid-19 infection at a similar or even higher rate than adults. Thus, the experts said that they are already protected and not at additional risk.
"This also informs us that in spite of schools not been open, children did interact with peers and neighbours their lanes and villages," they said.
"There is evidence available from US and Italy to conclude that attending physical schools does not increase the risk of children getting infected withSARS-CoV-2 or COVID related hospitalisation," they added.
Now, coming to the second fear, spreading the infection to other family members.
The experts highlighted a study that showed that children were less frequently symptomatic (61.8 percent) compared to adults (92.8 percent), had fewer symptoms compared to adults, and had a shorter duration of symptoms (mean 3.8 compared to 4.9 among adults.)
Another meta-analysis showed that the risk of asymptomatic transmission is significantly lower than that of symptomatic transmission.
These studies suggest that children may be transmitting the infection less.
Another report from 15 countries on school reopening and COVID surge suggests that only three countries observed an increase in transmission due to school opening, however, this surge was not proven scientifically to be linked to school attendance, the experts said.
Reiterating their case, the experts said that most districts in the country are reporting nearly zero cases for many weeks.
Since economic and other activities have opened up considering these as essential activities and all community members including children are having practically pre-covid level interactions, opening of schools in this scenario is not likely to increase the risk of community transmission significantly.
"Among all the activities which may contribute to spread of the SARS-CoV-2; we outweigh the benefit versus risk and decide on the reopening of particular activities," they noted.
How Can You Safeguard Yourself at Different Levels?
The IAPSM has recommended some precautions that are desirable and should be adapted as per local conditions and resources.
Ensure school preparedness
Optimise school attendance
Train the staff & students on Covid-appropriate behaviour
Train class teachers on identifying respiratory symptoms
Vaccination for staff
Self-declaration of respiratory symptoms
Facilitate safe transport
Prepare the child
Monitor the child's health
Vaccination for vulnerable individuals in the household
"Benefits of resuming physical classrooms for children outweighs the risk of SARS-CoV-2 in children and the community at large. Resumption of physical classrooms for children is advisable," the experts noted.