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Schools need to be reopened in a phased manner, says ICMR study


Schools should be open with implementation of multi-layered mitigation measures.

Schools need to be reopened in a phased manner, says ICMR study. Image: PTI

The Indian Council of Medical Research (ICMR) in its latest study suggested that schools need to be reopened in a phased manner.

The study also said that schools should be allowed to remain open and safe with the appropriate implementation of multi-layered mitigation measures where children's participation remains essential.

"It is essential to realise the impact of prolonged school closures during the COVID-19 pandemic on the overall development of the children. Therefore, schools need to be re-opened in a phased manner (beginning with primary schools followed by secondary schools) and allowed to remain open and safe with appropriate implementation of multi-layered mitigation measures where children's participation remains essential," says ICMR study.

Published by the ICMR, the Indian Journal of Medical Research is a peer-reviewed open-access publication authored by ICMR Director-General Dr Balram Bhargava, Samiran Panda and Tanu Anand.

The study observed that school closures in India for more than 500 days have affected over 320 million children as per the UNESCO report.

Another school children's online and offline learning survey conducted across 15 states in the country, among children from 1,362 sampled households of relatively deprived hamlets and bastis (slums) in August 2021, revealed that only 8 per cent of school students in rural and 24 per cent in urban areas were studying regularly while nearly half of the respondents were not able to read more than a few words.

"Another survey reported that while students and parents 'missed out on social interactions, 'lacked physical activity and 'had a sense of losing bonds with friends due to prolonged school closures' during COVID-19 pandemic, teachers believed that the pandemic had caused irreparable damage on the overall development of the future generation (personal communication)," it noted.

As per the study, there is ample evidence to suggest that children aged 1-17 years have similar susceptibility to a mild form of SARS-CoV-2 infection as in adults. However, the risk of severe disease and mortality in children when compared to adults is much less. This may be attributed to various factors including lower density of angiotensin-converting enzyme-2 (ACE- 2) receptors lining the respiratory tract of children that provides the site for the binding domain of the spike protein of SARS-CoV-2.

ICMR remarked that the fourth round of the National Serosurvey for COVID-19 held in June 2021 in India revealed that more than half of the children aged six-17 years were seropositive, which implicated that a considerable proportion of children became exposed to and infected with SARS-CoV-2 infection and the infection did not remain restricted to the adults only.

"Treatment centres did not experience attending to severely ill SARS-CoV-2 infected children with any greater frequency during the second wave of COVID-19 in May & June 2021 compared to the previous year, while adults were being treated in inpatient facilities in considerable number throughout the country coinciding with the rapid spread of delta variant in 2021," study said.

Referring to data from the United Kingdom, ICMR paper noted that reopening of schools with younger children was unlikely to push the reproductive number (R) above one while reopening secondary schools resulted in more number cases as older students had their respective family members infected as well, while another school setting in Ireland did not report any secondary transmission.

Paper authored by DG Bhargava interestingly points out that it should also be noted that global evidence suggests schools as 'non-drivers' of transmission of SARS-CoV-2 infection in the community.

As per the study, the benefits of reopening of school during the present scenario of COVID-19 in India (post-second wave) therefore, need to be assessed against the associated risks. Evidence indicates that restoration of functioning of the education system as it was in pre-COVID times, as early as possible appears prudent in the current Indian context. However, it would be necessary to examine the State-specific as well as district-specific data on earlier waves of infection and the status of adult vaccination coverage to project any plausible third wave and its potential intensity to inform such decisions related to schools re-opening.

ICMR paper advised measures to bring physical and social distancing, with staggered timing, alternate day schools, hybrid learning with online classes for compromised children. Alternate class arrangements in well-ventilated areas, ballrooms, open garden areas is advised.

"Air conditioners should be avoided while exhaust fans should be installed in classrooms to create negative pressure for curtailing the potential spread. Children should be advised against sharing meals or spending long hours in canteens or dining halls. Visible display boards with innovative behaviour change messages generated through active engagement of school children and teachers within the school premises could go a long way in this regard," ICMR said in its study.

ICMR also suggests that frequent testing of school staff and students for early detection of cases is essential to prevent outbreaks.

"Testing strategies for SARS-CoV-2 infection in schools should act as an adjunct and not substitute to other organizational and behavioural interventions. Routine temperature or symptom checking in schools should be avoided due to limited evidence on their utility. It is also recommended that schools should have access to onsite testing facilities as per existing country-specific guidelines. Temporary or localized closures of a class or school may occur depending upon the local community transmission levels or if COVID-19 indicators worsen," the study added.

In solution offered by ICMR, school teachers, staff and those involved in the transportation of children should be vaccinated on an emergent basis along with the adoption of mask use post-vaccination and said," This combination-intervention is critical as vaccination against COVID-19 does not prevent acquisition or transmission of infection, which holds true for adults and children alike. Opening of schools under this combination-intervention will ensure not only continuity of in-person learning but also instil confidence among parents that schools are safe for their children."

The ICMR study also says currently, COVID-19 vaccine trials for children and adolescents are still ongoing in India and the available evidence suggests that children aged 12 years and above are at a high risk of contracting the infection and therefore must be prioritised for vaccination compared to the younger children. 

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