Schools Reopening: Paediatric Body Issues Post-Covid Guidelines

The Indian Academy of Paediatrics (IAP) has expressed concern about children – homebound for over 17 months now due to Covid-19 – that they are displaying “significant physical and psychosocial health issue” in addition to the increasing educational void.

While stating that studies have shown “schools do not act as significant sources of viral transmission”, the IAP cautions that the decision for school reopening needs to be taken vigilantly with a scientific temper. National President of IAP Dr Piyush Gupta says that the decision regarding the reopening of schools should be decentralized, taken at the level of districts (or taluka/city/village/school) according to the local situations, rather than at the national or state level. Also, once opened, the decision should be reviewed every 15 days.

A ‘Task Force on School Reopening 2021’, headed by Dr Gupta, has come out with its report, acknowledging that while reopening of schools and bringing back normalcy are eagerly awaited, the horrific experiences during the second wave are acting as a big barrier to any attempts to bring the children back to school. “Government authorities, school administrators, and parents appear to be in dilemma and confusion,” it states.

While giving recommendations and laying down the criteria for bringing the children back to schools, the IAP cautions against using sero-positivity of the population as an epidemiological indicator for school reopening. “The current scientific research suggests that seroprevalence is an unreliable indicator with high false positivity and should not direct policy decisions on social restrictions,” the report says. 

This unreliability is due to factors like restricted population surveys, non-representative samples, uncertainty around test accuracy, and limited knowledge about antibodies in the long term. “To understand the disease epidemiology, the survey results need to be interpreted in the context of other external information, such as confirmed cases, deaths, and infectious disease models,” the report adds.

The recommendations for reopening of schools include:

1) Strict compliance to the COVID-appropriate behaviour (social distancing, masking, sanitization, etc.) by everyone in the community should be encouraged and ensured.

2) Isolation, testing, and contact tracing of symptomatic school attendees should be carried out as per local health guidelines.

3) The health care system should be adequately geared up to handle any potential outbreaks through meticulous microplanning.

4) Local COVID-19 statistics should be vigilantly followed. The decision regarding keeping the schools open should be reviewed every 15 days.

5) COVID-19 vaccination drives should be undertaken to cover all the vaccine-eligible populations as early as possible.

6) Schools and governments should facilitate the joining of students to school by arranging school transport as before, and not imposing restrictions such as RTPCR of students etc.

For the authorities, the report says, they must ensure the following three criteria are met:

The case positivity rate for COVID-19 (that is, the number of RT-PCR positive per hundred tests) should be less than 5% for the preceding two weeks OR if the case positivity rate is greater than 5%, the total number of new cases should have been steadily declining over the preceding two weeks.

The number of new cases per lakh population per day should be less than 20 for the preceding two weeks.
Vaccination coverage (as measured by at least one dose of any of the COVID vaccines) of the adult (or the vaccine-eligible) population should be 60% or more.

The report has listed guidelines for the schools too. These include:

All the adult members working at and closely associated with schools, including the teachers, non-teaching staff, support staff, commute drivers, attendants, and school visitors, should have received at least one dose of any COVID-19 vaccine.

Students above the age of 18 years should have received at least one dose of the COVID vaccine.
Parents and other adult members of the students’ households who are eligible for vaccination should have received at least one dose of the COVID-19 vaccine.

Parents should be willing and should give consent for sending their wards to schools.
High-risk staff members (those with diabetes, high blood pressure, obesity, chronic lung or kidney diseases, etc.) should have completed two doses of vaccination 15 days before attending the schools.

High-risk children (those suffering from chronic diseases like asthma, kidney diseases, disabled children, children on steroids etc.) should consult their paediatricians before joining the schools.
Anyone who is not feeling well should refrain from attending the school and consult a medical professional before returning.