Reopening schools: It's no longer about whether but how to

Ahead of the Global Education Meeting on July 13, 2021, the chiefs of UNICEF and UNESCO noted in their joint statement that primary and secondary schools were closed in 19 countries, affecting over 156 million students. School closures can lead to learning loss, mental distress, exposure to violence and abuse, missed school-based meals, vaccinations and reduced development of social skills. They put it unequivocally: "Schools should be the last to close and the first to reopen." It has been the opposite in India.

The results of the fourth national sero-survey for Covid-19 conducted by the Indian Council of Medical Research (ICMR) tested for the presence of antibodies specific to the SARS-CoV2 virus across 70 districts in 21 states; the sero-prevalence was 57.2 per cent among children aged 6-9 years and 61.6 per cent among 10-17 years. This raised optimism that schools could reopen. Earlier, the Supreme Court, in its order of January 13, had ordered states and Union Territories (UTs) to decide, by January 31, on the opening of Anganwadi (Integrated Child Development Services) centres.

Recent experience in the UK and other countries indicates the Delta variant's role in transmission among school children in years 7 to 11; the surge has been under control, though. The SARS-CoV-2 transmission in schools may be less important in contributing to community transmission than was earlier believed. School-based transmission is a known driver of influenza epidemics, thus requiring mandatory closure. Some countries did not shut down schools and early child care centres in the Covid-19 pandemic; others did so as a precautionary principle. While outbreaks do occur in school settings, transmission is lower than or similar to the levels of community transmission if prevention strategies are followed. The focus, therefore, is not anymore about whether but how to.

The WHO underscores that decisions regarding public health and social measures (PHSM) – critical to limiting transmission and deaths - should be based as much on the situational assessment of the intensity of the transmission and capacity of the health system as they are on the consequences on the welfare of communities. With vaccination a work in progress, PHSM should be deployed "in a tailored and agile way" by local administrative levels and regularly reviewed and adjusted according to the local epidemiology. In its June 14 guidance document, five situational levels (0 to 4) have been identified by the WHO based on seven transmission scenarios.

Education settings are advised to remain open with precautionary measures in place across situational levels 0 to 3. The advisory for situational level 4 (uncontrolled epidemic with limited or no additional health system response capacity available) is to make all efforts to continue with in-person learning, failing which consider blended learning. Children of essential workers should be allowed to attend in person; closure should be considered when there are no other alternatives.

A document jointly developed by the WHO, UNICEF and UNESCO put forth a set of comprehensive, multi-layered measures. Community-led initiatives for risk reduction include addressing incorrect and misleading information, rumours and stigma; protection/shielding of vulnerable groups; and safe public transportation.

Though the Union government has announced the possibility of vaccines being available for older children in August or September, it is not a prerequisite for the resumption of schools. Given the primacy that schooling deserves, teachers and staff ought to have been treated as priority categories for vaccination early on. Screening and managing sick students, teachers, and other school staff and enforcing the "staying at home if unwell" policy is singularly important. Prompt isolation of cases and contact tracing and quarantine of contacts should be implemented while maintaining confidentiality.

At the school level, administrative policy changes entail setting attendance and entry rules; keeping students and teachers in small groups that do not mix (popularly, bubble or capsule); staggering start of school, breaks, bathroom, meal and end times, and alternating physical presence (alternate days or alternate shifts).

Reorganisation of the physical space is crucial: identifying entry/exits; marking the direction of walking; handwashing facilities; and modifications to facilitate the appropriate use of space. Adequate and proper ventilation is critical, as is encouraging outdoor activities.

Protocols inside the classrooms vary depending on local transmission levels. In districts/sub-districts with situational levels 3 or 4, a distance of at least one metre between all individuals (students of all age groups and staff) should be maintained. In the other situational levels (with lower risk), children under 12 years are not required to keep physical distance at all times, and where feasible, children aged 12 years and over should keep at least one metre apart from each other. Teachers and support staff should keep at least one metre apart from each other and students.

The advisory for masks in situations of intense community transmission or where physical distancing cannot be achieved is as follows:

• Children aged five years and under are not required to wear masks.
• A risk-based approach should be applied to the decision to use a mask among 6-11 years, including the child's capacity to comply, availability of appropriate adult supervision, the potential impact of mask-wearing on learning and psychosocial development and children with disabilities or underlying diseases.
• Children and adolescents 12 years or older should follow the national mask guidelines for adults.
• Teachers and support staff should continue to wear masks.

Central to the success of all these will be communication with parents, students, teachers and school staff. Inclusive and early collaboration between the school and the community shall help build confidence in the changes and protocols that are being instituted. Frequent communications and messaging on Covid-19 and school measures along with flexibility and modification of approaches as needed will reassure parents, students and teachers that schools are safe to attend once mitigation measures have been undertaken.

(The writer is Chairperson at the Centre of Social Medicine & Community Health, Jawaharlal Nehru University, New Delhi. He is also a member of the National AEFI (Adverse Effects Following Immunisation) Committee.)

Disclaimer: The views expressed above are the author’s own. They do not necessarily reflect the views of DH.