Schools should be re-opened by taking do precautions
We are shocked to know that the expert task force in Maharashtra has opposed the decision of the education department to restart schools. Such a decisions should be taken on the basis of the science of Public Health. But the task force does not contain any Public Health expert. Public Health experts should be included in the Task Force. The report of the task force about this issue should be made public for examination by public health experts. It seems that the task force has not taken into account the following facts, issues –
Closure of schools has led to a great deal of damage to the physical and psychological health of school children. Children are no more receiving the cooked supplementary nutrition in anganwadis and schools. Instead dry ration is given which may or may not be used for children. This has worsened the malnourishment in children from labouring population and this in turn may lead to increased incidence of tuberculosis. This damage needs to be compared with the possible damage due to Covid-19 infection to children and their family members after reopening of schools. For this purpose the following things need to be taken into account-
1) The 4th all India survey done by the Indian Council of Medical Research in July has shown that on an average 67% of Indians have developed antibodies in their blood and this proportion is almost the same in children. Though the prevalence of Covid-19 infection in children is the same as that in adults as shown by this survey and secondly though the age group 0 to 14 years accounts for about 26 % of the Indian population, children do not account for not even 0.5% of total Covid-19 deaths! These data tally very well with our experience. This is because the incidence of severe Covid-19 disease is comparatively very very low in children and mortality is also comparatively much lower. Given these facts and the fact that the prevalence of infection in children is almost the same that in adults despite closure of schools all these months, there does not seem to be any rationale or wisdom in continuing the school closure.
2) There is possibility of the third wave of covid-19. But it should be borne in mind that even though the second wave of Covid-19 was very severe, the incidence of severe Covid-19 disease and death was extremely low in children. The third wave will not be as severe and big as the second wave. This is because before the beginning of the second wave the prevalence of Covid-19 infection in the Indian population was just 24%, overwhelming majority was yet to be exposed to the virus. Now more than 67% of Indians have already been exposed to the virus or have been vaccinated. Experts say that when 80% of the Indian population gets infected, India will reach the stage of herd immunity. Currently almost 70% of the population has already been infected or have received the vaccination and therefore is now immune to Covid-19 disease. Therefore now in India there is no more a huge number of an unexposed population which can become the basis of a big third wave. Therefore the third wave is likely to be much smaller than the second wave.
3) It is true that in children Covid-19 can lead to the serious ailment – multisystem inflammatory syndrome. However the incidence of this syndrome is very very low and children who have some health problems like Type 1 Diabetes or some congenital health problem are more likely to get develop this syndrome. The risk of this syndrome can be reduced by advising parents of such children not to send their kids to the school.
4) It needs to be noted that despite very good precautions, Covid-19 infection will happen in certain children because of aerosol transmission. Though children themselves are much less likely to develop serious Covid-19 disease, they will carry this infection back home and which may be dangerous to their grandparents or are other members of the family who have health problems like diabetes, hypertension etc.etc. Despite this risk, there is not enough justification to continue closure of schools, given the above mentioned situation. Schools need to be opened by taking all due precautions to reduce the chances of Covid-19 transmission in schools.
5) It is argued by some people that the Covid-19 vaccine for children will be available in coming months and school should be opened after children are vaccinated with this vaccine. Neither the World Health Organisation nor the Indian Academy of Pediatrics has kept vaccination of children as a precondition for reopening of schools. In many developed countries schools have been opened without vaccinating the school children. In India vaccine for children is still not available. When it is available in coming some months it will take further many many months for vaccinating all school children in India. Do we want to keep schools closed for one year from now? in England vaccine for children has received marketing approval but only some children between the age of 12 to 17 are being vaccinated. In general vaccination of children to protect them from Covid-19 is a controversial topic and there is no consensus among experts about it
6) In most developed countries schools have been partially opened except during lockdown. Standard Operating Procedure for reopening of schools have been prepared by many expert organizations. We can draw upon these guidelines to prepare our own. The Indian Academy of Pediatrics has recommended that schools should be opened in areas where the positivity rate is less than 5% and where number of new cases per million population is less than 20 a day.
Given the above facts and considerations, Jana Arogya Abhiyan demands that anganwadis and primary schools should be started immediately with proper precautions and preparation along with adherence to Covid appropriate behaviour in the schools. Some schools have started and their experience is not negative. In supplementary nutrition programme, instead of dry rations, serving fresh, hot cooked food should be re-started in anganwadis and primary schools. Detailed guidelines and protocol should be prepared on the basis of the science of Public Health and should be properly followed. For example all school teachers and all non teaching staff should certainly receive two doses of the Covid-19 vaccine but sterilizing schools before opening is not needed. Finally it needs to be understood and accepted that despite good precautions, aerosol transmission of Covid-19 can occur in schools and in such an eventuality, no action should be taken against the concerned school teacher or the headmaster.
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