Available evidence suggests that children aged 12 and above are at a high risk of contracting COVID-19 infection and must be prioritised for vaccination compared with younger children, say experts at the Indian Council of Medical Research (ICMR).
They say schools should be reopened in a phased manner (beginning with primary schools) and allowed to function safely with appropriate implementation of multi-layered mitigation measures where children’s participation was essential.
An opinion piece titled “Reopening of schools during COVID-19 pandemic: a persistent dilemma” published in the Indian Journal of Medical Research stated that there was ample evidence to suggest that children aged between one and 17 had similar susceptibility to a mild form of SARS-CoV-2 infection as in adults. However, the risk of severe disease and mortality in children was less.
The fourth round of the National Serosurvey for COVID-19 done in June 2021 revealed that more than half of the children aged between six and 17 were seropositive, which indicated that a considerable proportion of them had been infected with SARS-CoV-2. “However, 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 numbers throughout the country coinciding with the rapid spread of the Delta variant in 2021,” noted the ICMR in its paper.
It pointed out that the Union Health Ministry had issued guidance on wearing masks by children belonging to different age groups. While masks were not recommended for children under five, those between six and 11 may wear a mask depending on their ability to use them safely and children aged 12 and above must wear masks under the same conditions as adults.
The ICMR stressed that adequate ventilation was critical to prevent the spread of COVID-19. Therefore, schools should ensure that indoor spaces were well ventilated and wherever possible, limit the time spent by students in closed settings. Air-conditioners should be avoided, while exhaust fans should be installed in classrooms to curtail a potential spread of the virus, it suggested.
Testing strategies in school settings could serve as key interventions to check the potential spread of the virus, the paper emphasised.
“It must also be acknowledged that the testing strategies for SARS-CoV-2 infection in schools should act as adjunct and not substitute to other organisational and behavioural interventions,” the ICMR said. Frequent testing of school staff and students for early detection of cases was essential to prevent outbreaks.
“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 on-site testing facilities as per existing country-specific guidelines. Temporary or localised closures of a class or school may occur depending upon the local community transmission levels or if COVID-19 indicators worsen,” added the paper.