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Indian Pediatr 2021;58:959-961 |
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Indian Academy of Pediatrics Revised
Guidelines on School Reopening: First Revision, September 2021
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Swati Ghate, 1 Siddhesh
Zadey,2 Rajeev Kumar Thapar,3
Dheeraj Shah,4
GV Basavaraja,5 SS Kamath,6
Ramesh Kumar R,7 Nimesh G
Desai,8 Bakul Jayant Parekh,9
Vipin M Vashishtha,10 Ashok Pandey,11
Piyush Gupta12
1Babylon’s Newton Child development and Support Centre, Jaipur,
Rajasthan;2Duke UniversitySchool of Medicine, Durham, NC, USA;3School of
Medicine & Research, Sharda Hospital, Greater Noida, UP;4Departments of
Pediatrics, University College of Medical Sciences and GTB Hospital,
Delhi;5Indira Gandhi Children’s Hospital, Bengluru, Karnataka;6Indira
Gandhi Cooperative Hospital, Kochi; Kerala;7Apollo Adlux Hospital,
Kochi, Kerala;8Institute of Human Behaviour and Allied Sciences,
Delhi,9Bakul Parekh Hospital for Children, Mumbai, Maharashtra;10Mangla
Hospital, Bijnor, 11Ahlcon Public and International Schools,
Delhi;12President, Indian Academy of Pediatrics, Mumbai, Maharashtra.
Correspondence to: Dr Piyush Gupta, Professor and Head, Department of
Pediatrics, University College of Medical Sciences and GTB Hospital,
Delhi.
Email:
[email protected]
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Justification:The COVID-19 pandemic has affected
schooling for more than 24 crores students, since March 2020. Students
need a respite from the long standing social isolation so that they
regain their chance to develop holistically, but after the devastating
effects of the second wave, the administrators as well as parents are
skeptical about the decision of school reopening. Process: The
Indian Academy of Pediatrics constituted a task force comprising of
national and international experts in the field who deliberated on the
issue. Objectives: To bring out scientifically supported
guidelines on the prerequisites of opening and attending the schools, in
the current context of the COVID-19 pandemic. Recommendations:The
task force recommends i) Decentralization of the school reopening
decision; ii)Three epidemiological parameters, case positivity
rate (<5 or steadily declining number of cases for past two weeks),
number of new cases(<20 per lakh population per day for past two weeks)
and vaccination coverage (>60% of the vaccine-eligible population) to be
met at the local level, before the schools reopen; and iii)
Criteria regarding health and vaccination to be met by the
schoolattendees.
Keywords: COVID-19, Education, Formal education, Pandemic.
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D uring the COVID-19 pandemic, crores of
children and adolescents are negatively affected across various
domains of their health and development [1]. With prolonged
school closures, the educational void is increasing day by day
and education is probably suffering the most [2]. An Indian
survey study on more than 16000 students across five states has
shown that, about 92% and 82% children have declined in (at
least one) mathematical and linguistic abilities, respectively
[3]. Another survey study conducted across 15 States revealed
the gross failure of online learning methodology to reach out to
all the students. Only 24% students from urban area and 8% from
rural area are reported to study online regularly; 37% rural
children are completely out of the education stream [4].
Children are homebound for more than 17 months now.
Consequently, they are displaying significant physical and
psychosocial health issues [1]. Reopening of the schools and
bringing back normalcy in their lives is eagerly awaited.
It has been amply proved that more than half
of the children infected with COVID -19 are either asymptomatic
or develop mild form of the disease [5]. There are studies to
prove that schools do not act as major sources of viral
transmission [6]. Outbreaks have been reported where the
mitigation measures were not strictly adhered to [7].
The latest body of research on COVID-19,
particularly in children, and the advent and the availability of
the vaccines, are scientifically favorable factors for relaxing
the social restrictions imposed on children. But the horrific
experiences during the second wave are unforgettable and act as
a big barrier when there is any attempt to bring the children
back to schools. The Government authorities, the school
administrators, as well as the parents appear to be in a state
of dilemma and confusion. The decision for school reopening
therefore, needs to be taken meti-culously and with scientific
evidences.
To address the issues of schooling during the
pandemic, the Indian Academy of Pediatrics (IAP) had framed
recommendations on ‘School Reopening, Remote Learning and
Curriculum during and after COVID-19 Pandemic’, in October, 2020
[8]. We, herein, provide an update to these guidelines.
OBJECTIVES
To frame guidelines to readdress the
epidemiological parameters for school reopening, and to
formulate recommendations for individuals (staff, students and
visitors) while attending the school.
METHODOLOGY
The Indian Academy of Pediatrics constituted
an expert panel, the ‘Task Force on School Reopening 2021’ in
August, 2021. The panel members exchanged their ideas and
thoughts through Zoom meetings, group mails and other social
networks. They studied relevant latest research papers and
articles, other currently released guidelines and took into
consideration, the experiences of school reopening at various
places across the globe. After deliberating on the matter, the
guidelines were drafted and circulated to all the members for
their suggestions and approval. The Task Force thereafter
finalized the following revised recommendations on ‘when’ to
open the schools:
RECOMMENDATIONS
General Recommendations
• Decision-making regarding the school
reopening should be decentralized. It should be taken at the
level of districts (or taluka/city/village/school) according
to the local situations, rather than at the national or
state level.
• Strict compliance to the COVID
appropriate behaviour (social
distancing/masking/sanitization/respiratory hygiene etc.) by
each and everyone in the community should be encouraged and
ensured.
• Isolation, testing and contact tracing
of symptomatic school attendees should be carried out as per
local health guidelines.
• Healthcare system should be adequately
geared up to handle any potential outbreaks through
meticulous microplanning.
• Local COVID-19 statistics should be
vigilantly followed. The decision regarding keeping the
schools open should be reviewed every 15 days.
• COVID vaccination drives should be
undertaken to cover vaccine eligible population as early as
possible.
Criteria for School Reopening
These criteria need to be met at the local
level.
1. The case positivity rate for COVID-19
(i.e., 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 [8].
2. Number of new cases per 1 lakh
population per day should be less than 20 for preceding two
weeks [8].
3. 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
[9,10].
When all these three criteria are met, the
local authorities may consider opening of the schools.
Criteria for Attending the School
• 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 COVID-19 vaccine.
• Both parents and all other household
adults of the student should have received at least one dose
of COVID-19 vaccine.
• Parents should be willing and should
give consent for sending the ward to the school.
• High risk staff members (like those
suffering from diabetes, high blood pressure, obesity, lung
diseases etc.) should have completed two doses of COVID -19
vaccination 15 days prior to joining the schools.
• High-risk children (like those
suffering from chronic diseases like asthma, kidney
diseases, children with special needs, children on steroids
etc.) should consult their pediatricians before joining the
schools.
• Anyone who is not feeling well should
refrain from attending the school and consult a medical
professional before returning to the school.
The current evidence suggests that the
seroprevalence is a highly volatile indicator with high false
positivity and it is not a robust criterion for policy decisions
on social restrictions. The results of seroprevalence surveys
are influenced by several factors like restricted populations,
non-representative samples, uncertainty around test accuracy,
and limited knowledge about presence of antibodies in the long
term. Further, these are required to be interpreted in the
context of other external information, such as confirmed cases,
deaths, and infectious disease models, to understand the disease
better[11,12].
IAP will update the advisory as and when new
scientific data emerges.
Funding: None; Competing interests:
None stated.
Contributors: All authors were part of
the IAP Task Force on School Reopening, 2021, that formulated
these guidelines. PG, GVB, BJP and SG conceived the guidelines,
prepared the agenda, and executed administratively. PG led the
discussions and all the members actively participated. DS, RR,
SSK, SZ, GVB contributed on the epidemiological aspects. ND and
VMV contributed on the vaccination issues. SG and SZ reviewed
the literature. SG and SZ wrote the first draft. ND and AP
suggested edits. RKT and PG did the final edits. All the authors
approved the final recommendations of the guidelines.
REFERENCES
1. Unicef Report. Press release, March 2021.
Accessed on 4 September 2021.Available from:
https://www.unicef.org/press-releases/schools-more-168-million-children-globally-have-been-completely-closed
2. Araújo LA, Veloso CF, Souza MC, Azevedo
JMC, Tarro G. The potential impact of the COVID-19 pandemic on
child growth and development: a systematic review. J Pediatr
(Rio J). 2021;97:369-77.
3. Azim Premji Foundation Research Group.
Loss of Learning during the Pandemic. Azim Premji
University;February 2021.Accessed on 13 Sep, 2021. Available
from:https://archive. azimpremjiuniversity. edu.in/SitePages/pdf/Field_Studies_Loss_of_Learning_
during_the_ Pandemic.pdf
4. The SCHOOL Team. Locked out: Emergency
Report on School Education. September 2021.Accessed on 13 Sep,
2021. Available from:https://www.google.com/url?sa=t&source=web&rct=j&url=
https://counterviewfiles.files.wordpress.com/2021/09/locked-out-emergency-report-on-school-education-6-sept-2021
5. Cui X, Zhao Z, Zhang T, et al. A
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disease 2019 (COVID-19). J Med Virol. 2021;93:1057-69.
6. UNICEF. In-Person Schooling and Covid-19
Transmission: A Review of The Evidence; 2020. Accessed on 4 Sep,
2021. Available from:
www.unicef.org/documents/in-person-schooling-covid-19-transmission-review-of-evidence
7. Stein-Zamir C, Abramson N, Shoob H, et al.
A large COVID-19 outbreak in a high school 10 days after
schools’ reopening, Israel, May 2020. Euro Surveill.
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8. Ghate S, Parekh BJ, Thapar RK, et al.
Indian Academy of Pediatrics Guidelines on School Reopening,
Remote Learning and Curriculum in and After the COVID-19
Pandemic. Indian Pediatr. 2020; 57:1153-165.
9. Wang W, Wu Q, Yang J, et al. Global,
regional, and national estimates of target population sizes for
covid-19 vaccination: descriptive study. BMJ. 2020 Dec
15;371:m4704.
10. World Health Organization. Coronavirus
Disease (covid-19) – Herd Immunity. WHO; 2020. Accessed on 4
September, 2021.
https://www.who.int/emergencies/diseases/novel-coronavirus-2019/mediaresources/science-in-5/episode-1
11. Brownstein NC, Chen YA. Predictive
values, uncertainty, and interpretation of serology tests for
the novel coronavirus. Sci Rep. 2021;11:5491.
12. McConnell D, Hickey C, Bargary N, et al.
Understanding the challenges and uncertainties of seroprevalence
studies for SARS-CoV-2. Int J Environ Res Public Health.
2021;18:4640.
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