Jaipur: At a government upper primary school in rural Rajasthan, about 50 km from Jaipur, a large water tank in the school yard provides water for drinking as well as for washing hands. The toilets do not have running water. The school, which has about 57 children enrolled, is an L-shaped, one-storey building, with seven small classrooms, and four teachers, set along a yard.

"If we run the school in shifts or have only certain grades come in on a single day, we can follow Covid-19 precautions," the school principal, Khemchand Tanwer, had told IndiaSpend in August 2021, before the Rajasthan government had allowed grades IX to XII to return to school beginning September 1.

Cut to another government school in urban Jaipur. This school is built around a central courtyard; the same premises are used by an upper-primary school in the morning and a primary school in the evening. The toilets have running water and a separate facility for drinking water.

"Yes, students need to return to school, but, honestly, we cannot ensure that all Covid-19 guidelines can always be followed… sometimes even before you notice it, they [children] would have shared their water bottle," Sunita (she gave us only one name), one of the teachers in the school, told IndiaSpend.

Schools in India had remained shut for about one-and-a-half years due to the pandemic, before several states allowed them to re-open, starting in July 2021. School closure has meant that children have lost out on learning; the lack of access to digital education for the poorest and most vulnerable families has increased inequality; and children have lost out on social and peer learning as well as friendships, we reported in the first part of 'Education Disrupted', our series on the impact of the pandemic on children's education and development. School closures also make children more vulnerable to child labour, marriage and abuse as schools are often the first source of help for at-risk children.

But given the differing resources available to different types of schools, the decision to open (or close again) amidst the Covid-19 pandemic would have to be taken by individual schools and their districts, experts told IndiaSpend. At a bare minimum, well-ventilated classrooms, physical distancing--either by running multiple shifts or staggering grades over different days of the week--masking, vaccination of school staff, and adherence to hygiene and hand-washing protocols are necessary for schools to reopen while ensuring that families feel safe to send their children to school.

"Every school is going to have a different capacity to implement guidelines," Swati Ghate, a Jaipur-based paediatrician and co-author of the Indian Academy of Pediatrics' October 2020 paper, 'Guidelines on School Reopening, Remote Learning and Curriculum in and After the COVID-19 Pandemic', told IndiaSpend. The key is to see "schools as places of social interaction and social learning rather than just places to complete the academic backlog," said Ghate. Even if schools can call a child once or twice a week, it will be a good start… after many months of the pandemic, we see that children are resilient against Covid-19."

Fewer than a third of low and middle-income countries reported that all students had returned to in-person schooling, per a survey between February and May 2021 by the World Bank, the United Nations Children's Fund, the United Nations Educational, Scientific and Cultural Organization and the Organisation for Economic Co-operation and Development. It was "mainly high-income nations" that are "taking steps to measure learning losses at the primary and lower-secondary levels", the survey found.

What international, national and state Covid-19 guidelines for reopening schools prescribe

The central government had issued guidelines for operating schools last September, which advocated digital over in-person learning. For in-class learning, it suggested that schools seat mask-wearing children at least six feet apart, either by running classes in shifts or biweekly classes per grade, using open spaces when possible, maintaining health and hygiene standards and avoiding school congregations or events. In case a child or staff member was diagnosed with Covid-19, a physician or a district response team should assess the risk, contact screening be conducted and the school premises be disinfected. It also asked states to prepare their own rules for school re-openings.

Some states had opened schools for high schoolers in the lull between the first and second Covid-19 waves. After the second wave, many states set guidelines and opened schools beginning in July 2021. For instance, Madhya Pradesh opened schools for grades IX to XII from July 26, with 50% attendance; Punjab from August 2 for all grades; and Uttar Pradesh for grades IX to XII from August 16, with 50% attendance.

The Chhattisgarh Samagra Shiksha department asked all schools to arrange 'Mohalla classes' for children with the permission of the School Management Committee and families from the beginning of the school year in July. In guidelines issued on July 7, the department asked that teachers and students be masked, that students sit in circles, with adequate distancing, and that teachers be vaccinated against Covid-19.

Some schools have subsequently reopened, following these guidelines and allowing not more than 20 children in one class at a time, Milind Chandra, school in-charge and a master teacher trainer at a primary school in Durg district of Chhattisgarh, told IndiaSpend. In some villages, gram panchayats are yet to permit schools to reopen, he said.

The Indian Academy of Paediatrics (IAP) also published guidelines in October 2020, suggesting that schools open when they have the necessary infrastructure to implement Covid-19 protocols, emphasising staggered timings, social distancing, and hygiene and hand-washing. They also recommend restricting the number of people school-going children interact with outside of their cohort.

IAP's guidelines mention three epidemiological criteria that must be met before schools reopen: the number of new Covid-19 cases should be steadily decreasing, daily cases should be less than 20 per 100,000 population for the preceding two weeks, and the district's test positivity ratio--the proportion of positive tests to total samples tested--should be below 5%. These guidelines will be soon updated, adding the need for vaccination of all school staff and an epidemiological marker of what proportion of the district's population would have to be fully vaccinated to protect children and adults as schools reopen, said Ghate.

The World Health Organization (WHO) recommends masking for children older than five years and who have reached the developmental milestones for that age. Children with cognitive, respiratory or other disabilities should not be asked to wear a mask. For children between the ages of five and 12, the WHO suggests masking based on several factors, including the intensity of Covid-19 transmission in the community, the child's ability to manage a mask and the impact of mask-wearing on child learning and development.

"There is awareness about masking but adherence to masking varies across schools," said Chandra.

On physical distancing, the WHO recommends one foot between children, while the Indian government guidelines recommend six feet. The UK no longer asks for physical distancing between students, while the US recommends a three-feet distance between elementary school students and a six-feet distance between staff, and between staff and children. As with the Indian government guidelines, they also suggest alternate seating on school buses and staggered students' arrival to avoid overcrowding.

"There are some schools that do not even have five classrooms for five grades," said Chandra, and these schools could find it difficult to re-open with precautions.

Some schools, such as this one in Hadota, near Jaipur, have large compounds and classes, and can follow Covid-19 protocols. Others, which are smaller, might find it harder to do so.

UNICEF also provides checklists for schools and governments before schools re-open.

"Making children follow precautions is easier said than done," N.K. Arora, the executive director of health research nonprofit Inclen Trust International and chair of the Covid-19 National Technical Advisory Group on Immunisation, told IndiaSpend. "But it is very important to avoid overcrowding and a lot of other precautions will be taken care of," he said.

Instead of mandating that a class only have 50% students or a specific number of students, it might be more useful to let a school take that decision, he said. For instance, schools with large classrooms might be able to seat more students with distancing, while small classrooms might not be able to manage distancing with even less than half the students in class.

In addition, given alternate day classes, the possibility of sudden school closures and the fact that not all children might come to school, schools will need to continue with a hybrid model--combining in-person teaching with digital lessons and at-home assignments, said Arora.

Resource-poor schools will find it difficult to follow Covid-19 hygiene protocols

All guidelines--from India or other countries--underscore the importance of hygiene, including frequent hand-washing especially before eating, clean toilets and school environments.

Government data show a high proportion of schools (95%) in India have functional toilets while 80% have functional electricity connections. As many as 93% have functional drinking water facilities, but these include hand pumps and wells as well, 2019-20 data from India's District Information System for Education Plus show. About 90% of schools have a hand-washing facility.

In Rajasthan, the Standard Operating Procedures say that children should be advised to bring water from home and sharing of water bottles should be dissuaded. For children who cannot bring water from home, clean water should be made available at a fixed, hygienic spot.

"Frankly, I do not think all Indian schools will be able to follow all the hygiene protocols as many do not even have potable water or good toilet facilities," said Ghate. Just making changes to how the children will sit and changing the timings etc. is "grossly inadequate".

"This will lay bare the true extent of a school's problems," said Chandra. This should be an opportunity for the administration and principals of schools to make sure that all schools have the bare minimum facilities, he said.

In Rajasthan, for instance, the government has said that schools should use 10% of the funds from the composite school grant towards keeping the school and all facilities clean.

But solutions to such issues should be found rather than delaying school reopening, said Arora, adding that the solutions would have to be local. For instance, when this reporter mentioned that about 45% of schools have hand pumps, Arora said that an attendant could operate the hand pump to resolve the issue of many children using the same handle to pump water.

Further, given that the rest of the country, including markets and malls have opened up, and children are meeting others, even without precautions, why should schools not open up with precautions, a private school manager about 40 km from Jaipur city asked.

Schools have now opened in Chhatisgarh, with Covid-19 protocols. Pictured, the first day at the government primary school in Selud. Photo credit: Milind Chandra

Vaccinating children, testing not mandatory for schools to re-open

Children do not need to be vaccinated for school to re-open, said Arora of Inclen Trust. This is because children are at low risk of severe disease from Covid-19, as Chandrakant Lahariya, an epidemiologist and public health specialist, explained. "All adults should be vaccinated to protect themselves in case children transmit the infection to them," Arora said. "They should be fully vaccinated but even if they have got the first dose, it is a good start."

On August 25, India's health minister, Mansukh Mandaviya said that the central government would provide an additional 20 million vaccine doses to states to vaccinate all teachers before September 5. It is unclear how this would be implemented.

In the government school in Selud in Chhattisgarh, most adults, including childrens' families, have got at least one dose of a vaccine, said Chandra. "I keep track of this at my school but not all schools would be aware. This is something that can be done," he said.

Once a vaccine is available for children, the government will make those children above the age of 12 years, who have comorbidities, eligible for vaccines first. This is because they are more likely to have serious infections, Arora said.

The UK guidelines suggest twice weekly rapid Covid-19 tests for children and staff, while the US guidelines say that some schools might randomly test students and children.

"Neither is [random, regular] testing needed, nor is it practical," said Ghate. "We are a resource-poor country so we cannot expect our system to work so far ahead of the basic needs. Testing should be done for those who are symptomatic and for contact tracing," she explained. Instead, "when schools open, we have to be watchful about symptoms and children's health--a message that should go to teachers and parents".

In Rajasthan, for instance, the guidelines for schools do not include regular testing, but they ask every village to have an oversight committee that explains the signs and symptoms of Covid-19, asks villagers to be cautious, and for students with any symptoms to not come to school.

Local level decision-making would be best

In a situation where there are very few Covid-19 cases in the community, decisions about school closures in the case of a few cases within the school should be taken by the school, parent-teacher committees and the local administration, Lahariya said.

The authority to make decisions on whether schools should open or close should be decentralised, and lie with the district magistrate, Poonam Muttreja, executive director of the Population Foundation of India, told IndiaSpend in July 2021.

All three departments--education, women and child development and health--should work together to form guidelines in the state, and the district should have a plan in case of the spread of Covid-19 or even other transmittable illnesses, Arora said.

For instance, in case a child or teacher contracts Covid-19, which had recently happened at a nearby school, that school is to be shut for 15-20 days in Chhattisgarh, said Chandra.

Despite schools being shut since March 2020, 57.2% of children aged six-nine years and 61.6% of those between 10-17 years had Covid-19 antibodies, almost equivalent to the proportion of adults (including vaccine-induced antibodies), the fourth national serosurvey conducted in June-July 2021 showed. Still, the rate of severe disease and death in children from Covid-19 is low, we had reported in May 2021. A post-Covid-19 infection, called Multisystem Inflammatory Syndrome in Children or MIS-C, can be dangerous if not caught in time, we had reported. With the right medical facilities, MIS-C is treatable, doctors had told us.

But the medical expertise, equipment and approach needed to treat children with Covid-19 or MIS-C is unique and this is a challenge in India where the health infrastructure has been hit by decades of underfunding and neglect, we had reported in May 2021.

The government should allot medical equipment, such as thermometers, to schools so that we have basic medical care at the school itself, said Mamta (she uses one name), a government school teacher in Bugala, Rajasthan. "We can't play with children's lives--either their health or education. We can see how staying at home has changed children--they don't talk freely, are not disciplined and have stunted mental and physical development...The government should make all possible arrangements so that children can come back to school," Mamta said.

Other than Covid-19 precautions, "schools need to hire counsellors and build a psychological support system in schools", said Arora.

Is a mask-less future for schools possible?

Masking and physical distancing rules could become less important as Covid-19 cases stay under control in the area, and more and more adults are fully vaccinated, said Lahariya.

In the UK, for instance, earlier school reopening guidelines from July 2020 had recommended masking and 'bubbles'. Now, as more people are vaccinated, those below the age of 18.5 years do not need to wear a mask in school, nor do visitors in classrooms or common areas, and children do not need to be isolated even if a close family member tests positive for Covid-19. Masks are recommended only when in crowded areas, in public and while using public transport.

Schools should aim for a situation in which children can unmask in open areas, then remove physical distancing and masks completely, so that children are able to freely study and interact, Lahariya said. "The benefits of close interaction between children outweigh the risks of Covid-19, especially in children under the age of 12."

Not all experts are so sure. Ghate said that masking and physical distancing would continue to be important. "This could be a lull in cases just like between the first and second Covid-19 wave," said Ghate, citing the example of the states of Illinois and Florida in the US where masks were not mandatory and could have contributed to a rise in Covid-19 in children.

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