The State is in the best position to open schools, with 70% of the adult population having robust natural immunity to the virus and an overall immunity (natural immunity and vaccine-induced) of 82.6%.
Yet, unlike in other States where Delta virus ran riot, Kerala’s situation is unique in that a majority of our children - 60% - are still susceptible to infection. Thus, school reopening is a major activity which is likely to alter the current transmission dynamics of COVID-19.
According to the latest study from U.K. in The Lancet (October 28), while the fully vaccinated individuals are at lesser risk than the unvaccinated (by 13%) of contracting the Delta infection, “fully vaccinated individuals with breakthrough infections have peak viral load similar to unvaccinated cases and can efficiently transmit infection in household settings, including to fully vaccinated contacts.”
The study confirmed that the protective immunity of vaccines begins to wane within 2-3 months of vaccination.
This context should be borne in mind when schools reopen, that a chunk of the population who have only vaccine-derived immunity, the small proportion of unvaccinated individuals and 60% of susceptible children can drive disease transmission up in the community.
“Since March, we have been vaccinating chunks of our population. Given the property of waning vaccine immunity, most of the elderly who were vaccinated early as well as a good proportion of others who were vaccinated hence are now susceptible to re-infection/breakthrough infection and can transmit it efficiently too. While going ahead with school reopening, it is important that this complex situation is understood. Clear protocols for the close and consistent monitoring of the virus transmission dynamics should be laid out so that school reopening does not lead to an exponential increase in transmission,” a senior public health expert said.
A spurt in cases and some clustering should be expected across the State when children go back to school but it should be ensured that the rise in transmission does not result in an increase in mortality. Rather than just case numbers, every episode of infection, the context and the pattern of outbreaks will have to be analysed for continuous policy revision.
“COVID-19 in children is mostly asymptomatic and hence we are likely to miss cases. Managing potential cases and outbreaks, reducing transmission within households while protecting the elderly and vulnerable could be challenging,” pointed out S. Geetha, associate professor of paediatrics, Konni Goverment Medical College Hospital.
“Not much is known about the role of children in household transmission. Are schools equipped to manage specific situations when COVID-19 cases are reported in children; what are the contingency plans in place in schools when children test positive and the criteria for returning to schools after a student tests positive are some grey areas that need more attention,” she said.
The focus of all guidelines for school reopening has been on disease prevention and protection through universal precautions, which might not be fully efficacious, given the behaviour of children.
While schools have been asked to be in touch with the Health Department helpline in need of emergencies, they might need more hand-holding when it comes to managing specific contingencies, without pressing the panic button or allowing a situation to dissolve into a blame game, it is pointed out.
