Should Schools Reopen Early or Late? - Transmission Dynamics of COVID-19 in Children.

To the Editor: Prolonged closure of schools during the COVID-19 pandemic is likely to have negative psychosocial effect in children besides secondary economic effects. Societal learning and grooming of children that happens in school environment cannot be supplanted by a virtual learning platform. In the current scenario, there is uncertainty regarding time line of school reopening. In our opinion, the unique disease characteristics and the transmission dynamics of COVID-19 in children favour calibrated early reopening.

A notable feature of COVID-19 pandemic is that children account for only less than 2% of total COVID-19 cases and most develop only mild illness [1, 2]. Even when children with co-morbidities are being reported at risk of severe disease, mortality was very rare. Many asymptomatic infections were noted. Most acquired infection from close contact with adults in family clusters. However, transmission from children to others was rare. In a recent report, mother of a two-year-old SARS-CoV-2 infected child was found to be uninfected despite having prolonged close contact [3]. Also, WHO-China Joint Commission did not find a single instance of children transmitting infection to adults [4]. An infected child linked to the cluster of COVID-19 in the French Alps, attended three schools while symptomatic, but did not transmit the virus to any of the close contacts [5]. This is in sharp contrast to the reports of a few adults acting as ‘super-spreaders’ [6]. Experience from Sweden, which has not implemented strict lockdown and allowed schools to function, and Spain where schools were re-opened early, present a favourable picture.

In the light of above observations, it might be prudent to anticipate an optimistic scenario when schools open. However, caution is necessary; role of asymptomatic carriers in transmission dynamics in children should be prospectively reviewed. One study reported few children shedding virus for up to one month in stools [7]. Another concern is the practical difficulty in adherence to social distancing, wearing mask etc. in young children.

Weighing the pros and cons, high transmission of COVID-19 in school settings is unlikely to happen. However, strict adherence to preventive measures is desirable; “at risk” individuals (children/adults with co-morbid conditions and the elderly) should avoid contact with school going children. Studies on asymptomatic infection and possible protection by heterologous immunity by vaccines in universal immunization program in school settings are desirable.