School incident a lesson in COVID transmission

Experts call for study and documentation of outbreak in Malappuram schools

Public health experts have called for a deeper epidemiological study and documentation of the transmission of COVID-19 in the two schools in Malappuram district and draw lessons from the incident as schoolchildren may play a key role in augmenting disease transmission through the community.

This is especially so as children, while they are as susceptible as adults to the disease, have mostly asymptomatic or mild infection and in all likelihood would go unrecognised as potential disease transmitters.

Chance for repeat

Schools in State are set for reopening in full strength and similar incidents are likely to be repeated in all districts. Finding and breaking disease transmission in the younger population is thus a priority or else huge outbreaks can result in the community, says T.S. Anish, Associate Professor of Community Medicine, Thiruvananthapuram Medical College.

“Many adults have already had natural infection and are in the process of getting vaccinated and this herd immunity has kept the children too protected inside homes. Despite the herd immunity in the community, schools can easily become disease transmission hubs as all children are un-immune,” he points out.

Many school transmission studies point to the fact that unlike adults, children remain largely asymptomatic even after contracting COVID. It is highlighted that only a small proportion of children have been identified as infected through testing, which was performed concurrent with the onset of symptoms (JAMA editorial, August 28, 2020).

The study, Symptomatic and Asymptomatic Viral Shedding in Paediatric Patients Infected With SARS-CoV-2, referred to by JAMA, says that a surveillance strategy that tests only symptomatic children will fail to identify those children who are silently transmitting infection while moving about their community and schools.

School clusters

Malappuram DMO K. Sakeena said that in both schools where clusters were identified, only one child each were found to have symptoms. The rest were all asymptomatic. Large-scale testing thus initiated has helped prevent many potential school and community clusters, she said.

“The focus of surveillance should shift to the contacts and households of children and grandparents at home should be either kept away from home or kept protected. If infection is spreading from s classroom to rest of the school, it is more likely that teachers are carrying the disease from classroom to classroom. The focus of surveillance and testing should shift to teachers if there are large clusters inside schools,” according to an epidemiologist.


Apart from the Education Department’s general guidelines, it should be communicated clearly that any child with respiratory illnesses must be kept at home and that if any adult at home had the symptoms, the child should not be sent to school.

In Malappuram, testing will now move to rest of the schools and tuition centres, Dr. Sakeena says.

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