Why homes and classrooms are emerging as major hubs of infection spread in India -

As India experiences seasonal rises in viral and respiratory illnesses, clinicians are observing patterns that closely mirror new behavioural evidence on how people interact in daily life.

Recent research published in Nature Communications highlights that in India, unlike in regions where workplaces or public events drive most transmission, the closest and most prolonged contacts tend to happen at home and in schools. This home-to-school-to-home transmission pattern is now visible in clinical practice and is shaping how doctors understand spread in communities.

Core transmission settings

According to the study, in India, participants reported an average of 10.2 daily person-to-person contacts among 10- to 19-year-olds — one of the highest across age groups. Household members accounted for 36–44% of all contacts, making the home a major setting for sustained exposure, with the longest contact durations occurring there (mean 2.5 hours per contact).

The study highlighted that schools were the dominant non-home site of contact, especially for children: among 10- to 14-year-olds, 64% of all contacts occurred in school, the highest school-based contact proportion among the four countries studied. For children under five, India had the lowest proportion of contacts with non-household members (45% among 6–11-month-olds), yet the exposure-hours with non-household members still primarily took place at home — indicating that visitors, extended family, and caregivers contribute to indoor transmissions.

“Households continue to remain a key area for infection-prone diseases. Once one family member shows symptoms, the risk of transmission to others is high,” says S. Satyamanasa Gayatri Vinay, senior consultant, paediatrics, SRM Global Hospitals, Chennai. She notes that many infections begin outside the home, especially in schools, and then move inward. “Children or adolescents who acquire an infection at school often transmit it at home. The school-to-household chain is strong.”

This pattern is clearly visible in respiratory clinics. R. Nithiyanandan, consultant interventional pulmonology, Apollo Hospitals, Chennai, says: “We have seen a rise in household clusters of respiratory infections where one member falls ill, and others develop similar symptoms within days.” He links this to seasonal changes, indoor crowding and reduced attention to mask use, ventilation or hygiene practices that were more common during the pandemic. Among those most vulnerable in these clusters are older adults and individuals with chronic lung conditions such as asthma and COPD.

Schools continue to be important in shaping how infections move among children and then into families. Surendran R., consultant, infectious diseases & hospital infection control, SIMS Hospital, Chennai, explains that classrooms naturally bring children into close contact through seating, play and shared materials. Respiratory viruses spread easily through droplets released during coughing, sneezing or even regular conversation. When children return home, it becomes easy for the infection to spread to parents or grandparents who may have weaker immunity.

Also Read: How a Kerala school helped its students develop hygiene, safety habits

Changing behaviour

At the same time, doctors view schools as places where change is possible. Improved ventilation in classrooms, reminders to stay home when unwell and simple habits such as regular handwashing can interrupt transmission chains.

Dr. Gayatri Vinay notes research in which most transmission among siblings occurred at home following school exposure, meaning that prevention in schools directly influences family health. Dr. Nithiyanandan adds that schools are among the strongest environments to reinforce healthy behaviours because children often carry these habits back into their household routines.

Preventing spread

Similar findings have been reported in earlier studies, including POLYMOD and CoMix contact-pattern studies and Indian household transmission studies during COVID-19, which estimated household secondary attack rates in the range of ~30–40%, indicating that homes and schools consistently act as major settings of infection spread.

Across clinical observations, experts emphasise that the most effective measures remain straightforward and consistent. Families can reduce spread by ensuring good handwashing routines, covering coughs and sneezes properly, and increasing airflow by keeping windows open or allowing fresh air to circulate indoors. When a family member feels unwell, they should rest and have limited close contact with others when possible.

Cleaning frequently-touched surfaces helps reduce shared exposure. Vaccination, especially the seasonal flu vaccine, continues to be an important tool, particularly for children, older adults and those with chronic illness. “Rest and recovery help break the chain of transmission, and staying home when symptomatic is crucial,” says Dr. Nithiyanandan.

Building community awareness

The study also found that work contacts formed 6% of all interactions in India, and 11% of contacts occurred during transit, adding additional pathways for spread between households and school

Doctors agree that hospitals and clinicians have a broader role in strengthening community awareness. Advice on infection control needs to reach beyond outpatient visits and into everyday spaces. Dr. Gayatri Vinay says that community outreach, school engagement and clear messaging through local networks can help families understand what practical steps matter most. Dr. Surendran explains that demonstrations of proper hand hygiene or cough etiquette during hospital visits create visible, relatable guidance. Hospitals can also work with school parent–teacher associations, local public health workers and community groups to ensure that prevention messages remain consistent and accessible.

Begin at home

What emerges from both research and clinical observation is a shared understanding that infection prevention in India must begin where daily life is most intimate and continuous. Close-knit, multigenerational homes and densely occupied classrooms are not only the places where infections spread most easily, but also the places where prevention can be most effective. As weather patterns shift and respiratory illnesses circulate more widely, focusing on these everyday environments may help reduce both frequency and severity of infections

Ultimately, experts say, protecting India’s health may depend less on large-scale restrictions and more on reinforcing care and caution in the spaces where people live, learn and recover together.