The school closing problem

The easiest way for public officials to scare the crap out of people is to tell them "not to panic." A variant on this is, "It's not time to panic," implying that there will be such a time or that there is ever such a time. The first to panic are usually public officials because they feel powerless at a time when people are expecting them to do something. So what they do is incite panic by telling people not to panic. Public anxiety -- often well founded -- is not the same as panic. If parents are keeping their kids out of school from fear it is a flu incubator, that's not panic. That's a fairly reasonable judgment, which may be incorrect or fruitless but it isn't panic. Many parents don't let their kids walk home alone or drive around town for fear something will happen to them. That's not panic. So when I read this, it makes me shake my head:

Responding to an alarming increase in absences at two city elementary schools, the Philadelphia School District and the city Department of Public Health announced plans yesterday to quell a rising panic surrounding swine flu in schools.


District spokesman Fernando Gallard said the two schools - William H. Hunter Elementary, at Front Street and Kensington Avenue, Kensington; and Rowan Elementary, on Gratz Street below Godfrey Avenue, Ogontz - had experienced a high volume of absences.

After a meeting for parents held at Hunter on Wednesday night, Gallard said that parents weren't convinced that there wasn't a risk.

"Parents are really concerned. They have not been reassured enough that this is another seasonal flu," Gallard said. "[And essentially] they're saying, 'We don't believe you, we're keeping our kids at home.' "

At Hunter, 57 percent of its 560 students were absent yesterday - up from 33 percent earlier in the week - while at Rowan, 22 percent of its 523 students were absent. (Julia Terruso, Philadelphia Daily News)

Here's the situation. Two city schools in Philadelphia have high absenteeism at a time when a novel influenza virus is circulating in the community. Parents know this is a contagious disease. They are uncertain what the meaning is because the public health community itself is uncertain about the meaning. School and public health officials can't tell anyone if the absences are from flu and admit they are no longer keeping track of how many cases of the new flu there are. The state has hundreds of cases and two deaths. They apparently have tried to minimize what is happening by portraying it as no different than seasonal flu. The parents don't believe them.

The parents shouldn't believe them because this isn't seasonal flu. It's a novel flu strain that is circulating outside flu season and targeting school age children and young, healthy adults. That's not seasonal flu.

The similarity is the clinical presentation, which is much like seasonal flu, at least at this point. As city Health Commissioner Donald Schwarz is quoted as saying, "This is influenza, period. This is not influenza-plus." That's both correct and exactly the problem. While most flu cases recover without treatment, it's a miserable illness and "most" is not "all." Influenza has a nasty side and at the moment we don't know why some people get extremely sick or die while most don't. We know that if you have one of a number of fairly common underlying conditions, of which asthma is the most common, you are at increased risk. But half to a third of the serious cases are in healthy people without underlying medical conditions. Moreover it's the elderly and infants at most risk from seasonal flu, but this flu, even though it is clinically like seasonal flu, is making a different set of people sick: children and young adults. This includes school age children. So it is misleading to say "it's just seasonal flu." And parents aren't misled.

I understand the perspective of school and public health officials. Closing a couple of elementary schools won't slow flu in the community. The virus is afoot in Philadelphia, not just in the schools. Moreover there are real consequences to closing schools. It's an important source of good nutrition for many students and students need to learn. Many states stipulate how many days of school are required each year, so missed days whether from snow or flu have to be made up. For families where both parents work, closing a school creates a major child care problem, so there is a differential impact when closing a school. Policy makers must and shold take that into consideration. So it looks different from their side. But they should still be accurate about this. It isn't just seasonal flu.

No school official can in all honesty say sending a child to school when flu is being easily transmitted there is without added risk. That's just a fact. One option would be to keep the schools open but afford some flexibility for parents who wish to keep their children home. It's not an ideal solution, but it does satisfy several needs at once. I expect that parents will send their children back to school after a reasonably short interval if they feel confident it is not unduly risky. There are costs to pay for keeping a child home and no guarantee they won't get flu via another route.

This kind of thing is supposed to be part of a pandemic flu plan, but on paper it was still pretty abstract. This is not on paper. This is real life. And we may well be facing it again in the fall. It's best to start thinking this through now.


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Any family with a member in the high risk group is right to be concerned about a child bringing this flu home.

There are also families with members who lack health insurance or who have high deductable and co-pays who would rather not bring this flu home.

Then there is the problem with the lack of sick time and child care, which was recently discussed on this forum.

My husband is currently on medication which has affected his immune system. He pretty much stays home now, and I am very careful and limit my outings to necessities.

I don't consider any of this panic. Panic would ensue from having an asthmatic child with this flu hospitalized and on a ventilator, or a relative on chemo in a home where a child just brought this flu from school.

By Anonymous (not verified) on 13 Jun 2009 #permalink

What are the data on the effect of school closures as means of infection prevention? A few weeks ago, I quizzed my public-health neighbor on the subject, and he said "oh sure, we'll close schools, mainly to calm people down, but really it only delays infections." The model published by the Robert-Koch-Institut in their latest epidemiological bulletin (check out the graph on p. 221)(
seems to bear that out -- the cusp of the parabola just moves to the right, the curve itself doesn't change. So what's the current thinking of the reveres on the subject?

After a meeting for parents held at Hunter on Wednesday night,

During which the flu spread like wildfire from parent to parent!

But seriously.... I'm actually shocked that closing schools does not have any actual effect. I question this. What are the emperical data on which this is based? (What schools were closed for the study???) .... What is meant by "closing schools"? Whatever the science says the science says, but I'm sceptical that the science could possibly have been done to address this.

acb: We don't have data but we have models that give some indication. Once the virus is circulating in the community, school closures per se probably don't do that much. The idea, though, as you indicate, is to flatten the epidemic curve (the curve that expresses the number of cases over time) and move its peak to a later time. The total number of people infected is the area under the curve, which may or may not change when you do this. But even if it doesn't change, you have both bought time and you have decreased the burden on the health system, so it is a reasonable step if it works. In this case, school officials are saying the horse is out of the barn so it won't work for this purpose. But from the parents' point of view, it looks different. They aren't considering it from the population (public health) perspective but from the individual child's perspective, leading to a different conclusion.

In Hong Kong, ALL elementary schools are closed for 2 weeks after some students are found to be infected from an untrackable source. I wonder how effective it is.

So what measures can truly reduce the total number of contraction?

Greg: We don't have empirical data on this (ask yourself what that would mean in this case), but we have reasonable modeling that gives some plausible ideas. The issue is what is happening in the community, not just the schools. If there are many alternative routes of exposure, closing a few schools (note in this case we aren't talking about closing all schools) doesn't show a meaningful effect on global measures. As I point out in comment #4), it may look different from an individual's perspective than from a population perspective.

passerby: You can decrease the overall burden of infection by decreasing contact between susceptibles and infectious cases. There are at least three major ways to do this, corresponding to contact and the susceptible and infectious components of this. The first is by social distancing, but then you have to keep doing this until the virus is at a low enough level that most contacts are not with infectious cases; or you can decrease the number of susceptibles by antiviral prophylaxis or vaccination, or you can decrease the infectious by isolating the sick or treating them in a way they are less infectious (e.g., shed virus less). There are variations on this, but this is the general scheme.

There has been some analysis regarding the swift public action St. Louis took in the 1918 outbreak (curtailing public gatherings, etc.), and their CRF was reported to be significantly lower than other cities (notably Philadelphia) where these steps weren't taken. Obviously not a controlled study, but worth noting. Several analytic studies have been conducted however - here are a couple:


2. Influence of school closure on the incidence of viral respiratory diseases among children and on health care utilization, Heymann A, Chodick G, Reichman B, Kokia E, Laufer J,Pediatr Infect Dis J. 2004 Jul;23(7):675-7

And another, looking at the rate of infection in French schoolchildren, both during school time and holiday time:

"Here, from the joint analysis of surveillance data and holiday timing in France, we quantify the role of schools in influenza epidemics and predict the effect of school closure during a pandemic. We show that holidays lead to a 20-29% reduction in the rate at which influenza is transmitted to children, but that they have no detectable effect on the contact patterns of adults. Holidays prevent 16-18% of seasonal influenza cases (18-21% in children). By extrapolation, we find that prolonged school closure during a pandemic might reduce the cumulative number of cases by 13-17% (18-23% in children) and peak attack rates by up to 39-45% (47-52% in children). The impact of school closure would be reduced if it proved difficult to maintain low contact rates among children for a prolonged period."( Nature. 2008 Apr 10;452(7188):750-4)

These show evidence that school closures could possibly reduce the number of children who become ill during the time they are out of school - but this is not evidence that fewer children overall fall ill within the year. In other words, it would slow but not prevent the spread of illness. Only vaccine would reduce the level of infection overall, that I'm aware of.

Even so, slowing the curve is key if at all possible, but this seems difficult for my non-public health friends to get their heads around: the benefit of prevention seems obvious, but the benefit of slowing down the curve doesn't seem to be as instinctive. An explanation that seems to work is likening a hospital to a restaurant, and slowing the infection rate (i.e. people needing acute care) is like taking reservations for time slots spread out over the whole night, instead of making them all for 7pm. If you want everyone to have a table and actually receive food, that is.

Good schools can function as a conduit for information, structure, and community during times of trouble. School funding is often dependent on getting kids to physically go to school, but in a pandemic situation kids' and families' needs could be better served with online learning, home visits and school lunch programs that morph into family meals on wheels.

Closing schools could be a step towards limiting face to face contacts, but only if the kids can actually stay home with care and supervision.

One big problem here is that I, as a parent, expect that school administrators are not so concerned with giving me accurate information, as with getting me to do whatever they've decided they want me to do with my kids. That may me for my kids' good, or the community's good. But it seems at least as likely to be for the administrative convenience of the school system, or the political convenience of the city/county government, or for some other goal.

By albatross (not verified) on 13 Jun 2009 #permalink

I appreciate the political problems in being seen to be 'doing nothing' - but I have heard no other counter arguments to the following notion: that while swine flu is in its current mild-moderate phase, it might be advisable to keep schools open so that as many people as possible do catch it, and thus have some immunity when it returns in the autumn/fall and again in the winter - by which time it may well have become a significantly more serious illness. I'd really like to hear this discussed - or be pointed to where it has been discussed.

David: you may try to search for "swine flu party" here and the Internet.

It's interesting to read about one's own work on Effect Measure. I work as the Health Alert Network Coordinator in Philadelphia. My work, and the work of my colleagues, this week was consumed by just this topic.

Revere's right, this is an impossible situation. Telling students to stay home won't do much to quell transmission, because they'll just hang out together outside of school. Plus, Pennsylvania is one of those states that requires a minimum number of school days. So if we recommended that the School District closes schools, those days will have to be made up, in the summer, with no air conditioning, and no teachers under contract.

There are seven days left in the school year, the decision, as of this week, was that it was best to leave the schools open, and parents could choose to consult with their physicians about recommending children with comorbidities stay home. That could change next week based upon new information. We're also working with the affected schools to decrease transmission in the schools that are seeing lots of transmission (such as canceling assemblies and field trips, active surveillance and exclusion of symptomatic children, encouraging students to eat lunch at their desks, etc). Our recommendations and rationale is available from our clinical provider website: (pdf document).

We've been meeting with parents and School District administrators all week to try to answer questions they have, and provide rationale for our decision. There are obviously concerns, and every one of them is valid.

I'll keep an eye on this post, so if anyone has any questions, feel free to ask them, and I'll do my best to answer them.


By Jim Garrow (not verified) on 13 Jun 2009 #permalink

On the issue of data on whether (and/or how) school closure works to reduce epidemic size, in addition to historical analysis and modeling, there's an interesting study published in Nature, from Ferguson's group. In France, schools close for holidays at different times in different regions, AND they also have very good surveillance data. So this provided a good natural experiment. Here's a snippet from the abstract:

We show that holidays lead to a 20â29% reduction in the rate at which influenza is transmitted to children, but that they have no detectable effect on the contact patterns of adults. Holidays prevent 16â18% of seasonal influenza cases (18â21% in children).

Thanks, Jim, for contributing to this discussion. It should happen more often. ;-) School closure is always a difficult decision, and there will be consequences either way.

On the subject of kids hanging out outside of school, it really depends on the age group. I would assume that younger kids don't/can't do much of that, but for high school students, I think we need to look at the numbers carefully. The issue is how many close contacts do they make a day? Do they get more contacts a day in school, or at a day out at the mall?

The US dept of Education says 50% of high school students go to schools with 1500 or more kids. I'd imagine most city schools would fall at the upper end of the range. Most high school students take 6-8 classes a day, with different kids in different rooms (with some overlap of course). So all day they are moving around, from one class to another, and so is everyone else. That's a LOT of mixing - consider the number of people they come into close contact with, when they pass through hallways, in locker rooms, standing in line for lunch at the cafeteria, on school buses, and other activities.

As a rough guess, I'd think it would not be unusual for kids to get in close contact with some 200 or more people at a day in school. I doubt that they will meet the same number on a day at the mall.

Jim, it's interesting and reassuring to hear about the thinking that you're doing on this issue. Did you inform the parents about the various types of comorbidity that can raise the risk to their children? There's a discussion on FluWiki about school closure, pointing out how parents will opt for safety over other considerations, and also showing graphically how explosively the 1918 flu spread in Philadelphia when they kept to their schedule for the bond rally (and how much lower and more spread out the death rate was in St. Louis, which reacted quicker to stop the spread).

But we are missing the target here folks. Granted, this isnt a highly pathogenic scenario we are dealing with here. The last time that happened was in 1918 as we all know. Everyone listened to the learned public health officials who said it was over in San Francisco, so they started to party. Two days later there was a surge and then mass death from that.

Even more granted is that this is 2009, people can read and write and make big boy decisions. But... This decision is being based on a "mild" case scenario at least for the time being. I am sure Philadelphia and the schools there are paid by average daily attendance, most are. So, do you keep them in, or do you keep them out? I remind folks that during the SARS epidemic in China a few years ago that they found something they didnt even know was happening. As they dropped like flies from SARS, several were found to have had not SARS, but bird flu after finally testing the samples. Only took them 12 years to do it.

So, you know the drill. Kid picks up what is believed to be H1N1 and then cruises into school its really recombinant H1N1 with H5N1 and a touch of highly infectious seasonal flu mixed in.

He infects people at school for about 3-5 days before he turns seriously symptomatic. He heads with the parents to the doctor. While there he contaminates the people and the room with his honked out funk, the inevitable play room scenario where other kids are playing too while they wait. Then he infects the triage nurse and the doctor. All go on to infect not less than 33 people in a working environment a day. At Day 7 several thousand people start showing up at the hospital because they cant get an appointment for weeks. On Day 8, the school, the doctor and all surrounding them end up at the hospital.. Diagnosis? Probable 33% deaths but load out of all available doctors, nurses, hospital beds. This is the reason that Australia is so important to watch. They are closing schools and ordering kids not to hang at the malls. They are dead serious.

With H5N1 running around on the other side of the planet it could be here overnight as a recombination/reassort and we wouldnt know it because it was masked as H1N1. They would figure it out somewhat later when the bug started killing them in high numbers. Close the schools? Cant do it for the economics. Close the offices? Cant do it for the economics.

We are in deep trouble and a warning shot has come across their bow. The answer? The glass is half full...again.

By M. Randolph Kruger (not verified) on 13 Jun 2009 #permalink

It will be interesting to see how school closings and decreased attendance affect a school's progress as defined by No Child Left Behind. NCLB requires that all schools report their average daily attendance and if attendance slips below a certain level (I think it is 85% for elementary and middle schools) a school may not meet Adequate Yearly Progress (which could trigger other consequences).

A small number of schools are also notorious for keeping their low achieving students away from school on days when high stakes tests are administered in an attempt to raise their school scores. The NCLB attendance requirements and disaggregated data seek to shine a light on these practices, but what happens if the high stakes tests were administered as the pandemic was taking hold? While they may not admit it to the public, a number of factors could influence a school's decision to close or not to close.

Kruger: There are always hidden chance of disaster, or black swan, but how can we guard against it with reasonable cost? Economics tells us that we always have trade-off.

raph: One of the pandemic planning activities for the fall will be to adjust requirements to accommodate the possibility of absenteeism or closings. Some schools this year were closed in Mass. during the state test I have heard. Don't know what arrangements were made for these students.

Early school closure is perhaps the most effective NPI possessed by public health authorities in their struggle against influenza.

What we have learned from this first stage of the pandemic is that even the best informed and altruistic public health establishment within the US was unable to implement this NPI in early May when it would have been most effective.

Public health in the US has been sacrificed upon the economic alter by our elected officials and powerful business stakeholders. While the poorly made decision has in retrospect turned out OK, what is completely irresponsible IMO is that this could not be known in prospect. In other words, TPTB gambled with the lives of the nation.

If the pandemic flu becomes more virulent over the next couple of months during its visit to the southern hemisphere, I have no confidence that US or other northern hemisphere public health officials will be any more effective in the early implementation of early school closure.

To be clear early school closure means closing the school before the virus has entered the community.

As pointed out by Susan Och and SusanC above, the value of early school closure is in slowing the transmission rate of the virus not stopping it. Many lives can be saved by doing this because it results in less pressure being placed upon our health care system and economy by lowering the peak of the curve. Everyone susceptible to the disease will get it in the fullness of time but the time that this occurs in is delayed so the ROC will be the same. Delaying the pandemic passage through the population also provides more time for production and distribution of an efficacious vaccine.

Regrettably though I have little faith in our public health officials ability to overcome the political and economic forces aligned against them come the fall.

By The Doctor (not verified) on 13 Jun 2009 #permalink

kristin, I didn't see that you've already posted the nature article!! ;-)

You made a good point:

These show evidence that school closures could possibly reduce the number of children who become ill during the time they are out of school - but this is not evidence that fewer children overall fall ill within the year. In other words, it would slow but not prevent the spread of illness. Only vaccine would reduce the level of infection overall, that I'm aware of.

I don't know about within the year, but in the context of one pandemic wave, Ferguson has some interesting analysis in this paper The chart to look out for is here. Basically what he's saying is an unmitigated epidemic almost always overshoots, beyond the point where you might get herd immunity. So mitigation is useful to avoid that overshoot, but you have to be aware that if you slow it down TOO much then there may still be too many susceptible individuals when you rescind the intervention, and you'd get a resurgence of the epidemic.

The paper didn't quite say why an unmitigated flu epidemic would overshoot, but I would guess it's because the generation time is much shorter than the time needed for people to gain immunity. Revere or someone correct me if this is not accurate.

I suppose it would be too much too ask if during a pandemic, all schools remained closed for the duration. I look at modern urban schools and to my amature eye they resemble industrial farms- many young individuals confined to intimate contact for long durations.

Perhaps a strategy could be to refine how schools operate during pandemic if they can't be closed. How might we proceed? Could we rotate classes on half time either shorter days or less days per week or month, spacing the contact out? Would smaller class sizes help?

Perhaps a strategy could be to refine how schools operate during pandemic if they can't be closed. How might we proceed? Could we rotate classes on half time either shorter days or less days per week or month, spacing the contact out? Would smaller class sizes help?

Posted by: Jimmy | June 14, 2009 12:24 AM[kill]â[hide comment]

I was wondering a while back about the possibility of videoconferencing. We're already using it for meetings and seminars, and to some extent for education. That could be one way of avoiding transmission at schools without having the kids fall behind. Obviously there's some expense involved, but if it were set up as a cloud computing system the actual hardware requirements on the student's end would be minimal. We're moving in this direction anyway, it seems to me, so it'd make sense to expedite it somewhat.

USA put out a Battle of Falulljah video game, glorifying the killing of an entire city of males. Short the fuck out of USD and leave Obama's legacy as the Banker Prez.

By Phillip Huggan (not verified) on 13 Jun 2009 #permalink

Just when people are looking for informed guidance on questions like this (close schools or not; send kids or not), the Los Angeles Times has published a piece that seems to be riddled with misinformation and tendentious or convenient interpretations of data.

Its bottom line conclusion is:

Swine flu, being no more contagious and far milder than seasonal flu, calls for absolutely no actions that wouldn't apply to seasonal varieties.

If it's as poorly done as I think it is (and by a self-described specialist on science and health issues), Reveres would do a public service by correcting its claims.


I agree, it IS riddled with misinformation and IMO distortion of data. In the meantime, here's another view, from Ab Osterhaus, one of the most eminent and respected experts on influenza. When Osterhaus speaks, I sit up and take notice.

Swine flu could grow far deadlier, says WHO adviser

The virus shows worrying similarities to Spanish flu, which wiped out 50 million people in 1918

As the pandemic continues to escalate, Professor Albert Osterhaus, an adviser to the World Health Organisation (WHO), expressed his fears that swine flu may develop into a far deadlier strain. "In a doomsday scenario, we could have a severe pandemic, similar to the Spanish flu, and that could arise out of a mutation of the virus," he said.

"Spanish flu also started as a relatively mild strain, comparable to the seasonal flu virus. Then, after half a year, there was a major peak and tens of millions of people died worldwide." Both viruses seem to target largely healthy adults and children, he added.

The global pandemic gives swine flu an opportunity to mutate into another form, said Professor Osterhaus, head of virology at the Erasmus University Medical Centre in Rotterdam and the man who discovered the H5N1 avian flu virus in humans.

"We cannot predict what's going to happen, or how likely or unlikely it is that we will have this scenario, but I think the precautionary principle is important and we should be prepared for the worst, even if there's only a small chance of it happening. We cannot rule out a repeat of a pandemic on the scale of the Spanish flu."

Jimmy at al: closing the schools has a major ripple effect on everything else, from providing proper nutrition to a large proportion of poor children to loss of income and job absenteeism for families where both parents work. You can't just close schools without incurring other major adverse effects that have to be balanced with the possible benefit.

There's a survey by the Harvard School of Public Health on this and related issues. In case of pandemic flu majority of Americans willing to make major changes in their lives

School Closings If schools and daycare were closed for one month, 93% of adults who have major responsibility for children under age 5 in daycare or age 5 to 17 and have at least one employed adult in the household think they would be able to arrange care so that at least one employed adult in the household could go to work. Almost as many (86%) would be able to do so if schools were closed for three months (Figure 4). However, six in ten (60%) say that at least one employed person would have to stay home if schools were closed for a month.

More than nine in ten (95%) adults with major responsibility for children age 5 to 17 report that they would be willing to give school lessons at home if schools were closed for three months.

More than eight in ten (85%) of these adults also think that if schools were closed for three months and public health officials recommended it, they would be able to keep their children and teenagers from taking public transportation, going to public events, and gathering outside home while schools were closed.

"A surprisingly large number of people would be able to keep their children home and away from others if schools closed during a severe pandemic," said Blendon.

Also 25% of those who have major responsibility for household children under 5 years old in daycare or 5 to 17 years old had 1 or more children on free school meals. Asked whether they would have a major problem if schools close for 3 months, this 25% breaks down to 17% no problem, 5% minor problem, and 3% would have a major problem.

So that's 3% of households with kids.

The USDA says in a declared emergency, they would switch to emergency food stamps for kids on free school meals. I suspect there needs to be an additional interim solutions, cos there will be a gap before that can happen. Since the FNS (Food and Nutrition Service) can only serve school meals when schools are in session and the food has to be consumed on the premises, there are some obstacles that need to be overcome. I wonder if they can pass emergency legislation to change the terms for the FNS, so that, say, the schools can still provide the meals to be picked up, or something like that?

If the flu can be as serious as that in 1918, why didn't we do everything we can to contain it at the first place? Or the spread and death is really inevitable for a flu virus as deadly as that in 1918?

You can't contain it. By the time this was discovered, it was already widespread. Also, right now it's mild. But if it turns severe in the fall, there needs to be more vigorous interventions to mitigate the effects - slow down the spread so services don't get overwhelmed, etc. School closure would be an important part of that.

But it was already widespread in Mexico and some parts of the US in late April. Can we quarantine people from these areas traveling to other areas for 3 days to stop its spread?

I mean to quarantine everyone... with or without symptoms. If people know that it can be potentially deadly, people are willing to accept that, or simply cancel the trip. Better than closing border.

Here in Sydney, Oz we have had some spot closures of short duration as responses to small clusters in schools, but not on the scale of Victoria...yet. I and others have been asking the NSW Department of Education what the plan is for extensive and prolonged closures in the event of a severe pandemic, meaning are they prepared to continue lessons at a distance for 1 to 2 months. The answer is as you would expect, nah.
So here is my question. Are we prepared to lose a significant proportion of our kids to a highly virulent pandemic, or not? If the answer is no ( I would hope)then we'd better get our act together whether this particular pandemic is deadly to kids or not, and I agree with Susan C. the precautionary principle is paramount.
Now, how do we close schools for extended period(s)without throwing society into chaos as parents stay home to babysit?
1. Develop distance education delivery using the Internet with interactive chat/messaging. It's not rocket science, it is here now.
2. Find out which parents can stay home when, and work out a rotating roster so small groups of kids of same age can be supervised. These small groups always stay together and do not mix with other groups. They are NOT allowed to go out and "mix and the mall." The parent works through the course material delivered on the Internet with them.

Yes, this has to be planned in advance. What the hell have we been doing for the past couple of years when we had a wake up call from our friend H5N1?

Sorry, I meant "mix at the mall".

One of the things I brought home from a recent meeting in Buffalo was the idea that this is actually quite a bit like seasonal H1N1, which also prefers younger folks. Symptoms (like vomiting & diarrhea) are similar, too. I hadn't heard that before and found it interesting.MoM


Thanks for the comments. We specifically identified asthma, diabetes and physical disability, but recommended that anyone that had more questions talk with their pediatrician or primary care doc.

One other thing I'd like to address, and this is not official policy at all, but the idea of closing schools and implementing an online distance learning program is simply not feasible in some places like Philly. We have literally tens of thousands of children who are so poor they qualify for free lunch AND breakfast. I know of children that also qualify for a free dinner. The only way these kids have even seen a computer is in the public library or at school. Internet access is a luxury that is below even getting a phone line into the house. Truly a great idea, but there's no infrastructure for it at all.

Thanks again for the great discussion,

By Jim Garrow (not verified) on 14 Jun 2009 #permalink


Yes that is very true that there are segments of society that are unable to access an online solution. However that does not preclude those with an Internet connected PC from participating, and there can be paper based course materials that could be supplied in appropriate circumstances. It is better than nothing.
It is a similar situation with home preparedness and stocking of a few weeks of unperishable food. Not all can afford it or have room for it, but those that do lessen the burden when services have to be delivered to the community.
There will be issues with any mitigation strategy but that does not validate doing nothing, especially when kids lives are at stake.

Your point about official saying "don't panic" hit it on the head. Go Revere!

How do we get them to stop?

By Mr. Nobody (not verified) on 15 Jun 2009 #permalink

First post. This is a topic that I, as a parent and public health worker, feel very strongly about. I like the comment about the school allowing flexibility to the parents. I made a similar comment to a coworker about a week ago and it just makes sense. Their reasoning for not closing the schools because children will just go to the malls or congregate somewhere else might be true for some but not for all. There are parents who will make the effort to reduce their child's risk of exposure and those parents need to be heard also.

Further up I was looking for reasoned discussion of the notion of not closing schools - but essentially letting the virus run wild in this, its (presumed) 'moderate' phase, thus at least partially immunising as many as possible before it returns in more virulent form in subsequent waves - fall and winter. A lot of the arguments I found against the idea seem not all that reasoned. And when reasoned the argument ran that this was not a good idea, because if you deliberately allow as many people as possible to get infected 'now' - then you are inevitably going to kill some people in this phase: this is not like chickenpox, flu can kill, even mild flu. I cannot argue against that. It is almost certainly true. Except to say that more people are likely to be killed in the returning phases, who might not have been if they had been infected in this phase, even though it is not chickenpox. It's a very tough call. And very few seem to be prepared to make the call. Of course, it is virtually unmentionable from the governmental/political perspective...

I've been reading your blog religiously (ha ha) for the last few weeks-- I live in Queens, NYC, one neighborhood over from the schools that were shut down from Swine Flu. Plus I've got asthma and two cute little disease vectors, 5 and 14 months. I am very keen to be as knowedgeable on this topic as possible, for very personl reasons.

I just posted a link to this site in my blog, and my friends' comments (all, like me, parents) ranged from "puts her fingers in her ears and hums" to "There was a confirmed case of swine flu where I work and someone in my classroom got it (unverified, but is there any other flu going around?) Just wash your hands a lot and it'll be fine. At least, that's what the midwives told me."
(Not to mention the person who sent me to a WHO page and said See, hardly anyone is dying!)

I don't want to sound like a tinhat wearing person, but besides sending a general link to this blog (again) what can I do to make my friends Believe and Prepare? (I posted about the housing bubble two years ago, but they all went out and bought houses anyway, so I don't have a great track record with this convincing argument thing.)

What has worked for others? What can you suggest your friends do without sounding paranoid? What can you do now so that you can best help your friends later? (Especially friends who don't live nearby. The ones nearby, I can deliver chicken soup to. It's the ones far away that I'm worried most about.)

Thanks very much for this site. Hope my question doesn't get lost for being so old-- the more recent posts didn't seem an appropriate place to ask.

alia, It's not easy to get people to Believe and Prepare, as you put it. ;-) My point of view is, people ought to be informed. Whether they want to do anything about it is their choice.

If you haven't already, check out the Flu Wiki forum, where people from all over are tracking and collecting the news, sharing information and ideas. You can send or post a link and let people explore. Sometimes it works better if they find out for themselves.

The 5/1 Rockville High School closure in Maryland,…, is an interesting case study. Initially, I thought it was incredibly stupid that they sent their students to another school to take the SAT, but they actually did put some effort into keeping the Rockville students separated from the other students.

Additionally, they DID utilize distance learning,…

I really hope that the "powers that be" use this supposedly mild flu as a "test run" to get processes and procedures down for a real emergency. For example, is it more important to prevent the spread of a pandemic or to take the SAT??? Can the federal government declare a "state of emergency" which will mean that schools aren't penalized for closing / absenteeism and that Free / Reduced Lunch / Breakfast kids are transitioned to a meals-on-wheels or a food stamp benefit INSTANTLY? I would also like to see schools taking a more proactive approach, e.g. contacting the parents of "high risk" students to make sure, for example, that they understand that their asthmatic child is at greater risk -- not just sending a note home (not all notes get to parents and, sadly, not all parents can read).

Jim Garrow -- It sounds like Philadelphia is fortunate to have you. A few questions: Do you know if any data exists as to what percentage of your free/reduced lunch kids have asthma, diabetes, or other "comorbidities"? Or how many of those kids have a "physician or primary care doc"? I am also wondering how information is disseminated to parents -- is it just a note home?