Flu summit thoughts

The "school planning" materials are here - http://flu.gov/plan/school/index.html

Skimming at random the lack of clear advise on how and when to trigger a closing is very frustrating. Reading between the lines the advice seems to be. First: develop a relationship with the state health department. Second: use the legal prep document to puzzle out who has the power to close the school(s), be sure they are briefed and ready. Later: chat with the above and decide.

But I don't see any suggested triggers or scenarios. I find that lame.

If children in the United States went to school more often (year round) then perhaps temporarily closing schools for a public health emergency would have less of a negative impact on their overall learning and be less burdensome for families. This wouldn't eliminate the consequences of closing schools, but perhaps could mitigate some of the overall strain.

Ben, I also find that lame.

revere,

The problem of school closings is not just pulling the trigger but the consequences of doing so. If we are prepared for the latter it will be easier to do the former. That's going to require working through many other issues, from nutrition programs to sick and family leave policies.

This problem has been debated umpteenth times in the past few years. What I see is a lot of people saying school closure has benefits but also has consequences, and then they list all the consequences, but there the debates stop, and not much has been done to address them. Almost every single discussion about school closure in the past few years have ended with that open question unresolved. Everyone leaves with a sense that something must be done, but NO ONE leaves with a sense that it is THEIR job to make sure these issues are dealt with.

Part of the problem is, those consequences do not lie within the domain of public health. Many do not even lie within education. For example, from a bureaucratic point of view, which agency does the can fall, when parents miss work cos their kids are off school? Ultimately, you might say, it would be the governor of each state, who should have been banging heads together to get this solved, but with the economic and fiscal crises they all face, how many has enough foresight and vision to bring some leadership to the table?

It isn't too late. There ARE solutions, like this proposal from a Flu Wiki mom Between All and Nothing: Suggestions for Flexible Schooling in a Pandemic, which offers IMO some pretty darned good practical solutions.

Officials, especially those in the Department of Education, need to get out of their boxes and stop acting as if those negative consequences are inevitable and intractable, and start looking for solutions that lie between the 2 ends, of either closure or no closure.

Susan: First, I agree with everything you said. It was what I was trying to say, too.

Ben, Susan: Yes, it's "lame," but why do we think so? If the idea is to leave more of the decision making in the hands of locals (there is an argument for that), then prescribing what to do is not compatible. It appears lame because no one wants the responsibility for making the decision because of the consequences. Susan's point that we can at least soften this by working on the consequences is right on target. But it is a different point than whether CDC should prescribe when to close a school. If they just give "guidance", then locals are unhappy it still leaves them holding the bag -- or, they use "guidance" as a way to say, "CDC told us to do it." Again, Susan's point is germane: we need to work on the consequences and that will ease the burden of the decision, whoever makes it.

When I was a little kid in the second or third grade, our school got hit hard with a flu epidemic.

I remember it well, because one day in class, out of 30 kids, there were 4 or 5 present. Pretty eerie.

If there is a full bore pandemic, the schools will effectively close themselves.

I understand the problems with the cost/benefit analysis. But IIRC, cities that practiced "social distance" during the 1918 epidemic had a lot lower attack rates and death rates than cities that didn't. Really need some data to drive the decisions. That is why no one really knows right now what to do and when.

Revere,

Your initial post raised this issue of the local authorities not wanting the responsibility of making the decisions. At the risk of threadjacking a bit, I think this is a widespread problem at many levels of government. Spending money, writing documents, and continuing to do whatever your government or agency has always done is safe and relatively easy, but making any actual decisions has costs--you might screw up, or you might be forced to make an unpopular but right decision.

But that's the job of the governor or mayor or superintendent of schools or whatever. I can easily imagine that they'd like to not have to make the decision, to say "well, I would have liked to have kept the schools open, but those unfeeling b-stards at the CDC wouldn't let me" or some such. But we ought not to be giving decisionmakers a pass in those situations. That's what they get paid for.

School closures do present problems but nothing like the problems we might have if we have high absentism from essential services, some public, some private. Hospital staff sick of course aggravates the problem of treating the ill. But we have been through efficiency reductions in the staffing of our electric grid workers and now face cuts in employment by municipalities that are under stress which will under staff water and sewer. These are the major areas to worry about but not the only areas. The grid more than anything needs constant monitoring to prevent blackouts. As we know a few years back a small event cascaded into a major area wide blackout in the North East. Redundancy doesn't make money most of the time but gives you slack to deal with problems such as a pandemic. Revere has already noted the lack of extra staffed hospital beds. Let us hope that the economic downturn has not further eroded the staffing of humans qualified to keep the electric grid up and running. Our lives truly depend on electricity. Wasn't always so, but mostly so in the age we live in.

I see SusanC already posted the link to my diary over at FluWiki:
Between All or Nothing: Suggestions for Flexible Schooling in a Pandemic

I don't know how practicle the suggestions are, but I think the basic premise is valuable.

Revere you said: "...no one wants the responsibility for making the decision because of the consequences."

That's why the parents should be informed partners in the decision making process. They should be educated and they should share the decisions.

Parents are the only ones who know their work situation. They know their needs for school meals (or not). They know their risk tolerance. They know their kids' health. They know their access to health care. They know their own abilities to keep kids home or not.

Parents should have access to information to make their decisions. They need to know about cases, hospitalizations and deaths.

If schools had a way to remain "open" while instructing some, many or even all students as "homebound students" (with temporary modifications to allow parents to assist in monitoring instruction and teachers to monitor via telephone, internet or even old - fashioned work packet) those parents who wished could opt for homebound instruction and those parents who didn't could opt for regular school.

No "trigger" would be needed. Parents would self-select. Students who do remain in school should have a modified day that greatly reduces the number of respiratoy contacts they come into contact with, so spread of flu would be less explosive. (This would go beyond "Cover that sneeze please") and at any point health officials could close the schools for all. These are suggestions I explain in my diary.

I don't know all the intricacies of school funding, and I don't know exactly how practical all my suggestions are. But I think the basic principals are key: flexibility at an individual (not just school) level and sharing decision making with parents. They will help with decisions not just to close schools (or not) but also with the related question of when do we reopen?

ACM: I agree. I made a similar suggestion in a post about a month ago. Find the flexibility for parents who wish not to send their kids to school to get the work done but not be penalized for not showing up. Meanwhile, keep school open for those that need it, was my suggestion and it sounds like you are advocating something similar. It needs working out and it doesn't take account of absenteeism among school staff. But its possible. In any event, some kind of cfreative thinking can make the consequences less and also acieve the objective, if not fully, at least partially.

They will close them too late and send kids home with the bug to infect the sibs and mom and dad. But it wont matter. Dad and Mom from their jobs or simply going to the market will be infected. But, they CAN stop recurrences by simply not putting school back in until the last cases in a county school or school system are resolved. Hard to get it if you are sitting in the living room and watching reruns of X-Files.

There are WAY to many assumptions made that the system is going to work. I assume zero and if its there then great, if not then I know what to do. If high path is in the area, then send them to summer school and tell the school system to bite it if they demand your child return. As soon as they can call an all clear then sure, else its 21 days by criteria since the last active case in the population.

They will of course ignore this as they have ignored every other criteria for pandemic control and prevention. Its all good in the Obamahood. That will include sending the kids back and when they turn up sick and it starts another wave, you can refer back to this and see if it was right or wrong.

I dont like them experimenting with the kids as the canaries in the mines. If you have active cases in the schools...close them! Especially in the South where rural schools are generally near pastures, cows, pig farms, chicken ranches etc.

As a public school teacher, I have a major interest in this. I think that a criteria should be set at the national level which says at what point a school should close. That takes it out of the political football realm: left to local school boards or superintendents who have to worry about getting reelected or fielding irate backlash from those who will invariably feel closure is unnecessary, it will never happen until, as MRK says, it is too late.

What to do about the consequences? First, let's be real: missed educational days is the least of the worries. Make up sessions during the summer can be set to fill in for the missed days or weeks when the school was closed, no problem, no loss of teaching time or educational time. It's the working parent dilemma that is going to have the biggest effect. If larger companies organized ahead of the fact (not impossible: find out who in your employ has school age children that will need care if there are school closures) they might be able to work out a rolling buddie system where employees trade off child care and work duties.

It really comes down to biting the bullet and deciding - as a country - that school closures when the pandemic reaches a certain predetermined point of "dangerousness" - are going to be mandatory across the board.

Once the quibbling and uncertainty of that is removed, companies and communities and schools can get down to making some solid plans how to deal with the repercussions. But as long as it is left in this grey never never land of indecision, no plans can or will go forth.

This suggests to me that part of school pandemic planning should include how to transition to a mostly-empty school running on reduced staff, where the goal is pretty explicitly keeping the kids in safe, supervised place, giving them food and a quiet place to read/do homework, and keeping them from accidentally spreading the virus further among themselves. This will prevent the social services part of public schools (free babysitting + food) from falling apart even when conditions make it hard for them to perform their main purpose of teaching. (And teaching can continue, but if half the class and the teacher are out, you're probably doing something more like a long studyhall with a homework packet and a substitute teacher keeping the kids from running wild.)

albatross: You are thinking along the right lines. The idea is to minimize risk form social contact but not eliminate the social contact that causes an even bigger problem. That's a balancing act and might look different in different settings or locales, which is why locals need to be involved in fashioning it. The task is to get parents, teachers, administrators working on it ahead of time so the optimal configuration for each school and community can be figured out. Just the process of thinking it through calmly and rationally will go a long way to making a better outcome.

This needs to become a wikipage over at http://www.FluWiki.info

Some ideas could be useful for more than one country.

I think the core concept is not "school closure" or even "sending kids home", but "reducing the number of respiratory contacts for students".

In fact, the core concept for most of what we want to do is "reduce infections while we keep essentials running".

We can try and keep everything running and then it's stopped, at least to a certain extent, by the pandemic itself. And we can reduce infections by stopping society, but that's dumb. We want to find the pathway between the two fires, or whatever metaphor is most appropriate.

Of course, what's essential and how do we reduce infections are both tricky. And worth it.

Which is why we need concepts and options and multi-way communication and open creativity.

After 4 years, it looks like we've only started. If we have a number of weeks, and we look at the steps that need to be taken in reverse order, from checkmate to current position, what does a general strategy look like?

Ok, started wikipage here: http://www.fluwiki.info/pmwiki.php?n=Brainstorming.Schools

Imagination isn't needed to know the situation of a parent with a sick child, scrambling for a sitter on a work day, nor a workplace with too many absences, requiring shifted jobs or temporary workers, even delayed tasks. Most people have experienced these situations. Can the alternate realities of a moderate-to-severe pandemic be demonstrated, beforehand? We'd need (A) a path of prudence, where schools are closed early enough to dampen the virus spread and (B) the other, haven't-learned-from-history path, where schools are closed one by one after its students and staff are ill. I think it's likely we'd see cities following path B have more failures in critical operations and more overall illness and deaths. How can we nudge the imaginations of decision makers and parents so that their minds can visualize the benefits of school closure and not just the problems? A long PSA? Internet games, like Sim City? News interviews on PBS? We really need a national history lesson about 1918.

Seems like broad public policy issues cannot be put into easy use in a given community. Most of the population at this time is collected into cities. Great for transmission of influenza.

But much of the problems of mothers keeping their jobs while their children are not sick but forced out of school will be solved with some common sense. Lots of businesses will be affected by this in a given community with rampant cases of influenza. They are most likely going to retrospectively apply common sense.

We need to focus on insuring our family's survival and put the job second for a week or so. Most small business owners will be in the same mode at such a time.