# 3583
For a variety of reasons, officials are keen on keeping schools open this fall despite the likely return of the novel H1N1 virus.
First this report, from the Washington Post, and then some discussion.
U.S. revises swine flu strategy
Federal officials to put less emphasis on school closures
By Spencer S. Hsu
updated 11:49 p.m. ET, Mon., Aug 3, 2009
WASHINGTON - The Obama administration is finalizing guidelines that would scale back when the federal government recommends closing schools in response to the swine flu pandemic, several people involved in the deliberations said Monday.
Such guidance would mark a change in the government's approach from this spring, when health officials suggested that schools shut down at the first sign of the H1N1 virus. They later relaxed that advice.
This fall, federal authorities would recommend closures only under "extenuating circumstances," such as if a campus has many children with underlying medical conditions, a senior U.S. health official involved in the talks said. The official added that discussions are continuing that and no final decision has been made.
Schools also might be advised to close if many students or staff members are already sick or otherwise absent, officials said.
"The framework is to try to keep schools open to the extent possible," the senior health official said, speaking on condition of anonymity because the White House has not completed its review of the issue.
Federal, state, and local officials point to a long list of reasons why they believe keeping schools open, and students in their seats, makes good policy. Particularly when the virus isn’t perceived as being `any worse’ than seasonal flu.
A few of their commonly made points include:
- Many working parents rely on the schools to watch their kids during the day. Closing schools could force some parents to stay home from work, at a time when absenteeism due to illness will already be a burden to the economy.
- Kids, out of school, may very well congregate and spread the virus amongst themselves anyway.
- Once the virus is already spreading widely in the community, little impact to that transmission can come from closing schools.
- Many children rely on the school lunch program for a larger part of their daily nutrition.
- A Pandemic could last for a year, perhaps longer, making temporary closings of little use.
- And the easiest venue to deliver a pandemic vaccine (2 shots over 3 of 4 weeks) to kids is through the schools.
Socially, and economically , these are all pretty good reasons to try to keep schools open. And if the virus cooperates – and stays mild – it may actually work.
But I have some reservations.
Kids are not only walking Petri dishes when it comes to germs, they have also been the hardest hit group by this influenza virus. Overall, this virus may be `no worse’ than seasonal flu, but for those under 18, this flu seems to have had a greater than normal impact.
This fall the expectation is that once schools let in, we will begin to see a major resurgence of illness.
When that happens, it is all but inevitable that a great many kids – after going to school for a days or weeks– are going to fall ill.
Some will be hospitalized, and a few will die.
When this happens, you can expect the news media to rush to highlight these deaths, some parents to blame school districts for the loss of their child, and public opinion to become sharply divided on the issue of school closings.
It has the makings of a public relations nightmare.
From a macro public health and policy perspective, I’m sure keeping the schools open (if possible) makes sense. Where this has the potential to break down is on the individual level.
According to the American Lung Association:
Asthma is the leading serious chronic illness of children in the U.S. In 2006, an estimated 6.8 million children under age 18 (almost 1.2 million under age 5) currently had asthma, 4.1 million of which had an asthma attack, and many others have "hidden" or undiagnosed asthma
Asthma is considered a `high risk’ comorbid condition for this influenza.
How many parents of asthmatic children will simply decide that it isn’t worth the risk to expose their kids to the flu at school?
Particularly when hospitals and emergency rooms are going to be overrun with flu victims, making it even more difficult for them to get care for their child if needed.
And how many pregnant women with school aged children will think twice about sending her kids to school, when they could bring the virus home to her at the end of the day?
These are not `unreasonable’ concerns, even if the virus remains`mild’.
If you’ve never had to care for and comfort an asthmatic child during a crisis, you have no idea of the lengths parents will go to spare their child, and themselves, that sort of trauma.
I have a great deal of sympathy for public officials, and emergency planners, on this issue.
They are literally in a no-win situation here.
This is just one of a number of `damned-if-you-do, damned-if-you-don’t’ pandemic policy decisions that has a very high explosive potential.
Politically, it is a hot potato, with no one really anxious to make decisions on when to close (or re-open) schools. While the Feds are providing guidance, they are leaving the final decision to local authorities.
Hopefully local officials will find ways to accommodate parents who decide against sending their kids to school during a pandemic outbreak, not to coerce or punish them.
That would only backfire, I believe.
When it comes to dealing with parents concerned about their kids safety, heavy-handed tactics are only likely to make matters worse.
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