As the nation's 55 million children prepare for a new school year, the foremost question on many parents' and school administrators' minds is, How will we protect our students from swine flu? Some education officials anticipate that each of the country's 100,000 public schools and thousands of private schools may have to close at some point between now and next summer to stem the tide of the H1N1 pandemic.
But according to officials from the Centers for Disease Control and Prevention (CDC), which issued new guidelines Friday, Aug. 7, for grades kindergarten through 12, preventing H1N1 infections should begin with less drastic measures: frequent hand-washing and coughing into sleeves (not hands), and keeping all children with flu symptoms at home. The CDC recommended that schools remain open, even during outbreaks of flu a shift from its recommendation at the beginning of the pandemic last spring, when schools were advised to shut down immediately when students became ill.
The new guidelines are based on a study of how H1N1 is now making its way through the southern hemisphere it is the dominant flu strain there, but most cases are mild and still treatable with antiviral medications.
Balancing the social costs of widespread school closures including the risk of unsupervised children at home against the potential health risks of remaining open, government officials advised schools to not shut down in most cases. "If there are a handful of [flu] cases in a school, the real goal is to keep the school open," Secretary of Education Arne Duncan told reporters at a press conference also attended by Secretary of Health and Human Services Kathleen Sebelius, Secretary of Homeland Security Janet Napolitano and CDC director Dr. Thomas Frieden.
The government also recommended that schools create isolation-type facilities, where sick children can be housed to prevent the spread of infection before they are taken home. The Federal Government will provide masks and other resources to local authorities for use by sick students and school staff.
The most significant change in the CDC's guidelines, compared with those issued last spring, is to allow children back to school 24 hours after their fever subsides (without the benefit of fever-reducing medication). Previous guidelines, issued during the height of the outbreak, suggested that kids stay home for seven days after the onset of the first flu symptoms. "This recommendation is based on new information from studies both in the lab and person-to-person on how the virus spreads," said the CDC's Frieden. "This is a shorter period, and it's more practical."
In the event that H1N1 mutates into a more virulent form, guidelines call for active screening of students for fever or signs of flu as they arrive at school, and for distancing measures, such as reducing large gatherings of students and increasing the space between students' chairs in class.
The ultimate decision to close a school, however, still rests with state and local health officials, the CDC said. "The fundamental point from the end of last spring and now is the same it's a local decision," said Frieden. "Now it's more clear to us than before that there are relatively rare times where it makes sense to close a school just because a virus is present."
Those rare instances involve schools whose students have specific health concerns that increase their risk of severe illness, said Frieden, such as schools for pregnant teens or students with muscular dystrophy or cerebral palsy, conditions that interfere with breathing or may otherwise complicate influenza. The government also advised schools to take into account trends in outpatient visits for influenza at local hospitals, as well as rates of hospitalizations and death from the disease, in determining whether to close.
CDC officials said the H1N1 vaccine, which is still in development, appears to be a good match to the virus so far; the shot is currently in the human-testing phase but probably won't be available until mid-October at the earliest. Officials have not yet determined whether a vaccination program will be necessary, but if it is, schools may become a center for administering shots to students, who were identified by the CDC last week as one of the first target groups for vaccination, along with pregnant women and those living in households with infants younger than six months. The vaccination will require two injections, three weeks apart, for maximum protection against infection.
The guidelines issued Friday did not include U.S. colleges or schools for children younger than kindergarten age; those recommendations will be issued Aug. 23, officials said. In the meantime, CDC experts are closely monitoring the march of H1N1 through the southern hemisphere, in Australia and in South America as well as in the U.S. So far, data show that the virus is having about the same health impact as seasonal flu, which still causes about 30,000 deaths each year. And, as Sebelius noted, "Typically parents do not keep their children home if their classmates come down with the flu." That's worth remembering this fall, as the school year gets under way.