Published Online: April 30, 2009

Closing Schools May Not Stop Flu Transmission

WASHINGTON (AP) — Students aren't the only ones staying home as swine flu spreads through schools across the country. Parents are nursing their ailing kids while trying not to get sick themselves.

Raquel Mooradian and her husband, Greg, have been holed up in their apartment in the New York borough of Queens since their daughter Felicia, 17, fell ill on Friday. Felicia is a senior at St. Francis Preparatory School, where hundreds of students got sick after a group returned from spring break in Mexico.

Raquel has been skipping her classes at a local college, and Greg has called in sick at work. Raquel Mooradian said she covers her face when she goes into her daughter's bedroom to bring her soup, water or Gatorade.

"She's able to talk but says, 'Let me sleep, let me sleep,'" Raquel said.

As of midday Wednesday, about 100 of the nation's 132,000 schools had closed and Texas authorities had suspended high school sports. But the number of closures was growing: On Wednesday night the Fort Worth Independent School District in Texas announced it was closing its 140 schools, with about 80,000 students.

Preparation by schools and state officials is crucial, because children are expected to play a major role in spreading infection. In the past, pandemic planners have said illness would be greatest among children, with rates approaching about 40 percent.

In a worldwide epidemic — which the swine flu outbreak is not — government planning documents say schools could be closed for up to 12 weeks.

The consequences of having kids at home reach far beyond school walls.

President Barack Obama said Wednesday parents everywhere should start preparing for the possibility that their kids may be sent home.

"Our public health officials have recommended that schools with confirmed or suspected cases of this flu strongly consider temporarily closing," Obama said as he began a news conference Wednesday night. "And if more schools are forced to close, we've recommended that both parents and businesses think about contingency plans if their children do have to stay home."

Homeland Security Secretary Janet Napolitano said employers need to plan too.

"All of us should be dusting off our business contingency plans, looking at things such as telecommuting and the like so that operations keep on going," she said.

"There is a large ripple effect," acknowledged Kathleen Sebelius, Obama's newly approved health secretary. "What happens to the parents? Where do those children go? Do you close the day care center if a younger sibling is there?"

Local officials make the decisions on schools, after weighing conditions in their cities, towns and counties.

So far, closings have affected fewer than 60,000 students out of 56 million enrolled nationwide in K-12 education in public and private schools. Most of the closings are individual schools, not entire systems. Most are expected to be short-term, a week or so. Some of the children who got sick are already recovering.

If the outbreak turns into a killer flu, classes could continue even if schools are shut.

If they've planned for it, teachers could give their lessons by Internet, television, radio, telephone, mail or through their community newspapers.

If a flu case is confirmed at a school, local district officials may close down that school alone. Clusters of cases at different schools could prompt the closing of an entire system. Closings in many communities may lead to a statewide shutdown.

The decision to close a school is not to be taken lightly.

"It's not just about the schools," explained Kim Elliott, deputy director of Trust for America's Health, an independent public health organization. "If a community is thinking about closing schools, they're also probably thinking about closing day care centers. And children also depend on schools for a lot of services other than education, including lunch programs and after-school care."

In Mexico, where the illnesses have been more severe, the government closed schools nationwide. In the U.S., authorities will deal with the problem from the ground up, not from the top down.

"It is the state and local role to plan what's going to happen, as far as day-to-day or hour-to-hour," said Brenda Greene, director of school health programs for the National School Boards Association.

The federal government has taken a leading role in helping states and local communities plan for a public health disaster. Washington's concern grew from the anthrax attacks of 2001 and the 2005 bird flu scare that sparked fears of global infection.

In Congress, the chairman of the House Education and Labor Committee, Democrat George Miller of California, said Wednesday he will hold a hearing next week on how schools and businesses are prepared to handle the swine flu virus.

On a conference call Monday, officials from the Education Department and the Centers for Disease Control and Prevention answered questions from more than 1,400 people from school districts, state education offices and education groups.

Education officials said many asked what circumstances should prompt schools to close. They were encouraged to follow the CDC's recommendation that schools close if they have a confirmed case or if they have a suspected case that is linked to a confirmed case.

In the end, making the decision is a balancing act, not an on-off switch, said Robert M. Pestronk, a former public health officer who heads the National Association of County and City Health Officials.

"Because there is one case in one school, or 10 cases, doesn't lead to a decision to close a whole district," said Pestronk. "It's a case of balancing the risk that is potentially present against the need for communities to operate normally on a day-to-day basis. You're trying to protect people's health and not completely shut down communities."

There may be alternatives to closing schools.

Researchers at Georgia Tech modeled the effects of two options: a voluntary quarantine of affected households in a severe flu, and school closures. They found that both would work about as well.

"It's information that boards of education should consider," said Julie Swann, a professor of industrial engineering who collaborated in the study. "In some cases, you might want to do both kinds of interventions."

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