Flu concerns are causing headaches

By John Lynds

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As a new school year began across East Boston last week, there is still uncertainty, fear and even misinformation on the H1N1 influenza pandemic, commonly referred to as swine flu.

Last year, two Eastie schools–the Mario Umana Middle School Academy and the James Otis Elementary School–were closed for a week due to a flu outbreak. At that time, about 100 students and staff fell victim to the flu, with one confirmed case of swine flu.

Adding to the fear, the Boston Public Health Commission released a study that suggested Latinos and African Americans were contacting swine flu at a greater number than whites. In Eastie, with its large Latino population, health authorities vowed to be more vigilant in the neighborhood as the school year begins and flu season approaches.

However, as the Eastie students returned to their classrooms last week, the World Health Organization (WHO) issued advice on measures to parents, teachers and school administrators that can be undertaken in schools to reduce the impact of swine flu.

Experience to date has demonstrated the role of schools in amplifying transmission of the pandemic virus, both within schools and into the wider community. While outbreaks in schools are clearly an important dimension of the current pandemic, no single measure can stop or limit transmission in schools, which provide multiple opportunities for the virus to spread.

WHO continues to recommend that students, teachers, and other staff members who feel unwell should stay home. Plans should be in place, and space made available to isolate students and staff who become ill while at school.

Schools should promote hand hygiene and respiratory etiquette and be stocked with appropriate supplies. Proper cleaning and ventilation and measures to reduce crowding are also advised.

Decisions about if and when schools should be closed during the pandemic are complex and highly context-specific. While WHO cannot provide specific recommendations for or against school closure that are applicable to all locations, some general guidance comes from recent experience in several countries, in both the northern and southern hemispheres, mathematical modeling, and experience during seasonal epidemics of influenza.

School closure can operate as a proactive measure, aimed at reducing transmission in the school and spread into the wider community. School closure can also be a reactive measure, when schools close or classes are suspended because high levels of absenteeism among students and staff make it impractical to continue classes.

The main health benefit of proactive school closure comes from slowing down the spread of an outbreak within a given area and thus flattening the peak of infections. This benefit becomes especially important when the number of people requiring medical care at the peak of the pandemic threatens to saturate or overwhelm health care capacity. By slowing the speed of a flu spread, school closure can also buy some time as countries intensify preparedness measures or build up supplies of vaccines, antiviral drugs, and other interventions.

The timing of school closure is critically important. Modeling studies suggest that school closure has its greatest benefits when schools are closed very early in an outbreak, ideally before 1 percent of the population becomes ill. Under ideal conditions, school closure can reduce the demand for health care by an estimated 30–50 percent at the peak of the pandemic. However, if schools close too late during a community-wide outbreak, the resulting reduction in transmission will likely be very limited.

WHO spokesmen said policies for school closure must include measures that limit contact among students when they’re not in school. If students congregate in a setting other than a school, they will continue to spread the virus, and the benefits of school closure will be greatly reduced, if not negated.

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