The Debate Over School Closures

 

# 3519

 

 

On the day that The Lancet published a study that suggests that closing schools could help slow the spread of a pandemic, we get a statement from a Canadian Medical Officer stating that closing schools is an ineffective way to combat the virus.

 

It appears that we have a decided difference of opinion.

 

First the two articles, then I’ll return for some comments. 

 

 

School Closures May Help Limit Swine Flu Damage, Study Finds

 

By Naomi Kresge

July 20 (Bloomberg) -- Closing schools during a severe flu pandemic may cut infection rates as much as 40 percent at the peak of the outbreak because of children’s role in spreading the disease, U.K. researchers said.

 

School closures might be even more effective against swine flu than against seasonal flu, according to a study published today in The Lancet. The research weighed the pros and cons of such a move and stopped short of endorsing it.

 

“The H1N1 pandemic could become more severe, and the current cautious approach of not necessarily recommending school closure in Europe and North America might need reappraisal in the autumn,” the Imperial College London researchers wrote.

(Continue . . . )

 

 

Closing schools ineffective against swine flu: N.B. medical officer

Last Updated: Monday, July 20, 2009

 

The Department of Health isn't planning for any school closures this fall even as swine flu cases in New Brunswick have spiked in recent weeks.

 

Dr. Paul Van Buynder, the deputy chief medical officer of health, said in an interview on Monday that it is likely children will catch the swine flu virus when classes resume in September, but shutting down schools wouldn't do much to protect them.

 

"You're chances of being infected are just as high in the supermarket or the local sports park as they are in the school settings,' Van Buynder said.

 

"So for that reason, I think we would need special circumstances before we start imposing on the education department to close their schools."

 

He said it's up to parents to use common sense when children show symptoms of H1N1, such as keeping them home from child care, summer camps and later this fall, from school.

 

(Continue . . . )

 

 

There are a great many societal and economic costs to closing schools, and many officials are loathe to consider it except under the most extreme conditions.  

 

Working parents rely on schools to watch their kids for much of the year during the day, and many low income families benefit from the school lunch program.  And of course, when schools are closed during a pandemic, some kids may congregate and spread the virus anyway. 

 

Many parents, however, would take exception to the notion that their kids are `safer in school’ when a pandemic strain of influenza is circulating.  Not only does it, in their estimation - endanger their children – it increases the odds of them bringing the virus home to the rest of the family as well.

 

And if the answers were obvious or clear cut, we’d have no debate.  The problem is, we really don’t know which policy is `right’.  

 

Since some communities will attempt to keep schools open during this pandemic, while others may close them, we have an opportunity to perhaps figure this out over the coming months.

 

Pandemics are learning experiences.   And since this probably won’t be the worst, nor the last pandemic we endure, we’d do well to take note of the lessons this one offers us.

 

Personally, I believe the case for closing schools is a strong one –if they are closed early enough and remain closed until a pandemic wave has passed.   

 

But those are two big `ifs’.   And I’m not sure that most communities have the resolve to do either.

 

But while officials plan and schools debate policy, there are a couple of wildcards here that may be the actual determining factors.

The first is, that parents may simply refuse to send their kids to school. 

 

In fact, we’ve already seen that sort of reaction.  No matter how well reasoned or forceful the argument by local officials, if parents fear for the safety of their kids, those arguments will fall on deaf ears.

 

And second, if teachers or other personnel are absent due to illness or fear of contracting the virus, then the reduced level of staffing may force the closure of schools. 

 

For now, while this pandemic virus is perceived as being mild (and hopefully remains so), there is a strong desire by officials to try to keep it from disrupting our society, and economy, any more than is necessary.  

 

The hope is that we can find a way to `conduct business as usual’.

 

And ideally, that would be the best thing for society. 

But whether we find that to be possible . . . well, that’s one of the many lessons this pandemic will probably teach us.

No Good Deed Ever Goes Unpunished

 

# 3518

 

 

 

Over the next 60 days a staggering number of potentially `risky’ decisions are going to have to be made by a variety of public health officials, across many nations, and most will have to be made with far less time and information than they would like.

 

While a relatively `mild’ illness for most people, the H1N1 pandemic virus can, and does, cause severe illness and even death in some small percentage of those it infects.  

 

Since viruses can mutate, it would be dangerous to assume that the low percentage of deaths won’t increase over this fall and winter.  Maybe we get lucky . . . maybe we don’t.

 

It is against this backdrop that these public health decisions must be made. 

 

Decisions that involve billions of dollars of tax payer’s money, the use of a new untested vaccine, and recommendations on social distancing that could potentially affect the economic recovery.  

 

And the one luxury that these doctors and scientists don’t have is a lot of time.

 

The clock is ticking . . .  the virus is spreading rapidly in the southern hemisphere . . .  and is poised to ramp up here in the northern hemisphere as early as September.

 

There is great uncertainty regarding this virus, and there are some who believe the threat is overstated.  We’ve seen some countries decide to downplay the threat, and treat this virus like a seasonal flu.   Finland and South Africa are two examples.

They may end up being right, but it is a huge gamble.

 

Of course, mitigation efforts are not without their dangers.   There are the budgetary costs of course.   Billions of dollars for vaccines just here in the United States, and billions more to dispense them to the arms of 300 million Americans.  

 

If the virus turns nasty, and the vaccine is safe, effective, and delivered in time -  public health comes out looking like a hero.

 

But practically any other combination of events:  A milder than expected virus, a less-than-effective vaccine, or one delivered too late, or worse, a vaccine that causes a substantial number of adverse side effects – and public health takes it on the chin.

 

There are numerous external forces at work here, most of which are beyond the control of public health officials and pandemic planners. 

 

During a pandemic, there are so many things that can go wrong, even if they do their jobs right, that it may actually be better to be lucky than good.

 

At every turn, it seems, there is a `damned if you do, damned if you don’t’ decision for public health officials.  School closings, fast tracking a vaccine, using an adjuvant, closing public venues to limit the spread of the virus . . . 

 

Added to that is a distrustful, and at times, uncooperative public.  A watchdog media ready to pounce on any `good’ story, and a million internet bloggers taking pot shots at their every move.

 

Be glad it isn’t your job.  

 

Be glad that potentially tens of thousands of lives, the nation’s economic prosperity, and vital elements of our infrastructure don’t hinge on the decisions you are forced to make in a crisis. 

 

And be glad that everything you say and do isn’t going to be scrutinized, analyzed, and criticized in the media over the next couple of years.

 

I suppose, having been in the position of having to make life-or-death split second decisions as a paramedic makes me a bit more sensitive to the plight of public health officials.

 

There will no doubt be ample legitimate targets for criticism during, and after this pandemic.   And I’m not suggesting we turn a blind eye to egregious or malicious actions, greed, or bone-headed decisions.

 

But I do respect the pressure that most public health officials are working under. 

 

That, all too often, they are working with less data and time than they really need, inadequate resources, and are subject to a variety of political, economic, and societal pressures.

 

And that, even with the best of intentions, their decisions may not always turn out the way we would hope.

 

 

I don’t think the public understands yet what we are about to ask of our public health sector over the coming months.  

 

That everyone, from the underpaid and little appreciated school nurse, to the the staff of your local health department, to the doctors, nurses, and techs in your local hospitals, clinics, and nursing homes are going to be asked to go above and beyond over the next year or so.

 

They are not only going to be on the front lines, exposing themselves (and potentially their families) to the virus, they will be asked to work nearly impossible hours and to deal with an enormous workload.  

 

Many will be asked to put their jobs and duty first, and their families second or third during this crisis.

 

Emergency operations, first responders (police, fire, EMS), and volunteers with CERT, the American Red Cross, the Medical Reserve Corps and other agencies will also be out there, doing difficult and at times dangerous work.

 

Even if we are lucky enough to only see a mild pandemic (and the jury is still out on that one), we need to be prepared for the idea that not everything is going to go smoothly.  

 

Mistakes will be made, and bad outcomes are to be expected.

 

If we’re smart, we’ll learn from our mistakes and our shortfalls, and use that knowledge to be better prepared for the next pandemic or crisis to come our way.

 

My fear is, we will simply content ourselves with publicly flogging those who worked to try to mitigate this pandemic, and then go back to sleep until the next time.

A Cautionary Tale From The UK

 

# 3517

 

 

A reoccurring theme in this blog has been the importance of convincing people to get the things they will need to treat influenza in the home - now . . . before they need them - and before the flu season picks up in the fall.

 

Over the next 6 to 9 months hundreds of millions (perhaps billions) of people around the world are expected to fall ill due to the Swine Flu virus.  

 

Most will probably only suffer mild to moderate illness, but many will still need some medical attention.

 

There’s a pretty good chance that you, or someone in your household, will be sickened.  And most people are going to have to be treated in their homes. 

 

If you don’t have supplies now to deal with flu, you may find them difficult to obtain when you need them.  Millions of people will be trying to acquire exactly the same sort of supplies that you will be seeking. 

 

Shortages are more than a little likely.

 

And most importantly, by purchasing what you need now, you are helping to reduce the demand on the supply chain in the fall.    

 

Do you have a good oral thermometer?   What about fever-reducers like acetaminophen or ibuprofen?   Do you have alcohol hand sanitizer?  Pedialyte or other oral rehydration solutions?

 

What about other sick room supplies?

 

Do you already have surgical facemasks? 

 

The CDC recommends you have them for those who are sick to wear, particularly if you have to take them outside of the home (like to a doctor, or a hospital), and to help protect other members of the household they may be around.

 

If you are in a high risk group, and may be called upon to care for someone with the flu, the CDC suggests that you consider using N-95 respirators to help protect yourself from the virus.

 

These are likely to be in very short supply this fall and winter, and difficult to get.

 

 

Even though it is summer in England, and not yet `flu-season’,  we are already hearing of some spot shortages of basic sickroom supplies.  

 

A hat tip to Crof at Crofsblog for posting this story.

 

 

Sold out: swine flu makes thermometers hot property

 

The operator on the swine flu hotline needs to know if I have a fever. No fever, no swine flu. So I venture out to buy a thermometer. The pharmacy at the corner has run out. I drag myself to the next chemist on the high street, but the shelf is empty: the last digital one sold yesterday. Nearby is a Superdrug. Sweating and coughing, I run through the store looking for thermometers. None.

 

I call Superdrug. They say sales of thermometers have doubled each week for the last three weeks. Lloyds pharmacy has sold 700% more thermometers than for the same period last year.

 

Even thermometer suppliers are getting nervous. Andrew Brannan, of Brannan thermometers, says it was the same with Sars. "We couldn't keep up." So how did it end? Did we all find a long-lost one in the bathroom? "No," he says. "The story disappeared and the demand stopped."

 

I finally found a chemist that had some stock. I don't have swine flu, but I will keep this new thermometer tucked away for the next crisis.

 

 

The takeaway message is, it is better to prepare now, than to sweat trying to find important supplies when you, or a loved one, is already ill.  

 

There are a number of excellent resources available that you should examine now, that offer suggestions as to what you might need.

 

The CDC has guidance available to help you take care of a flu victim at home, including some suggestions on some of the supplies you may need: 

 

Interim Guidance for H1N1 Flu (Swine Flu): Taking Care of a Sick Person in Your Home

 

The Canadian government has a similar document entitled:

Influenza Self-Care: It's In Your Hands

 

 

And of course, one of the best guides is  Dr. Grattan Woodson’s free guide on the treatment of Influenza, available from his website.

 

A relatively new manual is this 81-page PDF file which cover a lot more than just caring for the sick. 

It also has sections on establishing `communities of care’, laying in emergency supplies, general preparedness websites, even emergency cooking. 

 

While a free download, the authors are set up to accept donations.  If possible, you should consider supporting their work.

 

 

Branswell On Government Vaccine Testing

 

# 3516

 

Helen Branswell of the Canadian Press brings us an in depth look tonight at some of the testing hurdles that the various competing pandemic vaccines must negotiate (or potentially, skip) in order for vaccinations to be offered this fall.

 

Vaccine manufacturers will conduct the normal safety and efficacy trials that are usually associated with each year’s vaccine, but a variety of government agencies in the United States and Canada are going to be looking at other issues.

 

There are serious questions regarding the co-administration of seasonal flu vaccines at the same time as the H1N1 vaccine.  Probably not a problem . . . but it’s never been done before.  

There will be trials to determine the usefulness, and safety, of adjuvants added to vaccines to boost the recipient's immune response.   These aren’t licensed here in the US, but could conceivably be used under an Emergency Use Authorization.

 

And since most vaccines are still manufactured using eggs, people with egg-allergies have traditionally been told not to get the flu shot.  There will be testing to try to determine how dangerous these vaccines really are for people with these allegeries.

 

Helen Branswell brings us greater detail in her story.   Follow the link to read it in its entirety.

 

 

 

Studies aim to answer key questions as world readies for swine flu vaccination

Provided by: Canadian Press
Written by: Helen Branswell, THE CANADIAN PRESS
Jul. 19, 2009

A research scientist works in the vaccine research lab at the British Columbia Centre for Disease Control in this file photo.

THE CANADIAN PRESS/Darryl Dyck

 

TORONTO - A flurry of innovative vaccine trials is in the offing as governments and regulatory agencies prepare for the probable launch of mass swine flu vaccination programs in the fall.

 

The results of the trials could determine whether people with egg allergies can be offered pandemic (and regular) flu vaccine, whether pandemic and seasonal flu shots could be given at the same time and whether one company's vaccine can be given with another's adjuvant, a compound that boosts its potency.

 

Vaccine manufacturers are either unable or unlikely to undertake the complicated studies required to answer these questions. Governments will fund the work instead.

 

Infectious diseases expert Dr. Anthony Fauci says the goal here for organizations like the U.S. National Institute of Allergy and Infectious Diseases - which he heads - is to fill key knowledge gaps for vaccine regulators.

 

"What are they going to need that somebody else can't do?" Fauci explains.

 

Some of those priorities will be aired Thursday in Washington when the U.S. Food and Drug Administration's vaccine and related biological products advisory committee meets in a session on clinical trials for pandemic vaccines.

(Continue . . . )

The Difference Between Ignorance And Apathy

 

# 3515

 

 

According to the old joke, the answer is, “I don’t know, and I don’t care!”

 

Unfortunately, six weeks into this pandemic, we seem to have an abundance of both.  

 

Summer is here, and most people in the northern hemisphere are more inclined to think about vacations, spending time out of doors, and more leisurely pursuits than seem interested or concerned over this flu.

 

Today, in a news report from a local TV station here in Florida (WTSP-10), local’s were interviewed about their level of concern over the swine flu outbreak.

 

 

Swine flu is back with a vengeance

St. Petersburg, Florida - The Bay area has already had dozens of confirmed cases of H1N1 but this is the first time we've seen so many deaths in one week that are directly related to the virus.

 

So far, statewide, there have been fourteen deaths due to swine flu. Three of those were in the Bay area -- two in Sarasota County and one in Polk County.

 

"Three deaths, just recently? That's pretty serious," said Tampa resident Lisa Johnson.

 

While Johnson worries, Kasha Vaskolo of St. Pete doesn't. "To me, it is just another cold, like SARS, people were freaking out but it never really got anywhere."

 

I’ve heard of SARS described many ways, but `just another cold’ is a new one on me.  

 

Unfortunately, this is pretty typical of the way many people regard threats.   They tend to dismiss them unless it has killed someone they know . . .  recently.

 

I know that most people’s days are filled with innumerable deadlines, responsibilities, and distractions and that it is hard to devote much, if any, of their attention to anything that is more than 24 hours in the future.  

 

That’s why so many people in Florida don’t prepare for hurricanes in May or June, and wait to see if one pops up in August or September.  Or why most Californians put off putting together that earthquake emergency kit. 

 

There’s always a belief that there will be ample warning, and plenty of time to make preparations, if a threat really comes a knockin’.   

 

But of course, you can’t always count on that.  

 

The time to put together that first aid kit, or to take a CPR course, is before you are faced with a medical emergency.    And many disasters can strike with too little warning to allow for preparedness.

 

But we go through our busy days, convinced it will never happen to us, and even if it does, it won’t be so bad, and even if it is, someone will come to our rescue.

 

Right now, we are in the middle of the Atlantic Hurricane season, and while so far its been a quiet season, the tropics normally don’t ramp up until August and September.    Earthquakes . . . well, they can happen anytime.   As can tornadoes. 

 

All perfectly good reasons to have a 72 hours (or greater) emergency kit in your home and automobile, a family emergency plan and a well practiced business disaster plan.

 

Added to the normal mix of threats we now have a pandemic. 

 

Maybe not the monumental event that many expected (although its eventual severity is unknowable), but serious enough that we should all be thinking about how we will deal with it later in the year.

 

Which is a good enough reason for people to be preparing now to be able to care for flu victims in their homes, and to stay home for a week or perhaps two, if isolation or quarantine requires it.

 

And as an added bonus, having some extra supplies on hand may enable you to share them with a friend, or relative, or neighbor who is in need. 

 

Whatever the envisioned crisis, our preparedness goal should be making our communities more resilient.   And for that to happen, we need to do more than just stockpile some extra supplies in our homes. 

 

People should seriously consider volunteering with the American Red Cross, The Medical Reserve Corps, CERT, or their Neighborhood watch.

 

People may find other opportunities to assist through their local church, school, civic organization, or by volunteering at a hospital or nursing home.   

 

A crisis, even a pandemic, is no time to hide away in our homes and wait for others to help our communities.

 

 

For more information on preparedness, you can go to any of these reputable sites.

 

FEMA http://www.fema.gov/index.shtm

READY.GOV http://www.ready.gov/

AMERICAN RED CROSS http://www.redcross.org/

For Pandemic Preparedness Information: HHS Individual Planning Page

 

For more in-depth emergency preparedness information I can think of no better resource than  GetPandemicReady.Org.