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Are You Breaking Swine Flu's Golden Rule?

Staying Home When You're Sick is Key Advice That Some Find Unrealistic

Dealing With School Closures

The stay-at-home guideline may also mean temporary school closures or keeping kids home with flu symptoms, even if school is still open.

Gerald Harkins, associate vice president for campus safety and security at the University of Texas at Austin, kept a close watch on how local school districts for students in grades K-12 handled swine flu this spring.

"If the school districts close ... it has a tremendous impact on us, because our staff, faculty, and even students have children in those school districts," Harkins says. Several local schools did close, and Harkins says "we've worked our way through, as a region ... in terms of what are we going to do."

But he's not sure that school closures were effective.

"The thought was that if you closed the K-12 schools that [students] would then stay home and kind of self-isolate. In reality -- in many cases, in many areas, from what I understand -- they went to the mall. They didn't stay home. ... So the question is, is it better to congregate in school or somewhere else?" Harkins asks.

School closures are a last resort, notes Koonin.

"What we believe is that the best place for a sick child is at home, recovering, and the best place for a well child is in the school setting, as long as the severity and extent of illness in the community makes that an appropriate thing to do. So we're going to be doing everything we can to work with schools to keep schools open, functioning, running, and safe during this next flu outbreak until it becomes evident and important that we take another measure," Koonin says.

The decision to close schools due to swine flu is made locally, not by the CDC, which is studying how effective school closures were this spring. 

Keeping Kids Home From Child Care

Unlike public schools, child care programs aren't run by a central authority that can order a closure during a swine flu outbreak, notes Linda Klein, executive director of the National Association of Child Care Resource & Referral Agencies.

Klein says parents "have an obligation" to learn about and support their child care program's H1N1 policies as best they can. Those policies may include when kids must stay home and when they're allowed to return after flu.

Klein argues that "a child should not be excluded from child care unless ... they're too sick to participate or they impact the staff's ability to do what they need to with other children."

Klein says she doesn't expect child care closures, and she says such closures would "further disburse children into other settings," as parents may turn to neighbors, relatives, or other sources for child care.

When it comes to kids "it's the combination of fever and acting sick that should signal being out of contact with others that they have not already been in contact with," says Susan Aronson, MD, FAAP, professor of pediatrics at the University of Pennsylvania and co-author of the American Academy of Pediatrics publication, Managing Infectious Diseases in Child Care and Schools.

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