Aug. 7, 2009 - Schools should try to stay open if swine flu hits, new CDC guidelines urge.
Schools and parents should do everything they can to limit the flu spread within schools. They should close only if the school isn't able to function or if the swine flu virus mutates into a more deadly form.
Flanked by three members of the Obama Cabinet -- Health and Human Services Secretary Kathleen Sebelius, Homeland Security Secretary Janet Napolitano, and Education Secretary Arne Duncan -- CDC Director Thomas R. Frieden, MD, today announced the new guidelines at a news conference.
"We now know closure of schools is rarely indicated, even if flu is in the school," Frieden said.
Frieden was health commissioner of New York City when swine flu hit last spring, infecting some 800,000 people. "There were many schools that had many cases that we did not close," he said. "There were also more than 50 schools we decided to close -- and we might have closed fewer if we knew then what we know now."
Sebelius stressed the fact that so far, disease caused by swine flu is not more severe than disease caused by seasonal flu.
"What we are seeing looks like seasonal flu so far," she said. "Normally, parents would not keep their children home if some friend or classmate came down with the flu."
Closing schools causes severe social disruption. The new CDC guidelines leave decision-making up to local communities, but urge communities to weigh the very real harm of school closings against the potential harms of increased flu spread.
It's nearly inevitable that after weighing these risks and benefits, some communities will decide to close schools.
"We hope no schools will have to close, but realistically, some will close this fall," Duncan said. "It is important that our children continue to learn. Home schooling plans must be in place, whether for a few students or for the entire school."
Some schools, such as those for pregnant teens or for kids with disabilities affecting their lungs, might still have to close in order to protect those at highest risk of severe swine flu disease. These "selective dismissals" aren't intended to reduce flu spread in the community.
Some communities may, however, opt for "reactive dismissals," closing schools:
- If there is excessive absenteeism among students or staff.
- If large numbers of kids are visiting the school health office or being sent home during the day.
- If the school isn't able to keep sick people out.
- For other reasons that "decrease the ability to maintain school functioning."
- Closed schools should also cancel school-related mass gatherings.
And if swine flu surveillance indicates that a more severe wave of flu is about to hit, communities should consider "preemptive dismissals." In this case, closed schools are also urged to cancel all school-related gatherings such as sporting events, dances, performances, rallies, and commencements.
New Swine Flu Rules for Schools
If schools don't close during a wave of pandemic swine flu, what should they do? Here's the CDC's advice.
If swine flu severity stays the same as it was last spring:
Stay home when sick. If you've had the flu, don't go back to school until 24 hours after your fever goes away.
Separate ill students and staff. Students and staff who appear ill should be sent to a room separate from others until they can be sent home. They should wear surgical masks if possible; those that care for them should wear masks, too.
Wash hands, observe cough/sneeze etiquette. Frequent and thorough hand washing will be more important than ever. So will covering each cough or sneeze with a disposable tissue (or shirtsleeve or elbow if tissues aren't available).
Routine cleaning. School staff should clean areas that students and staff touch often. Use normal cleaners; bleach and special cleansers aren't necessary.
Early treatment of at-risk students and staff. People at high risk of severe swine flu disease -- for example, those who are pregnant, have asthma or diabetes, neuromuscular diseases, or immune deficiency -- should see a health provider as soon as they become ill. Early antiviral treatment is very important for them.
If swine flu becomes more severe:
Active screening. Students and staff should be checked for fever and other flu symptoms every morning; those with these symptoms should be sent home. Throughout the day, students and staff should be on the lookout for people who appear ill.
High-risk students/staff should stay home. Students and staff with conditions that put them at high risk of severe flu disease -- such as pregnancy, chronic asthma, or heart disease -- should stay home from school "when a lot of flu is circulating in the community." Schools should immediately start planning for the continued education of such students.
Students with ill family members should stay home. Students should stay home for five days starting from the first day their household member got sick. This is the time they are most likely to get sick themselves.
If sick, stay home longer. Stay home for at least seven days even if you feel better before then. If you still feel ill after seven days, stay home for 24 hours after your symptoms finally go away.
Consider school closure. If it's deemed necessary to close a school, the school should remain closed for five to seven calendar days and then consider whether to reopen.
A "communication toolkit for schools" is available for download from the CDC web site at https://flu.gov/plan/school/toolkit.html.
The CDC will soon be issuing specific guidance for preschools. Guidance for colleges and universities is scheduled for release later in the month.