Short-Term School Closures May Worsen Flu Pandemics

[Mayabird]

Short-Term School Closures May Worsen Flu Pandemics
by Staff Writers
Pittsburgh PA (SPX) Jan 06, 2010

Closing schools for less than two weeks during a flu pandemic may increase infection rates and prolong an epidemic, say University of Pittsburgh researchers in a study published ahead-of-print and online in the Journal of Public Health Management and Practice. The findings, developed from a series of computer simulations based on U.S. census data, indicate that schools may need to be closed for at least eight weeks in order to significantly decrease the spread of infection.

The value of school closures has been debated as a possible strategy to stem or slow the current H1N1 influenza pandemic. Indeed, hundreds of schools across the country have been closed at different periods during 2009 for fear the virus would spread more quickly if they stayed open.

"Although closing schools may seem like a reasonable way to slow the spread of flu, we found that it was not effective unless sustained for at least eight weeks after implementation," said study lead author, Bruce Lee, M.D., M.B.A., assistant professor or medicine, epidemiology and biomedical informatics, University of Pittsburgh. Closing schools quickly at the start of an outbreak was much less important than keeping them closed continually throughout the epidemic, he added.

According to study authors, short-duration school closures can increase transmission rates by returning susceptible students back to school in the middle of an epidemic when they are most vulnerable to infection.

The study also found that identifying sick students individually and keeping them from attending school had minimal impact on an epidemic. In addition, there were no significant differences between individual school closures and system-wide closures in mitigating an epidemic.

The study was based on an agent-based computer simulation model of Allegheny County, Pa., that represented the county's population, school systems, workplaces, households and communities. Simulations were based on the movement of residents each weekday from their households to designated workplaces or schools, and included 1.2 million people - 200,000 of whom were school aged children. The study also included more than 500,000 households and nearly 300 schools.

Co-authors of the study include Shawn T. Brown, Ph.D., Pittsburgh Supercomputing Center; Philip Cooley, M.S., William Wheaton, M.A., and Diane Wagener, Ph.D., RTI International; Ronald Voorhees, M.D., M.P.H., Allegheny County Health Department; and Maggie Potter, J.D., Samuel Stebbins, M.D., M. P.H., John Grefenstette, Ph.D., Shanta Zimmer, M.D., Richard Zimmerman, M.D., M.P.H., Tina-Marie Assi, M.P.H., Rachel Bailey, M.P.H., and Donald S. Burke, M.D., University of Pittsburgh.

Mind you, this was a computer simulation, but I note that all the school closures/schools being wiped down with alcohol did exactly jack and shit for slowing the spread of H1N1. A feel-good measure for parents at best, and possibly making things worse by people letting their guard down (how long does it take to teach kids to cover their mouths when they make those raspy coughs of theirs). It is a good thing it didn't turn out to be Spanish Flu Take II this time.

Though it does bring up the point that to stop such a pandemic, we'd have to do far more drastic measures than people would probably be willing to accept at first, and then it might be too late with the speed of travel and trade these days. Thoughts?

[Mayabird]

Crap. Forgot the link. I blame drifting snow. Or being out of practice.

There we go.

[Simon_Jester]

Hmm. So why doesn't it work? Is the problem that the infection doesn't have time to burn out, so that infected students come back after the closure and start making people sick again?

[Mayabird]

Hmm. So why doesn't it work? Is the problem that the infection doesn't have time to burn out, so that infected students come back after the closure and start making people sick again?

I'm thinking that the problem is that students won't just catch the flu from their classmates. If the school is closed short-term, there's still plenty of time for some students to get infected outside of school without knowing it and then come back to school, thus infecting the still-susceptible population. This article was just focused on schools since so many were closed.

Of course, in a real very bad pandemic there'd have to be more restrictions than just closing schools.

[RedImperator]

It would be virtually impossible to convince school districts to close for eight weeks in the middle of the year. It would seriously disrupt the learning process (when the kids came back, you'd have to reteach them weeks, possibly months of material they forgot), it would screw teachers who don't have enough savings to get by for two months without pay (and cost a fortune if the district kept paying teachers), parents who work would have to find sitters for two months on short notice (and find a way to pay for them), and everybody would howl about losing summer vacation to make up for it (not to mention, in buildings without air conditioning, it would be practically impossible to hold lessons over the summer). The only way you'd get schools to close for that long is if people were dropping dead from the flu, and as you said, by the time it got bad enough to convince schools to do it (or public health authorities forced them), much of the damage would already be done.

[Solauren]

Another problem is school closures is you're always going to have someone get sick at the last minute, then bring the disease roaring back into the school, restarting the outbreak on a 'local' level.

The only thing I could think of, as it involves schools, to slow down outbreaks would be strongly enforced rules against coming to school sick.

i.e if your kid comes to school sick, they are suspended from school until they come back in with a doctors note, combined with a fine against the parents in the thousands of dollars range. (The kid doesn't get back in until that fine is paid too).

You'd have people complaining about it, but it would slow the spread of any diseases.

[RedImperator]

Another problem is school closures is you're always going to have someone get sick at the last minute, then bring the disease roaring back into the school, restarting the outbreak on a 'local' level.

The only thing I could think of, as it involves schools, to slow down outbreaks would be strongly enforced rules against coming to school sick.

i.e if your kid comes to school sick, they are suspended from school until they come back in with a doctors note, combined with a fine against the parents in the thousands of dollars range. (The kid doesn't get back in until that fine is paid too).

You'd have people complaining about it, but it would slow the spread of any diseases.

How the fuck is that supposed to accomplish anything? Most communicable diseases, including the flu, have an incubation period where the patient is asymptomatic but still contagious. By the time you start showing symptoms, you've already spread the disease. Meanwhile, you've now given every parent an incentive to panic and yank their kid out of school at the first sniffle (and every kid who doesn't want to go to school an easy way to skip with mom's approval), which will cause absolute chaos for teachers trying to plan their lessons and activities, and disrupt hundreds' of students educations over phantasms. On top of that, parents whose kids had mild or ambiguous symptoms (like a slight headache or tiredness) or no symptoms at all (or their kids just don't tell them), whose symptoms then worsen during the course of the day, are now on the hook for kilobucks in fines for acting like rational people. I especially like how the kids can't come back to school if their parents don't pay the fine. That's super-fair to them, especially if their families are poor.

Why are all your ideas always terrible?

[Uraniun235]

Though it does bring up the point that to stop such a pandemic, we'd have to do far more drastic measures than people would probably be willing to accept at first, and then it might be too late with the speed of travel and trade these days. Thoughts?

What would be actually effective, short of imposing a total curfew and delivering food rations to everyone? Are there actually any proposed "ideal" responses to a deadly pandemic, or is the plan basically "welp a lot of people die and then the survivors get to clean up afterward"?

[Mayabird]

Though it does bring up the point that to stop such a pandemic, we'd have to do far more drastic measures than people would probably be willing to accept at first, and then it might be too late with the speed of travel and trade these days. Thoughts?

What would be actually effective, short of imposing a total curfew and delivering food rations to everyone? Are there actually any proposed "ideal" responses to a deadly pandemic, or is the plan basically "welp a lot of people die and then the survivors get to clean up afterward"?

It really does look like an all-or-nothing deal. Either have strict travel and congregation controls or don't bother. Half-measures like closing the schools for a day aren't effective and only serve to inconvenience everybody.

[CaptainChewbacca]

For something like the flu, you have to do something like suspend inter-city travel and impose a curfew, and then use the military to protect distribution of resources and utilities and in the meanwhile ban all large public gatherings (including school).

Realistically, in a serious flu pandemic you'd probably lose a year of schooling.

[The Duchess of Zeon]

Though it does bring up the point that to stop such a pandemic, we'd have to do far more drastic measures than people would probably be willing to accept at first, and then it might be too late with the speed of travel and trade these days. Thoughts?

What would be actually effective, short of imposing a total curfew and delivering food rations to everyone? Are there actually any proposed "ideal" responses to a deadly pandemic, or is the plan basically "welp a lot of people die and then the survivors get to clean up afterward"?

It really does look like an all-or-nothing deal. Either have strict travel and congregation controls or don't bother. Half-measures like closing the schools for a day aren't effective and only serve to inconvenience everybody.

Flu containment measures used to be much more strict. I think it's an interesting social question of why we consider the kind of quarantines and closures that were acceptable in 1918 - 1919 unacceptable today.

[Simon_Jester]

Hmm. For schools in particular, it may be because school went from being seen as a luxury (so skipping it for eight weeks in a national emergency was fine) to a necessity.

Other possibilities... lack of obvious mass death from plagues? Vaccines and clean water supplies have pretty much stopped all the diseases that used to go on the rampage by easy transmission, at least in the developed world, so people don't have the same direct experience of losing childhood friends to diptheria outbreaks and things like that. Yes, there's AIDS, but AIDS strikes disproportionately in certain communities, doesn't transmit easily, and is a 'slow burn' disease; it doesn't have the same shock effect that a sudden outbreak of more contagious stuff would.

Another, more speculative possibility:
The farther the twentieth century went on, the more atomized society in the developed world became. We depend much less on extended family and home life and much more on public institutions for basic day-to-day social needs. Close down those public institutions and a lot of people are practically shut-ins; that makes the prospect of doing so more alarming.