A couple of weeks ago there was a discussion of closing schools in response to the threat of H1N1 Influenze ("Swine Flu"). I suggested that closing the NY City schools would be counterproductive, as the kids would just find someplace else to hang out together, while making it impossible for parents to get any work done.

About a dozen schools in NYC are currently closed due to flu scares - the aparently well loved assistant principal of one of them recently died of the disease. Every morning the news radio interviews hysterical parents calling on the city to close the schools out of caution, and absenteeism is currently quite high.

And yet, according the the NY Times, here is what happens when the schools close:

Flu Closings Fail To Keep Children At Home

It seems to me that if it is serious enough to close the schools, then the kids need to stay home (I personally think these closings are an over reaction, but I don't have a kid in a school with lots of sick kids. Maybe I'd feel differently if I did). I suspect that the flu is much more likely to spread, however, from people like the man sitting across from me on the train last night, who was continually coughing without covering his mouth in any way. I moved away from him, and got thumbs up from several other passengers as I did.

Cutting the spread of disease is very much about personal responsibility and actions. If you're sick, stay home. If you're likely to become sick, because you've been around others who are actively sick, you should probably stay home too. And if you don't stay home, please don't cough all over me on the train!

WARNING,,,,,WARNING,,,,,JesselP is speaking "common sense", AGAIN!!!!

Jesselp, I believe I backed you on that one, for the same reasons. Kids dont go to school, they will go play with their friends. And, it will spread THAT way. Parents simply cannot afford to stay home for 2 weeks to keep an eye on them. Now, in MA, they are following suit, and closing schools. Yet another knee jerk reactions, by jerks that need a knee to...well...you know where I'm going with that!

they closed the schools to get them off the hook if something go's around and not as a general anti flu measure--anyway thats my take on it...

They close the schools to minimize the number of persons each individual comes into contact with, to prevent infection and being infected. Do the math: a typical student has 6 classes of ~25 students per day (many more if you include time in the hallways brushing past other students going to the next class). That means 6 hours of exposure to 150+ other students, in classroom settings, generally close enough to infect / be infected. Maybe they have lunch too, in a room with several hundred other students. A student released from school may sit at home and do homework and only interact with sister Sue and mom and dad, or sit with friends and play Xbox. Or you're right, maybe he/she will go to the mall where they can come into contact with hundreds of others every hour, to say nothing about subway / mass transit rides.

Social distancing works if you minimize your contact with other people, by volume. If there was a significant mortality you know that schools would close, and so might the malls, or at least advisories would read go home and stay home. I am skeptical of whether social distancing will keep you from getting sick - you will get sick if the flu is virulent enough. There's the possibility that your illness might be delayed, and you could find yourself getting sick outside the crunch that exceeds the capacity of the medicos to deal with you.

I'm with Lono on this one. Your chances of becoming sick are a function of how many people you come into contact with, not where you come into contact. A healthy kid whose school is closed faces just as great a chance of contracting the virus if he goes to the mall, because he will probably come into contact with just as many people.

Closing schools in NYC may be an overreaction, or it may be out of concern that the available data suggests that the young, healthy populace is being disproportionately infected (as compared to the 'normal' flu that kills 30,000+ each year, mostly elderly and immune sysmtem compromised).

Lono-Fox--i'm sure your right but after 20 something years working for the goverment i've seen alot of "we better cover ourself on this one"..so i get a bit cynical--

Here in the Seattle, area, 70% of confirmed cases are among kids ages 5-18. There's a nearby High School with over 300 flu cases (uncormfirmed), but the school isn't closed - whereas in the early days of this H1N1 scare they closed several Seattle schools for as few as 1-2 unconfirmed cases. The reason why the school with 300 apparent cases isn't closed: low/no mortality.

I say - let the virus run its course, infect as many as possible, and possibly build a bit of immunity for when it turns on us and comes back more lethal. I can say that, having had the flu about 1 week ago, and not being a doctor or anyone with the slightest concern for the public health. Life's a crapshoot sometimes.

http://seattletimes.nwsource.com/html/localnews/2009247543_webflu21m.html

Understood, and sometimes I agree. But nothin will kill you quicker than cynicism. Or lack thereof...

There is a science to risk communications that I'd like to learn more about - an actual best method to put across risk to the public to have the most desired effect and to minize bad ones. If everyone understood risk the same way it would be easier, but we don't. Personally I'm happy with the public health messaging on this so far, but I am inclined to listen with a selective ear: looking for key words like deaths, lethality, heavy hospitalization rates, overtaxed respirators and licensed technicians etc etc

Unfortunately, as with most crises, information like this is not necessarily forthcoming in the early stages of any rapidly unfolding event. So, leaders are put in the unenviable position of having to make decisions with imperfect knowledge since in reality, no one can ever have the full, complete story before making some important decisions. If you wait, people could start dying while you're waiting for more information before acting. The "fog of war" applies to more than just war.

School closures were and still are controversial. After the fact, after it became apparent that H1N1 wasn't as lethal as the initial reports coming out of Mexico made it sound, people almost universally cried "Over-reaction!" and used words like "knee jerk reaction". I think many people feel jaded about the advice from public health officials now. Unfortunately, the public does not seem to realize why they did that and what the rationale for it was. It wasn't simply an over-abundance of caution or simple CYA at play. That is a specific strategy to combat a pandemic.

This is the first potential pandemic we've faced in our borders in a long time. H5N1 and SARS were scary, but those disease were never able to spread person-to-person with with the ease with which the reports coming out of Mexico reported in the beginning. So, it's been a long time since scientists and doctors have had a chance to deal with an apparently highly transmissible disease like this H1N1 outbreak.

One of the tools that weren't available in the last pandemic is unimaginable gobs of computer processing power. Taking cues from climatologists and nuclear physicists who simulate hurricane storm tracks and nuclear detonations, scientists can actually simulate the daily lives of individual people. The minute-by-minute actions and social interactions of every individual in a large, metropolitan region or beyond can be estimated, for weeks or even months of simulated time to study how a disease spreads through the population.

There are a number of groups doing this work around the country. The big dog right now seems to be the folks at Virginia Tech. They seem to have the most sophisticated models, which require clusters of supercomputers to execute and are actually contracted by the Department of Health and Human Services to advise the Federal government in situations like this. Actual experiments are useful, but you can simulate things which are impossible to study in real life and you can tweak things over and over again to your heart's content.

One strategy which stood out as particularly effective in stopping a fast spreading disease like a pandemic flu in simulations is "social distancing," particularly of school age children, since they are prolific vectors of the flu. The most effective way to implement closing schools is right at the very beginning of an outbreak. In the earliest stage of an outbreak, the number of infected cases is growing exponentially. The actual numbers may seem small in the very beginning, but the rate is very high and before you know it, you could be overwhelmed with cases.

That is why school closures were recommended even with just one or two cases in the beginning of this H1N1 saga. If you wait until you start seeing sizable numbers, it's too late. Closing the schools does little good, in the end, if you start too late. And that is why there was so much emphasis on closing schools (but not businesses or other places where adults congregate) and to do it very early on.

These simulations were also instrumental in shaping policy on border closures. H1N1 was already inside the US. Many clamored for border closures but simulations have repeatedly shown that they don't slow down the disease that much. Certainly nowhere near what your average person thinks it would do, and the economic, political, and personal costs of border closures are tremendous.

Japan, an island nation, didn't have any confirmed cases two weeks ago. Up to that point, they had some of the strictest screening procedures of any country. But now there's a mini explosion of cases in Japan and they are apparently already relaxing their rules, since apparently they also believe that once H1N1 is in, there is not much benefit to further intense screenings.

The fact that H1N1 is relatively mild for most folks is a good opportunity to try and change things up and try and find what works. Obviously, the idea of closing schools has some practical problems--like kids not listening to their parents and heading to the mall. It's all part of the learning process. We know junk food is bad for us, but can anyone make most Americans eat healthy? The best solution in some ideal world is not necessarily what works in real life.