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.