As kids begin returning to schools this month, anxiety about the spread of the H1N1 flu (Swine Flu) has soared. That’s because, as you’ve read here in past posts and heard in my lectures, schools are natural amplifiers of infections like influenza. During the previous 3 pandemics of flu, the timing of the outbreaks with respect to the school year was a major determinant in the severity of the pandemic (see: Chapters 2 and 3, Germ Proof Your Kids – The Complete Guide to Protecting (without Overprotecting) Your Kids from Infections (ASM Press, 2008).
This week, the CDC has issued new guidelines for protection of kids and staff in schools; these represent a general “softening” of the rules regarding school closures based on the observations that, so far at least, the cases of Swine Flu have not been more severe than cases of routine, “seasonal” flu. Reprinted below are the new CDC recommendations, along with my commentary in bold italics. Should the severity of cases increase, additional measures might be necessary. These would increase the number of school closures and the stringency of prevention measures in the school. The CDC also lists those in it’s current recommendations, which you can find at www.CDC.gov. I will update you on those recommendations should they become necessary because of a worse disease profile for this fall’s Swine Flu than what we observed last spring and this summer.
Recommended school responses for the 2009-2010 school year
Under conditions with similar severity as in spring 2009
- Stay home when sick:
Those with flu-like illness should stay home for at least 24 hours after they no longer have a fever, or signs of a fever, without the use of fever-reducing medicines. They should stay home even if they are using antiviral drugs. Dr. Rotbart:This is a good rule for all febrile illnesses, not just Swine Flu
- Separate ill students and staff:
Students and staff who appear to have flu-like illness should be sent to a room separate from others until they can be sent home. CDC recommends that they wear a surgical mask, if possible, and that those who care for ill students and staff wear protective gear such as a mask.
Dr. Rotbart: The risk here is stigmatizing kids in front of their friends; the best solution is to get the sick kids home quickly and therby avoid the separation and masking
- Hand hygiene and respiratory etiquette:
The new recommendations emphasize the importance of the basic foundations of influenza prevention: stay home when sick, wash hands frequently with soap and water when possible, and cover noses and mouths with a tissue when coughing or sneezing (or a shirt sleeve or elbow if no tissue is available). Dr. Rotbart: Again, this is important for all germ prevention, not just Swine Flu
- Routine cleaning:
School staff should routinely clean areas that students and staff touch often with the cleaners they typically use. Special cleaning with bleach and other non-detergent-based cleaners is not necessary.
Dr. Rotbart: There are important differences between “cleaning” and “disinfecting”. The latter actually kills germs, whereas cleaning alone removes visible dirt (and the germs the dirt contains) but can leave the invisible germs. I believe disinfecting is more effective than routine cleaning and a simple additional step to take to prevent school (and home) transmission of germs like Swine Flu. I prefer disinfectants that contain bleach because of the proven virus-killing capabilities of bleach.
- Early treatment of high-risk students and staff:
People at high risk for influenza complications who become ill with influenza-like illness should speak with their health care provider as soon as possible. Early treatment with antiviral medications is very important for people at high risk because it can prevent hospitalizations and deaths. People at high risk include those who are pregnant, have asthma or diabetes, have compromised immune systems, or have neuromuscular diseases.
Dr. Rotbart: There have been a very few cases of Swine Flu that have been resistant to the antiviral drugs. Right now, treatment with these drugs for high risk individuals appears to be still effective
- Consideration of selective school dismissal:
Although there are not many schools where all or most students are at high risk (for example, schools for medically fragile children or for pregnant students) a community might decide to dismiss such a school to better protect these high-risk students.