U.S. government scrambles to revise pandemic planning in time for public school openings

Reading Spencer Hsu's report is like being transported to a mountain top after you've been struggling through thick jungle in the attempt to get your bearings.

It's all there, laid out in a few paragraphs: the confused thinking that dominates at the federal level and the equally confused thinking at the state levels of government, as officials try to determine how best to respond this fall to the swine flu outbreak.

Both levels of government make the same mistake. They assume they have the option of treating a pandemic virus as if were a test subject in a laboratory:

Strategy On Flu Under Revision
Federal Officials to Put Less Emphasis on School Closing

By Spencer S. Hsu
August 4, 2009
The Washington Post

The Obama administration is finalizing guidelines that would scale back when the federal government recommends closing schools in response to the swine flu pandemic, several people involved in the deliberations said Monday.

Such guidance would mark a change in the government's approach from this spring, when health officials suggested that schools shut down at the first sign of the H1N1 virus. They later relaxed that advice.

This fall, federal authorities would recommend closures only under "extenuating circumstances," such as if a campus has many children with underlying medical conditions, a senior U.S. health official involved in the talks said. The official added that discussions are continuing that and no final decision has been made.

Schools also might be advised to close if many students or staff members are already sick or otherwise absent, officials said.

"The framework is to try to keep schools open to the extent possible," the senior health official said, speaking on condition of anonymity because the White House has not completed its review of the issue.

School closings this past spring raised questions about whether they slow the spread of H1N1 and were worth the educational and economic cost. The federal government's decision could have a far-reaching effect on tens of millions of Americans, the economy and other countries wrestling with similar choices.

President Obama's top scientific advisers, Cabinet members and national security aides are racing to update the government's flu strategy before the school year begins this month, when infections are expected to surge -- particularly among young people.

Decisions on school closings will be made locally because the flu's severity varies geographically and because local and state governments have authority over school and public health matters, officials said. Local officials tend to rely on federal scientific advice, and federal guidance could change if the virus becomes more virulent or lethal, officials said.

John O. Brennan, the deputy national security adviser who chaired two Cabinet-level meetings in the White House last week to coordinate H1N1 planning, said the internal debate is intended to "think through all the angles" and avoid "knee-jerk" decisions, and he said it was too soon to predict the outcome.

"There will be circumstances where it makes sense to close schools, but what we are trying to do is refine" those instances, Brennan said.

U.S. authorities will release within days other "community-mitigation" measures, intended to help keep businesses operating, help hospitals avoid being overwhelmed and guide local authorities in deciding whether to cancel public events, officials said.

Experts say such decisions are timely because of the quickly approaching fall flu season.

The H1N1 virus does not appear to be more lethal than seasonal flu, but it might be two or three times as infectious and is expected to hit young, healthy people and schools especially hard.

[...]

Advocates of school closings say it is among the best options to slow a pandemic -- and thus reduce deaths and the strain on hospitals -- after developing a vaccine and antiviral drugs.

More than 700 schools nationwide, with nearly a half-million students, closed in late April and early May, following a pandemic plan that the U.S. Centers for Disease Control and Prevention published in early 2007.

On April 29, facing a spiraling H1N1 outbreak in Mexico, Obama urged U.S. schools with confirmed or suspected flu cases to strongly consider closing for as much as two weeks.

But the CDC stepped back May 4, noting that the disease did not appear as lethal as feared. The CDC said sick students and staff members should stay home for seven days. U.S. officials agreed to revisit the issue by fall.

Education officials said they felt bound to respect what federal officials were telling them, but they decried the effect of the closures, particularly the lost instruction time.

Federal officials proposed school closings after studying the outbreaks of severe acute respiratory syndrome (SARS) and avian flu in Asia earlier this decade, examining the 1918 and 1957 flu pandemics and using new computer models to consider the data.

But opponents of school closings said that the research relied on unrealistic assumptions and overlooked real-world factors.