# 2030
One of the `hot button' issues when it comes to mitigating a pandemic is the prospect of prolonged school closures. While no one wants to place children at greater risk during a pandemic, there are concerns that closing the schools could have severe repercussions in our communities.
Pandemics, and pandemic waves, come in all types and severities. The CDC has developed a scale for ranking these events, similar to the Saffir-Simpson scale for hurricanes.
Future Pandemics will be ranked from Category 1 (mild) to Category 5 (severe) based on the CFR (Case Fatality Ratio) of the virus.
Figure A. Pandemic Severity Index
While the preliminary Community Strategy for Pandemic Influenza Mitigation calls for the closing of schools for up to 12 weeks, it does so only in a severe Category 4 or Category 5 pandemic wave.
Table A. Summary of the Community Mitigation Strategy by Pandemic Severity
(click to enlarge)
The severity of pandemic waves can be difficult to define until after they have passed:
- There may be a certain amount of `fog of war', where information is slow in coming, particularly from overseas
- The CFR and/or the attack rate could change in the middle of a pandemic wave
- Even if the CFR is low, there could be unexpected sequelae among those who recover from the illness.
Predictions, and even real time assessments, are likely to be difficult. In 1918, the first pandemic wave in the Spring was generally described as `mild', and it wasn't until the flu returned in the fall that it became a killer.
As epidemiologist's like to point out. If you've seen one pandemic . . . you've seen one pandemic.
All of this could make it difficult for emergency planners to know when to `pull the trigger' and close the schools. The feeling among most health officials is, better to do so too early than too late.
But of course this opinion isn't universally held.
There are concerns that closing the schools would force working parents to stay home with their kids, that kids that depend on the school lunch program will go without proper nutrition, and that kids will congregate in other places, negating the beneficial effects of school closures.
Valid arguments, all.
But when weighed against the potential loss of thousands (perhaps tens or even hundreds of thousands) of children's lives, they do seem to lose much of their persuasiveness.
There are 80 million children in the United States under the age of 20, and past pandemics have shown that the young are often more grievously affected by novel viruses. The potential for disaster here is too great to ignore.
While school closings may not be a panacea, they are likely to reduce the spread of any virus, and help reduce a pandemic's impact.
Assuming they are done in time.
Lisa Schnirring, of CIDRAP news, has the details of a recent study done on the closing of schools in North Carolina for 10 days in 2006, showing less impact than expected.
Survey finds little disruption with short school closure
Lisa Schnirring
Staff Writer
May 29, 2008 (CIDRAP News) – A survey of North Carolina families affected by a 10-day school closure due to a sharp rise in influenza-related absences found that the measure didn't cause families major hardships, but many did not heed a recommendation to avoid large gatherings.
The findings by researchers at the US Centers for Disease Control and Prevention (CDC) and the North Carolina Department of Health and Human Services were published yesterday as an early online article in Emerging Infectious Diseases (EID).
School closures are among the nonpharmaceutical interventions that public health experts hope could mitigate the effects of a flu pandemic. Few studies have gauged the negative effects of school closures, which could include conflicts with parents' work schedules, forced changes in childcare arrangements, and a lack of meals for children who depend on federally subsidized school breakfast and lunch programs.
Up close to a school closure
The authors of the EID report seized a relatively rare opportunity to study the effects of a school closure in November 2006, when officials from a rural school district in western North Carolina canceled school for 10 days after a widespread influenza B outbreak struck many students and staff.
The day before officials closed the schools, 17% of children in the school district were sick along with 10% of staff members. Officials said they closed the schools because of a shortage of staff.
While not a perfect match to a pandemic scenario (10 days vs 3 months), this report does give some hope that the effects of school closures might not be as severe as some critics have suggested.
If and when the next pandemic starts it is going to take swift and decisive action on the part of emergency planners to mitigate its effects. Not everything thing they do will work perfectly, or as expected.
But with luck, layered appropriate measures can, and will, reduce the morbidity and mortality of the next global health crisis.
