Forum: The Case for Early School Closure

This is my attempt at summarizing some very important discussions that ended up in 4 or 5 different threads. School closure is used as the most important NPI (Non-Pharmaceutical Interventions) for a pandemic, but some of the arguments can also apply to other NPI’s

Reasons for NPI

1. Pandemic will happen
2. Problems with availability and distribution of antivirals and vaccines
3. Health services will be overwhelmed
4. There will be supply issues
5. There will be absenteeism issues
6. #4 and #5 in distant countries can affect local services even before virus
7. Resources will be stretched to deal with both medical and infrastructure problems
8. Hence any ‘flattening of the curve’ will reduce the impact

TLC = Targeted Layered Containment

Basis for TLC

1. at least 1/3 of all flu transmissions will be due to children
2. closing schools early will reduce the attack rate (AR) for children and decrease overall number of cases, but will increase transmission in community and in households
3. keeping kids at home will reduce community transmission but increase the relative importance of workplace transmission
4. household quarantine ie keeping sick people and their family at home, especially with antivirals, will reduce overall transmission further but increase the relative importance of workplace and community transmission
5. promoting social distancing will result in further reductions

A few assumptions for pandemic planning from the National Strategies for Pandemic Influenza Implementation Plan p 25

1. overall 30% attack rate, 40% for schoolchildren, 20% for working adults
2. R0=2
3. CFR cannot be predicted and may vary by ‘an order of magnitude’
4. Multiple waves of 2–3 months each
5. Virus is transmissible before onset of symptoms

Mortality

An AR of 40% and CFR of 2% for those aged 1–19 will result in the same number of deaths as deaths from all causes in 20 years.

Mitigation strategies should be tailored to severity of pandemic

But pandemics happen extremely fast, so all interventions should be planned in detail in advance.

Evidence presented at IOM meeting:

1. Early interventions– before 3% cumulative infection, shown to have substantial effect
2. Early school closure consistently related to reduction of epidemic peak, both from modelling and from 1918 data
3. Closure of churches, theatres, and other ‘social distancing’ measures also work
4. Multiple early interventions increase benefit further
5. Social cohesion, local leadership, and trust in government important
6. Measures not found to provide benefit – quarantine, banning of public funerals, making influenza notifiable

Case for early school closure:

• According to the National implementation plan “Children will play a major role in transmission of infection as their illness rates are likely to be higher, they shed more virus over a longer period of time, and they control their secretions less well.”

• density of school

• further mixing on schoolbuses In the United States, about 23,500,000 children ride school buses to school, and then return home on school buses, this gives an estimated 10 billion student rides annually, whereas all other public transport gives another 9.6 billion
• mortality of kids (discussed above) - losing children is recognized as severest trauma by psychologists
• once deaths occur, parents will take their kids out of school. Unplanned school closures will not happen early enough to reduce mortality, but resulting chaos and mistrust will reduce compliance for further interventions and damage social stability

Benefits

Secondary Impact of school closure & their mitigation

• Parents who will have to quit work - Working couple and single working parent with children <12 make up 13 million. That is 13/141 = 9.2% of the workforce.

Businesses can pre-identify this group as part of pandemic continuity planning

• Children on free school meals will not get food

• “Kids will hang out in malls” – Implement measures to ban kids from malls without adults
• Crime - Juvenile violent crime rate higher on school days, non-violent crimes eg shoplifting same on school days as non-school days.

Precautionary Principle

The application of the Precautionary Principle is better understood in Europe than in the US, for historical and political reasons that I won’t go into. I am citing it here as a reference in principle, not as a point of law, since it can be interpreted in myriad ways in that regard. The following is a description quoting the European Commission:

The communication stresses the need for “reliable scientific data and logical reasoning.” Before “triggering” the use of the principle, it requires identification of a potentially hazardous effect, with “all effort” being made to “evaluate the available scientific information,” “leading to a conclusion which expresses the possibility of occurrence and the severity of a hazard’s impact on the environment, or health….” The analysis must also include an assessment of the uncertainties in the scientific data. It stresses the wide range of actions that may be taken under the principle, including no action at all. Perhaps more importantly, the communication provides five guidelines for using the principle in a politically “transparent” manner (see the table below).

Guidelines for Application of the Precautionary Principle*

Proportionality “Measures…must not be disproportionate to the desired level of protection and must not aim at zero risk”

Nondiscrimination “comparable situations should not be treated differently and… different situations should not be treated in the same way, unless there are objective grounds for doing so.”

Consistency “measures…should be comparable in nature and scope with measures already taken in equivalent areas in which all the scientific data are available.”

Examination of the benefits and costs of action or lack of action “This examination should include an economic cost/benefit analysis when this is appropri ate and feasible. However, other analysis methods…may also be relevant”

Examination of scientific developments “The measures must be of a provisional nature pending the availability of more reliable scientific data”… “scientific research shall be continued with a view to obtaining more complete data.”

• EC Commentary, 2 February 2000

This should be linked to from the main fluwikie.com page.

In short it will save lives. All the issues that have been brought up in opposition to closing schools pale in comparision. Parents [even single parents] cope with summer vacations, and other times schools are not open. Some of the same solutions will be utilised in the event of a pandemic school closing. No solution is perfect. But closing schools saves lives period.

Anon_22, I have some questions (surprise, surprise!)

Regarding slide 4 at 15:52

Please explain “???” in Quarantine/moderate cell.

What does “punctuated???” in the school closure/moderate cell mean?

Regarding slide 7 (Washington DC vs. Seattle) at 15:52

I’m assuming Seattle used NPI and DC did not, right? Dates are on one axis. What, exactly, is represented on the other?

General

No slides from IOM yet, huh, anon_22? I’ve tried working with copies from the threads, but they don’t print well. Figured I’d ask even though I know you probably don’t have them yet.

Thanks for the help!

at least 1/3 of all flu transmissions will be due to children How many would be due to pre-symptomatic transmission? Somewhere I read about 1/3 too.

Perfect summary of all the great info. i’m goin to forward to it to Board of Ed members. The only thing you might want to add is the WHO chart showing deaths by age group. It would make every High School principal stand up and pay attention.

LauraB – at 21:18

Laura, I’ve lost track of that particular graphic, and I’m going to a school board meeting tomorrow night. Do you know where I can find it off the top of your head?

I have it — if you send me your email address, I can email it to you along with other school board packet goodies. I can be reached at

cefprice@comcast.net

Edna Mode – at 16:49

Regarding slide 4 at 15:52 Please explain “???” in Quarantine/moderate cell.

What does “punctuated???” in the school closure/moderate cell mean?

These are slides that I pulled from their presentation. Some of these options are still under discussion, so I suspect the ??? are about that.

‘punctuated’ probably means intermittent, I think.

Regarding slide 7 (Washington DC vs. Seattle) at 15:52 I’m assuming Seattle used NPI and DC did not, right? Dates are on one axis. What, exactly, is represented on the other?

Deaths

No slides from IOM yet, huh, anon_22? I’ve tried working with copies from the threads, but they don’t print well. Figured I’d ask even though I know you probably don’t have them yet.

Nope, I’m kinda pushing, but it takes time.

Do you want the slides to print out on paper, or to be used as slides? Let me know how you want to use them and I’ll see if I can help.

Here’s one that I made from WHO figures

I’ve tried working with copies from the threads, but they don’t print well.

I don’t know what you mean by “they don’t print well”, but you could try these:

• Try using the “print” tag at the top-right of the page. You know, where it reads “print links backlinks”. That should help a bit.
• Then, you can tell your browser (Internet Explorer, FireFox, Safari (Mac), etc) to put bigger fonts for you, in the “View” menu after “Files Edit” (top left).
• There are ways to convert a webpage to PDF but I haven’t yet found how. I’ll ask.

For anyone wanting charts depicting the present situation regarding H5N1 in humans, we’ve collected a good bunch of links at the “confirmed cases updated” page which in turn is linked to from http://www.fluwikie.com (couldn’t be easier).

The “by ages” chart is here (one with many colours and another with two levels of blue).

Anon_22 – at 03:12′s chart is better because it shows CFRs for each group. But it needs an explanation as to which colour means what (most cases have died so higher columns mean those who died in each age group). And the figures don’t match well with WHO’s chart which is also not as recently updated.

lugon,

I made up that chart from official WHO confirmed cases. It is more up to date, but also the WHO chart showed the age groups 0–5 and 5–9 separately, whereas the rest of the chart is categorized by 10 year age gaps. I find that rather misleading, and understates the number of kids infected and died.

Also, the WHO chart excludes the Turkish cases.

As for the colors, red is those who died, and blue is total cases.

This is the WHO chart for comparison:

anon_22, thanks for the prompt clarification!

Lugon you’re the best. That’s the one. I know you have DC vs Seattle, but another good closure/stopping public gatherings chart is that ST. Louis vs Philly one, just for extra backup showing what a difference it can make.

Thanks anon_22, lugon, olymom, and LauraB.

I want to use the slides as handouts to the school board. I would eventually like to have them as both printouts and slides. When I said they wouldn’t print out well, what I meant is that the resolution for the graphics is too low to make high-quality printouts. They are very grainy. But that’s not a big deal. I already made PDFs and am going to spend some more time today trying to adjust the resolution in my graphics editing software. If it works, I’ll let you all know and can send out copies.

Olymom, I’ll be in touch by e-mail to get your packet of goodies. Thanks for the offer!

A pdf of this page could be added to the FluWiki file project. I think if Edna sends the pdf to Dude or Dem we could send this information to schools and public health officials. I plan to include the letter from the US Secretary of Education to schools asking them to add pandemic preparation to their emergency plans. There are several documents that may help provide them with direction to follow through.

Pandemic Flu: A Planning Guide for Educators (5 page pdf), Basic Components of Pandemic Planning (1 page pdf which is better than the Basic page in the previous document), and the checklists from pandemicflu.gov for school planning.

Started a schools page on the FluWiki. Not much on it because I need to wake up for work soon. Back to bed Fred.

important stuff

(anon 22; still getting some locally stuck on “Pandemic will happen”, but, adjustment reactions- the more this conference and graphs get seen, and the more people see the WHO’s 10 things, government checklists, ect, locally, the better chance we all have.)

The numbers generated through use of FluAid should not be considered predictions of what will actually occur during a pandemic. http://www.cdc.gov/flu/pandemic/flusurge_fluaid_qa.htm

…”Estimates from FluSurge are really illustrations: for a given scenario; therefore, accuracy cannot be guaranteed. FluSurge should be used as a starting point for planning. Given the large number of unknowns for a possible pandemic, any plan has to be flexible.

…we do not have any data regarding any aspect related to the potential impact of such a strain in humans. However, you can follow the instructions and alter FluSurge and FluAid outputs to reflect nearly any rates of health outcomes. “

We do have data on what H5N1 is currently doing with few patients getting a hospital’s care, attention, vents, and antivirals, concern needs to reflect facts on the ground.

Local health departments should not be minimizing information to schools, parents, or the community. Federal state/local checklist’s first task was to ‘’‘Establish a Pandemic Preparedness Coordinating Committee that represents all relevant stakeholders in the jurisdiction (including governmental, public health, healthcare, emergency response, agriculture, education, business, communication, community based, and faith-based sectors, as well as private citizens)

and that is accountable for articulating strategic priorities and overseeing the development and execution of the jurisdiction’s operational pandemic plan’‘’

If this has not actually taken place, such a diverse and open groups should be assembled, and start looking at Non-Pharmaceutical Interventions for their communities, and telling the public how to get preparing to cope during these interventions such as prompt, prolonged, school closures.

fredness – at 08:30

I am creating (what I think is) a document that will be visually easier to digest and follow. When I have it done, I will create a PDF and submit it so it can be posted here on the wiki. I will also create a PDF of this link so that can be posted for those who prefer to use it instead. It won’t be until Monday in all likelihood. I have to finish preparing it, shuttle kids to appointments in about an hour, then go present to the school board, and am off tomorrow on a birthday jaunt with my kids tomorrow (which, if I even attempt to open the wiki, will earn me a family ice out!)

I will post tonight briefly on how my meeting goes.

Anon_22 - Great summary. Very thought provoking.

I was wondering about one thing though; It has been my experience both as a student & as a parent the worst times for disease swapping is when the students have time to go away (more than just local travel), catch something from others & come back together to “share” with all their friends (especially the beginning of school, and after vacations).

What come to mind was after mid-winter break last year someone picked up the flu; within two weeks, over 80 middle school kids out of ~350 were out sick. It happened when I was in college too after Christmas break. They almost stopped classes for a day or two because so many kids were sick.

Has anyone given any thought to some sort of heightened awareness/ screening for those particularly vulnerable times? I see this as more critical in the reactive and/or punctuated scool closures.

If people could somehow allow time for staying home a day or two after they return, and then not go to work or school if they are ill.. (what job or school will allow for that?)

(Sure could have crossed the Chinese and Turkish strains in my town last Dec, if people had been in the wrong places at the wrong times, and I bet it is similar everywhere else, every week of the year; such a business and vacation travel web, nowadays, and, people commute so far to go to work, too.)

here is a case OF closure (instead of case FOR closure) but I thought it might be good to post it here as an example.

Yancey Schools Closing Due To Illness ’ A possible outbreak of the flu forces Yancey County school officials in to cancel classes through early next week.

About 250 students have gone home sick with flu-like symptoms at two schools and several child-care centers this week. There will be no school Thursday, Friday and Monday. Tuesday is a teacher workday, so students will return to class next Wednesday, November 8th. The Yancey County Health Department is waiting for test results to come back to determine if it is the flu. If that happens, Yancey will be the first county in North Carolina to have confirmed flu cases this season.

(posted 10:00 pm 11/01/06)

http://tinyurl.com/y52v45

DennisC — seems like a good test case for us all. If it is the flu (regular, seasonal flu) how long will it take to spread to our town? If it hasn’t already, that is…. Glad I just got my flu shot! (Assuming it works…)

crfullmoon – at 14:04 …I bet it is similar everywhere else, every week of the year; such a business and vacation travel web, nowadays, and, people commute so far to go to work, too.

Perhaps, this may be true where you live, a busy urban area? But actually, where I live, it is rural, people rarely commute far and distance travel for most is famiy vacations over the holidays. Different approches may be beneficial for different situation…just another tool in the tool box for consideration.

Since children are such known germ-spreaders for disease, I’ll suggest that it is travel of CHILDREN that spreads infectious disease.

Children don’t travel much on business, but here in the states at least they travel en masse with their families over both Thanksgiving and Christmas vacation week(s). And, they travel to be with other family members, usually more children.

Of course, during a pandemic and certainly at the start of a pandemic, no one will be taking any vacations.

(Technically, I’m not in an urban area. But people will drive an hour each way to work in Boston, (or Worcester).

Even rural life is not insulated; remember the one dogsled mail delivery that virtually wiped out a village in 1918. You perhaps get truck drivers, mail carriers, military, national guard, or missionaries, home on leave?

Even if just one person goes on a business trip, or officials or first responders have to attend an out-of-town meeting or conference or training, and everyone else stays local, the world is eventually at our doorsteps…

Since I don’t expect the start of the pandemic to be recognized for what it is in time, and, people hate to lose money on plane and hotel reservations at the last minute,…or business conferences not cancel, I’m afraid people will happen to be on vacation at the start of pandemic. And then, people in the “wrong” places will be trying to get back home…

Might adults be bringing home illnesses that then children bring to school even if they aren’t the ones who travel or work in institutional care, ect?

crfullmoon – at 14:40 “Even if just one person goes on a business trip, or officials or first responders have to attend an out-of-town meeting or conference or training, and everyone else stays local, the world is eventually at our doorsteps”

just excercising my brain (and having fun :)

…True…I agree, there’s always some level of probability or risk. I guess I’m just playing the odds. The situations you are describing are always there; say it’s the baseline…and at the start of a pandemic, before people are taking a lot of precautions, the odds are just higher at certain times than others. Why not look harder when the risk’s higher?

barn owl – at 13:46

Anon_22 - Great summary. Very thought provoking.

I was wondering about one thing though; It has been my experience both as a student & as a parent the worst times for disease swapping is when the students have time to go away (more than just local travel), catch something from others & come back together to “share” with all their friends (especially the beginning of school, and after vacations).

What come to mind was after mid-winter break last year someone picked up the flu; within two weeks, over 80 middle school kids out of ~350 were out sick. It happened when I was in college too after Christmas break. They almost stopped classes for a day or two because so many kids were sick.

Has anyone given any thought to some sort of heightened awareness/ screening for those particularly vulnerable times? I see this as more critical in the reactive and/or punctuated scool closures.

If you look at the curves from 1918, most of those with really low peaks, ie communities that were successful with their interventions, had mini-peaks further down the line. I don’t think you can prevent a recurrence when school re-opens, but you can probably do maybe staggered openings, or some other sort of graduated response, again to mitigate the effect. The harsh reality is that the virus has to get to a certain proportion of people (around 35%) to produce herd immunity, so someone has to catch it, unless you have effective vaccines.

Personally, I do not hold out much hope for effective vaccines being made, mass produced, distributed to everyone within the timeframe of the whole pandemic. We’ll be lucky if we get some to most people by the end of the first year, and that’s assuming, again that the vaccine is both safe and effective.

So to go back to your problem, we may have to toughen our minds and admit that we can’t protect all the kids. Just as many as we can.

anon_22

Understood. Thanks. I guess I was thinking more along the lines of a delay strategy not a prevention strategy. Slow it down getting from into the schools so you wouldn’t get the big flare-ups.

anon_22 – at 15:27 So to go back to your problem, we may have to toughen our minds and admit that we can’t protect all the kids. Just as many as we can.

Anon_22, I don’t view school closure as a way to protect just children. It is clear after reading the TLC info that it is a way to protect entire communities.

On another note, I just got back from the school board meeting. Spoke briefly about the US Dept of Education webcast and IOM TLC info. Handed out my handouts with charts and text. Was essentially redirected by the school board chairman to e-mail my list of questions to everyone, they would respond, and we could revisit the topic at a later board meeting if necessary.

At the end of the brief discussion, the superintendent said, “We had a meeting with Ms. X last spring. She met with our school nurses. The nurses worked on it. We have a plan.”

Sooo…I will continue to pursue, but not feeling particularly hopeful at the moment.

Anon_22, The IOM conference…there is going to be an official report with the IOM recommendations and conclusions based on its research and the exchange of ideas at the conference, right? I need a contact person there to try to get access to some “official” information. Is that possible? The school board members want links to or PDFs of the info, but all I can find on the IOM site are the agenda items and task statement. If you are uncomfortable posting info here, you can e-mail it to me. If there is no one in particular you’d recommend I contact, I’ll just contact them cold.

Edna and all,

According to anon_22 on another thread (and I’ve checked ;), the slides are here.

So, the superintendent has all his school families stocked up for a pandemic year with no meds nor vaccines, and a high death rate in young people? O-K…

Maybe he can send the Flu Wiki out his home learning plans for when schools are closed and turned into an Emergency Distribution Site or Influenza Specialty Care Unit, too…

which of course must be well-stocked with meds and staff by now, since Dr.Nabarro said, 11 months ago, …The biology colleagues that I speak with tell me that if the pathogenic characteristics of H5N1 were to be taken forward as it mutates into having a human-to-human transmission capacity, then we would have a virus with high pathogenicity. …

We have an awful lot more to do with the current bird flu epidemic. It is really not under control at all, and that means we have to build up vet service quickly to get on top of it. The longer it’s there, the longer we have a virus close to humans that is capable of mutating and causing a pandemic. And the situation is very, very serious indeed.

Number two, we’ve got to be ready to contain the pandemic when it starts. And that’s done through rehearsals and other drills, clear command and control. It requires a level of planning and preparation that’s much, much greater than the majority of countries are showing so far.

Number three, the pandemic will kill when it comes. But more seriously perhaps, it will do massive economic and social damage, because our systems of trade, finance and governance are interconnected and will not survive the impact of a pandemic on workforces. We need to be able to deal with both the human consequences and the economic, social and governance consequences if we’re going to survive it.

And believe me, the pandemic could start tomorrow.

By the time the pandemic starts, preparation will be too late.

So, you should be doing this now, and that’s my message.

And are the superintendents all ready with the mental health care professionals? Death of children is the most traumatizing thing that can happen to parents, and there will be plenty of distraught, outraged parents who’ll want to see their superintendent and principal, and, other public health officials, if they find out they weren’t told about what an influenza pandemic with H5N1 was long expected to look like… At least the WHO report is finally saying “high death rates” out in the press.

Edna, I am thinking about approaching my kids school with this information also. I am not certain what response to expect (gratitude, disbelief, brushoff, labeled as a troublemaker/kook?). Most people have not had the time (or inclination) to absorb the information that is so obviously important to us. One year ago this was hardly paid attention to. Now there are so many official guides it is obvious that this should be considered seriously. I hope to sent this to not only my children’s schools (directors and nurses) but others in the area, the disctrict and public health department. Possibly we will not recieve the reaction we hope for but I believe as more pressure is applied (some) people will come to understand the need to share this information with all parents. Send links or print the material to anyone in the area, groups as well as individual parents. We will gather momentum one person at a time.

US National Parent Teacher Association Find Your Local PTA US National Association of School Nurses List of US State Associations of School Nurses Public Health Departments page on the FluWiki.

(reposting this quote from another thread, hope that’s ok - I added the bolding)

anon_22 said,

“Also, the doubling time for each generation of cases is 2–3 days, or at 10-fold every 7–14 days.

So the time difference between 1% and 10% is only 1 week, max 2 weeks.

At R0=2, if you act at 0.5%,

you are only 2–3 days away from the critical 1% threshold, beyond which the interventions are unlikely to work.

So because of the speed of an influenza pandemic, acting early only involves a few extra days of interventions over the wave of a pandemic.

The additional cost of acting early would be relatively small. Plus those extra few days are easily consumed by delays in implementation, compliance, communication, etc. “

crfullmoon – at 15:25

Thank you! To complete the summary, here’s the other post. A more thorough discussion, which I highly recommend, is on the IOM thread

Remember a pandemic develops very quickly, with a 10-fold increase in no of cases every 7–14 days.

It is more useful to think of the 1% as the threshold beyond which interventions are likely to be useless, rather than think of it as a trigger.

Consider a house fire. The sooner you use the fire-extinguisher, the more likely you will put it out. Theoretically, there is a point beyond which the fire-extinguisher will not do the job. Do you want to wait for that point? It would make more sense to start trying to put it out right away.

This is a great slide (visual) for absenteeism due to child minding, which is the central economic argument being used by those opposed to school closure.

All the slides related to the IOM workshop are here (no tinyurls - just the full-view link):

http://www.iom.edu/CMS/3793/37624/37630/38059.aspx

They are all PDF files, and the sum of sizes is about 7 megabytes.

I write this in case someone wants to show the slides to schools etc. All it takes is a CD or a pendrive or a laptop. Or even a few floppies. You only need to be able to see PDF files in the target computer.

Let people look at things and tell you what to do, for a change?

fredness at 9:12- “Edna, I am thinking about approaching my kids school with this information also. I am not certain what response to expect (gratitude, disbelief, brushoff, labeled as a troublemaker/kook?).”

Now, there may be a bit of a normal adjustment reaction, like everybody experiences. It’s scary stuff. School people may have to take some time to wrap their minds around it. I have recently experienced the brush off, disbelief situation myself.

BUT once people went and thought about it and did a bit of their own research, they came back and wanted to talk. So you go for it and know that you are doing the right thing. Just realize that the thought of what could happen to kids in a pandemic is so horrifying to people dedicated to keeping kids safe that they can’t handle the truth, at first. I’m still working on it, personally.

We’ve already had months; we need to start using every week…

(Why do officials think shielding the public from the truth now will go any good, when later, officials certainly are not going to be able to spare the public from suffering all the consequences? Communities should be preparing.)

All the best to you and yours, prepperbabe.

Those in the US, now that the elections are over, let’s get the politicians hearing the public asking, Where’s the local pandemic preparedness? -the public/private committees from the federal pandemicflu.gov checklists, planning contingencies to protect our communities, since the federal and state said it is our responsibility; they can’t help everywhere at once?

Don’t fear “panic”, fear public outrage when they figure out how old the key memos are that parents weren’t shown. If H5N1 goes pandemic as is, it may just be fatal to students, who need to avoid infection, and that takes education and preparation.

I work in a private k-12 school. We recently received a document on avian flu and under the “exposure assessment” I read “State regulations require a school’s faculty wait until 10 percent of their student body is infected before the school can be closed.” I’ve searched and searched for ANY such state regulation, and I can’t find one. The implications of this statement from the school seems not only uninformed but also an attempt to tell faculty that they must stay until 10% get infected. Has anyone heard of such a state regulation?

That was probably for normal seasonal influenza - can’t really see them saying that to parents and staff if those knew what the current crf and WHO age graphs look like, and the recent WHO statement that it is possible it go pandemic with current high fatality rate.

Schools, staff and parents, need to see the graphs on this thread.

(see at 09:30)None of those CDC spreadsheets were meant to be taken as what will happen; those mild, low, attack and cfr rates are supposed to be adjusted depending on what a virus is doing…

If “open honest timely information” gets to them, somehow, people may “vote with their feet”.

The MA prepper thread had some lawyer going to give a talk about private school contract obligations during pandemic, I think…

Do schools really want something that is contagious before symptoms and may be completely fatal in young people who need ventilators (and there will not be enough, nor any antivirals for them) to hit 10% of their school? What if that turns out to be “until 10% of the student body is dying”?

Cases double every 2 to 3 days, tenfold in 7 to 14 days, right?

I’ll post more about this later, but I had a meeting yesterday with someone who is responsible for pandemic planning in our state. I gave her my little TLC/early school closure schpiel…

Come to find out, our state epidemiologist was at the IOM conference and is on board with TLC. PLUS, our state has legislation in the works to give the gov power to close all schools during a state of emergency.

Best part…it appears that the planners understand fully that school closures must be done early rather than after the fact when half the school population is symptomatic.

The law, which did not pass last session because it had a less popular amendment tacked on at the last minute having to do with Real ID issues. Hopefully that won’t happen this time around.

This page is being wikified.

I think the wiki page may need some structure. Something like this:

• Our response toolbox includes:
  1. avoiding infection
  2. treating infection, and
  3. dealing with the consequences of the pandemic and of our response
• Avoiding infection will take some pressure off the whole system. There’s a small but growing body of evidence of what would or would not work. We’re also getting a sense of what would really be available and for whom.
• Vaccines won’t be available in the first half of a pandemic unless things change a lot. Antivirals, where available, have an important role but it’s also a limitted role. Immunomodulators such as statins have at least some potential. Respirators, commercial masks, simple masks may add to the whole picture. Researchers are looking for evidence. If a pandemic strikes before there’s evidence, we’ll use whatever is available.
• Then there’s NPI … and here comes the wikipage.

Does the above sound right?

I guess I’m trying to frame it as a specific point of entry for people who might get into this mess, coming from the very valid “I have kids” concern, in a personal attempt to unravel it inside their own minds.

This “point of entry” would let us show them the big picture too.

Kind of like walking into a planetarium.

Imagine Carl Sagan explaining things on tv.

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Fredness: regarding approaching school officials. One thing that I did was approach board members I know personally (I don’t know them well, just casually from kids’ sports). By bringing it up in more causual conversation at soccer games then giving them some info later I think this has helped. It has taken some time for them to digest it and do more research. If anything I appealed to them on the paretnal level vs a board member. But, I am hoping this will intice them to take it to the board this month or next. I also sent them all the great info lugon put together.

Thanks for the great slides, anon_22 & Lugon.

I am definitely finding that the biggest objection to school closure is the “but what will we do with the kids for 12 weeks?” question. This is the objection given by those who are not thinking of the economic consequences, but those who just don’t know what they would do with their kids at home for that period of time.

I am beginning to answer by saying “I don’t care what they do for that 12 weeks. I don’t care if they all watch Sponge Bob marathons 24/7. I only care that your child is able to return to school, and is still alive, after that 12 weeks. In the end, whether or not they got any algebra done will be immaterial.”

The funny thing is, they seem to “get” that.

That usually opens up the topic of CFR and the age ranges involved in most H5N1 infections. When put that way, and the parents truly understand the threat, 24/7 Sponge Bob marathons for 12 weeks doesn’t seem so bad.

Still working on the wikified page. Added an entry point.

I’m glad this is useful, LauraB. Thanks!

Added some comments (from this thread) about pandemic speed.

It looks like we can now add an index at the top, no?

Pixie - this page (the wikified one) might be seen as a begginning, not an end. Assume it comes, assume we close schools down (before the close themselves down, that is) - now what?

Knowing what the size of the problem is in each community, and being creative about what to do: “what can they do?”, “what would they need/want to do?”, “is there anything we want them to do?”. They might learn a bit about urban agriculture, etc. Back to tribal. Techno-geekery. Or whatever. Options are good in this case.

That’s the new problem. We need a “Schools Closed, Now What” thread. Or if it has been covered already (I guess it has), then wikify that.

Hoping we have time for that, and then some more. :-)

A “free time at home is a resource, not a problem” sort of approach. Hmm …

Lugon, I agree that the next step is your idea of a “Schools Closed, Now What” thread.

I had the converstion on school closure with my children’s pediatrician last week. She was well aware that they are urging school closure for 12 weeks. She thinks the idea is absolutely necessary, and in the case of our area that the schools must be closed as soon as pandemic cases are identified anywhere in the world due to the high level of international travel here.

However, she still voiced the “what are the kids supposed to do for 12 weeks, they have to learn something” concern. Her suggestion was that our state dept. of ed. begin to work on generic curriculums for each grade and distribute them via the internet. I was trying to be positive, but I was thinking “I don’t think we have time for that.” Curriculums take a lot of time to draw up, especially by committee. And while some states at least have statewide textbook approval, we here in New England are more independent sorts which means that each town determines its own textbook purchases and curriculum. Hooking up a “see you - see me” internet camera system for the kids and teachers at home would be possible, but again by the time that there is finally “belief” in a pandemic because it is on our doorstep, there won’t be time to allocate those resources.

The time factor, then, seems to be the biggest blockade to doing something effective with that 12-week isolation. If school boards acted now, many creative responses could be found. But we know none of them will work that proactively, and action will only be agreed to once it is apparent that a pandemic has begun. Then we have the equivalent of 15 minutes to get our ducks in a row.

We should do the “Schools Close, Now What” thread because once it happens, they’ll be looking for ideas. And, who knows, somebody out there could be moving ahead proactively. (Somebody??) The idea of creating useful onlilne courses is something that could be done, and certainly we could link to the many online courses that already exist out there. It’s a start. (And Lugon if you are planning on creating the Techno-geekery course, sign me up because I am clueless in that area!).

I’ve added an index.

I’m not sure it’s a linear story we’re telling. I’d like it to be compelling, readable in one go, with each section eliciting questions that are answered to in the next section.

We’re getting near that, I think. Not there, but near. It needs some more thinking.

Pixie,

There’s vast resources we could tap into. (Love that phrase.)

People have been doing home schooling and distance education for ages. There’s downloadable books and stuff. We need to work with others.

The less time we feel we have, the more we have to do just that.

And no, I have no plans to create any techno-geekery course - unless someone teaches me some urban agriculture. ;)

lugon — sometimes I think I almost understand you but then I get lost again. Can you elaborate on your last post? You are looking to explain why schools will close and what that will mean for folks at home?

As to some earlier post — parents will click on to the idea of “what to do with their kids” instead of “why keeping kids from school during infectious illness is a good idea” at first because in their past experiences, most of them have had their kids home in snowstorms or whatever for serveal days to a week — they know what that is like, that it was hard, they have that experience to glom onto. Very few of us have actually experienced a deadly infectious pandemic.

I think the schools-closing-for 12-weeks, think about what you would do with the kids — is a very good entree to the complexities of what a pandemic may be like.

Here’s a crazy idea - sorry it is US focused because I don’t know the state of education in other countries — all over the US schools have cut music, art and even PE to get kids ready for all their standardized tests. Let’s encourage every household to stock recorders (cheap) or other musical instruments, learn-to-read-music books, song books, basic art supplies along with learn-to-paint and draw and skecth lesson plans — and a daily regimine of no-possible-harm calisthenics and physical activities. Provide a sugested schedule and list of cheap materials. For most kids there’s not much chance they’ve had a lot of this at school anyhow, and the parents could learn it too.

“lugon — sometimes I think I almost understand you but then I get lost again. Can you elaborate on your last post? You are looking to explain why schools will close and what that will mean for folks at home?”

Hmm - no mistery I hope. I was thinking out loud about the index; the index at the top of the wiki page.

The content is all there: each “slide” is meaningful.

Now, is there a better way to sort the slides?

It’s like this, right now:

   1. Framing the issue
   2. Abbreviations
   3. Reasons for NPI
   4. Basis for TLC
   5. Assumptions
   6. Mortality
   7. Mitigation strategies should be tailored to severity of pandemic
   8. Pandemics happen extremely fast
   9. Evidence presented at IOM meeting
  10. Case for early school closure
  11. Benefits
  12. Secondary Impact of school closure & their mitigation
  13. Precautionary principle

Maybe “assumptions” should be higher up? And “benefits”?

Still working on it.

Forum.SchoolsClosedNowWhat

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maryrose,

our school plan states that the school will close when we have our first confirmed case in the school population. Death sentence!

Birdie Kate – at 23:08 first confirmed case -Death sentence

I agree, It is wiser to put your mask on before TSHTF not after.

I have found that school officials, and parents, are really having a problem confusing the “regular flu” with “pandemic flu.” I have tried to find a better analogy.

The schools and parents are very focused on predators of late. It’s the kind of topic that Dr. Phil airs frequently, and it is one that all school districts have been forced to think about. They have not had to think about influenza much lately, however.

I have begun to try to run a new analogy by some people recently.

If there were a “predator” lurking near their child’s school that was routinely victimizing 30% of the school’s children day after day, what would they do? The answer often is that they would close the school until the “predator” was found and stopped.

I then ask what they would do if that same “predator” routinely then killed 70% of those victimized kids (or, pick your own %CFR). Would that be acceptable? They invariably say “no,” and say that they would really have to close the schools until the predator was contained.

For some reason, I have found that people understand this analogy. On the other hand, I have found that more education about “flu” is confusing for most, and they don’t understand the heightened threat implied by pan-flu (particularly H5N1) and the danger it presents to children (unless we go down that “ok, well your kid will turn blue and then….” path, which I try not to). But this analogy of a vicious “predator” that the kids need to be protected from, that they understand.

This thread has been copied to the new forum, and discussion will continue here. Thanks!