Swine Flu School Closures Continue In NY Metro Region

The New York metropolitan region continues seeing new cases of influenza and 17 schools have been closed in the past few days. The majority were closed following the death of assistant principal Mitchell Weiner, who worked at one of the affected schools. His school was closed days after Weiner and others contracted the illness.

It's also reported that an infant may have died after contracting the swine flu. One can clearly sense the rising fear and apprehension among the public in the area over the swine flu and the media response hasn't exactly helped matters either.

Every year, 36,000 people die of influenza in the United States, but that number doesn't generate the kind of fear that the swine flu and the relatively few cases that have come to light. It's in the absence of information that fear spreads, and school districts are grappling with that lack of information and are going to make bad decisions.

Here's what's known so far:

Education officials said citywide attendance yesterday was at 85.1 percent; last Monday, it was 86.5 percent.

Meanwhile, yesterday:

* The city Health Department said there have been 192 confirmed swine-flu cases in the Big Apple.

The Centers for Disease Control and Prevention said about 100,000 people are likely infected with the new flu around the country. Dr. Anne Schuchat, an interim deputy director, said the 5,123 confirmed and probable cases and six deaths in the United States were "the tip of the iceberg."

Many other flu deaths are likely to be masking the number of swine flu cases and vice versa since the symptoms are indistinguishable from each other.

There is little guidance on how school districts should respond.

Many school officials have shut the doors and had the custodians disinfect the empty buildings.

But that leaves parents confused and frustrated. Those whose schools remain open may fear that their children are in danger, and those with healthy children whose schools close may feel that officials have overreacted, burdening them with day-care costs and denying their young ones an education.

Even guidance from the top is ambivalent.

On May 4, the acting director of the Centers for Disease Control and Prevention, Dr. Richard E. Besser, said “closing schools is not effective” at halting the spread. Previously, the centers had advised schools to shut for up to two weeks if a confirmed case was found.

On Monday, New York City closed four more Queens schools after outbreaks of flu symptoms, bringing the total to 16 ordered shut since last week. In Texas, hundreds have been closed at various times.

“There’s no right answer,” Mayor Michael R. Bloomberg said at a news conference. “I’ve asked the question, ‘What would you do, Dr. Frieden, if you wanted to prevent the spread of flu around the entire student population?’ And the answer is, ‘Closing the schools for a month, prohibit all interaction among kids outside of school, and even then there’s no guarantee that you can do that.’ The bottom line is, case-by-case basis is probably the right thing.”

(Mr. Bloomberg was referring to Dr. Thomas R. Frieden, the city’s health commissioner, who has just been nominated to be chief of the C.D.C.)

Many parents and teachers have been calling local lawmakers wondering if their schools would be closed, said Eric Gioia, a City Council member from Queens who wants parents to be given the results of flu tests at their local schools and daily attendance figures.

Information is the key detail, and on that point Dr. Frieden's ability to disseminate information in a timely manner and maintain perspective on this public health threat hasn't exactly put the public at ease.

One has to wonder whether people are reacting differently to this particular flu outbreak because it was a named flu, rather than the garden variety influenzas that ravage anywhere from 5-20% of the nation every year.

The closure of schools is as much a political decision as a public health decision. The closures may prevent the spread of disease between students, but if infected individuals come in contact with other people, the disease will continue spreading. Also, if officials closed every school where students have flu symptoms there would be no schools open since influenza is a common ailment throughout the school year. Surely, there is no right answer since public health officials have to gauge the merits of keeping the schools open versus closing them and they will not know whether they've made the right decision until after the fact. It's too easy to second guess these officials.

The school closures also don't help parents deal with the fact that their kids are now suddenly home on an extended vacation. What are parents struggling to make ends meet at their jobs supposed to do? Parents can't just stop going to work to care for their kids, and some parents have been sending their kids to school while they are showing symptoms of influenza because they aren't able to stay home to care for their kids.

Some of the affected schools saw dozens of students come to the school nurses seeking medical attention. Reports that kids were nauseous and vomiting in class are prevalent, and it needs to be stressed that parents who see that their kids are showing symptoms must keep their kids home - not only for their own children's protection, but to protect their classmates from becoming ill.

Also, the whole idea of disinfecting schools is useless, as the virus can thrive for up to three days and the moment schools reopen, any infected students will quickly spread the disease among the population. The disinfection of schools is done for show (though it probably is a good idea to improve the hygiene at schools generally).

Still, it is cold comfort to those who are coming down with the flu, and swine flu is suspected in the death of an infant in Queens.

City and hospital officials said it was too soon to tell for sure if the baby succumbed to the H1N1 swine flu virus spreading sickness and death around the world.

"It will take days before the Centers for Disease Control and Prevention can confirm or deny that," said hospital spokesman Dario Centorcelli.

The unidentified infant's parents noticed he had a high fever when they put him to bed Monday night. They brought him to the hospital after he started turning blue, Centorcelli said.

The baby was pronounced dead at 10:20 p.m.

His 3-year-old brother and 1-year-old cousin were also being treated for flulike symptoms at the hospital.

UPDATE:
The CDC notes that about half of the influenza cases being reported are the H1N1 swine flu, with the rest being the normal circulating flu:

"We are now experiencing levels of influenza-like illness that are higher than usual for this time of year," Schuchat added. "We are also seeing outbreaks in schools, which is extremely unusual for this time of year."

New York City Health Commissioner Dr. Thomas Frieden agreed with Schuchat.

"We're seeing increasing numbers of people going to emergency departments saying they have fever and flu, particularly young people in the 5 to 17 age group, " Frieden, who has been named by U.S. President Barack Obama as the new CDC director, told a news conference.

About half of all cases of influenza are being diagnosed as the new H1N1 strain, while the rest are influenza B, or the seasonal H1N1 and H3N2 strains. Flu season in the United States is usually almost over by May.

What has public health experts worried is that there are a larger number of young adults sickened and requiring hospitalization, plus that this is at the tail end of the typical influenza season.

UPDATE:
The infant previously reported as having died from swine flu did not have the H1N1 strain, but further tests are needed. Also, 26 schools are now closed as a result of flu cases being reported.