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Give the Kids a Break, Cos They Deserve Their Lives

by: SusanC

Wed Apr 29, 2009 at 21:12:43 PM EDT


UPDATE Just a heads up to readers, I've since changed my assessments in line with new information available.  Please see this diary  May 4, 2009 19:00 EDT
SusanC :: Give the Kids a Break, Cos They Deserve Their Lives
It's only a few weeks before schools break for the summer.  A nationwide early dismissal of classes will put a powerful brake on an outbreak that is on the verge of becoming explosive.  Millions of lives may depend on decisions made in the next 48 hours.  TPTB must find a way to make it happen.

It's often said that 5 minutes into a disaster, all plans go out the window.  We say that not because the plans are useless, but because the best plans cannot take into account the infinite number of ways that events will unfold differently than you anticipated.  Here's one (almost) amusing example, a screenshot from pandemicflu.gov that says we are in WHO Pandemic Phase 5 and US Pandemic Phase 0, even though the US now has the largest number of confirmed cases outside of Mexico.

This is because when the plans were being written, the biggest threat on the horizon was avian flu H5N1.  A pandemic seemed most likely to start from a country far far away, such that the first human case in America would not happen till some time after the beginning of WHO Phase 6.  (see this chart for Federal Response Stages)  

Since we are (still) not in Phase 6, the Federal Government Response Stage remains awkwardly stuck on 0.  ;-D

But, that's ok.  As the CDC has repeated in the past few days, it doesn't matter what we call it as long as we do the right thing.  I agree wholeheartedly.  Still, this issue is important because when it's time to activate those plans, like now, we need to apply the same logic: it doesn't matter what the original plans said as long as we do what those plans were intended to do.

Now that cases are appearing all over the country, and with the tragic death of the first child, it's time to activate the community mitigation strategies.  Here we encounter the same problem, as stated in the CDC swine flu website, posted on April 28, 2009 02:45 PM ET:


The previously published United States government guidance on community mitigation relies on knowledge of the Pandemic Severity Index (PSI) to characterize the severity of a pandemic and identify the recommendations for specific interventions that communities may use for a given level of severity, and suggests when these measures should be started and how long they should be used.

The substantial difference in the severity of the illness associated with infections from the same virus, the relatively low number of cases detected in the United States, and insufficient epidemiologic and clinical data to ascribe a PSI, present a formidable challenge in terms of assessing the threat posed by this novel influenza A virus until additional epidemiologic and virologic information is learned.

Quite.  Especially if you have some rather weak links in the system.  And especially if the plans depend on these links for activation/implementation.

Like other federal guidance, the CMG was written with the assumption that implementation decisions will be made at the local level.  However, just like the Federal Response Phase 0 situation, reality is very different from what's in the book.  For example, there is huge variability in how familiar state and local PH are, with either the original CMG guidance issued in Feb 2007, or the more recent Federal Guidance for States released in 2008, with this chart created to inform the timing of activating interventions.

This chart may look familiar to us diehard flubies, but government moves slowly, and many state and local PH had not gotten round to integrating the recommendations in this (and other) federal documents, before the current H1N1 pandemic is suddenly upon us.  For example, the pandemic flu preparedness and response plan for NY City, has a publication date of July 2006, with a cover letter signed by Mayor Bloomberg.  OTOH, while the NY State pandemic plan released in June 2008 does include community mitigation plus the triggers and intervals, it is not clear how the state vs city plans are supposed to work together.  We have already seen how, despite having the most number of confirmed cases in the country, NYC continues to close one school at a time as cases are confirmed, as if infected kids will somehow magically only excrete virus in school, but not anywhere else on their way to and from school, hanging out with friends, being with their families, etc.  

Texas, the state with the second largest number of confirmed cases, 1 dead toddler, and 2 others in critical condition, is not doing any better either.  Watch this Houston official saying reassuring words to the public after the death of the first case of swine H1N1.  I'm especially astonished by the logic expressed by Dr. David Persse from the Houston Department of Health and Human Services, that since this child was a patient transferred from elsewhere, his death "really doesn't change the landscape" of risk.  

While WHO, CDC and other scientists scramble around the clock to collect information on the severity of this outbreak, it doesn't seem to disturb Dr Persee that the death of this child just overturned the widely held belief (or hope) that cases outside of Mexico tended to be mild.  I suppose if you've spent substantial parts of your career differentiating between what counts and what doesn't count, for bureaucratic reasons, it would be hard to imagine there may be other reasons to start thinking differently, eg, that disease transmission respects no borders nor categorization, and that a sick and dying child may well be the tip of a gigantic iceberg of unidentified or incubating cases ready to explode into the community.  In a sad mirror-image of CDC's approach, it appears that here the logic is, it doesn't matter what we do about it, as long as we count it correctly.

What are we left with then, this morning as the world stares into the abyss?  

We are on the brink of a pandemic caused by a virus with less human-adapted genes than any other virus since 1918.  The age distribution of fatal cases in Mexico is also reminiscent of that pandemic.  With 1 dead and 2 on the critical list and 16 confirmed cases in Texas, hopes for a 'mild' outbreak may be receding.   It's obvious that this virus is transmitting easily and rapidly, with an R0 possibly much higher than originally assumed when the CMG interventions, intervals, and triggers were put together.  The situation is evolving faster than our ability to identify, diagnose, and report cases.  The outbreak is reaching the classic 'explosive' point in NYC, the most populous city and home to Wall Street.  

The stakes are high.  It's time to activate community mitigation interventions, not piecemeal, not school by school, not driven by the residency status of a particular case, but as one would launch the New Deal or the Manhattan project, courageously and ambitiously.  A country is nothing but a community of communities.  The mechanism for mitigation may be local, but the benefits of success will cascade to every single community whether cases have been confirmed or not.  Successful mitigation in the US will generate the data upon which other countries can base their mitigation.

Can this be done?  I don't know enough about Fed vs state jurisdiction to tell.  But these are extraordinary times, and there are many extraordinary heroes working tirelessly to combat this threat to humanity.  I'm confident the will exists; I'm sure they will find a way.  They cannot fail.  They must not, for the future of our children are in their hands.

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A nationwide early dismissal of classes?
The mechanism for mitigation may be local, but the benefits of success will cascade to every single community whether cases have been confirmed or not.  Successful mitigation in the US will generate the data upon which other countries can base their mitigation.

These are both excellent points.  

A nationwide early dismissal of classes would need to be accompanied by frequent explanations of why this is needed -- not just "to keep kids safe" but "to slow the spread of illness so health care can keep up with the more severe cases"... one of which may be YOU or YOUR CHILD even if no one is currently sick at your child's school.  

I have hopes to see early school closure happening here in the US, but did not think of the repercussions for other countries, many of whom have very poor health care, little Tamiflu and little hope of vaccines.   Social distancing may be all they can do, and if we in the US can do it, they can see how much better it works (hopefully) if started sooner rather than later, as in Mexico.

GetPandemicReady.org - non commerical website with practical ways for families to prepare.


Bravo Susan and ACM
Let me state here and now that these two people informed me about this issue several years ago. They have been in the first ranks for why early school closure is one if not the most effective NPI PH measure to slow the pandemic strain's transmission rate.

Thanks guys.  You are the greatest!

It is hard to focus on what is important when so much is happening.  Clearly you two have the vision and knowledge to do just that.

GW


[ Parent ]
Follow the lead:
I can think of no better words than those of the Comal County School Districts that closed their schools in Texas:

"So, out of an abundance of caution and because our school district needs to do its part to help stop the spread of infection
.

It's time to throw caution to the wind and get the schools shut. This is no time to be playing with the lives of our children.  

www.EmergencyHomePreparation.org -- A 'card-catalog' style of prepping information.   -


Shut the schools
The time is now, not later.  The child you save may be your own, whether they are 12 or 22 years old...or even 42.

[ Parent ]
You too ReadyMom
have been a long-term advocate of early school closure.  Well done.

Gw


[ Parent ]
If...
schools are not shut in time then there will be huge numbers of children in need of anti-virals, as well as their infected family members.  This will rapidly deplete the stocks.  Close the schools and the anti-virals will go much farther.  Every day which delays the spread of this disease is another day in which anti-virals can be manufactured and brings us a day closer to a viable vaccine.

You got it in one Okiman
GW

[ Parent ]
And if we limit antivirals to "serious" cases
the one's that need it may be given it too late to help.

A difficult choice.  

ITW(Joel J)
Courage is resistance to fear, mastery of fear - not absence of fear.
- Mark Twain
 


[ Parent ]
"Precautionary principle" should work here, too.
Close the schools and colleges and explain why.  Right now there aren't many people (employers, parents, officials) who know the elements of the case that SusanC has made, but they can learn it if it's explained.

Waiting to close schools until cases appear reminds me of whack-a-mole, except in that game, you expect the mole to reappear.  New cases shouldn't be a surprise; they will keep popping up, just like the mole.

When historians analyze this later, it will be clear what should have been done.  Who wants sorrow, regret, and guilt as a legacy?  Or a citizenry that has lost its trust and become angry?

"The truth does not change according to our ability to stomach it."  Flannery O'Connor


on line
I have now moved all my final exams (college - next week) to be available on line.  No one will have to come to class to take the exam unless they really want to... but everyone liked the on line idea  (open book, unlimited time... ).

I really teach at two colleges - two classes "live" locally and one on line (Amridge Univ) that has students all over the world. (hay you can get an accredited degree from home- not bad for the current events).  Students are happy to do college safe from home (or one in a foxhole).  I am getting rumors of flu events now from all over the world-  Lot of rumors of sick people but no deaths.  Parents should consider on line colleges for the fall - I think it will really hit  bad then.  If you pick an accredited college most of the credits should transfer latter if you pick the right classes.  There are quite a few these days that have some online classes.  - Keep the kids safe.  

Be Prepared


[ Parent ]
Excellent Example. Bravo. On-Line Tests For Everyone
This is the kind of thing that, with a little bit of preparation and organization, can save lives without spending billions of dollars.  

Let's get to it.  

ITW(Joel J)
Courage is resistance to fear, mastery of fear - not absence of fear.
- Mark Twain
 


[ Parent ]
The only issue I can see with that is
What if someone doesn't have a computer or netbook and internet access at home?

That probably isn't an issue at college, since most that go to college have to have a computer, but for the poor/homeless in the lower grades that might be an issue.


[ Parent ]
there will always be trade-offs
and compromises.  We all wish there is no pandemic, ever, and we can always do things the way we want.  But reality does not work like that.  

The virus does not care whether your kids have computers or don't have computers.  

If this turns out to be anything more than a moderately severe pandemic, the life experiences that kids will gain, living through it, will affect them for the rest of their lives.  As parents, we can help give them some perspective, that life is not just about getting grades and passing exams.

Just my 2 cents.



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


[ Parent ]
Agreed about the grades and exams - not so important for sure
I was just thinking about maybe something could be done for the issue of not having access, like having those with more than one computer loaning them out, and the phone company instituting internet access for those that qualify for things like food stamps.

That would probably take too long, though.

Oh, wait, couldn't things be done over cell phones? Can't people browse the web with those? (can you tell I am not familiar with them?) Perhaps people with more than one could pass them along to those in need.


[ Parent ]
Creative Accomodations
Even if they had to come into school or go to a local library, if social distancing rules could be maintained, it is better than packing them into a petri dish, I mean class room.  

ITW(Joel J)
Courage is resistance to fear, mastery of fear - not absence of fear.
- Mark Twain
 


[ Parent ]
School bus
When I was a kid I had to ride the bus for an hour to school and an hour back home.  School buses are not good places to be during a highly contagious disease.

[ Parent ]
What if you taped off seats to create distance?
That may not solve the school issue, which has other implications, but mass transit - do we just shut it down or try to apply safe distance rules?

BTW:  Every time I hear, "when I was a kid" I think of my Dad, who used to tell us "when I was a kid, to get to school we had to walk two miles each way - to and from school, and it was uphill both ways."

You think you had it rough.  : ^ )  

ITW(Joel J)
Courage is resistance to fear, mastery of fear - not absence of fear.
- Mark Twain
 


[ Parent ]
my hope is for churchs,.... to help
My hope is that temples, mosque, churches will help take care of the kids.  It does not have to be classes but in people's home.

We will need to help each other.
I know I would help keep 1,2,3, kids during the day if asked/needed.

I am already getting the church to let me convert the sermons to MP3 files so we can have "online" church for those ill or want (I hope) to stay away.


Be Prepared


[ Parent ]
Faith Based & Community Organization - No time like the present Links
Faith-based and community organizations will play an integral role in the event of a pandemic. The Department of Health and Human Services (HHS) and Centers for Disease Control and Prevention (CDC) have developed a checklist to assist community organizations with their pandemic planning. The Medical Reserve Corps has adapted HHS planning checklists to create guidelines for Medical Reserve Corps (MRC) units.

http://www.pandemicflu.gov/pla...

Southern Babptist Convention
Associational Preparedness for Disaster Relief
Manual:

Introduction
The goal of the Associational Preparedness manual is to help associational leadership learn about disaster relief needs and resources in their area, evaluate their disaster relief possibilities, and develop plans and protocols to assist churches in responding to the community following a disaster.

A pretty "hands on" manual that could be adapted to many religious or community organizations.  
Includes forms:

Appendices
Appendix One: Church Member Disaster Relief Interest and Skills Survey 6
Appendix Two: Church Potential for Disaster Response 7
Appendix Three: Inventory of Key People in the State, Country, City, and Community 8

http://www.namb.net/atf/cf/%7B...

Strengthening the Strengtheners
A Toolkit in Public Health
Emergency Preparedness and
Response for Congregations

http://www.montgomerycountymd....

ITW(Joel J)
Courage is resistance to fear, mastery of fear - not absence of fear.
- Mark Twain
 


[ Parent ]
You are too cool Dennis, way to go!
GW

[ Parent ]
Wake a Mole
Absolutely, waiting until the first case is confirmed in a school to close it is waiting too long.  The delay between case confirmation and spread of the disease takes a week to 10 days due to the fact that it takes a couple of days to confirm a case and that kids infected with the virus remain assymptomatic yet infectious for a week or longer before getting sick.

Schools have to be closed before there is a confirmed case or an asymptomatic case to be an effective NPI.  

This is why I called for this last Sunday night. I call for it now too.  Specifically all Mexican, US and Canadian day care centers, schools, and universities should be closed post haste.

Grattan Woodson, MD


[ Parent ]
Forgive my ignorance
But what about the current flu is substantially different (in terms of CFR) than a seasonal flu? Why don't we close schools every flu season? You could make the same arguments as above for seasonal flu b/c the flu does kill. Help me understand...I'm very new to this flu stuff.

On another note, there is an online option for school for younger kids too. Check out www.k12.com. Much of the time this curriculum is available through the state as a public school option. I'm considering it for next year so I won't have to deal with these issues.


Different from regular flu
Magdelaine: I am not even nearly a doctor or medical expert, but when you get a flu from a different species that kills healthy young adults, as in Mexico, and health care workers, it is not like the seasonal flu. It is true that so far the experience in other nations (including the US) has not been nearly so bad as Mexico, but the feeling is that until it is clear that Mexico is for some unknown reason an exception rather than the rule, it is better to be safe than sorry. Also, there is no vaccine right now and supplies of Tamiflu would run out or run low if mitigation measures were not taken. The Tamiflu might be needed in the fall, when some fear (as in 1918) a more deadly second wave. Finally, even if this flu "only" killed another 30-40 thousand in the US and pup to 1 million globally, many might imagine that some extra precautions were in order, no?  

[ Parent ]
the difference lies in the degree of susceptibility
Most people have some immunity to seasonal flu.  In any single season, about 5-20% of people become infected (CDC), and the disease is milder.  

But with a novel/pandemic virus, everyone is susceptible, so you get much higher infection rates (30-50% or more depending on density of the environment), with many people getting sick and overwhelming healthcare services.  This happens even in a normal bad flu season, but it gets a lot worse with pandemic flu.  Which is why it is so much more important to dampen down transmission.

Go for more on school density, transmission, and how to use community mitigation to save lives.



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


[ Parent ]
Mitigation!
Ah ha! Now that makes sense. I live is a small, rather isolated town of about 27,000. It wouldn't take a lot for our local ER/hospital to be overwhelmed (in fact it happens several times a week), and the nearest emergency services are a forty-five minute and two hour helicopter/ambulance ride, respectively. Now, given the effect that mitigation has on sheer numbers of sick individuals, it makes a lot of sense for our school district to close before cases are detected in schools. If not, it may be too late to prevent a major health crisis in our little town by the time the first cases are detected.

Hmmm. Is there a CDC document you could point me to for this information? I might be able to make some headway with the school board if I have the facts laid out in a way they will accept.


[ Parent ]
yes that would be very helpful
Hmmm. Is there a CDC document you could point me to for this information? I might be able to make some headway with the school board if I have the facts laid out in a way they will accept.

Here's the link to the CDC page, with the latest guidance and document http://www.cdc.gov/swineflu/mi...




All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


[ Parent ]
Thanks!
I'm contacting school board today.

[ Parent ]
I see that now you have gotten it M
Way to go..

GW


[ Parent ]
But will the kids stay home?!
I was just reading a comment on another board from someone in, IIRC, Texas, who said she popped out to the mall & grocery store & it was FULL of teens as one of the local schools had shut. The kids are all 'whoohooo, day off!' and goofing off in public places.

Pretty much defeats the point of shutting the school.


malls should close to kids
If schools are closing to prevent spread of illness, then as a public health measures children should not be permitted to congregate elsewhere.  Movie theaters, malls, etc.

Going to the grocery store with parents is a different thing in my book.  Yes, you come into contact with some people, but it would be nowhere near the 100+ in close quarters children come into contact every day in the school setting.

GetPandemicReady.org - non commerical website with practical ways for families to prepare.


[ Parent ]
good question!
We've heard this 'objection' over and over again, that if you close schools, kids will just go to the mall.  What most people do not realize, is that kids come into close contact with many times more people during the schoolday, than they would meet in the mall.  This is especially so for high school students, as shown in the following handout





All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


[ Parent ]
the prep school in NYC
where some 200 students fell sick within a couple of days, had 2,700 students.  



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


[ Parent ]
thanks for that
Very informative brochure.

I homeschool my kids anyway so I rarely pay attn to school stuff - except that I notice if it's pro D day because all of a sudden we don't have the world to ourselves any more LOL.


[ Parent ]
That's Why It's Necessary to Explain "WHY" We're Shutting Schools
If I explain the principle or rule behind the action, it's always easier when a slightly different situation comes up.


ITW(Joel J)
Courage is resistance to fear, mastery of fear - not absence of fear.
- Mark Twain
 


[ Parent ]
Good point
You have to keep them from getting together with their friends.  I know this is a tall order but is what we need to do.  I would suggest we allow them to be with two or three neighborhood friends but not go to the mall of movies etc.  To allow that would defeat the purpose of school closure.

GW


[ Parent ]
I sent this diary link to the directors of Public Health for IL and for my town.
I hope they read it soon.

Wonder if these officials from different states and different towns talk to each other about closing their schools?  The more who read SusanC's essay, the better.  

Has anybody else sent it out?  Post here if you have.  Magdelaine has a good idea about sending it to school boards too.  That's my next step.

"The truth does not change according to our ability to stomach it."  Flannery O'Connor


I just sent it to both the elementary and the high-school school boards. n/t


"The truth does not change according to our ability to stomach it."  Flannery O'Connor

[ Parent ]
Closing universities...
I work at the University of Delaware where we have 4 confirmed cases and 12 more probable cases -- they will not close the university because then the kids will go home and infect their communities. However, they don't know if those 4 students have remained on campus or went home...

So they'd rather have the kids stay there and infect more of each other
and then go home and infect their communities.

Ijots.  

ITW(Joel J)
Courage is resistance to fear, mastery of fear - not absence of fear.
- Mark Twain
 


[ Parent ]
I agree...Ijots...
You hit the nail on the head.  Finals haven't started and graduation isn't until May 30th.  We have a 'small' group from the CDC here on campus evaluating things -- not sure what that is all about.  Faculty and staff are being told to see their personal physicians if they aren't feeling well, so no one is tracking the number of non-students that may be sick. Also, a large number of students opted to be seen in the local ER instead of using student health -- there numbers aren't being tracked either.  

[ Parent ]
Hmmm
What you describe seems to me to be an excellent reason to close before any cases emerge.

I believe we had a discussion on this forum once about children at college and whether the parents would stand for them being forcefully kept there under quarantine.  I don't remember it being a happy discussion.  


[ Parent ]
That is the most ridiculous excuse I have heard so far
for not closing the schools.  While they are correct, the longer they wait to close the schools the more children will contract the virus and take it home with them.

What a disaster!

The crazies really are running the asylum.

Where do these officials get their advice?  

GW


[ Parent ]
Planning guidance for parents
Parents need clear guidance NOW as to how to plan for school closure. I don't watch enough TV - is this happening?

Work out flexible hours/work arrangements with employers ahead of time when possible.
Work out a two- or three-family collaborative plan and keep no more than 5 kids together.
Avoid taking children to places that are crowded - malls, church, movie theaters, and the like.

The list is longer - my time isn't.  What else?


Make suitable arrangements in shared custody situations
What "suitable" is will obviously vary, but if shifting between parents adds to the numbers of groups or individual contacts, it would be counter to the general principles discussed here:  
http://www.pandemicflu.gov/pla...

ITW(Joel J)
Courage is resistance to fear, mastery of fear - not absence of fear.
- Mark Twain
 


[ Parent ]
Right.
The goal would have to be to limit contacts.

Teenagers are a challenge.  They are very socially connected, and they are likely to be unwilling to be bottled in their houses.  


[ Parent ]
do they tend to gather in stable tribes? how numerous?
are there figures about that?

a 20-teen gang is still 10 times less than a "200 contacts a day" school

You arm yourself to the teeth just in case.  You don't leave the gun near the baby's hand.


[ Parent ]
Stable? Teenagers? Faughgetaboutit.
Tribes vary but the modeling that was done assumed that many children in the teens would typically interact with numerous "tribes" of various sizes - especially at school.

Outside would be less in the absence of activity groups they would encounter in school - but still probably more than one group for most kids.  

ITW(Joel J)
Courage is resistance to fear, mastery of fear - not absence of fear.
- Mark Twain
 


[ Parent ]
Yes Lugon. Are you so old that you have forgotten
what it is like to be a teen.  Of course they are tribal and that is why they want so desperately to associate with their peers. At that age they are much more attracted to their peers and the tribal milieu than their parents and their wisdom.

GW


[ Parent ]
btw, the US phase 0 part
has been removed from pandemicflu.gov.  That's good, saves confusion.

I'm glad someone from HHS is reading here.  I hope they got further than the phase 0 part!



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


This is probably thanks to this diary Susan.
Since we know CDC and HHS monitors Fluwiki (for a variety of reasons) it is very likely that they say you comment about the WHO being in Phase 5 and the US in level 0.  Someone big got a Sunday call and took this action.

My bet is they go directly to level 2 and in a few days, if the CAR keeps rising at an epidemic rate (plus a higher severity index and CFR) they will move it to level 3.

If the US DHHS goes to level 3 then there will be more pressure on local school systems, day care centers and university officials to do the right thing and close.

That is just a wild guess but it is what I think nonetheless.

BTW, if the supositions elaborated above are correct then you have made a difference Susan as have all of us posting here.  Someone may be listening.  What a hopeful thought.

Cheers!

GW


[ Parent ]
it pays to buy time, for 10 reasons
Many here have been thinking about school closure, or sending kids and students of all ages home, for quite some time.

Now's the time to summarise:

1) It will directly save the lives of a number of children.  How many depends on transmissibility, lethality, and size of the country.

2) It will reduce infections in the home, i.e. in adults, which will save lives in that age group too.  This includes the elderly.

3) #2 will, in turn, reduce disruption in the whole of society.

4) There'll be more time to study each case because there'll be fewer of them per time unit.  Great learning about what works, both in prevention and in treatment.  Do masks work?  Do statins work?

5) All of the above will happen not just in the US, if others copy the practical leader.  If the US is friends with a given country, and that country benefits, the US will benefit.  If the US is not in such good terms with another country, then that other country will have less disruption inside and less reasons for being unfriendly.

6) Let's face it: the health care system is ill prepared, and it needs time to speed up, get more masks and respirators, etc.  Time will be used, now!

7) Same goes for businesses.  Bought time will be used time.

8) And finally, same goes for families.

9) If older students are "released" first, many of them and the teachers will be able to take care of at least some of the younger children, allowing for more essential working parents to go on going to work.

10) The "cost" of sending students home early and proactively means it's done 1-2 weeks before the pandemic does it itself.  So we're only talking about the cost of an extra 2 week holiday every 30 years.  Now's the time to do it.

Please point out any argument I may have missed.  Thanks!

You arm yourself to the teeth just in case.  You don't leave the gun near the baby's hand.


still thinking
How long did it take scientists to find out better treatments for SARS?  How much of a difference was there between the best treatment and the initial ones?

If an unmitigated pandemic wave is flattened, and you look at say week #6, then:

1) In an unmitigated pandemic wave, maybe 80% of cases happen before week 6, and the remaining 20% after week 6.

2) In a mitigated pandemic wave, maybe percentages are reversed.  Which means 80% of patients benefit from the scientific knowledge gained in the first 6 weeks.

Which is why my SARS-related question is "slightly" relevant.  Does anyone know?  If true, it would certainly help make the case!

You arm yourself to the teeth just in case.  You don't leave the gun near the baby's hand.


"help make the case" even for those already convinced!
It certainly has that effect on me.  FWIW.

You arm yourself to the teeth just in case.  You don't leave the gun near the baby's hand.

[ Parent ]
lugon, SARS annnotated diary here,
but I haven't found the answer to your question.  Your idea is nevertheless another good reason to do the best mitigation we can should this virus become more virulent, IMO.
http://newton.uor.edu/Departme...

A 2006 systematic review of all the studies done on the 2003 SARS epidemic found no evidence that antivirals, steroids or other therapies helped patients. A few suggested they caused harm.[12]

The clinical treatment of SARS has been relatively ineffective with most high risk patients requiring artificial ventilation. Currently, corticosteroids and Ribavirin are the most common drugs used for treatment of SARS (Wu et al., 2004). In vitro studies of Ribavirin have yielded little results at clinical, nontoxic concentrations. Better combinations of drugs that have yielded a more positive clinical outcome (when administered early) have included the use of Kaletra, Ribavirin and corticosteroids. The administration of corticosteroids, marketed as Prednisone, during viral infections has been controversial. Lymphopenia can also be a side effect of corticosteroids even further decreasing the immune response and allowing a spike in the viral load; yet physicians must balance the need for the anti-inflammatory treatment of corticosteroids (Murphy 2008). Clinicians have also noticed positive results during the use of human interferon and Glycyrrhizin. No compounds have yielded inhibitory results of any significance. The HIV protease inhibitors Ritonavir and Saquinavir did not show any inhibitory effect at nontoxic levels. Iminocyclitol 7 has been found to have an inhibitory effect on SARS-CoV in that it disrupts the envelope glycoprotein processing. Iminocyclitol 7 specifically inhibits the production of human fucosidase and in vitro trials yielded promising results in the treatment of SARS, yet one problem exists. A deficiency of fucosidase can lead to a condition known as fucosidosis in which there is a decrease in neurological function.


http://en.wikipedia.org/wiki/SARS

"The truth does not change according to our ability to stomach it."  Flannery O'Connor

[ Parent ]
Lets get out of denial and face the fact that the pandemic is underway
or at a minimum it is highly likely.

My guess is that the new H1N1 virus is already circulating in every major city in the US and Europe and has begun to spread into the country side.

It is inconceivable that the public health authorities within these regions are ignorant of the high probability that this assessment is correct yet they fail to act.

As of today at their joint news conference and Q&A session the US acting head of the CDC who knows better and the unprepared but well meaning new Secretaries of US DHS and US DHHS do not recommend that anyone use N-95 masks, avoid crowed conditions such as planes or public transportation, or most importantly close schools unless there is a verified index case already present in the school.

This goes completely against what we know about effect implementation of non-pharmacological interventions (NPI) for influenza.  What is going on?  The only explanation that makes any sense is that these officials are more concerned about the potential risk to the economy of recommending that citizens protect themselves by wearing N-95 masks when in public, avoid crowded conditions, and that day care centers, schools and universities be closed immediately.

The specter of the fallout from the 1976 false pandemic alarm has been repeatedly presented in the media for the past 48 hours. Never before have there been more reports about this appearing in the media. I wonder what PR firm is passing out this propaganda and why?  In fact until 2 days ago the only one I recall mentioning this other than myself for many years was an op ed written by the pandemic denier Marc Seigel, MD who is now a Fox News Medical Consultant.

Irrespective of the current condition or my opinion, TPTB have spoken and there will be no early school closures or other sensible NPIs taken to reduce the transmission rate of this virus.

God help us since the choices these and other government officials have made place us all at great risk.

Thank goodness for Joe Biden.  He is the only government official who has spoken the truth about these issues and what did the spin doctors do to him all day today?  They accused him of "putting his foot in his mouth" and "being a loose cannon on deck."

Grattan Woodson, MD


Doctor -
Not one word of argument will you hear from me about any of this.  I thought it was understood that the meaning of WHO's phase 5 is that a pandemic is imminent.

I see those accusing people here of promoting hysteria, but if there's anything I see clearly it is a failure on the part of many to realize and verbalize the seriousness of the situation in which we find ourselves.

We need to stop focusing on the almighty dollar and start thinking about something far more difficult to replace - human lives.  

Like you, I believe this virus has now been seeded everywhere.  It's a frightening thought - I've felt for days as though I woke up one morning and found myself having taken up residence in The Twilight Zone.  I'm not sure, at this point, that I'll ever again find myself residing elsewhere.


[ Parent ]
CDC new guidance on school dismissal
http://www.cdc.gov/h1n1flu/K12...

also for colleges

http://www.cdc.gov/h1n1flu/col...



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


do nothing
Basically, this is saying do nothing. That's how the colleges will see it. If anyone thinks for one min. a kid is going to miss finals, and "stay home if you're sick" in order to protect other students, they are out of their minds. A kid will drag themselves to exams, burning with fever, cuz the profs won't let them do over unless they've been hospitalized. The schools won't shut until they are forced by outraged parents. Policy at colleges is IF they get a confirmed case, they will evaluate. This close to the end of the year, with graduation ceremonies, they will push it to the end, even if they do get confirmed cases. I have no faith they will do the right thing by our kids. It's all about the money.

[ Parent ]
I couldn't agree more...
You are correct -- it is all about the money.  This little college town will suffer a lot if the university closes and students are sent home.  Even during the summer there are tons of students here. Despite that, they should close -- I can't beleive that they don't have a plan for this in place -- after all we received a lot of $$ to research bird flu...
http://www.udel.edu/PR/UDaily/...

[ Parent ]
I think this is a parent's responsibility
Whether schools are officially closed or not, parents need to decide to keep their children home for their own safety. I was a single parent for a long time, so I know how tough it can be to find someone to watch your children. However, there are many more options now than there were 25 years ago. Telecommuting, taking kids to work, trading off with other workers, etc. If all kids are home, I imagine there will be a lot of high school kids able to babysit.

Parents need to tell their children who are old enough to stay home alone that they, in fact, need to stay home. I just don't see this as a government function. Parents are responsible (to a point) for thier  children's behaviors. Teens are social creatures, but virtually all of them have cell phones and/or Internet access. Parents need to explain "You/we could die if you disobey me" and reinforce the seriousness of the situation.

If my children attended public school (we home school), I wouldn't send them at this point. I'd ask the school to fax/email their work, they'd complete it here, and I'd fax/email it back. It is our responsibility/choice to make as parents and I think parents need to step up to the plate at this point. The government does not make choices for our children. We do.

Don't send your kids to school. Think outside the box and figure a way to make it work. It can be done.


that's 2 different issues
In response to an outbreak, parents of course can and will make their own decisions.  But for the purpose of mitigation, ie slowing down an outbreak, school closures are effective only before 1% of the community is infected (see this diary for why).  Case identification is a major problem.  How long does it take for someone to become ill, seek treatment, suspicion raised, initial tests done, further samples sent to CDC, then confirmed?  

The best illustration is from investigation of the Yancey County outbreak, with a novel influenza B virus.  Working it out backwards, by the time the first 3 cases in the school district were identified (on the same day), the infection rate was close to 10%, ie too late for mitigation, and yet which parent is clued up enough to pull their kid out, when only 3 cases were identified in the whole county?  

So, for the purpose of mitigation, in order for school closure to happen before the 1% community spread threshold, the trigger really needs to be taken at the county if not state level, ie closure of all schools with the confirmation of the first case in the area, and not just after kids in specific schools are infected.



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


[ Parent ]
Excellent, excellent point!
"... which parent is clued up enough to pull their kid out, when only 3 cases were identified in the whole county?..."

We know kids are super-spreaders. We know history shows significant impact on the CAR/CFR when NPI's are in place during a flu pandemic. Why oh why then do we keep re-inventing the wheel?


It is better to look ahead and prepare than to look back and regret.


[ Parent ]
how legally
I live in Fl. and took my kids out on Wed. I was told today that if I don't bring them back by Monday they would fail them. I had to have a dr's note to keep them out and was not allowed to keep them at school. Am I missing something? Legally can we keep them out if the school is not willing to work with us. I asked them if she could do her work at home and they said not without a Dr's note and even then the max was 18 days. Any advice would be welcome.

[ Parent ]
If you want them kept out of school
Then I'd keep them out and deal with the consequences later.

Would it really be the end of the world if they failed, or the end of your world if they contracted the flu and died, or became so ill that they suffered sequelae for the rest of their lives?

So much of this is a judgement call - you have to weigh your concerns against the ignorant demands of a school system that should have been closed down a week ago . . . it's my belief that no school in the US should have opened its doors last Monday, or since.

You always have more responsibility for your children's safety than the public school system.  I don't think you're missing anything, except possibly the fact that the inmates appear to be running the asylum . . .  


[ Parent ]
my kids have been out for a week.
the principle, guidance counselor, attendance officer and all teachers supported my decision.

This week each teacher emailed or faxed work to me and i supervised them. I worked their little butts off.

we had a great time, watched the news and discussed constantly.

I highly recommend it... and guess what? they are healthy as can be. I hope i can keep it taht way. pressure is mounting to send them back because the virus is "mild"

what a load of crap. Its early in the wave and the Tamiflu is working. Wait till they run out of tamiflu.


Tell the truth


[ Parent ]
"wait till they run out of tamiflu"
The stockpile may be set aside for a predetermined group of people ie first respondersn, docs etc. And there is no guarantee that the virus will remain sensitive to it.

It is better to look ahead and prepare than to look back and regret.

[ Parent ]
here in the panhandle
They are not willing to work with us, but that is fine I found a homeschool program that will except them as just the last nine wks of school. They said they can not send me just the last five wks but if I didn' mind them doing the last nine wks of the third grade it would be fine. I am going to the school Monday and pulling them out now that I have the homeschool info. Wish our school would of worked with us like yours did. oh well I will do what I have to do.

[ Parent ]
Concerned Parent
Tell them, "Fine, I plan to homeschool them from here forward." They will change their tune because they don't want to lose the money. It's always about the money. Legally, you can homeschool them anytime you want, and put them back in any time you want. Look up FL HS laws, and serve them with a notice of intention to homeschool. They will be falling all over your wishes. There is FL Virtual School online, too. Free to all in FL.

[ Parent ]
do you have a link
I am paying $150.00 for just the last nine wks of school. ( There safty is worth it) Money is hard right now but they are taking care of her school records and sending me  all the school lessons already planned out and put together. My kids have been out since Wed and I am not bringing them back. I also had to have all this done by Monday or the school said they would fail her with out a DR's note. So that did not leave me with a whole lot of time to make phone calls on friday.

[ Parent ]
FLVS
If you can, preview the curriculum.  Several years ago I wasn't impressed, but for all I know, now it could be excellent.

[ Parent ]
K - 8 Curriculum is great!
I homeschooled my son with this for a while (through CAVA; california version), and the curriculum is top-notch. High school was a disaster, though.

[ Parent ]
That explains.
I am a high school teacher and had signed on to teach online in KY but pulled out of the program when I saw the high school English curriculum.  The high school stuff was developed first.  Sounds as if much was learned from first attempts - glad to hear that the K-8 curriculum is strong. :-)

[ Parent ]
that did it
I pulled them out signed all the paper work and then went back to talk to one of the teachers and by the time I left the principle pulled me in his office and told me I was not the only parent and that he would not fail her. He said I could pick her work up at the school and make the teacher make me a packet for the next month. Thanks for the link and advice.

[ Parent ]
Yay! Concerned Parent!
Good for you for having the guts to stand up to them! I knew it would work. Now, you and the kids may decide you like this whole hs thing ;-) and decide not to go back next fall.

[ Parent ]
Haven't they heard of homeschooling?
What is with them? I've known lots of people that homeschool, so why couldn't you?

[ Parent ]
Age Profile of US Confirmed Cases and Unverified Profile on Mexico
In its April 27 briefing, the CDC said that of the 40 US cases it had confirmed at that point this was the age-attack profile:

The median age is 16 years with a range in age of 7 to 54 years and as I've been trying to stress, as we continue to look I expect that we will see cases in other parts of the country, and I will fully expect we'll see a broader range in terms of the severity of infection.

(Had to retype - kept getting 'Soapbox exception' )
http://www.cdc.gov/media/trans...

Also, I was listening to Osterholm on NPR's Science Friday

http://www.npr.org/rss/podcast...

(podcast will be up around 5 pm Central Time.)

http://www.sciencefriday.com/p...

and thought I heard Osterholm say towards the end of the Swine Flu discussion that the Mexican health authorities are now digging into the backlog of suspect samples and testing them for H1N1 Human Swine virus.

I have been unable to verify this but thought I heard him say they were finding 90% of them positive and with those as part of the statistical universe, 80% were below 18 years of age.

Have to see if we can confirm this.  Until then, count it as a rumor.  I post it here because it is not far from the US results and relates to this thread.  

ITW(Joel J)
Courage is resistance to fear, mastery of fear - not absence of fear.
- Mark Twain
 


Confirmation on Mexico Working Through Backlog Also Indications of False Positives?
Still looking for confirmatin re age profile of attack.


Mexico, the first country known to be hit by the new H1N1 flu strain that has reached 11 nations, has about 35,000 samples waiting to be analyzed, said Dick Thompson, a spokesman at the World Health Organization. Those samples, which experts say hold the key to understanding the virus, are held in a guarded laboratory surrounded by walls, gates and guards, that's less than 4 miles from downtown Mexico City.
...
"While we know of a given number of confirmed swine flu deaths, we do not know by any means the actual number of swine influenza cases that have occurred in Mexico," Checchi, a WHO epidemiologist, said in an April 28 e-mail. "It is extremely difficult to assess just how lethal the virus is in Mexico."

...

As testing ramps up, the number of people confirmed with swine flu is likely to jump into the thousands in the coming days to weeks, said Gustavo Reyes, laboratory chief at Mexico's National Institute of Respiratory Diseases' Center for the Investigation of Infectious Diseases in Mexico City. About 90 percent of suspected cases of swine flu, which now number about 2,500, will soon be confirmed, he said.

"Overall we had an almost exponential growth compared with two weeks ago," he said in an interview yesterday.

Many cases may never be diagnosed, Reyes said. The new virus has a tendency to disappear from sputum five to seven days after infection, and people who arrive at the hospital later than that often can't be sampled, he said.

Not sure how to reconcile the 35,000 number used by WHO's Thompson and the 2,500 used by Gustavo Reyes (unless the 2500 represent that portion of the backlog they have worked through so far.)

http://www.bloomberg.com/apps/...

Hat Tip to texasrocks at Godlike Productions:
http://www.godlikeproductions....

ITW(Joel J)
Courage is resistance to fear, mastery of fear - not absence of fear.
- Mark Twain
 


[ Parent ]
Sorry. False "Negatives". nt


ITW(Joel J)
Courage is resistance to fear, mastery of fear - not absence of fear.
- Mark Twain
 


[ Parent ]
Age distribution
I have been unable to verify this but thought I heard him say they were finding 90% of them positive and with those as part of the statistical universe,  80% were below 18 years of age.
In the last two days, this "W-shaped" age distribution curve, similar to the 1918 pandemic, shows up consistently in U.S. reports when the age distribution is mentioned:
  • Dr. Ann Schuchat (U.S. CDC) today: "The median age of cases is 17 years.  Still quite young people are primarily affected. [...] We think that very few of the cases we have confirmation in are over 50." and " In our small sample so far of hospitalizations from this new H1N1 virus, it's in older children and younger adults." (link)
  • Arizona posted the age distribution of its cases: 17 confirmed cases in 4 counties; 2 were hospitalized;  88% were under age 18 link)
  • New Mexico (as of May 2): 9 probable cases in 6 counties; 8 of the 9 were between ages 14-27; the other patient was 1yo (link).


[ Parent ]
looks increasingly like 1918
in pattern but not in severity.  So far, touch wood.  Hard to say for the second wave



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


[ Parent ]
Thankfully true, Susan
But the age distribution of these influenza cases points out the increased importance of targeting community mitigation efforts toward children.  Even if it is no more serious than seasonal influenza (so far), it is an influenza that is hitting children the hardest.  That makes it even more important for schools to be very proactive.

[ Parent ]
was 1918 W-shaped in first wave!?


You arm yourself to the teeth just in case.  You don't leave the gun near the baby's hand.

[ Parent ]
yes
Check out these results for Copenhagen http://www.pubmedcentral.nih.g... and this one for New York http://www.pubmedcentral.nih.g...



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


[ Parent ]
closing for a suspected case
SusanC --

It seems that schools are closing, not for a positive case (which would take time for the test to come back) but for a suspected case, which is apparent much earlier.

Isn't this good enough to slow spread of illness enough to make a significant impact?

GetPandemicReady.org - non commerical website with practical ways for families to prepare.


not for slowing the spread
the CDC says the AR within households is 25-30%, similar to seasonal flu, so this virus is as transmissible as seasonal flu.  Read the Yancey County analysis again. http://www.newfluwiki2.com/sho...



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


[ Parent ]
"AR within households is 25-30%" do they know that for the new virus?
someone has a link, please?

You arm yourself to the teeth just in case.  You don't leave the gun near the baby's hand.

[ Parent ]
yesterday's press briefing
http://www.cdc.gov/media/trans...



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


[ Parent ]
but if you want to conduct a 'natural' experiment
You'd let schools and communities decide to close willy-nilly, all in their own different ways.  After it's all over, you can analyze and compare the different impact of different ways of closing.

But then, since the cases are mild and cannot be diagnosed without testing, and they are NOT doing extensive testing, then it's hard to know the true extent of the spread.  Maybe they can do seroprevalence later.  That would be one way of finding out.  But the studies would be notoriously complicated eg how to define the cohort for seroprevalence testing for this purpose, that would be a real issue.

All this, assuming we've got the luxury of waiting for such extensive analysis, before the fall wave is upon us.  And that's assuming this wave continues to be mild.



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


[ Parent ]
New K-12 CDC Guide Recs Nearby School Closure
On Friday, May 1, the CDC revised and expanded its guidance on K-12 School Closures.

They increased the duration from 7 days to 14, increased the est. on infectious period for children and expanded their closure recommendations by saying there should be consideration of closing all the schools in a given district or area if more than one school had a suspect H1N1 patient or if a closed school was close and/or had mixing of the schools' populations.

Dismissal of students in a school and closure of childcare facilities should be considered in schools with one or more laboratory-confirmed or non-subtypable influenza A case among students, faculty or staff in order to decrease the spread of illness in the community.

Dismissal of students from schools and closure of childcare facilities should be considered for not-yet-affected schools and childcare facilities in the same area (e.g. a feeder school network or a geographic area) if more than one school or childcare facility in that area has confirmed or non-subtypable influenza A cases among their students, faculty, or staff. This would include preemptively dismissing students from schools in that area, including schools without current laboratory-confirmed cases.

Neighboring schools to those that dismiss students should also consider preemptively dismissing students from schools without current laboratory-confirmed cases. Issues to consider include geographic proximity and extent of mixing of student populations among area schools.

http://www.cdc.gov/h1n1flu/K12...

More discussion on duration and infectious period here:
http://www.newfluwiki2.com/sho...


ITW(Joel J)
Courage is resistance to fear, mastery of fear - not absence of fear.
- Mark Twain
 


[ Parent ]
people need to get used to the idea
Yes, virus outbreaks are unforgiving, but that doesn't change human nature.  Most people need a lot of convincing, and social consensus, before they will accept a new idea.  As and when more districts close for 2 weeks, parents will realize that they DO have to start thinking what they are going to do if their kids' schools close for that long.  They will have to start negotiating with employers, and look for solutions.

It's the beginning of the preparedness mindset.



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


[ Parent ]
School sports and school trips
What statewide set of circumstances should trigger the cancellation of school sports?  Kids are regularly bused from one campus to another, change in another school's locker rooms, etc.  

There are likely many school trips planned for this last month of school. How wise are these trips, given spreading infection. Schools are having to make decisions about these kinds of programs as well as school dismissal for suspected flu cases.

Guidance from the CDC would be useful - such guidance would offer leverage when difficult and sometimes unpopular decisions should be made for the sake of students' safety.


at the moment
anything that triggers school closure also triggers all school-related activities.



All 'safety concerns' are hypothetical.  If not, they'd be called side effects...


[ Parent ]
And that will include
Graduations ans proms over the next several weeks. :(

www.EmergencyHomePreparation.org -- A 'card-catalog' style of prepping information.   -

[ Parent ]
Yes, that's a given.
That fact does not address, however, what precautionary measures schools might reasonably take before a suspected case makes both school dismissal and the cancellation of activities necessary. Some schools will cancel trips; others will not. I wonder what difference that may make.

I'm not just thinking of now, with a virus that may turn out to be no more virulent or transmissible than seasonal flu, but later on, when we may have to deal with an uglier virus.



[ Parent ]
Help your Children get them Q shield
Wash the childrens hands with Q shield every morning before school and can be sure they won't pick up nasties from their class mates unless they get to kissing or something.

A recent airline audit showed that the vast majority of infectious organisms were not present in the air on the planes, no they were on the fittlings and seats.

Surprising isn't it?

 Man occasionally stumbles over the truth.  Most of the time though, he manages to pick himself up and carry on as if nothing had happened.

Winston S Churchill


JK


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