| This section brings clarity on the issue of school closure and under what conditions is it recommended. It gives a few global examples and advises how panic and not caution is the need of the hour. |
In India, it was in Pune, Maharashtra where the first casualty of Influenza A (H1N1) was reported and within days civic authorities decided to shut down malls, cinema halls, schools and colleges. With stray deaths being reported from other parts of the state, panic spread and Maharashtra government responded by ordering closure of all public schools, malls and cinemas in India’s financial capital of Mumbai for a week. Elsewhere too the spiral effect caught on and advisories were issued telling people to stay at home if exhibiting flu-like symptoms telling them also to not venture out to public places.
Meanwhile, risk managers began weighing the flip side of the situation and questioned if there were any benefits to closing schools and if kids who were not sick were going to get leeway to spend the entire day just hanging around idling time and how were schools to verify whether those opting to stay at home were indeed afflicted with the flu.
British researchers in the journal Lancet Infectious Diseases said earlier this month that governments needed to draft plans for when and how to close schools if the Swine Flu pandemic worsens. The paper argued that closing schools can help break the chain of transmission, slowing the pace of the disease, lessening the burden on health care systems and reducing the peak in worker absenteeism. But the researchers also noted the considerable economic costs if parents were forced to stay home to look after their children.
During the recent outbreak, US authorities recommended that affected schools close for two weeks if there was a suspected case, but when the virus turned out to be milder than feared, they switched to advising parents just to keep sick students home. Schools could still close if a large number of students and staff were reporting sick.
School closure: a non-pharma intervention
School closure is a non-pharmaceutical intervention often suggested for mitigating influenza pandemics. In pandemic preparedness plans, rationales for school closures are that children are thought to be important vectors of transmission and more infectious and susceptible to most influenza strains than adults, and high contact rates in schools favour transmission.
These are strong arguments in the current situation, where 60% of cases infected with H1N1 are 18 years old or younger and many of case clusters have happened in schools. It is therefore hoped that closure of schools during the pandemic might break the chains of transmission, with the following potential benefits:
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Slowing the epidemic to give more time for vaccine production |
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Reducing incidence of cases at the peak of the epidemic, limiting both the stress on health care systems and peak absenteeism in the general population, and thus increasing community-wide resilience. |
Although some health benefits can be expected, there is still substantial debate about if, when, and how school closure policy should be used. There is no consensus on the scale of the benefits to be expected and recent reviews highlighted the lack of evidence for social distancing measures such as school closure and even if benefits are substantial, they must be weighed against the potential high economic and social costs, difficult ethical issues, and the possible disruption of key services such as health care and negative effects on key workers since, for example, many doctors and nurses are also parents.
Important operational issues related to school closures, though not impossible to overcome, need preparation. Therefore, if schools are expected to close as a deliberate policy option, or just because of high levels of staff absenteeism, it is important to plan to mitigate the negative features of closure.
WHO’s stand on the issue has been one which has placed the onus on the affected countries. "School closure is one of the mitigation measures that could be considered by countries," WHO spokeswoman Alphaluck Bhatiasevi told a news conference in Geneva recently. "As WHO has been saying, different countries would be facing the pandemic at different levels at different times. So it is really up to countries to consider what mitigation measures suit them in regard to the situation in individual countries."
Communication of the policy to the public also poses challenges, especially in a context
where some countries (or even regions within a country) might close schools proactively, others perhaps only reactively, and some not at all. But since historical experience is that many schools close during pandemics just because of high levels of illness-related absenteeism, it would seem sensible for all countries to at least have plans for reactive closure.
Assess, evaluate and then decide on closure
Stringent and costly measures like the decision to close schools, offices and advice against mass gatherings must be made on the basis of the prevailing level of community spread, age-specific estimates of severity and local illness load. Based on early reports of a new virus outbreak in Mexico, the initial recommendation from US authorities was to close down affected schools for two weeks, if there was a suspected case. But when the virus turned out to be milder than feared, they switched to advising parents just to keep sick students home. Schools could still close if a large number of students and staff fell sick. This perhaps seems like a sane approach and not one that is based on a knee-jerk reaction to panic.
It would be pertinent to remember that when there is community transmission of the virus, closure of institutions and travel advisories have only limited effect because of a near certain possibility of people acquiring infection from other sources anyway. So, when considering mitigating the spread of influenza A (H1N1) in school settings, full school closures may not be warranted. What however could be an option is to have class suspensions.
India’s stand on the subject
In India, Health Minister, Ghulam Nabi Azad on 11th August, 2009 said that closing down schools was no solution to control the spread of H1N1 unless the affected children restricted themselves at home. Because, if they used their time off to socialise, party and move around town, the hazards would only multiply and the purpose of closure become a mockery. He said that state governments had to take their own decision based on how the influenza was spreading in their state.
Caution, not panic is the need of the hour
The current wave of H1N1 pandemic is mild. Since there is a possibility that it could become more severe, issues such as school closure may need to be revisited in the future. At present, there is no need for self imposed restrictions on going to school, socialising at small gatherings or travelling on vacation to different cities in India. Routine life need not be interrupted so long as the virus is still mild.
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