Saturday, August 01, 2009

Pragmatic Preparation for Swine Flu

A few years ago a Woodland Park family made a financial gift to the school and worked for an employer who matched its employee’s donations. In filling out the paperwork, the parent asked me for our “organization’s mission statement.” Since we’ve never had such a thing, I made one up:

To expose young children to as many childhood illnesses as possible before they get to kindergarten.

I was only half joking. Preschools are notorious breeding grounds for coughs, colds, pink eye, chicken pox, and dozens of other maladies. Two-year-olds without older siblings are often hit particularly hard. My friend Charlotte must have missed half the school year due to fevers, sniffles, and tummy aches.

And while we all hate it when kids are sick, it’s one of the important ways they strengthen their immune systems. It’s not an accident that Charlotte’s younger sister Annabelle missed very few days when she was two. And I won’t be surprised if their youngest sister Penelope winds up sporting a perfect attendance record.

I mention this by way of establishing my credentials as a pragmatist when it comes to illness. And it’s as a pragmatist that I mention that those of us who teach, or have children in school, need to prepare for the H1N1 (Swine) Flu. While it hasn’t so far turned out to be as virulent as once feared, it is a real pandemic, and when flu season hits a lot of us are probably be going to be experiencing its symptoms, either first or second hand.

I do not want to feed panic, because that doesn’t help anyone, but after receiving an email from a Woodland Park parent who is a public health researcher and reading an article from yesterday’s Washington Post, it seemed like complacency is not a pragmatic option either.

If current cases are any indication, it sounds like most of us, and our children, are only likely to suffer the usual delights, but the Center for Disease Control (CDC) has put pregnant women in the highest risk category for severe consequences from H1N1. A Lancet study found a 32 percent hospitalization rate for women at one month. There tend to be a lot of pregnant women in and around preschools, so if only for their sake, it’s vital that we do everything we pragmatically can to prevent the spread of H1N1 this flu season.

But as we do, please keep in mind the words of World Health Organization Director General Margaret Chan:

“Between the extremes of panic and complacency lies the solid ground of vigilance.”

The good news is that a vaccine is expected to be ready by September, according to yesterday’s Post article, although it may take a few more months to get it distributed.

Beyond this and until then, there are common sense non-medical precautions that we all need to take, most of which we should already be doing. I’m looking at this as an opportunity for Woodland Park to reinvigorate our disease prevention measures. What follows are the current CDC recommendations regarding K-12 schools and child care programs:

Interim Recommendations: K-12 Schools
-School dismissal is not advised for a suspected or confirmed case of novel influenza A (H1N1) and, in general, is not advised unless there is a magnitude of faculty or student absenteeism that interferes with the school’s ability to function.

-Students, faculty or staff with influenza-like illness (fever with a cough or sore throat) should stay home and not attend school or go into the community except to seek medical care for at least 7 days even if symptoms resolve sooner.

-Students, faculty and staff who are still sick 7 days after they become ill should continue to stay home from school until at least 24 hours after symptoms have resolved.

-Students, faculty and staff who appear to have an influenza-like illness at arrival or become ill during the day should be isolated promptly in a room separate from other students and sent home.

-Aspirin or aspirin-containing products should not be administered to any confirmed or suspected ill case of novel H1N1 influenza virus infection aged 18 years old and younger due to the risk of Reye syndrome. Refer to pediatric medical management for guidance regarding use of any medications, especially those containing aspirin. (

-Parents and guardians should monitor their school-aged children, and faculty and staff should self-monitor every morning for symptoms of influenza-like illness.

-Ill students should not attend alternative child care or congregate in other neighborhood and community settings outside of school.

-School administrator’s should communicate regularly with local public health officials to obtain guidance about reporting of influenza-like illnesses in the school.

-Schools can help serve as a focus for educational activities aimed at promoting ways to reduce the spread of influenza, including hand hygiene and cough etiquette.

-Students, faculty and staff should stringently follow sanitary measures to reduce the spread of influenza, including covering their nose and mouth with a tissue when coughing or sneezing (or coughing or sneezing into their sleeve if a tissue isn’t available), frequently washing hands with soap and water, or using hand sanitizer if hand washing with soap and water is not possible.

Interim Recommendations: Child Care Programs
As for schools, closure of child care programs is not currently recommended due to novel H1N1 influenza in the community or the child care facility. Child care programs should follow the above recommendations for schools along with the other recommendations in this section.

-Child care programs should work closely and directly with their local and State public health officials to make appropriate decisions and implement strategies in a coordinated manner.

-Child care providers should conduct daily health checks on all children. Although daily health checks have been recommended for child care programs before the current H1N1 flu situation, programs that do not conduct routine daily health checks should institute this practice. (See Caring for Our Children Standards 3.001 and 3.002 for information on how to do this

-Ill children should stay home and not be taken out of one child care program and put into another child care program even temporarily.

-Childcare facilities should clean and sanitize frequently-touched surfaces, (such as desks, doorknobs, computer keyboards, toys) routinely and if they become visibly soiled.

-Child care programs can help serve as a focus for educational activities aimed at promoting ways to reduce the spread of influenza, including hand hygiene and cough etiquette.

I hope that a year from now we will be placing Swine Flu into the same category as “killer bees” and the Y2K panic. Although as we laugh about them now, no one will ever know the role pragmatic preparation played in preventing our worst fears from being realized. Besides, it can’t hurt to be prepared, as long as we don’t freak out.

Note: I am not an expert on disease prevention, so if I’ve made any mistakes or if you have any additional information, PLEASE let me know.

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Amy said...

Hi Tom! As requested, a couple of my thoughts...

The CDC guidelines are really thorough and detailed, and while it's a great protocol not super practical in my view. I believe that your best resource is the NSCC Risk Management Manuel. It has not been specifically updated for H1N1 (to my knowledge) but the spread of H1N1 is no different than any other virus. There is a link to the manual on the NSCC website under "forms and reference." However the bottom line is 1) hand washing and 2) parents and children should not come to school if they are sick. At Victory Heights this past year, each of our classes also devised a toy cleaning protocol (washing any toy that wound up with slobber or boogers on it).

As far as the vaccination goes, it's not part of the required childhood vaccinations (yet). It's unclear if it will be ready, who it will be available to (aside from pregnant women as you mentioned) and if it will have any impact on severity of disease. North Seattle is a notoriously unvaccinated part of the country, and it will be interesting to see how the H1N1 vaccine flies. I would suggest anyone interested should discuss it with their doctor.

In the meantime, I think that having a good Health and Safety officer at preschool will help remind parents to stay home when sick, wipe noses, cover mouths and wash hands. As you know, I'm pretty vigilant about these things and not very shy. It's going to be a particularly interesting flu season and might take some extra communication in our communities about how we want to respond.

Amy Hobson

Teacher Tom said...

Thanks Amy!

For those of you who don't know, Amy is a doctor, a cooperative preschool parent, and most importantly, my sister.

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