|
|
<Home> <Newsletter> <Third Issue> <The 2009 H1N1 Pandemic Disease> <Measures in school settings>
THE 2009 H1N1 PANDEMIC DISEASE
11 SEPTEMBER
2009 | Experience to date has
demonstrated the role of schools in amplifying transmission of the pandemic
virus, both within schools and into the wider community. While outbreaks
in schools are clearly an important dimension of the current pandemic,
no single measure can stop or limit transmission in schools, which provide
multiple opportunities for spread of the virus. WHO recommends the use
of a range of measures that can be adapted to the local epidemiological
situation, available resources, and the social role played by many schools. National and local authorities are in the best position
to make decisions about these measures and how they should be adapted
and implemented. WHO continues to recommend
that students, teachers, and other staff who feel unwell should stay home. Plans should be in place, and space made available, to
isolate students and staff who become ill while at school. Schools should promote
hand hygiene and respiratory etiquette and be stocked with appropriate
supplies. Proper cleaning and ventilation and measures to reduce crowding
are also advised. School closures and class suspensions Decisions
about if and when schools should be closed during the pandemic are complex
and highly context-specific. WHO cannot provide specific recommendations for or against
school closure that are applicable to all settings.
However, some general guidance comes from recent experience in several
countries in both the northern and southern hemispheres,
mathematical modelling, and experience during
seasonal epidemics of influenza. School closure can operate
as a proactive measure, aimed at reducing transmission in the school and
spread into the wider community. School closure can also be a reactive
measure, when schools close or classes are suspended because high levels
of absenteeism among students and staff make it impractical to continue
classes. The main health benefit
of proactive school closure comes from slowing down the spread of an outbreak
within a given area and thus flattening the peak of infections. This benefit
becomes especially important when the number of people requiring medical
care at the peak of the pandemic threatens to saturate or overwhelm health
care capacity. By slowing the speed of spread, school closure can also
buy some time as countries intensify preparedness measures or build up
supplies of vaccines, antiviral drugs, and other interventions. The timing of school closure
is critically important. Modelling studies suggest
that school closure has its greatest benefits when schools are closed
very early in an outbreak, ideally before 1% of the population falls ill.
Under ideal conditions, school closure can reduce the demand for health
care by an estimated 30–50% at the peak of the pandemic. However, if schools
close too late in the course of a community-wide outbreak, the resulting
reduction in transmission is likely to be very limited. Policies for school closure
need to include measures that limit contact among students when not in
school. If students congregate in a setting other than a school, they
will continue to spread the virus, and the benefits of school closure
will be greatly reduced, if not negated. Economic and social costs When making decisions,
health officials and school authorities need to be aware of economic and
social costs that can be disproportionately high when viewed against these
potential benefits. The main economic cost
arises from absenteeism of working parents or guardians who have to stay
home to take care of their children. Studies estimate that school closures
can lead to the absence of 16% of the workforce, in addition to normal
levels of absenteeism and absenteeism due to illness. Such estimates will,
however, vary considerably across countries depending on several factors,
including the structure of the workforce. Paradoxically, while school
closure can reduce the peak demand on health care systems, it can also
disrupt the provision of essential health care, as many doctors and nurses
are parents of school-age children. Decisions also need to
consider social welfare issues. Children’s health and well-being can be
compromised if highly beneficial school-based social programmes, such
as the provision of meals, are interrupted or if young children are left
at home without supervision.
|
