Study traces variation in pandemic school closures

Feb 2, 2011 (CIDRAP News) – A study that put school closures during the 2009 H1N1 pandemic under the microscope says that jurisdictions varied in their reasons for shuttering schools and that officials often were uncertain about who had authority to make the decision and what federal guidance was in place.

The study, by researchers at Jefferson University and Georgetown University, was published online yesterday by BMC Public Health. They noted that more than 700 schools closed at some point during the pandemic months.

To identify issues that came up during school closures, they reviewed relevant news stories that they found in an electronic database and in Google searches. They also observed conference calls and meetings between school and public health officials in Boston and Washington, DC, and conducted informal interviews with decision-makers and other community members.

The analysis showed that goals for school closure decisions varied, including limiting community spread of the virus, protecting students in risk groups, and responding to staff and student absences. Limiting community transmission was the most common rationale in the United States, the report says.

The authors found no closures prompted by staff or student absenteeism in the spring wave of the pandemic, but closures caused by high student absenteeism became common during the fall wave.

Much of the variation in school closure decisions during the pandemic was related to differences from place to place in who had authority to make the decision, the researchers found. Depending on the jurisdiction, the decision may be made by school or public health officials at either the local or state level.

Public health officials and school administrators were sometimes at odds over school closure decisions, the report says. For example, health officials in Montgomery County, Maryland, decided to close the schools, but the school superintendent protested the decision shortly afterward. In some states, schools faced a loss of state funding if they closed for public health reasons.

The researchers also found that the level of scientific uncertainty and quickly changing guidance from the Centers for Disease Control and Prevention (CDC) early in the pandemic seemed to surprise decision-makers and caused some frustration. For example, after one of the guidance changes early in the pandemic, one Texas official complained that the agency was changing its guidance "on a daily basis."

The report notes that the CDC recommended on Apr 26, 2009, that schools should close for 1 week if a pandemic flu case emerged, but on May 1 this was changed to 2 weeks. Then on May 5 the CDC changed course and advised that schools generally did not need to close, but students should be kept home for a week. On Aug 7 the CDC recommended against closure in most cases.

The authors concluded that the use of school closures as a social distancing tool can be improved when officials clarify closure goals and tailor their decisions with those goals in mind. In addition, they write, identifying in advance who is empowered to close schools can help streamline the decisions, and officials should factor a degree of uncertainly about the disease, especially early in the outbreak, into their planning.

News editor Bob Roos contributed to this story.

Klaiman T, Kraemer JD, Stoto MA. Variability in school closure decisions in response to 2009 H1N1: a qualitative systems improvement analysis. BMC Public Health 2011; early online publication Feb 1 [Full text]

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