May 22, 2009 – Health Commissioner Thomas R. Frieden and Schools Chancellor Joel I. Klein today discussed the rationale behind closing individual New York City schools in response to the presence of the H1N1 virus in New York City. All evidence suggests that the new virus is causing a large proportion of the city’s current flu cases. To date, 40 schools have been closed in an attempt to slow transmission within the school community.
The main goal of school closures is to protect those at highest risk of complications from flu in that particular school community – students, staff, and their close contacts who are under 2 or over 65 years of age, pregnant, or who have a chronic medical condition such as asthma or diabetes. School closure is not done with the expectation that it will interrupt the spread of flu in the city as a whole.
“The new H1N1 virus is here in New York City,” said New York City Health Commissioner Thomas R. Frieden. “Many school children have mild flu, as they do each flu season. We are closing certain schools in an effort to slow transmission within the school community and protect those at highest risk of complications from flu.”
“In some instances when many children are sick, closing a school and keeping children home can reduce further infection. We continue to work alongside the Health Department in monitoring schools and closing them when the Health Department so recommends,” said Chancellor Joel I. Klein.
The Health Department and the Department of Education work together to monitor daily flu-like illness in New York City schools. School nurses notify the principal and contact the City’s Office of School Health if there are five or more children who come to the medical room and who have a fever that meets the standard definition of being over 100.4O accompanied by either cough or sore throat.
Once that threshold is reached, the Health Department reviews daily flu-like illness among students coming to the medical room, as well as absenteeism data over the past week. The Health Department looks for either a sudden or a sustained increase in flu-like illness. Every school with a cluster of students with flu-like illness is monitored daily. High absenteeism, by itself, is not a basis for closure. If parents keep sick children home, it can reduce transmission and the risk to vulnerable people
There is no single number upon which school closures decisions are made. The Health Department carefully evaluates the circumstances occurring at each school and considers many factors including:
- The number of visits to the nurse by children with
documented fever flu-like illness
- The trend of flu-like illness over several days and
the potential benefit of reduced transmission over weekend days, when school
is not in session;
- The percentage of children absent with flu-like
- Reports of teacher illness while they are in the
- Special circumstances of the school, such as children
in District 75 schools – schools for students with disabilities;
- Whether a school is an elementary, intermediate or high school.
The Health Department pays closest attention to schools in which over 1-2% of the student body comes to the medical room on a given day with fever and cough or sore throat. This indicates that a significant number of students are ill while at school and may be spreading infection to those at risk.
The decision to close a school balances a definite harm – lost education, parental wages, school nutrition programs and possible unsupervised children – with a possible benefit. The potential benefit is a reduction in the number of people who might get seriously ill from flu because they have an underlying risk condition and they study or work at that individual school or are a household contact of someone at the school.
Examples of schools that were closed:
P.S. 19Q (District 24) has 1,979 students. On each of the five days of the week May 11 through 15, four or fewer students came to the medical room with a fever and cough or sore throat. On May 18, 33 students came with fever and flu-like illness. This sudden increase accounted for over 1.5% of the student body. The school was closed.
P.S. 130Q (District 25) has 304 students. On Monday, May 18, three students were seen in the medical room with fever and cough or sore throat. The trend repeated on Tuesday. On Wednesday, six students came in with flu-like symptoms. Though the number of students with symptoms was low, it represents 2% of the student body and was a doubling from the two days before. Also, absenteeism was high on Wednesday at nearly 30%. The school was closed.
Examples of schools that were monitored and not closed:
P.S. 204K (District 20) has 985 students. On Monday, May 11, seven children came in with flu-like symptoms and the Health Department began monitoring the school daily. Over the course of the week, the number of children coming to the medical room with fever and cough or sore throat steadily decreased and never exceeded five. Absenteeism in this school was relatively high, reaching up to 30%. Although it is almost certainly the case that flu is affecting many students in the school, since there are not a high number of students getting sick while in school and spreading infection, we did not recommend closing. Absenteeism has since declined by half and has remained at 13-15% and there were few students with flu-like illness on each of the subsequent days.
I.S. 227Q (District 30) has 1,456 students. The number of students with flu-like illness coming to the medical room was one to two per day from May 11 to May 14. On Friday, May 15, 15 children with fever came to the medical room. Though this was a substantial increase, it represented 1% of the student body. After the weekend, the number of children with flu-like symptoms dropped to six and continued to decline, so the school remained open.
Recommendations for New Yorkers with underlying health conditions
The Health Department advises any New Yorkers with the underlying health conditions listed below to seek medical consultation if they have come in contact with someone with flu, have flu-like symptoms or have any trouble breathing – especially children with asthma. This would also include children and staff with these conditions who attend or work at a school that has been closed. Those at higher risk include:
- People over 65 or under 2 years of age
- People with chronic lung disorders such as asthma or
- People with chronic heart, kidney, liver or blood
- People with diabetes
- People whose immune systems are compromised by illness
- Pregnant women
- People on long-term aspirin therapy
Recommendations for doctors
- Only people with more serious symptoms, such as difficulty breathing or shortness of breath, should go to the emergency department. Doctors should do everything they can to help prevent people with mild flu symptoms from going to the emergency department and should consider prescribing Tamiflu or Relenza over the phone for their patients with mild illness and underlying health conditions.
- Doctors should make sure that all people who are below 2 or above 65 years old, or have diabetes, emphysema, asthma, or other chronic illnesses get treated with antiviral medication, like Tamiflu, if they get the flu. Asthma is the most common chronic illness among children in New York City, and these children are at higher risk for severe illness if they get the flu.
- When treatment is indicated for one the above reasons, it should be started as soon as possible, ideally within 48 hours after the person first feels sick.