Targeted school closings may help prevent widespread flu transmission

Closing school during influenza outbreaks: Understanding the true consequences

Fumanelli et al identify worker absenteeism and missed educational opportunities as the only socio-economic impacts of closing schools during disease outbreaks in the United Kingdom. However, because schools may be the only option for millions of children to receive vital services, administrators throughout the United States must consider additional factors when determining whether to close during outbreaks.

While the federal government develops recommendations related to school closures, it is the more than 13,500 local school districts that are empowered to make these important decisions. This commentary explores how school closures during disease outbreaks could impact access to vital nutrition services.

School administrators are responsible not only for student learning, but also for the safety and health of approximately 50 million students in grades pre-kindergarten through 12, attending 98,500 public and charter elementary and secondary schools, with 3 million full-time teachers. Schools serve a diverse student population including those who live in families with low-incomes, have physical or mental disabilities, are homeless, migrants, runaway, or foster children. Nationally, over half of all public school students live in families with incomes below the federal poverty level ($24,300 for a family of four in 2016). During the 2013-2014 school year, 1.36 million public school students were homeless and 6.4 million children received special education services required under the Individuals with Disabilities Education Act (IDEA) in 2012-13.

Over half of all public school students qualify for federally-supported free or reduced price breakfasts and lunches at school – from a high of 71% in Mississippi, to a low of 27% in New Hampshire. Federal programs also provide free fresh fruit and vegetables in elementary schools, and subsidized milk to students in half-day programs.

In addition, some states and school districts have developed weekend and holiday meal programs. The Schenectady, New York school district collaborates with community partners to provide students with backpacks filled with food so students can eat while schools are closed. As a result, approximately one third of students who participated in the 2014-15 school year, had improved their academic performance compared to the previous year, attended an average of six more days of school during the year, and received 26% fewer disciplinary referrals.

Unexpected school closures present particular concerns, preventing low-income students from accessing meals without emergency planning and special accommodations.

For example in January 2016, a crippling snow event caused schools throughout the Washington, DC metropolitan area to remain closed for approximately one week. For the first time, public school officials kept 10 schools open in areas where up to 80% of students receive free and reduced price meals. Volunteers served several hundred cold breakfasts and hot lunches to anyone who could travel through the snow. As a result, vulnerable students were ensured that meals were available to them.

Because nutrition services are critical to student success, administrators could consider several strategies to prevent school closures. The Centers for Disease Control and Prevention guidance clarifies how schools could avoid closing during influenza outbreaks:

1.  Encourage vaccination of staff, students and parents.
2.  Develop and implement flexible workplace and school sick leave policies to encourage both parents and children to remain at home when they are ill. In particular, educate students, parents and staff to:

• Stay home at least 24 hours after fever resolved
• Separate sick staff and students from others until then can leave school
• Take antiretroviral drugs if prescribed by physician; and
• Use proper hygiene techniques – covering mouth etc.

3.  Eliminate perfect attendance incentives.
4.  Cross train workers to cover for ill staff.
5.  Encourage routine surface cleaning through education, policies and provision of supplies.
6.  Establish relationships with state and local health officials and develop emergency plans before an outbreak and communicate with state and local officials.

Modern American public schools have evolved from institutions of learning to essential community resources, providing meals to millions of students. Because schools can act to mitigate the impact of disease outbreaks, and the consequences of school closure are severe, schools serving meals could implement the CDC recommendations as the first step to avoid closing.

In the event schools must close, emergency plans could be developed to ensure schools provide uninterrupted meal services. For example, only cafeterias could remain open in locations accessible to high need students, or the school grounds could serve as a distribution site where families could obtain meals. Providing consistent meals to students who otherwise would go hungry, should take precedence over avoidable school closures.

Alexandra M. Stewart, JD
Associate professor
Department of health policy and management
Milken Institute School of Public Health
The George Washington University

Marisa A. Cox, MA, MPH, MSPM
Research scientist
Department of health policy and management
Milken Institute School of Public Health
The George Washington University