Anticipating a new surge of swine flu in the fall, federal health and education officials on Friday urged schools to stay open, but to plan to segregate sick students and staff and to provide protective gear such as face masks to prevent further infection.
Schools should plan now to react to an influx of cases of the novel H1N1 influenza virus, including finding ways to continue operating even when some children and staff show up sick, officials said.
"Closure of schools is rarely indicated, even if H1N1 is in schools," noted Dr. Thomas Frieden, the director of the federal Centers for Disease Control and Prevention.
His comments came as the CDC issued new guidelines Friday for the nation's 130,000 schools, which serve about 55 million children. Frieden was joined at a news conference by top officials overseeing the swine flu crisis, including Health and Human Services Secretary Kathleen Sebelius, Homeland Security Secretary Janet Napolitano and Education Secretary Arne Duncan.
The new recommendations continue to urge parents to keep sick children home, to wash hands frequently and to cover coughs. But they also say that kids can come back to school 24 hours after the last sign of fever, instead of making them wait a week.
The guidelines are aimed at preventing further infection with the virus, but also intended to limit disruptions of education and community life.
"It's a balancing act. When you close a school, you have real social costs," Frieden said.
As the virus spread to students last spring, more than 700 schools in half the states temporarily closed their doors. Unlike regular seasonal flu, this virus has not retreated during the hot and humid summer months and so far has infected more than 1 million Americans.
Health officials also urged people at risk for complications, including pregnant woman and children with medical conditions, to be isolated quickly and to be sent home at the first sign of illness.
The decision to close schools will remain a local one. In general, schools with only a few cases of flu should remain open and parents should be confident about sending their kids. But if large numbers become sick, or if there are special populations, including pregnant women and students or staff with severe medical conditions, that could warrant closure.
"We absolutely hope no schools will have to close, but realistically, some will have to," said Duncan.
He urged school officials to start thinking now about putting in place homeschooling plans, including telephone or Web-based instruction, in case classes are canceled. Schools will get help paying for the costs of coping with flu with some $260 million in federal money distributed to communities. Duncan also said education officials would be flexible in helping schools meet federal requirements while also grappling with flu.
The new school guidelines also outline plans if the H1N1 virus were to change and become more deadly. So far, it has not mutated and most cases of illness have been mild. If that were to change, schools might start screening kids and staff for illness, asking people with underlying illness to stay home, or to keep kids apart from each other as much as possible, perhaps isolating classrooms or having students sit farther apart from each other.
They also stressed that parents need to think now about contingency plans if their kids become ill, and to watch themselves and their children for signs of flu.
"We can't stop the tide of flu from coming in, but we can reduce the number of people who become ill from it," Frieden said.
In addition to new guidance for when to close, the CDC and Education Department said this week they have set up a new monitoring system to track school closures across the country.
Still up in the air is whether schools will be turned into vaccine clinics, though Health and Human Services Secretary Kathleen Sebelius has said that seems logical. "We're seeing schools as potential partners," she said at the forum with Duncan.
Children are on the priority list for the first doses of swine flu vaccine, but because of time needed for testing and manufacturing, inoculations can't begin until school has been in session for more than a month; the government is aiming for Oct. 15. Many questions remain, including whether people will need one shot or two for protection. That is in addition to the regular winter flu vaccine that is also recommended for children.
States and school districts should be preparing for the possibility of mass vaccinations, federal officials have said.
The Associated Press contributed to this report