New flu plan seeks prevention over containment

Ruth Lynfield and Sanne Magnan
Minnesota Health Commissioner Sanne Magnan (right) and state epidemiologist Ruth Lynfield hold a press conference on the state of the H1N1 flu outbreak in Minnesota.
MPR Photo/Tom Weber

Since the first probable case of the flu was found in Minnesota, schools have turned to the state health department for advice. The department said it has sided on being 'overly cautious' in recommending closing. That advice is changing.

"[The] world looks a lot different than a week ago when we had little information about the influenza virus," said Minnesota Health Commissioner Sanne Magnan.

Magnan said the state's response to H1N1 had been aimed at isolating individual cases in an effort to contain the disease. But that's no longer possible, it's out there. So a better course of action is to prevent spreading. So far, Minnesota's one confirmed and six probable cases have all been mild.

State epidemiologist Ruth Lynfield said people might take comfort from a school closure because it's such a dramatic action. But that probably isn't the best way to prevent spreading.

"If there's a single case and the case is ill and you close the school - it's hard to know: were there others that had gotten the illness?" Lynfield said. "Are these students that are now off for two weeks going to congregate in the mall and increase spreading? It appears that the transmission of this virus is like seasonal influenza - it's close contact - large droplets. So the messages of covering cough and staying home if you're sick will have an impact."

In other words, it's becoming less about parents checking to see if their kids' school is open, and more about checking actual kids to make sure noses aren't running, throats aren't sore and foreheads aren't hot.

Schools that now find a probable case can still close - that decision has always ultimately been a local one. But another option is to stay open and isolate the sick student - in much the same way kids are already isolated when found to be sick.

Commissioner Magnan said that should not be interpreted as the state letting down its guard. This strain of flu is potentially fatal - especially considering there's still no vaccine.

But even more good is done, she said, if Minnesotans really take a moment to think about how well they follow the guidelines.

"People don't really wash their hands as much as they say they do," Magnan said. "Next time you go to the bathroom, see how long you'd really take to wash your hands. It's something we should do all the time, but we need to be on heightened alert at this time."

And how many times have we ever woken up feeling blah and decided to tough it out at work or school? Magnan said this isn't a good time for that. Stay home.

One new requirement for schools, starting today, is to state the number of students who are absent with repertory illnesses.

In Cold Spring, where the first case was reported last week, Rocori Middle School was supposed to be closed today but now will open.

In Minneapolis, where Emerson Spanish Immersion School will be closed for a second day today -- spokesman Stan Alleyne said the new guidelines have the district at least reviewing whether to keep the building closed all week, as first planned.

"We will continue to counsel with the health department," Alleyne said. "We feel they still have expertise in public health issues. So we will listen to their counsel but it does change how we think this process through."

The four other Minnesota schools that have closed are in suburban Long Lake. Orono High will stay closed today, but two elementary and a middle school on the same campus are re-opening.

High school principal Dave Benson wrote a letter to students yesterday, trying to answer non-health questions that the closure has prompted. Today was supposed to be the first day for AP - Advanced Placement - tests, and a good AP score can mean college credit. But any missed test will be made up later this month.

Secondly, not every sporting event that's canceled by the closure will be rescheduled.

And finally, Orono High hopes to make a final decision today about whether prom will still happen on Friday. If no, an alternate date has already been arranged.

Benson's letter to students concludes with a suggestion that transcends any flu outbreak -- "this is a good time," he writes, "to catch up on your assignments and prepare for your classes."

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