As children return to school for the spelling tests, the science labs and after-school clubs, area schools will be trying to keep them and staff members from getting swine flu.
Health officials worry that cases of H1N1 influenza could take off as classrooms fill with children coming back from summer vacation.
Schools are accustomed to dealing with seasonal flu. But H1N1 is different and experts believe it will be the dominant strain during the fall and winter flu season.
No one has immunity to the novel virus and H1N1 has tended to strike harder among young people and adults ages 20 to 55. The seasonal flu is usually more deadly to the elderly and the very young with pre-existing health conditions.
According to the federal Centers of Disease Control and Prevention, the highest rate of H1N1 infection has occurred in people 5 to 24 years old and that group has the second-highest rate of illness requiring hospitalization.
Children with conditions such as asthma or diabetes are at higher risk of serious flu complications, experts say.
Officials have tried not to trigger alarm, however, because the severity of H1N1 is about the same as seasonal influenza, which results in 36,000 deaths each year in the United States. Most people infected have mild to moderate symptoms and fully recover.
"There is not any evidence it is changing in terms of severity," said Dr. Randy Bergen, the clinical lead for Kaiser Permanente's flu vaccine program in Northern California. "I would anticipate the same degree of severity we saw when it broke out last spring and what we are seeing in the Southern Hemisphere."
Since emerging in Mexico last winter, the swine flu has spread worldwide, causing 477 deaths in the United States and putting more than 7,500 people in U.S. hospitals. In Stanislaus County, two adults have died and 36 people (with a median age of 30) have been hospitalized. There has been one death in Merced County and two in San Joaquin County.
For area schools, the state and federal guidelines have changed since the spring, when the first cases were recorded in California, said Dr. John Walker, public health officer for Stanislaus County.
Walker met with the Stanislaus County Office of Education on Thursday to discuss how schools should respond.
The focus is now on isolating students with flu symptoms, instead of closing campuses when cases emerge. If students appear to have the flu, school staff members are supposed to send them to the nurse's office, where they should be isolated from others until their parents take them home.
Under the previous policy, children suspected of having swine flu were kept home for seven days; the new policy could permit their return to school earlier. They can return to school 24 hours after the fever is gone and they have stopped taking fever medications for the same time.
At that point, the illness is no longer considered contagious.
Keeping sick kids at home urged
Schools also are expected to teach students to wash their hands regularly and use alcohol-based hand cleansers and to cover coughs with a sleeve or tissue. Schools also are telling parents not to bring their children to school if they come down with symptoms at home.
School officials said they are in agreement with the guidelines, developed by the CDC, the California Department of Public Health and the state superintendent of schools.
"We want a consistent response from schools across the county so parents aren't confused," said Jane Johnston, assistant county superintendent and liaison between Stanislaus County's school districts and the county health department.
Because swine flu is hitting younger people and there is no vaccine, schools are taking extra precautions, Johnston said.
Walker said he agrees with the diminished emphasis on closing campuses because of the collateral impacts of school closures. Schools are a source of food for many low- income students, who may eat one or two meals per day at school. In addition, closures interrupt learning and force parents to arrange for day care or to stay home from work.
Schools also are watching attendance because it affects the bulk of their funding.
Still, school closures will be considered if a large enough portion of students and staff become infected, Johnston said, but it's mainly an option reserved for extreme cases.
Walker said the swine-flu guidelines could be revised if the pandemic grows more severe. Another measure could involve screening students and staff for symptoms as they arrive on campus.
School officials are sending student attendance counts to county public health, which also is using electronic links to monitor for flu-related hospital admissions and ambulance calls.
Some schools are in session, although most students are heading back to campuses in the next two weeks.
At Hickman schools, which are back in operation, Superintendent-Principal Rusty Wynn said classrooms are armed with anti- bacterial sprays, wipes and gel.
"It's on the front of people's minds," Wynn said. School officials sent letters home telling parents they were treating swine flu as they would the regular flu. They cautioned parents that if their children are ill, they should stay home and see a doctor.
Thursday, Wynn was having etiquette signs made for each classroom. Friday, teachers went over the importance of hand-washing and covering up sneezes and coughs, he said.
Emily Lawrence, coordinator of K-12 instructional services and emergency operations coordinator for Modesto City Schools, said swine flu guidelines were e-mailed to teachers last week. Modesto's high schools, middle schools and most of its elementary schools are scheduled to start Aug. 24.
"I think communication is the key," Lawrence said. "We don't want to spin everyone into a panic, but we want to keep everyone informed."
No plans to restrict sports
Gil Ogden, director of student services for Turlock Unified School Districts, said the district has no plans to restrict student assemblies or sports activities. Most fall sports are outdoors and student assemblies are not held often, he said.
Turlock schools are ready to isolate any students with flu symptoms until their parents take them home, he said. When they're well enough to return to school, they will need to stop at the nurse's office for clearance before returning to class.
"I think there is heightened awareness," Ogden said. "Because we want what's best for the kids, we are going to take precautions and handle problems as they arise."
Because of the pandemic, influenza outbreaks have occurred in the Northern San Joaquin Valley this summer. About 30 percent of respiratory cultures taken at Kaiser Permanente health clinics in Northern California have been positive for swine flu this month, down from a peak of 50 percent in July, but experts such as Bergen, with Kaiser's vaccine program, believe the virus isn't going away.
"I think we are in for an early influenza season," he said. "The swine flu is expected to be the dominant influenza virus in the fall and winter and many people will become sick from influenza this year."
One reason is a lack of vaccine for swine flu. The seasonal flu vaccine will be available for distribution in early October. But a swine flu vaccine still is being tested with human subjects and may not be distributed until December.
Bee Staff Writer Michelle Hatfield contributed to this report.
Bee staff writer Ken Carlson can be reached at firstname.lastname@example.org or 578-2321.