Flu season that never stopped

When thousands of students at Chicago public schools return to classrooms on Sept. 8, they'll see something that wasn't there a year ago: hand sanitizing gel. Along with demonstrations on proper hand washing and coughing etiquette, the gel is part of the effort of the nation's third-largest school district to stifle the spread of the H1N1 swine flu virus.

It's also an attempt to follow the advice of the Centers for Disease Control and Prevention (CDC), the federal government's top public health agency, responsible for monitoring the spread of H1N1 throughout the nation. Before school season got back into swing, the CDC issued guidelines on how schools should deal with flu cases. The nation's 130,000 public and private schools are taking cues from worried federal officials but also want to avoid an overreaction.

For instance, the CDC advises schools to send home students who "appear to have an influenza-like illness"-such as a fever, cough, and runny nose-and to offer them surgical masks to wear until someone picks them up.

Some schools think that's too extreme. "If you have to wear a mask, you shouldn't be in school," said Monique Bond, the communications director for Chicago Public Schools, which briefly shut down two of its 666 schools last spring because of flu concerns (one of the schools had a confirmed case of H1N1).

Bond said the district will closely monitor attendance at individual locations and watch for unusual patterns. The schools will use temperature strips to check for fevers and in some cases ask parents to monitor their children for flu symptoms.

Tony Lux, the superintendent of eight schools in northwest Indiana that comprise the 7,000-student Merrillville Community School Corp., agrees that masks are over-the-top and said he's heard conflicting advice about their practical effectiveness. Lux said his schools will watch for flu symptoms and remind kids to wash hands and carry tissues, but that there are "a lot of vague, gray areas in this thing. We don't want to see a lot of kids staying home for a week at a time when all they have is a cold."

Most people who contract H1N1 experience a fever, cough, sore throat, perhaps a runny nose, and are back on their feet within a week. But in rare cases, the virus takes a quick turn for the worse, debilitating lungs and leaving the infected person short of breath. And unlike other flu strains, the 2009 swine flu is most likely to hospitalize younger people: children, teens, and young adults.

It worries flu experts that H1N1 has spread steadily during summer months, when flu transmission is normally sluggish. Strict counting has ended, but experts estimate H1N1 infected as many as a million Americans between April and June. By mid-August hospitals across the nation had reported nearly 500 deaths associated with the virus. During the 1957-58 outbreak of Asian flu, the number of cases soared in October, after students resumed classes. Federal officials are watching for a similar pattern this fall.

Although a U.S. federal advisory panel recommended that the FDA approve an H1N1 vaccine without waiting for safety results from clinical trials, the doses probably won't be ready until mid-October. The CDC recommends inoculating 160 million people who are at a higher risk of developing complications from the disease-including children and teens. Depending on the severity of the flu this fall, Americans may see a federally led campaign for student immunization.

If outbreaks worsen, the CDC recommends schools take further measures, such as screening students for fevers at the door, moving desks farther apart, or-as a last resort-dismissing classes for several days. If that happens, students who don't catch swine flu at school may at least bring home a week's worth of homework.