Variability in school closure decisions in response to 2009 H1N1: a qualitative systems improvement analysis

Abstract

BackgroundSchool closure was employed as a non-pharmaceutical intervention against pandemic 2009 H1N1, particularly during the first wave. More than 700 schools in the United States were closed. However, closure decisions reflected significant variation in rationales, decision triggers, and authority for closure. This variability presents the opportunity for improved efficiency and decision-making.MethodsWe identified media reports relating to school closure as a response to 2009 H1N1 by monitoring high-profile sources and searching Lexis-Nexis and Google news alerts, and reviewed reports for key themes. News stories were supplemented by observing conference calls and meetings with health department and school officials, and by discussions with decision-makers and community members.ResultsThere was significant variation in the stated goal of closure decision, including limiting community spread of the virus, protecting particularly vulnerable students, and responding to staff shortages or student absenteeism. Because the goal of closure is relevant to its timing, nature, and duration, unclear rationales for closure can challenge its effectiveness. There was also significant variation in the decision-making authority to close schools in different jurisdictions, which, in some instances, was reflected in open disagreement between school and public health officials. Finally, decision-makers did not appear to expect the level of scientific uncertainty encountered early in the pandemic, and they often expressed significant frustration over changing CDC guidance.ConclusionsThe use of school closure as a public health response to epidemic disease can be improved by ensuring that officials clarify the goals of closure and tailor closure decisions to those goals. Additionally, authority to close schools should be clarified in advance, and decision-makers should expect to encounter uncertainty disease emergencies unfold and plan accordingly.

School closure as an influenza mitigation strategy: how variations in legal authority and plan criteria can alter the impact

“…Though ordered for some schools in spring, summer, and fall of 2009, school-closures were determined typically by local school districts and individual schools; and closure durations rarely exceeded a few days [13,14]. It was reported that H1N1 school closure experience had much local variation in decision-making authority, disagreement between school administrators and public health officials, and lack of clarity about the goals for closure [15]. A review of laboratory-confirmed H1N1 cases in Alberta, Canada found that the 2009 summertime closure of schools had interrupted virus transmission among school-aged children but then failed to prevent a second wave of the pandemic when schools re-opened in the fall [16].…”

Community Mitigation Guidelines to Prevent Pandemic Influenza — United States, 2017

“…Certain public health departments reported difficulties in communicating the updated guidance on school closures to their communities, especially communities that were planning to implement school closures or had already done so ( 30 , 31 ).…”

A Tale of Many Cities: A Contemporary Historical Study of the Implementation of School Closures during the 2009 pA(H1N1) Influenza Pandemic: Table 1

“…I think that in situations where the strength of recommendation—the data on which recommendation is based—is less strong, then more flexibility is appropriate” (interview 5). This idea was echoed by nearly every public health and public education official we interviewed, as well as in other studies on the use of school closure during the 2009 pandemic (Jackson et al 2013; Klaiman, Kraeme, and Stoto 2011; Jarquin et al 2011). …”