THE THIN WHITE LINE: the history of a future avian influenza pandemic

Chapter 2: State of Emergency

Shutdown of the schools

    The flu spread rapidly in densely populated schools. Consider that the average elementary school child had an average of about 3.9 feet of personal space, well within the six feet considered to be the maximum distance for infection to occur, compared to 11 feet for an office worker. Those that caught it brought it home to their families; children became the primary carriers of influenza into the home. Although the 20- to 40-year-old age group suffered the highest mortality rate due to Avian Flu, children proved more likely to transmit infection because a higher percentage of them became ill, they shed virus for a longer period than adults, and they don’t control their secretions as well.
    The school closings slowed the rate of infections and reduced mortality among children and subsequent impacts on society (psychologists, for example, consider the death of their child the most significant trauma an adult can experience). However, government interventions presented tradeoffs. For every action, it seemed, there was a negative reaction. The school closings were no exception.
    Kids weren’t always confined to the home. They roamed the streets and searched out other children, continuing to spread infection among each other and bringing the disease into their homes to infect family members. Government encouraged parents to keep their children at home to prevent risk of infection, but it is estimated that only about one-third complied with this, although the rate increased to 80+ percent as the epidemic increased in severity.(30) Although the school closings virtually eliminated school-based contacts, it is estimated that home contacts doubled.
    Absenteeism also increased. In past decades, the Canadian workplace shifted due to demographic trends, resulting in a higher percentage of workers being dual earners or single mothers. For example, in 1976, 44 percent of single mothers with children under six participated in the workforce; by 2011, this increased to 63 percent. By 2011, an estimated 70+ percent of married or common-law couples had two working partners.
    These trends were accompanied by higher work/life conflicts, resulting in higher documented job stress. Workers suffering from a high work/life conflict exhibited absenteeism rates more than twice those of other workers——13.2 days per year compared to 5.9 days per year.
    After Alberta closed its schools, an estimated 2 percent of workers, or about 37,000 people, stopped reporting to their jobs.(31),(32) Unfortunately, a few of them included doctors, nurses, first responders, utility technicians and other essential workers. They stopped showing up because they didn’t have any other childcare options, particularly healthcare workers who were often stigmatized during the Pandemic because they worked directly with people infected with Avian Flu——a stigma that worsened as the media increasingly reported the flu’s most extreme symptoms such as hemorrhaging.
    Pre-Pandemic models suggested that early school closings would significantly reduce the peak number of flu cases, but only if this action could be taken early in the epidemic before a significant portion of children had become infected.
    Unfortunately, the disease had spread for nearly three weeks by the time Canada’s major cities closed their schools. The school closings therefore had an impact, but perhaps not as significant as it could have been. According to epidemiologists, the peak attack rate (but not the total attack rate) could have been reduced by about 40 percent if the school closings had been announced at the beginning of the epidemic. They estimate the effect on the epidemic in most provinces to be a reduction of peak attack rate of about 10 percent.
    The school closing decision demonstrated a major problem with community-based interventions: Government did not, or could not, implement every intervention early enough in the epidemic to make a major difference. Later in the epidemic, another big problem would become apparent: Not everybody will obey the government.