Schools in Grayville, Ill., closed on Monday, and won't reopen until Thursday, after more than 20 percent of the town's elementary through high school kids came down with the flu.
From Minnesota to Oklahoma, schools have made similar decisions, while workplaces, hospitals, churches and sports teams are taking their own precautions in the face of what is likely the worst flu season in more than a decade.
"Kids are generous in sharing secretions," said Dr. Marty Cetron of the U.S. Centers for Disease Control and Prevention, who has three kids of his own.
When the flu strikes, kids tend to be the first sick due to their lower immunity and more frequent contact with others -- including the natural intermingling at crowded schools.
"Once the virus gets into schools, it spreads fast," Cetron added. "Then kids come home, creating a cascading effect in the community."
In a study published in October, Cetron and fellow researchers evaluated the approaches taken by two Texas school districts' during the 2009 H1N1 pandemic. One district temporarily closed schools early in the outbreak, while the other kept doors open throughout.
Cetron said the differences were "profound," including fewer self-reported emergency visits and influenza-like illness in areas where schools had closed, even if only for a week or so. The benefits also extended beyond the students to entire communities.
Based on his own research, Bruce Lee, an expert in infectious diseases at the University of Pittsburgh, said he's less optimistic about the flu-fighting strategy. Closures may not only fail to protect kids from the flu or thwart an outbreak, he said. They may actually "refuel the epidemic" once those kids return to school.
"We found school closures prohibitively expensive and not very effective," said Lee, whose research used computer simulations based on census data.
Lee's research suggests that once a virus has spread throughout a community, schools would have to remain closed for a long time -- say eight or nine weeks -- to offer any lasting protection from the flu. That means significant losses in teacher productivity and parents' work time.
Modeling studies like Lee's are important, said Cetron, but "don't replace real life," such as the experiences of students in Dallas and Fort Worth, Texas, during the 2009 pandemic.
"Even a short term dismissal could allow people to become educated, get vaccinated and develop some immunity," said Cetron.
Still, Cetron acknowledged that many other factors, such as the timing, strain and spread of the virus, play a role. Simply reacting to a flu outbreak, as Grayville and other districts have done this year, is less effective than closing schools before a large number of students fall ill. Closing schools is also not a "trivial intervention," and its disruptiveness may be even less appealing to school officials before an outbreak's impact has played out, said Cetron.
Researchers including Cetron are now collecting experiences of places like Grayville, Ill., to evaluate the success of various strategies, while also noting that there is no one-size-fits-all approach.
"If you've got a school that serves special needs kids, or a faculty with high proportion of people undergoing cancer therapy, you might need different approaches," Cetron said.
Both Cetron and Lee agreed that a whole suite of interventions should be employed within a community.
"Not practicing 'presentee-ism' at work when you're sick, and being cognizant of where you sneeze and what you do with your hands, makes a big difference," said Cetron. "First and foremost, protect yourself -- get immunized. And if you get sick, be a good citizen in your community and don't share the virus with others."
In many communities, other social institutions are also taking their own steps to guard against the flu.
Some hospitals, for example, are limiting visitors. Portsmouth Regional Hospital in New Hampshire is going as far as to keep kids out -- unless they're seeking treatment, of course.
Churches, too, are taking the cue, with many urging parishioners to stay home if they have the flu and avoid shaking hands during rite of peace. Some Catholic churches have also stopped offering a shared chalice during Holy Communion.
Also among the gathering places in which germs can fly: sporting events and grocery stores.
The Manhattan Soccer club is reportedly encouraging its players not to shake or touch hands with opposing players during games. Rather, during the traditional post-game lineup for high-fives, the club suggests that "the safest thing to do is touch elbows."
Cetron said he is all for creating new ways to minimize the sharing of secretions. "If you decide to do elbow bumps instead of handshakes, that makes good sense as long as you are not sneezing into someone's face," Cetron said.
Pam Rankin keeps similar considerations in mind while she works at the IGA Supermarket in Grayville, reports a local news station, WTVW. One of Rankin's kids, who attends a now-closed school, iscurrently sick at home with the flu.
"I don't want to spread it to the customers and have all them come down sick either," Rankin told WTVW. "We've been using hand sanitizers, sanitizing wipes, spraying over everything."
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