The Social and Economic Effects of School Closure During an H1N1 Influenza A Epidemic in the United States

In the summer of 2009, more than 209 countries officially reported 25,174 deaths from influenza A H1N1 virus infection to the World Health Organization (WHO). As of mid-February 2010, the Centers for Disease Control and Prevention (CDC) estimated that 57 million people in the United States had contracted the H1N1 virus, resulting in approximately 257,000 hospitalizations and 17,160 deaths. In the event of an influenza pandemic, policies are implemented in order to attempt to lessen the spread of the disease. One of these regards school closure, a non-pharmaceutical intervention, often suggested for mitigating influenza pandemic in a population. Proactive school closure is defined as closing schools ahead of a pandemic arriving in an area, whereas reactive school closure occurs simply because many students and staff are sick and the schools feel it is necessary. Health officials making the decision to close schools must weigh the potential health benefits of reducing transmission against high economic and social costs, difficult ethical issues, and the possible disruption of key services such as health care. This paper examines the public health relevance of school closure as a public health policy in response to an influenza epidemic and shows that school closure as a mitigation strategy will have substantial economic, social, and ethical effects. Seven studies are examined regarding economic costs, social costs, social justice and ethical issues, and effect on the healthcare system, to evaluate the effects of school closure during an H1N1 influenza. Modeling studies are also discussed. Epidemiology studies and surveys highlight the social effects, ethical issues, and healthcare effects. Vulnerable populations often suffer disproportionately during an epidemic, therefore the sources of socioeconomic and racial/ethnic disparities during an epidemic are examined. Finally, there is a discussion on communication and implementation of school closure policies and recommendations for improvement of preventative methods as well as specific plans to minimize the disparities. Overall, closing schools in the United States for an average of four weeks could cost up to $47 billion dollars (0.3% of GDP) and lead to a reduction of 19% in key healthcare workers. School closure also raises a range of ethical and social issues, particularly since families from underprivileged backgrounds are likely to be most affected by the intervention. Some recommendations include simple educational campaigns to be implemented within schools and local businesses to help educate the community about H1N1 influenza. Because it can be extremely difficult for parents to take time off work to get their children vaccinated, doctor offices should offer H1N1 vaccinations during regular check-ups, and schools should try to hold vaccination programs. Finally, due to evidence of existing health care disparities among socially disadvantaged groups, distribution plans of vaccinations may need to include mobile community health centers that can travel to low-income areas and nontraditional sites like soup kitchens and shelters.