What if bird flu spreads its wings?

23rd June 2006 at 01:00
UK schools have relatively few safety measures to combat an avian influenza pandemic. Martin Whittaker reports

In March this year, a dead swan on a beach in Fife heralded the arrival of avian flu on these shores. It also dragged the seaside village of Cellardyke into the spotlight. Alison Anderson, head of nearby Anstruther primary, says the school was on holiday and so missed the media storm that swept through the community. By the start of the new term, the panic had subsided.

"Since it became apparent that it's not a pandemic and nothing else has happened since, it's calmed down a bit," she said. "But we are very aware.

I think everybody's getting a huge awareness now not to go near birds lying dead on the ground."

The incident made the school think twice about a Year 6 trip to the Isle of May, a nature reserve known for its seabirds. After taking advice and doing a risk assessment, Mrs Anderson decided to go ahead with the visit. But, as calm returned to the coast of Fife, the Cellardyke swan highlighted the need for more guidance about the risk to schools.

"It rammed home to people in education that there should be a 'what if'

scenario, without spreading panic," she said.

Fife council sent information to schools about bird flu, but said detailed guidance from the Government is overdue.

"We are working on an influenza pandemic plan that we would hope to have in place," said Colin Acland, education service health and safety officer. "So we would welcome any advice from either the Department for Education and Skills south of the border or the Scottish Executive."

Now, that advice is about to land on heads' desks. A cross-government working party has been examining the implications for education of a flu pandemic. In July, the DfES will publish detailed guidelines for schools, children's services, colleges and universities. The Scottish Executive and the Welsh Assembly are awaiting DfES guidelines before advising their schools and colleges.

The National Association of Head Teachers says that, apart from a few enquiries, heads have been too concerned with the day-to-day pressures of running schools to worry about avian flu.

Martin Ward, deputy general secretary of the Association of School and College Leaders, said its members had shown little interest. The only reaction has been to possible plans to close schools in order to limit infection.

"There was a reaction along the lines of, 'Why just schools?'" he said.

"It's the sense that schools are somehow expendable."

According to the World Health Organisation, avian flu has brought the world closer to a pandemic than at any time since 1968, when the outbreak of Hong Kong flu killed a million people.

Virologists say the worst-case scenario would be similar to the 1918 flu pandemic which killed up to 40m people.

With the deadly H5N1 virus now endemic in parts of Asia, human cases are still being diagnosed and the virus has spread.

"Each new human case gives the virus an opportunity to evolve towards a fully transmittable pandemic strain," said the WHO.

Professor Nigel Dimmock, who chaired an independent review of avian quarantine arrangements in the UK, said young people are particularly prone to such infections.

"That's not usually the case with influenza," he said. "It's usually the very young or very old, or people with underlying conditions such as diabetes or heart conditions who are not able to fight off the infection.

The trouble with schools is that you cram a lot of people together, and that gives the virus the best opportunity for spreading."

In the United States, the Centers for Disease Control and Prevention, in Atlanta, have been making information available to schools for some time, including detailed pandemic planning checklists. They say schools can play a key role in getting across messages about hygiene. These include posting information in toilets about the need for hand-washing, giving flu-prevention messages in daily announcements and disinfecting classroom materials.

They also produce posters and screensavers to remind pupils about hygiene in the classroom and exhort teachers to instruct children about the basics, such as covering noses and mouths with a tissue when they sneeze.

International schools have also taken the threat of a pandemic seriously.

In April, the European Council of International Schools held a conference in Barcelona to discuss the operational, legal and financial risks to schools.

What, for example, would happen if schools were ordered to close? How much advance warning would there be? And what would happen in the case of a quarantine during which students were unable to return to their homes? Would fee-paying private schools have to refund a proportion of their cost?

International schools have also been considering the possibility of teaching pupils at home through distance learning. The ECIS has also warned that schools could be commandeered as hospitals or morgues, and could play a central role in communications.

"If there is a pandemic, people will need to be reassured," it says. "For many families, the school is the primary source of information and guidance. Be ready to step up to the plate."

The WHO says that mass gatherings of people present the greatest risk of spreading the virus. But the decision to close schools is not straightforward.

A spokesman said: "One of the considerations for closing schools, if that is what a country decides to do, is what then happens to the children? If they are kept at home, this may cause parents to stay at home as well.

"If the parent is a healthcare worker or provides other necessary skills during a pandemic, then society might want that person at work. If children are kept from school, they may gather by themselves to play. How different would that be from attending school?"

Boarding schools in the UK are concerned about the practical issues. Adrian Underwood, director of the Boarding Schools' Association, was part of the DfES working party that developed the guidelines for schools. He says that schools are worried about the knock-on effects of closure, such as the legal implications and having to plan for distance learning. Some boarding schools may have to quarantine students.

"If it happens at pandemic levels, it will limit international travel," he said. "So boarding schools won't have any choice. They will have to retain some pupils until they are given clearance."

Professor Andrew Easton, of the department of biological sciences at Warwick university, says guidelines are likely to suggest that schools close in line with local conditions and the numbers infected. It would be a decision for local authorities.

"I think I would look for a good line of communication between the Department of Health and the DfES. That's essential - getting good information to the public."

Meanwhile, schools can start by getting basic hygiene messages across to pupils.

"It would be helpful to improve levels of hygiene so that when the circumstances arise, we're not asking people to make a big change," he said.

"Introducing children to the rules of hygiene is in general a good thing to do. It's a good habit to establish."

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