Big news in a small town: Responding to H1N1 flu
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Tuesday, May 5, 2009 - 8:33am
A confirmed case of swine flu, or H1N1 flu, in a Middlefield child is big news for a small town. Big enough for major news networks and print media to attend a community-wide forum on the topic with representatives from the Connecticut Department of Health (DPH), Board of Education, personnel from the school district and town health officials.
“We’re here tonight for an information session so we can talk about the facts that have been going on the last couple of weeks,” said Region 13 health director and Durham physician Dr. Brad Wilkinson at the forum on Monday, May 4. “We feel, naturally, this is a very important issue that needs to be addressed with common sense and all the facts on the table.”
Dr. Wilkinson was joined at the podium by Region 13 Superintendent Susan Viccaro, state epidemiologist Dr. Matthew Carrter of the DPH, and school liaison to the DPH, Debbye Rosen. Before questions and comments, which ranged from extremely positive to extremely negative on the way the local case was handled, the speakers brought everyone up to date on the specifics of the case.
According to Dr. Wilkinson, two weeks ago, after vacationing in Mexico, a child who attends John Lyman School in Middlefield came down with symptoms of the flu. She was subsequently diagnosed, but never returned to school after the vacation. She was treated with Tamiflu and antiviral medications, as was a sibling, who eventually did return to school. The child who was affected has been a-symptomatic for eight days as of Monday, Wilkinson said, and “using CDC (Center for Disease Control) guidelines, the child can return to school tomorrow.”
He then added, “Every decision Sue Viccaro has made has been in close concert with the DPH in what has been sometimes minute-by-minute advice.”
Dr. Cartter, who has been with the DPH for 25 years and has connections with a child in District 13, felt he was the right person to attend the forum to answer questions.
“This is a difficult time, I understand that, for parents,” he said. “We’ve learned so much in the last 12 days, and we ask for your patience as we share the information we know with you. I understand not everyone will agree with the DPH’s decisions.”
He went on to say that influenza, or flu, is a very specific illness, and is not like the common cold. Connecticut’s season for the flu is generally between November and the end of February into March, so there are many seasonal flu cases going on right now. Every year, about 36,000 Americans die from the flu, and 15 to 20 percent of the population comes down with it, he said. In Connecticut, one to two kids die each year from the flu. When H1N1 flu was declared a public health emergency last Sunday, one of the biggest questions was “Do we keep schools open or not?” he said.
“Schools don’t close for seasonal influenza, and the reason is because closing them doesn’t change the course or transmission of the epidemic,” he explained. “You would have to close all schools for four to six weeks, which is a burden on families and the structure of society.”
He reported that the CDC last week said that schools should consider closing if a child with a confirmed case did attend school. He then noted that every school in the state that has closed has done so on their own and not by recommendation of the DPH.
He continued, “There certainly is logic to closing schools, but what happens is parents will stop telling the truth about whether their kid is sick or not. They will stop saying they went to Mexico, and we need this flow of communication.”
At this point, Viccaro stepped in to explain the process that has gone on since learning of the swine flu case from Middlefield’s director of health, Dr. Matthew Huddleston. “I said, ‘What does this mean and give me some advice,’” Viccaro shared. She then spoke with Debbye Rosen. “My first question was should I close the school…my second question had to do with the sibling because I knew it would be a major concern for parents,” she said. Viccaro was not advised to close the school because the child had no exposure in school after returning from Mexico. She also said the family chose to keep the sibling home last Monday and Tuesday on their own.
Even so, there were many questions from the audience having to do with the sibling. Lynn Stanwood, whose daughter is in class with the sibling, said she wasn’t looking for the school to close, but “it would have been prudent to quarantine the sibling.”
But Dr. Carrter responded that because influenza is so easily transmitted, keeping the sibling home doesn’t do enough. “Quarantine is not recommended for influenza because it doesn’t control the spread,” he stated. He went on to say that a sibling who is non-symptomatic, is on Tamiflu and has been home for a short period is sufficient in controlling exposure to others, and the CDC said to not exclude the person if they are not sick.
Joe Millo, another parent with a child in class with the sibling, said he was unhappy with the lack of communication and having to “fill in the blanks on our own.” Though Viccaro posted information on the website and sent letters home to parents, his frustration was echoed by several other parents who felt communication was not substantial, especially to families who have children in the same class as the sibling and to those with children with weak immune systems.
Viccaro agreed with them. “We could have had better communication with parents… I absolutely own that.”
When another parent asked what the district will do going forward in terms of guidelines for parents, Wilkinson said he and Viccaro will work on providing more thorough handouts that address different issues.
Some people spoke in support of the way the district handled the situation. “Sue did what she was supposed to do. She followed protocol,” one audience member said, which earned applause. Another person said it is primarily up to parents to keep their children safe and for the school to follow the advice from the experts. “The school has never done anything detrimental to its students,” she said.
Other questions included: What is the incubation period? (Answer: this is being looked into, but it’s safe to say between 2-7 days.) How is H1N1 flu transmitted? (Answer: by droplets in the air that are either breathed in or touched to the eyes or the nose. The bacteria can live on surfaces for up to two hours, and sanitizing has little effect on helping control the spread.) Viccaro said she learned this after the custodial staff went through the schools “with a fine tooth comb” sanitizing fixtures and other surfaces.
Rosen repeated several times that the best thing to do is keep your child home if he or she is sick. She noted that schools and the community will close down based on the number of people in the schools becoming ill, which is not where Region 13 is at right now.
In fact, Dr. Cartter said there are only 14 probable or confirmed cases of H1N1 flu in the whole state, and there has not been a secondary case in households of any case here in Connecticut at this point in time.
Finally, John Lyman School principal Karen Brimecombe got up to speak on an issue that hadn’t been touched upon yet. “There have been very unkind comments to the sibling, and quite frankly it breaks my heart,” she said. “I ask you to talk with your children and friends about the core ethical values because no child or family should be hurt.”
