The closing of schools in the case of a pandemic has been discussed extensively in the public health community in the past few years. It’s a very disruptive kind of intervention. Not many working parents can look after their kids over several weeks. Also, a lot of these kids are getting their daily meals in their schools. So that creates a whole range of new problems. As long as we don’t see a lot of people dying in the US, I don’t think the experts are going to recommend the closing of schools.

I am also very interested in the other issue you hint at: much of what is being done is meaningless, and the things that could really make a difference are not being done. The New York Times ran a story today which reports that ten countries have now banned pork imports from affected countries, despite the fact that WHO and CDC say that it is impossible for the virus to be transmitted to someone consuming pork. I suppose it simply must just be politics. And good for the domestic pork industry.

On the other hand — back to my old example — they aren’t closing schools in New York. This seems to me like a basic precautionary measure, though I guess it is potentially very disruptive.

One of the problems lies with the WHO alert scheme. On the basis of the definitions of the different phases, we are clearly in phase 5. However, given the relative slow but steady spread of a relatively mild disease, the type of interventions prescribed by phase 5 seem over the top. So there is a problem here, which is an effect of anticipatory planning itself.

Finally, there is not much you can do anyway, except producing a protective vaccine, caring for the sick, and trying to avoid contact with other people. The rest is largely and almost entirely political.

As you know, the impact of currently available forms of intervention on the pathological effects of regular seasonal influenza are very limited.

The CDC is issuing massive amounts of interim guidance to states (and communities, and vulnerable populations, and occupational groups, and… etc etc) on the basis of what it knows *now* and what it can reasonably predict *now.* It can, apparently, reasonably predict deaths from this, just as it can for any seasonal flu (so why has that become so remarkable in this context?). But if the CFR is exceedingly low – i.e., virulence is mild – then what additional aggressive measures would one suggest? I’d say releasing one quarter of the SNS seems like it is an attempt to align itself to known information, including info about severity, today. Where should the other three-quarters go? On top of all this: Public health has a perennial problem with risk communication, insofar as messaging can sound either trite or overblown. Because of the uneven spread of illness, coupled with – at the moment – a fairly low PSI score, it is therefore a tricky proposition to communicate targeted behavior modification or policy prescription messages to specific locales or jurisdictions. Other jurisdictions might just do the same thing needlessly. Thus the seemingly odd balance between universal precautionary measures for individuals (shown to reduce community transmission) and judicious messaging in other respects.

On the question of what public health folks are doing, everyone here has really answered the question already. I’ll just say that, at the very least, this is what’s going on: (1) Increased epi and contact tracing as appropriate; (2) extensive active surveillance throughout the healthcare system; (3) laboratory ramp up; (4) receipt of SNS stockpiles; (5) planning for mass meds distribution; (6) regional, state, federal collaboration/planning, conference calls, etc.

As everything here is all my personal opinion, I’ll just take this moment to say I’m glad the US now has a Secretary of Health and Human Services.

“This proclamation cuts government red tape by:

* Ordering all state agencies and departments to utilize and employ state personnel, equipment and facilities to assist the Department of Public Health (DPH) and the State Emergency Plan as coordinated by the California Emergency Management Agency

* Ordering DPH and the Emergency Medical Services Authority to enter into any and all necessary contracts for providing services, materials, personnel and equipment to supplement extraordinary preventive measures being taken across the state

* Suspending non-competitive bid contracts for services, material, personnel and equipment needed to respond to this outbreak

* Waiving select certification requirements for public health laboratories to help in the state’s expansion of our testing capabilities”

On to what the public is urged to do:

“*Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.
* Wash your hands often with soap and water, especially after you cough or sneeze. Alcohol-based hand cleaners are also effective.
* Try to avoid close contact with sick people.
* If you get sick with flu, it is recommended that you stay home from work or school and limit contact with others to keep from infecting them. Avoid touching your eyes, nose or mouth. Germs spread this way.”

So on the level of the individual, not “an abundance of caution” but the advice to take basic precautions, for a cold or flu. On the level of the state, yes, maybe. Actions have been authorized, for when they need to be taken. There’s also something interesting in the “waiving select certification requirements for public health laboratories to help in the state’s expansion of our testing capabilities”. California can now confirm swine flu without the CDC. One, it is an act of faith in the state’s public health laboratories. Two, does it signal a lack of faith in the federal response?