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October 03, 2009
The Swine Flu debate in Bahrain
The Kingdom of Bahrain is actively debating the Government decision to extend the summer holidays in the schools here to prevent an outbreak of swine flu. In media and social circles, the Government's decision is being actively debated. While the Government stands firm on its decision to keep schools shut till Oct 11 and then reopen in a phased manner with the KG segment resuming early November, many parents feel that the decision is more driven by panic and the education of children suffer unnecessarily by this precautionary and preventive action by the Government.
Among the not so small sample of parents encountered by me, majority appears to be against the Government move in no uncertain manner. And I find myself in the minority ( at least in the sample) group that supports the decision. My support comes from my tracking of the spread and intensity of the pandemic from its early days and my belief in the role of good risk management in optimising risk and return.
Let me pen down my views on the issue based on statistical evidence.
1. Fear of the unknown
My first concern with the disease is that we do not know creature. In the present forms of its mutation, the virus is resistant to many drugs. with almost 3,42,000 cases and 4000 deaths,this puts the reported death rate over 1 per cent. This means that 1 out of 100 cases will die of swine flu. This is not due to operational failures, this is because of our lack of knowledge of the disease itself. When complications occur, doctors know little about the course of action.
You are encountering an unknown threat, better be cautious than sorry.
2. Reported Age Profile of cases
Clear statistics is not availble, but there are some indicative trends. In the US, out of 137,000 cases, more than 50 per cent were in the age group of 0-15. kids, it is now more or less accepted , are more prone to risk than adults. Sample statistics of US and Uk puts the death rate for kids in the range of 1.9-3.8 per cent, mostly in the schoolgoing age of 5-15 years. This statistics means that kids are about 3-4 times in danger than the adult population. Utmost care for kids is thus the bottomline.
3. The Death Rate of Swine Flu has not abated
The latest stats from WHO ( Oct 2 update no 68) shows that the death rate from H1N1 virus has actually increased from 0.42 in June 2009 to 0.76 in September 2009. The rise is a matter of concern, even when the media coverage has come down considerably. This means that the disease has become deadlier in the recent past , reversing the earlier trend. This is not good news.
4. WHO guidance on School Closure as prevention
Please read the WHO guidance carefully. It says that it is much more effective to close schools before a substantive outbreak. After the outbreak, a school closure is of limited value. Bahrain Government's action finds support from the following WHO guideline:
"School closure can operate as a proactive measure, aimed at reducing transmission in the school and spread into the wider community. School closure can also be a reactive measure, when schools close or classes are suspended because high levels of absenteeism among students and staff make it impractical to continue classes.
The main health benefit of proactive school closure comes from slowing down the spread of an outbreak within a given area and thus flattening the peak of infections. This benefit becomes especially important when the number of people requiring medical care at the peak of the pandemic threatens to saturate or overwhelm health care capacity. By slowing the speed of spread, school closure can also buy some time as countries intensify preparedness measures or build up supplies of vaccines, antiviral drugs, and other interventions.
The timing of school closure is critically important. Modelling studies suggest that school closure has its greatest benefits when schools are closed very early in an outbreak, ideally before 1% of the population falls ill. Under ideal conditions, school closure can reduce the demand for health care by an estimated 30–50% at the peak of the pandemic. However, if schools close too late in the course of a community-wide outbreak, the resulting reduction in transmission is likely to be very limited."
http://www.who.int/csr/disease/swineflu/notes/h1n1_school_measures_20090911/en/index.html
4. Risk - Return analysis
Weighing the risks of keeping schools opened in relation to its returns, to tell you the truth I was relieved when the circular came. Rarely do you see such good risk management practices in Government. The end of the summer break brings students back from all over the world. This creates a risky environ in schools. Controlling such risks involving unknown threats is crucial and i am happy that the Government has taken the correct step. The kids will learn, the curriculum and beyond, and a few weeks of holidays will not take a huge toll on their studies. The risk- return analysis suggests to me that school closure is an excellent preventive step and this needs to repeated should similar threats arise in future.
Three weeks of absence can be made up for, but loss of even a single innocent life can never be compensated.
Posted by sunandoroy at October 3, 2009 03:39 PM
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