( in Vietnam and Egypt. “No one’s arg...)U.S. Issues Guidelines in Case of Flu Pandemic,Health

in Vietnam and Egypt.

“No one’s arguing that by closing all the schools, you’re going to prevent the spread,” Dr. Markel added. “But if you can cut cases by 10 or 20 or 30 percent and it’s your family that’s spared, that’s a big deal.”

School closures can be very controversial, and picking the right moment is hard, because it must be done before cases soar.

Jeffrey Levi, executive director of the Trust for America’s Health, a health policy organization, noted that in poor city neighborhoods, 30 to 60 percent of all children get breakfasts or lunches crucial to their nutrition at school.

“What are you going to do about that?” he asked.

Dr. Markel said it might be possible to keep the cafeterias open and transport food to points where parents could pick it up, a move that would also keep cafeteria workers and bus drivers employed.

Several public health experts praised the C.D.C. guidelines, although there were some quibbles with aspects of them.

Dr. Michael T. Osterholm, director of the University of Minnesota’s Center for Infectious Disease Research and Policy, said he saw no point in fretting over exactly when to close schools, because his experience in meningitis outbreaks convinced him that terrified parents would keep their children at home anyway.

“I don’t think we’ll have to pull that trigger,” he said. “The hard part is going to be unpulling it. How do the principals know when schools should open again?”

Other experts pointed out that children out of school often behave in ways that are nearly as contagious. Youngsters are sent to day care centers, and teenagers gather in malls or at each others’ houses.

“We’ll be facing the same problem, but without the teaching,” said Dr. Irwin Redlener, director of the National Center for Disaster Preparedness at Columbia University’s Mailman School of Public Health. “They might as well be in class.”

Also, he noted,
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