By Amy Norton
Reuters
A new U.S. government study suggests that during a serious flu epidemic, closing schools can keep people - especially kids - out of the ER.

Now, researchers say, the big questions include, When is it best to close schools? And what are the downsides?

The study, reported in the journal Clinical Infectious Diseases, looked at what happened in two Texas communities during the H1N1 "swine" flu epidemic of 2009. In one community, schools were closed as a precaution; in the other, they weren't.

It turned out that in the district where schools shut down, there were fewer ER visits for the flu.

What's more, among kids age 6 and up, there was no increase in flu-related ER trips, while that rate doubled in the community where schools stayed open.

"The effect was most dramatic among school-age children," said Dr. Martin S. Cetron, of the Centers for Disease Control and Prevention (CDC).

There have been skeptics who've doubted that school closures could have much impact during a major flu outbreak, according to Cetron.

"They've said, well, people will just congregate in malls or other public places," explained Cetron, who directs the CDC's division of global migration and quarantine, and worked on the study.

But schools are different from malls, Cetron pointed out, with kids being in close contact with each other all day long.

He said he thinks this study, along with others, "settles" the question of whether school closures are effective. "Should this be an arrow in our quiver? I think the answer is ‘yes,'" Cetron said.

But lots of other questions remain.

"Under what conditions could (school closures) be warranted?" Cetron said. "What level of severity is needed?"

And if schools are closed, he noted, what are the downsides? Parents will have to stay home from work, or find child care. And kids and teachers will have to make up the lost school time somehow. So the expected benefits of school closings would need to be worth the troubles.

Prediction is difficult
Every year, between five percent and 20 percent of Americans get the flu, contributing to some 36,000 deaths. The elderly and people with chronic medical conditions, like heart or lung disease, are among those most at risk.

But the 2009 H1N1 flu epidemic was noteworthy in that it hit children and healthy young adults hard.

The current study looked at two adjacent counties in Texas: Tarrant County, which closed its schools for eight days after a few kids were diagnosed with H1N1; and Dallas County, where schools did not shut down after a few cases were detected.

Before Tarrant County's school closures, the flu accounted for about 3 percent of all ER visits to area hospitals; during the closures, that rate inched up to just over 4 percent. But the increase was bigger in Dallas County during the same time period: from 3 percent, to just over 6 percent.

The impact was most clear among kids ages 6 to 18. In Tarrant County, there was no increase in the proportion of ER visits blamed on the flu. In Dallas County, the figure more than doubled, from about 5 percent to 11 percent.

"It's important to point out that this was a pre-emptive school closure," Cetron said. "Usually, most closures we see are reactive."

Predicting how a flu outbreak might affect a local area is far from easy. It's not like tracking a hurricane, for instance, Cetron pointed out.

Decisions on school closures are made locally. For school districts to make wise decisions, Cetron said communication with local and state health agencies is key.

Mark Ralston / AFP/Getty Images

A school cafeteria worker hands out fruit and drinks to school children at the Normandie Avenue Elementary School in South Central Los Angeles on Dec. 2, 2010, the same day Congress passed The Healthy Hungry-Free Kids Act.

It may not sound like much but there’s a new item on the school menu: water.

Across the country, administrators are scrambling to comply with a new federal requirement that free drinking water  be offered at lunch as part of an ongoing push to improve the health of the nation’s 49 million public school children.

The solution isn’t as simple as pointing kids toward the nearest water fountain. Just ask Brian Giles, food services senior administrator at the Houston Independent School District, the nation’s seventh-largest district, with more than 202,000 students and almost 300 campuses:

“The majority of our schools do not have drinking fountains or ready access to water in the lunchroom,” he said.

To comply, he’s spent $60,000 to buy 3.5-gallon water coolers for each school cafeteria. In the lunch line, students can choose milk or juice, or a cup for water.

“Every kid needs access to water,” he said. “It would have been nice if the feds allocated some money for it.”

The mandate comes as schools struggle with budget cuts amid growing concern with childhood hunger and obesity. In December, President Barack Obama signed The Healthy, Hunger- Free Kids Act, which includes the provision that schools make water available at no charge during lunch.

Experts say water is the ideal drink for kids already drinking too many high-calorie, sugary drinks.

Like Houston, schools in Atlanta are putting out water coolers and making cups available. Other districts have invested in costlier water stations where students can fill cups or bottles.

 “We’re looking at what is the most cost-effective, practical and environmentally –sustainable way to provide water to our students,” said Seattle Public Schools spokeswoman Teresa Wipple. For now, the district puts out pitchers and cups in the cafeterias of its 94 schools.

While bringing more water into schools is a good idea, researchers say it’s only part of the solution to combating obesity.

“It’s a step in the right direction but it’s going to take more than that,” said Lindsey Turner, a senior research specialist at the Institute for Health Research and Policy at the University of Illinois at Chicago.

As the lead author of a 2010 study, Turner found almost half the nation’s public elementary school students could purchase soda, sport drinks and higher-fat milk during the 2008-2009 school year from vending machines, school stores and a la carte lines.

Getting students to drink the water is another challenge.

“We’re not seeing a lot of demand for it,” Giles said.