Are You Breaking Swine Flu's Golden Rule?

Staying Home When You're Sick is Key Advice That Some Find Unrealistic

By Miranda Hitti
WebMD Health News

Reviewed By Louise Chang, MD

July 15, 2009 -- Stay home when you're sick. That's one of the key steps that the CDC wants people to take to curb the spread of the 2009 H1N1 influenza, commonly called swine flu.

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"Our No. 1 strategy is to ask sick people to stay home," Lisa Koonin, MN, MPH, senior advisor for the CDC's influenza coordination unit, tells WebMD.

Will you follow that advice this flu season? And will you do so as soon as swine flu symptoms emerge, or only when you feel truly wretched?

If you're a parent, will you keep your kids home from school or day care when they get sick? Or only if their school or day care center temporarily closes?

How will you deal with sick co-workers who show up and cough all over the place, exposing you to their germs? And will job fears and the rocky economy nudge you to work despite being sick?

"That is a complicated issue that is even more complicated in these economic times," says Roslyn Stone, MPH, chief operating officer of Corporate Wellness Inc. in Mount Kisco, N.Y. "We're all concerned about that."

"We know that this is difficult," says Koonin. But she points out that this H1N1 virus is new, spreads fairly easily from person to person, and has led to some deaths and hospitalizations, though most cases haven't been severe.

No doubt about it -- staying home would be best for everyone. But some professionals in human resources, business, and child care tell WebMD they fear that advice is unrealistic for many people -- which could hamper swine flu prevention in the long run.

Afraid to Stay Home From Work

Stone, who chairs the workplace working group for the National Influenza Vaccine Summit, a joint project of the CDC and the American Medical Association, supports the recommendation to stay home when sick and not go back to work until you're better.

But she knows it's a tough sell in this economy.

"People have more job responsibilities. One employee may be doing the work of two. There's no one else to fill in for them when they do call in sick, or there are fewer people -- they're stretched thinner. They don't have accrued sick time. They're afraid to be out of the office. They're worried that their job isn't going to be there when they come back," Stone says.

Philip Deming, principal of Philip S. Deming and Associates, a human resources and security risk management firm in King of Prussia, Pa., says he's heard anecdotes of workers who are afraid to stay home when sick.

"If they have any inkling that their employer may be shutting down or doing a RIF [reduction in force], they're not going to chance taking the time off, especially if they don't have vacation time or sick time or [paid time off]," says Deming, who chaired a group that wrote pandemic flu guidelines for the Society for Human Resource Management.

"That's a problem," Deming says, "because you try to get your [sick] employee to leave the workplace [to] not to put others at risk."

And in small businesses, "in most cases the owner's going to show up if he or she can possibly make it, and probably most of their better employees will make an effort to get in to work," says Keith Ashmus, a partner in the Cleveland law firm Frantz Ward and chairman of the National Small Business Association.

"I think it's pretty extreme to say the first time you start having a little bit of fever or a little bit of respiratory problems that you're not going to do what you've done your whole life and suck it up and go to work," Ashmus says.

But going to work when sick can backfire, Koonin notes. "If a sick person comes into the business place and exposes other people, then absenteeism is going to be increased, and that's going to threaten the continuity of function of businesses," she says.

Will Your Business Understand?

Koonin says the CDC encourages businesses to develop flu policies that allow workers time to recover, and for businesses to communicate those policies to workers.

Stone agrees that businesses should make their plans now and inform workers that they should stay home if they're sick.

"A company needs to be sending that message out now, before we get into the fall, that our expectation is that you won't come to work sick, which is a slightly different message than what we've been saying to our employees all year ... you need to give 110%, this is not business as usual -- all those economic messages," says Stone.

"Nothing replaces being a good manager," Stone adds. "If your employees trust you, then you can say to your employees, 'I need you to stay home because you're sick. I will make sure you get extra hours next week to make up for it,' and follow through on that."

The question to ask yourself, Koonin says, is not how sick you are, but whether you have symptoms that mean you probably have swine flu.

"The primary symptoms are fever accompanied by a cough or sore throat," says Koonin. Other symptoms may include runny nose, body aches, chills, fatigue, diarrhea, or vomiting.

Fever, by itself, may not mean swine flu. "Usually with the flu, people have more than just fever alone. They have some other symptoms, as well," says Koonin. She adds that in May, a Harvard School of Public Health survey showed that of about 1,000 U.S. adults who were polled, 97% said that if public health experts recommended staying home for five to seven days with swine flu, they would do so.

Dealing With School Closures

The stay-at-home guideline may also mean temporary school closures or keeping kids home with flu symptoms, even if school is still open.

Gerald Harkins, associate vice president for campus safety and security at the University of Texas at Austin, kept a close watch on how local school districts for students in grades K-12 handled swine flu this spring.

"If the school districts close ... it has a tremendous impact on us, because our staff, faculty, and even students have children in those school districts," Harkins says. Several local schools did close, and Harkins says "we've worked our way through, as a region ... in terms of what are we going to do."

But he's not sure that school closures were effective.

"The thought was that if you closed the K-12 schools that [students] would then stay home and kind of self-isolate. In reality -- in many cases, in many areas, from what I understand -- they went to the mall. They didn't stay home ... So the question is, is it better to congregate in school or somewhere else?" Harkins asks.

School closures are a last resort, notes Koonin.

"What we believe is that the best place for a sick child is at home, recovering, and the best place for a well child is in the school setting, as long as the severity and extent of illness in the community makes that an appropriate thing to do. So we're going to be doing everything we can to work with schools to keep schools open, functioning, running, and safe during this next flu outbreak until it becomes evident and important that we take another measure," Koonin says.

The decision to close schools due to swine flu is made locally, not by the CDC, which is studying how effective school closures were this spring.

Keeping Kids Home From Child Care

Unlike public schools, child care programs aren't run by a central authority that can order a closure during a swine flu outbreak, notes Linda Klein, executive director of the National Association of Child Care Resource & Referral Agencies.

Klein says parents "have an obligation" to learn about and support their child care program's H1N1 policies as best they can. Those policies may include when kids must stay home and when they're allowed to return after flu.

Klein argues that "a child should not be excluded from child care unless ... they're too sick to participate or they impact the staff's ability to do what they need to with other children."

Klein says she doesn't expect child care closures, and she says such closures would "further disburse children into other settings," as parents may turn to neighbors, relatives, or other sources for child care.

When it comes to kids "it's the combination of fever and acting sick that should signal being out of contact with others that they have not already been in contact with," says Susan Aronson, MD, FAAP, professor of pediatrics at the University of Pennsylvania and co-author of the American Academy of Pediatrics publication, Managing Infectious Diseases in Child Care and Schools.

The CDC is updating its guidance on H1N1 flu and child care.

In the meantime, Koonin says sick kids should stay home and not be sent elsewhere for child care, and that child care staff should do informal daily health checks on kids and talk to parents about keeping sick kids at home.

Klein says good sanitation should help control flu in child care. Koonin agrees that sanitation is important, but she warns that that's not enough, and she points out that kids younger than 5 are a high-risk group for swine flu.

"It's spread through someone coughing and sneezing, or having the secretions from their mouth or nose being passed to another person," says Koonin. "Although sanitation will help reduce some of the transmission, most of the transmission is going to be through that close contact."

SOURCES: Lisa Koonin, MN, MPH, senior advisor, influenza coordination unit, CDC. Roslyn Stone, MPH, chief operating officer, Corporate Wellness, Inc.; chairwoman, workplace working group, National Influenza Vaccine Summit. Philip Deming, principal, Philip S. Deming and Associates, King of Prussia, Pa. Keith Ashmus, partner, Frantz and Ward, Cleveland; chairman, National Small Business Association. Harvard School of Public Health. Gerald Harkins, associate vice president for campus safety and security, University of Texas at Austin. Linda Klein, executive director, National Association of Child Care Resource & Referral Agencies. Susan Aronson, MD, FAAP, professor of pediatrics, University of Pennsylvania; co-author, Managing Infectious Diseases in Child Care and Schools.

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