Cabinet trio prepares for swine flu in schools.

THE SERIOUSNESS WITH WHICH the Obama administration is taking the possibility of a severe swine flu outbreak in schools is evident in the number of Cabinet secretaries who publicly addressed the issue over the summer: 3.

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In June, Secretary of Education Arne Duncan and Secretary of Health and Human Services Kathleen Sebelius issued a joint letter to schools and districts urging them to take action to prevent the spread of the virus, and in an address at the July meeting of the National Governors Association, Secretary of Homeland Security Janet Napolitano called on governors to work with state and local school officials on school closure prevention. "The ideal is to Keep schools open and keep sick students home," she said.

Duncan and Sebelius wrote that because a vaccine will not be available until well after the school year begins, "it will be critical for schools to begin planning non-pharmaceutical interventions to prevent disease transmission and protect students and staff, as well as local communities, from infection."

The three cabinet secretaries appeared together at a summit held in July at the National Institutes of Health attended by health and school officials from across the country, at which President Obama himself spoke by telephone from Italy. Two weeks later they joined Homeland Security Advisor John Brennan and Anne Schuchat of the Centers for Disease Control and Prevention for a briefing before a bipartisan group of House and Senate members.

They also appeared at a joint press conference in August, along with CDC Director Thomas Frieden, to announce updated guidelines for schools. One significant update is the length of time students or personnel with swine flu should stay out of school. Earlier guidelines recommended that they remain home for at least seven days and return only after being fever-free for 24 hours. The new guidelines scrap the seven-day recommendation.

Duncan also urged administrators to read the CDC's Preparing for the Flu (Including 2009 H1N1 Flu): A Communication Toolkit for Schools (Grades K-12). This toolkit, which includes fact sheets, Q&A for health and school officials, and template letters for schools to send to parents, can be downloaded at www.flu.gov/plan/school/toolkit.html.

Although officials from many federal departments and agencies have been working throughout the summer to plan for a resurgence of the H1N1 virus, not even the highest officials can know what will happen when schools open in the fall to millions of children who have not yet been vaccinated. "Influenza may be the least predictable of all infectious diseases," admitted Frieden.

"This is an evolving situation," added Napolitano. "Our strength is flexibility."