In War and Peace, I noted the similarity between medicine and military. At no time in the 20 years that I have been a practicing pediatrician has this been more true. We are right there in the trenches, with the enemy sniping at the people we are here to protect, and we have to make our decisions immediately, without waiting for the generals (CDC and the Health Department) to make up their minds about the intelligence that we ourselves are providing on the enemy. Another unfortunate similarity is that truth appears to have been the first casualty of the flu pandemic, much as it is in war. A cursory glance at local newspapers bears witness to the appalling mishandling of the situation by the media: the stories are all about panic while the sidebars mention, in passing and small print, that the panic is entirely unwarranted. If the media are so capable of distorting what is happening within stone’s throw from their editorial offices, I think we can safely ignore what they are saying about our troops overseas, and believe only what we hear from the soldiers at first hand.
In Kennel Cough, I argued that letting children with mild symptoms miss school would be a good way to slow down epidemics. Closing a number of schools in New York is, I suppose, just as effective, although a bit of an overkill. There seems to be no end of effort that the educational establishment will expend to avoid the simple, and heretical, solution of simply trusting families to send or not send their children to school in accordance with their best judgment.
In Epstein’s Mother I deplored the schools’ insatiable appetite for doctors’ notes with often unacceptable requests. A side example was a child who was told not to come back without a doctor’s note that there was no alcohol in her blood — a request that shows utter ignorance of technical (alcohol is completely gone the next day, which is when she came in) and legal aspects of this testing.  But far more egregious is the current practice of school personnel telling families to take their children with runny nose and low grade fever to the doctor IMMEDIATELY, and not to come back without a note of clearance.
OK, ready? Deep breath taken. Begin rant:
Is there no one in schools with the brains to realize that we have a huge influx of TRULY sick children to evaluate and treat? Yes, the flu really is here, and we give it the same attention we give any epidemic influenza — which is lots. Yes, there is ample evidence that this “swine” flu is milder than seasonal flu, with lower mortality — but any flu can be fatal, and we absolutely need to see the children with high fever, vomiting, headache, body aches, lethargy, shortness of breath, severe cough, or any combination of these. Having to pander to schools’ misguided directives places these children at risk. Also, while we continue to do influenza tests, they rarely show positive results in the early phase, before high fever starts, so it is a waste of time even for the children who have contracted flu to be seen that early. This is, once again, a shining example of educational establishment’s ignorance of any considerations outside their own policies, and of their utter disrespect for the families they serve.
I have met teachers, and I have met school administrators, and school nurses, and none of them so far have been stupid enough to have perpetrated the idiocies I have seen. Do they check their brains at the schoolhouse door? Is it confiscated by security at the mental detector? Or is it the pattern of groupthink, well-known as the source of flash-mob occurrences, that causes the dumbest ideas of each member of any committee to be incorporated into that committee’s final product?
End rant/. Must get back to work.
