How bad will the swine flu be in schools this year?

Will schools close if they reach a certain absenteeism rate?

Will schools vaccinate students?

If they do, how will they refrigerate potentially thousands of vaccines until they are distributed? Who will actually give the vaccines?

Will schools be responsible if someone has a bad reaction to the vaccine? How will they keep students, particularly younger ones, calm as they wait for a needle?

"There's a lot more questions than answers," said Cindy Burkhart, executive director of Intermediate Unit 13, which recently hosted a swine flu meeting with area superintendents and state officials.

"We all want to be able to open up a manual. There is no manual," she said. "There's guidelines, but there's a lot of gray."

And not much time to sort things out. State health department officials estimate that the first shipment of the vaccine could arrive sometime next month.

"There are some really important questions left to be answered," said Stacy Kriedeman, state health department spokeswoman. "We plan to work closely with districts, plan to answer questions and provide whatever assistance we can.

"This is unprecedented."

One of the most pressing issues for districts is whether they will choose to be a swine flu vaccine site for their students. Several districts, including Manheim Township, Ephrata and Lampeter-Strasburg, have either already pre-registered with the state or are planning to do so.

That does not obligate them to be a site, but it will provide them with information about storing, handling and administering the vaccine.

"It gives us more time to prepare," said Marcie Brody, spokeswoman for Manheim Township School District.

And there are many considerations.

For example, the state would likely ship districts one to two doses of the vaccine for each student. It is not known yet whether the vaccine will be given in one or two shots.

The district then would have to find a place to refrigerate potentially thousands of vaccines.

In some places, schools have decided to work with the local hospital in storing the vaccine, Kriedeman said, but schools would have to work out those details.

Districts, particularly those with a small health staff, are worried about finding personnel to administer the vaccine to potentially thousands of students.

"I'm one school nurse for the high school," said Teddi Book, the school nurse at Lampeter-Strasburg High School. "I'm also running the health room. Who's going to do that if I have to inoculate kids?"

The state does plan to offer assistance in administering the vaccine, Kriedeman said.

Districts also are concerned that they could be held liable if a student has an adverse reaction to the vaccine.

"We are looking at the what-ifs," said Stephanie Gingrich, spokeswoman for the Ephrata School District.

Kriedeman said, "There are federal laws meant to provide immunity in specific circumstances, but that's a conversation they should have with their solicitor."

Schools also would have to figure out how they would handle squeamish students.

"Kids getting a shot are anxious," Burkhart said. "We have to deal with that."

"I think everyone is very willing and wanting to assist in this. We're in this to help kids. But it's a matter of, gee, the logistics."

Another unknown is what schools would do if large numbers of students would become ill.

There is no plan to close schools if absentees reach a certain number or percentage.

"That is an absolute last resort," Gingrich of Ephrata said.

Kriedeman said, "Closing a school is disruptive. For some students, that's where they get breakfast and lunch. And not everyone is sick. So some kids have freedom. Parents have to worry about child care."

Instead, the state hopes that districts will keep absenteeism down by monitoring and managing the numbers of ill children.

Most districts have clear-cut illness policies, which many have already outlined in letters sent to parents.

"We will monitor for fever a little more closely this year," said Susan Horan, supervisor of nursing at Hempfield School District.

Students with a fever of 100 degrees or more, a cough, sore throat, runny nose, body aches, diarrhea or vomiting will be sent home.

The state also is suggesting that schools have a "sick room," where ill students can be isolated until their parents pick them up and take them home.

Students must be fever-free for 24 hours, without the use of medications, before they will be allowed to return to school.

Schools also will be communicating more with parents this year. If parents call the school and say their child is staying home because he is ill, the district may ask what the child's symptoms are.

Manheim Township is asking parents to tell a school nurse if they suspect their child has the swine flu, or H1N1 virus.

Schools all are emphasizing good hand-washing and coughing and sneezing etiquette. They will regularly clean desks, computers and other areas.

Districts are being asked to closely track attendance. At a last resort, if they see large numbers of absent students, school officials will consult with the health department about whether they need to consider a closure.

"We'll take it on a building-by-building basis," said Cindy Rhoades, Penn Manor School District spokeswoman.

"There is no one-size-fits-all policy," Kriedeman said.

E-mail: cstauffer@lnpnews.com