By BETSY MCKAY and CAM SIMPSON
The Obama administration, worried that tens of thousands of people could fall ill with H1N1 swine flu before a new vaccine is available later this fall, is urging Americans to adopt a series of preventive actions to slow the spread of the disease.
The emphasis on measures such as washing hands often and staying home when sick comes as schools across the country report a surge in flu-like symptoms.
More than 2,500 students at Washington State University have reported becoming ill since the semester began two weeks ago, in one of the largest school outbreaks yet. Emory University in Atlanta, which has had more than 220 ill students, set aside an empty dormitory to house several in isolation.
About 25,000 students were dismissed from 24 secondary schools Friday due to the flu, according to the Centers for Disease Control and Prevention.
The administration has been concerned that the virus would spread widely once school started and weeks before a vaccination program gets into full swing. An advisory panel to President Barack Obama warned in August of a possible scenario in which a new wave of infections could peak by mid-October.
The timing could be bad because the first doses of a new swine-flu vaccine won't be ready before Oct. 15, and the 45 million to 52 million doses expected on that date won't be enough for the roughly 159 million people the government has determined should get the vaccine first, such as pregnant women, health-care workers and people with underlying medical conditions. It also takes a couple of weeks after getting a shot to build immunity to the virus, and it still isn't clear whether most people will need one or two doses of the vaccine.
The message of prevention through basic behavioral techniques has become a mantra across the government. Homeland Security Secretary Janet Napolitano, Health and Human Services Secretary Kathleen Sebelius and Secretary of Education Arne Duncan have urged schools to stay open, businesses to plan for extended employee absences, hospitals to prepare for a potential surge in critically ill patients, and students to wear masks when they are sick and take disposable wipes to their dorm-room doorknobs to keep viruses from spreading.
President Obama has joined in the effort. "Cover your sneezes with your sleeve," he said at a Rose Garden event last week. "I don't want anybody to be alarmed, but I do want everybody to be prepared."
Anne Schuchat, the CDC's top official for immunization and respiratory diseases, has made multiple media appearances to press the need for proper hygiene. "We can't really completely stop transmission; what we're trying to do is reduce the spread and limit the impact."
The vast majority of cases have been mild and the recent increase in cases is "quite consistent with what we were expecting," Dr. Schuchat said. The virus also hasn't undergone any changes that would make it more deadly. But Dr. Schuchat cautioned that changes in the virus could still occur.
The stakes are high, both for public health and public confidence. The rise in infections comes as the White House is renewing its battle for a health-care overhaul amid growing skepticism about the government's role in medicine. And the success of what could become the nation's largest-ever vaccination campaign is far from assured.
Mr. Obama's personal involvement last week was meant to be "a way of saying this is serious, this is a very real issue," said a senior White House official involved in the H1N1 campaign, adding that the president's profile "raises both the visibility and also raises the importance" of the message. His involvement will be periodic, but important in the weeks and months ahead, the senior official said.
To get the hygiene message across in the absence of a vaccine, the Department of Health and Human Services is using its flu Web site, www.flu.gov, to sponsor a YouTube-style contest for public-service announcements focused on prevention; the winner will get $2,500. Finalists include one video showing a man in a bright yellow hazmat suit on a date and going about other mundane parts of daily life.
Three government agencies are teaming up with Sesame Workshop, the nonprofit educational organization that produces Sesame Street, for an ad campaign featuring Elmo that encourages children to wash their hands and sneeze into the bend of their arms. Health and Human Services staff also taped ads with 41 Republican and Democratic members of Congress promoting planning and prevention to offer to local markets.
The goal, says HHS spokeswoman Jenny Backus, is "to make everyone a messenger," from congressmen to neighbors and friends. The effort takes a page from recent presidential campaigns and corporate marketing efforts, she said.
The effort reflects the priority the government has put on preparedness following 9/11, the threat of a deadly pandemic avian flu, and the political fallout from Hurricane Katrina. "After Katrina they learned that reassuring people and turning out wrong does enormous harm, but warning people and turning out wrong does minor harm," said Peter Sandman, a risk-communications expert who has advised government health officials in the past.
A campaign to urge Americans to get vaccinated for both seasonal and the new H1N1 flu is also in the works, with some efforts starting this week.
It can be hard to keep the message coordinated and controlled. In late August, health officials scrambled to calm the public after the presidential advisory panel warned that as many as 90,000 people could die in the U.S. this winter from the new flu. The report was careful to couch the forecast as a "possible" or "plausible" scenario, and officials later stressed that that dire outcome was unlikely if the virus remains mild.
The administration's plan is a tweaked version of the strategy it implemented when the virus first emerged last spring, as officials held a total of 24 press briefings within two weeks.
While some critics later said the administration overreacted with the barrage of high-level attention, there were no such worries at the White House. "On a public health issue, to err on the side of overreaction is never a bad idea," the senior White House official said.
Write to Betsy McKay at betsy.mckay@wsj.com and Cam Simpson at cam.simpson@wsj.com
