School officials are gently but sternly warning parents to keep their kids home this fall if they are sick.

Their fears are based on the spread of the infamous swine flu, also known as the H1N1 virus.

That makes perfect sense in a perfect world.

But the reality is these decisions are made early in the morning under much duress. Any signs of illness must be assessed in a matter of minutes as the family scrambles out the door. And this is not done in a vacuum.

For many working parents, it's an economic choice as well. If your child does not go to school, who will take care of him? Does the parent have to miss a day of work? Is there a suitable sitter?

As schools open their doors here in the Lowcountry next week, parents will be faced with this ageless dilemma made worse by the threat of a global infection.

Lives in jeopardy

Don't be fooled. This is serious. This H1N1 strain of the flu virus is a pandemic, meaning it is spread across the globe.

Officials watched it flare up last year and know it has not gone away. In fact, it may get worse.

"It's still out there," DHEC's Dr. John Simkovich said at a news conference Wednesday. "It's widespread in South Carolina. We're expecting an active season."

And there will be no vaccine available to combat this virus until at least November. Which means our schools could quickly become incubators for this deadly disease. Indeed, Simkovich said 36,000 people die from flu viruses in the United States each year.

Charleston County School Superintendent Dr. Nancy McGinley stressed that parents should keep sick children at home but understands the issues.

"Most of our parents are working parents, and I feel for them," McGinley said. "And yet this could put lives in jeopardy if the wrong decision is made."

Hard to fake

So how do parents decide if their child is too sick to go to school?

Local pediatrician Dr. Thomas Quattlebaum, who has seen a half-dozen cases of the H1N1 virus this summer, agreed it's a tough call.

"Clearly, if the kid's got a fever, vomiting, diarrhea or coughing their head off, they should stay home," Quattlebaum said. "So it's pretty much common sense."

But these choices must be made quickly against a backdrop of social and economic circumstances that, unfortunately, are all too common.

How much fever? How much diarrhea?

"I would say that if a child's fever is less than 100 degrees, they can go to school," Quattlebaum said. "That means it's probably a small cold, and almost all experts say to go forward."

But this strain of flu is different. Kids have no immunity, and it can spread like wildfire, shutting down entire school systems when panic sets in.

Meanwhile, there is a bright side for parents trying to make this medical decision with an ornery 12-year-old who might not want to go to school.

"It's hard to fake being really sick," the doctor said.