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Pandemic
Flu Preparation- Why Schools Need to Take Action
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Many schools have begun
the process of planning for a pandemic flu. This article will review current
information on pandemic flu, why it is critical that schools act to expand
their current emergency response plans to include pandemic flu preparation
and how this emergency differs from others. It will also outline considerations
that schools should address in developing their plans. Specifics for each
school system will differ due to individual school community needs and
partnerships.
Imagine the effect on a school if 30% of the students were out ill for
many weeks as well as 30% of the teachers and other school staff absent,
perhaps more, because they were home ill or taking care of a family member
who was ill. Consider the effect if 30% of the bus drivers who transport
students to school were unavailable due to illness. Think of the effect
of 30% of the entire workforce being ill or hospitalized. Grocery stores’
supplies would be affected, utility companies’ work force decreased,
businesses, government, health care facilities all affected. This scenario
is indeed a possibility should a pandemic flu occur. The ramifications
are significant. And what is the likelihood that this will occur? Epidemiologists
have been studying this issue for several years and with the occurrence
of the H5N1 avian flu that has received much attention recently, the prediction
by many is that an influenza pandemic may be a reality.
Terms defined1 Seasonal
(or common) flu is a respiratory illness that can be transmitted person
to person. Most people have some immunity and a vaccine is available.
Avian (or bird) flu is caused by influenza viruses that occur naturally
among wild birds. The H5N1 variant is deadly to domestic fowl and can
be transmitted from birds to humans. There is no human immunity and no
vaccine is available.
Pandemic flu is virulent human flu that causes a global outbreak, or pandemic,
of serious illness. Because there is little natural immunity, the disease
can spread easily from person to person. Currently, there is no pandemic
flu.
What’s the concern? Schools battle
regularly with seasonal or common flu where staff and students may be
affected with an infection of the nose, throat, and lungs caused by the
influenza virus. Persons with the flu may present with multiple symptoms
including chills, fever, cough, headache, muscle aches, and sore throat.
Influenza or “flu” can be a very serious illness with complications
such as pneumonia, bronchitis, and sinus infections.
Avian flu is a disease caused by viruses that primarily infect birds.
The current avian flu, H5N1, that has affected wild and domesticated fowl
in 52 countries in Asia, Europe and Africa is the most severe outbreak
ever recognized. Avian flu does not usually infect humans, but because
flu viruses are constantly changing, they might, over time, mutate so
that they can infect and spread among humans. And that is exactly what
has occurred with the current strain of avian flu, H5N1. Since 1997, over
100 cases of avian flu infections in humans have been confirmed.2
Given the strength of this particular strain of avian flu and the fact
that it has “jumped” from an infection of fowl to infecting
humans, the world is watching to see if this strain, or perhaps a variation
of this strain, will be transmitted from human to human. That then becomes
the concern for a pandemic flu outbreak.
What does history tell us? A pandemic will be a long term event affecting
large portions of the population with significant death tolls. Since 1900,
the world has experienced three pandemics in 1918, 1957, and 1968. These
three pandemics came in three waves with periods of less intensity followed
by high concentrations of illness. These waves could extend over an eighteen
month period with each wave lasting from three to eight weeks. Given the
history, epidemiologists predict the following:
• Should a pandemic
occur, there will be little warning before it strikes. It is expected
to be severe with a significant number of the population requiring medical
care. Workforce and school absenteeism is estimated to be 30% or more
with a significant impact to the continuity of essential services including
health care facilities.
• A predicted
shortage of hospital staff, beds, and supplies may cause non-traditional
sites such as schools to be re-purposed to cope with demand for persons
seeking medical treatment.
• The need for vaccine is likely to outstrip supply and the supply
of antiviral drugs is also likely to be inadequate early in a pandemic.
Difficult decisions will need to be made regarding who gets antiviral
drugs and vaccines 3.
• Disease containment measures will need to be implemented including
isolation of ill persons, quarantine of exposed, healthy persons, infection
control (i.e. correct hand washing techniques, respiratory etiquette,
masks, mandatory exclusion from work if ill), and measures to increase
“social distancing” i.e. canceling schools or other mass gatherings
4 .
Preparation
Why do
schools need to prepare? Given the fact that schools house large numbers
of students and staff each day who are in close proximity and in constant
contact with each other, the impact of a pandemic would be extremely significant.
Should a school experience large numbers of staff and student absences
due to a pandemic (over many weeks at a time and in waves) or if schools
are forced to close as a “containment” public health measure,
State School Boards and local school systems will need to address:
•
The interruption of instruction and the instructional impact to the students;
• The use of school buildings as overflow medical sites;
• Maintenance of basic operations for central offices;
• The impact on families from loss of work due to illness or to provide
child care if students can’t attend school;
• Impact on employees – loss of time and leave, closing of schools,
taking care of ill spouses and children5; and
• The emotional responses that students, families and staff will
be experiencing.
Partners
The pandemic flu emergency response plan should be incorporated into the
emergency response plans schools and school systems have already established.
The United States Department of Education (USDE) requires all schools
to have an emergency response plan under No Child Left Behind (NCLB)6
.This “emergency” will look different, but established partnerships
will be vital in preparing for a pandemic. Rather than an “event”
such as a shooting or a natural disaster that might affect a school or
school district, the global nature of this emergency will involve entire
states and regions. Epidemiologists predict that because of the anticipated
widespread illness, resources will not be able to be relocated from one
region/state to another (as for example, in the Katrina emergency response).
Consider which of the key partners will be involved with this particular
emergency, including emergency response agencies, fire, local government,
law enforcement, education and health agencies. Because of the health
related nature of this emergency, it is likely that the local and state
health departments will take lead. With established partnerships and collaboration
evident, the stage is set for expanding those existing emergency response
plans to incorporate plans for pandemic flu.
Developing a Decision Matrix A decision
matrix will be essential and will entail careful planning and research.
This instrument would be used to guide school systems and public health
personnel in determining when a specified course of action is indicated
and how to implement that action. It will outline exactly who is responsible
for what action/decision. School systems and state governments will need
to examine who has the authority to close schools. Legal consults/office
of the attorney general/school attorneys will need to be involved
with the development of this instrument. Coordination with local, state
and regional authorities will be necessary.
Components
of the Plan
Once
the decision matrix is established, the other components of the plan should
include the following
(based on the resource Pandemic Influenza Preparedness Technical Assistance
Guide for Local School Systems and Schools; Maryland State Department
of Education7:
Surveillance: Schools should identify
an appointed health professional to assist in a pandemic and be prepared
to participate in the screening, surveillance, and tracking of students
and staff during a threatened pandemic. The World Health Organization
(WHO) recognizes three periods of a pandemic: interpandemic (influenza
virus in animals), pandemic alert (human infection present in escalating
phases), and pandemic (widespread infection in general population 8 ).
Within each of these periods, surveillance needs will be different. Local
school systems, schools and the local health department (LHD) will need
to determine surveillance activities related to pandemic influenza. School
based surveillance will provide data to the LHD regarding influenza-like
illnesses and related absenteeism in schools. The surveillance activities
may include:
• Monitoring
substantial increases in absenteeism among students and staff;
• Documenting and communicating findings to the LHD on a routine
basis (weekly or more often as necessary);
• Evaluating individuals who have symptoms, e.g. new cough or fever;
• Communicating with the LHD on any cases that are suspect for
an epidemic respiratory infection (ERI);
• Maintaining disease containment measures and implementing isolation
or quarantine rules as instructed by the state or local health departments;
• Maintaining adequate supplies for infection control (soap, paper
towels, masks if indicated) and Personal Protective Equipment (PPE)
(masks, gloves, gowns, etc.);
• Participating in any vaccine program implemented by the LHD;
and
• Assisting health officials with contact investigations as requested.
Prevention
Education for Staff, Students and Families: Education regarding
the need for proper disease prevention activities is a fundamental precaution
in limiting the transmission of the flu. Local school systems and schools
are a vital link for the dissemination of influenza prevention and education
to students, families and staff. Education resources are available from
the Centers for Disease Control and Prevention (CDC). The following prevention
and education activities can be included in a school’s plan:
• Identify individuals
who will be responsible to educate staff, students, and families about
pandemic flu and the school preparedness plan, including individuals
for whom English is a second language and students with special needs;
• Increase school community awareness of the scope, severity and
impact of an influenza pandemic in conjunction with the LHD;
• Implement a school-wide educational program on disease prevention
measures (e.g., wash hands often with soap and running water for 15-20
seconds; use alcohol-based disposable hand wipes or gel sanitizers when
soap and water are not available; cover mouth and nose when sneezing
or coughing);
• Post hand washing and respiratory etiquette signs throughout
the building; and
• Assess facility for adequate hand washing facilities/alternatives.
Communication:
Development of consistent and clear messages for families, students
and the community will be essential. Parents, families, students and
school staff will need to have clear, accurate information, especially
surrounding the potential spread of the disease and the preventive measures
schools will take. Considerations for the school’s public information
offices’ plan include:
• Coordinate
prepared messages with local, county and state agencies. These messages
should be consistent and provide accurate information to reduce confusion
and anxiety;
• Establish and maintain communication networks between local and
state health and education agencies;
• Establish phone hotlines and websites for media, school administrators,
teachers, parents, and others;
• Train school administrators and public information offices on
how to prepare the school community using consistent information;
• Prepare templates for press releases, media alerts and public
service announcements for both television and radio to have available
when the pandemic occurs;
• Determine one consistent location for the media to assemble with
an alternate site available. If an alternate site is used, staff should
have all necessary contact lists;
• Ensure that websites are maintained;
• Establish succession of communication personnel in case of employee
illness. Provide authority to backup personnel to make decisions, upload
information to website, etc.; and
• Ensure that communications are accessible to the visually and
hearing impaired and non-English speaking communities.
Instruction:
The interruption of instruction and the instructional impact to the students
of a pandemic will affect testing, grades, and graduation requirements.
Strategies to provide instruction in the face of staff absences might
include:
• “Restructuring”
the school calendar and school year if schools are to be closed for
long periods of time and/or large numbers of students are absent;
• Deliver ONLY those courses needed for graduation and/or core
subjects; and
• Utilize on-line instruction or other methods to provide instruction
in homes and/or hospitals and to allow students to continue assignments
if they are out of schools or schools are closed.
Perhaps
even more complicated will be the effect of student absences for the following:
• Mandatory testing
requirements;
• Mandatory days in a school year requirement;
• Graduation/grade level increases;
• Annual Yearly Progress (AYP)- participation and reporting, the
impact to schools’ improvement plans;
• Assessments – postponements, length of postponements, feasibility
of utilizing non-certified professionals to administer assessments in
cases where qualified/certified staff is unavailable due to illness;
• Vendor contracts deliverables that cannot be delivered or picked
up from a closed school (additional costs, alternative delivery locations
if schools are closed);
• Athletic events and playoffs;
• College entrance requirements e.g. SAT, credit requirements;
and
• Definition and verification/documentation process for serious
medical emergencies
The emergency
plan will need to address these issues as well as determine the approval
process for any changes in current policy.
School Facilities: Should a school
experience a large number of students and staff absences or is re-purposed
and used as an overflow medical site, special considerations should be
included in any plan to assure the public that buildings are safe and
sanitary.
• Ensure that
administrators control access and use of the buildings during changed
or staggered operating hours, including authority to restrict access
to certain areas;
• Assess the number of sinks for hand washing, the need for special
phone lines or communications to access emergency responders;
• Maintain accurate records of floor plans, locations of utility
shut off valves;
• Provide storage space to stock infection control and PPE supplies;
• Train school maintenance and custodial staff for appropriate
cleaning of school before re-occupancy; and
• Determine space most suitable for use by public health providers
as onsite vaccination clinics, medical clinics, or shelter facilities.
Pupil
Transportation: An emergency plan for an influenza pandemic
should include plans for transporting children if large numbers of transportation
staff are unavailable and how to assure the public that buses are disinfected
after illness or if used for the community to bus ill persons to hospitals
or temporary medical facilities. The plan should include:
• Establish policies
and procedures for transporting ill students;
• Maintain an emergency action plan addressing initial contact
persons, numbers of buses available, numbers of drivers available, holding
areas for buses, and locations/facilities to be used as staging areas
to transport students or adults to their homes or other locations;
• Provide training to pupil transportation staff for appropriate
cleaning of buses after transporting ill persons and procedures for
clean-up of blood, vomit, and other bodily fluids; and
• Develop a plan for the succession of personnel in case of bus
driver absences. Contracts and state laws often do not allow for just
any substitute to drive school buses. Special licenses or requirements
may be needed.
Employee
Issues: As a result of increased staff absences and the length
and expected waves of illness in a pandemic, schools will need to consider
the following employee issues.
• Examine succession
planning to clarify clear lines of succession throughout the organization.
Provide identified staff authority to act in the absence of senior managers.
Extensive cross training will need to be done to ensure that critical
functions are performed without interruption. This may also require
monitoring personnel attendance to determine who is available to perform
essential functions;
• Communicate to staff (see previous section on communication)
regarding the nature of the threat and the schools’ preparedness
plan;
• Provide training in disease prevention;
• Reassess the scope and availability of existing health plans
and Employee Assistance Programs (EAP) deal with the physical and emotional
trauma of a pandemic;
• Reexamine human resource policies. Sick leave and attendance
policies may not address a major employee absence. It may be necessary
to develop a policy to restrict access to the workplace in order to
prevent the spread of the disease; and
• Consider telecommuting as an option for employees who may need
to be at home to care for others or if a school is mandated to be closed.
Emotional
Preparation: An integral part of preparing for and responding
to any crisis is addressing the emotional and psychological needs of those
who are impacted. Most schools have a plan for crisis response. In the
event of a pandemic that includes long stretches of illness, absences
and loss, the following are suggestions as to what should be included
in an emergency plan specific for a pandemic flu event.
• Prepare school
counselors and others to address staff, student and family concerns
regarding illness and death among colleagues and family members, fear
of contagion and/or of transmitting disease to others; child care, economics,
pressures caused by school closures, disruptions in day care, family
illness, stress of working with sick or agitated persons, and with communities
under quarantine
restrictions, and the availability of vaccines;
• Utilize school health professionals, local health department
staff and others to provide accurate information;
• Provide clear, accurate information to allay anxiety and discourage
rumors; and
• Develop contingency plans to address school counseling shortages
that may occur due to illness.
Planning
template: Once the above components have been addressed, developing
a planning template will help with the implementation of this plan. Samples
are available, including one from the federal government for schools specifically,
but each plan will need to be tailored to a specific school/community’s
needs.
Implementation
of the plan: As with all emergency plans – it needs to
be practiced and refined. Setting up tabletop exercises with all community
partners is advisable. It is most important that the final plan be reviewed
by school boards, staff, community and other stakeholders.
Summary
Early planning
and communication will be essential to the ability of schools to function
during a pandemic flu. Schools have already established emergency response
plans and will need to incorporate plans for a pandemic, considering the
nature and specific needs of individual schools and communities in such
an event.
Resources
School
Preparation
Pandemic Influenza Preparedness Technical Assistance Guide
for Local School Systems and Schools; Maryland State Department of
Education, Mazyck, Lathroum, Romano, Johnson, Bice, Taliaferro, Pescatore,
Cellicci, Beck, Griffith, 2006. Contacts are Donna Mazyck dmazyck@msde.state.md.us
and Dominic Romano at dromano@msde.state.md.us.
This document was the basis of this article.
National
Association of State Boards of Education http://www.nasbe.org/
NASBE has written a policy update on schools’ preparation for the
flu.
National
School Boards Association has participated in a video conference regarding
the flu preparedness with Missouri Department of Health (Eddie Hedrick
,Emerging Infections Coordinator in the Bureau of Communicable Disease
Control and Prevention) and ESGN TV (www.esgn.tv).
U.S. Department
of Health and Human Services’ School Checklist - http://www.pandemicflu.gov/plan/schoolchecklist.html
National
Association of State School Nurse Consultants www.nassnc.org.
State school nurse consultants are available for technical assistance.
Maryland
Pandemic Influenza Planning, Dr. Jean Taylor, Senior Epidemiologist, Maryland
Department of Health and Mental Hygiene. Dr. Taylor’s PowerPoint
presentation on the pandemic flu is an excellent resource and can be found
at http://flu.maryland.gov/presentations/Maryland%20Pandemic%20Influenza%20Preparedness%20Planning.pdf
Pandemic
Flu
Centers for Disease Control and Prevention http://www.cdc.gov/flu/school/qa.htm
and http://www.cdc.gov/flu/avian/gen-info/facts.htm
U.S. Department
of Health and Human Services. http://www.pandemicflu.gov/
State websites:
President Bush has asked each state’s Governor to convene statewide
summits on pandemic preparation. Many states have set up websites with
information. Contact your governor’s office for further information.
Preventing
the spread of the flu
Centers for Disease Control and Prevention http://www.cdc.gov/ncidod/op/
and http://www.cdc.gov/germstopper/home_work_school.htm
CDC facts
sheets, posters and other school materials may be accessed at http://www.cdc.gov/flu/school/
- U.S. Health Human
Services. http://www.pandemicflu.gov/
Retrieved from the world wide web 8/1/06
- Taylor, Jean DrPH,
Pandemic Influenza Preparedness, May 31, 2006 presentation to Maryland
State Department of Education, School Based Health Centers
- US Department of
Health and Human Services, http://www.pandemicflu.gov/general/#impact.
Retrieved from the world wide web 8/1/06
- Taylor, Jean DrPH,
Pandemic Influenza Preparedness, May 31, 2006 presentation to Maryland
State Department of Education, School Based Health Centers
- National Association
of State Boards of Education, Policy Update, Influenza and School Preparedness,
Vol. 13, No. 11, December, 2005.
- Section 4114 (Local
Educational Program) of Title IV, Part A (Safe and Drug-Free Schools
and Communities Program) of the No Child Left Behind (NCLB) Act of 2001
(PL 107-110).
- Pandemic Influenza
Preparedness Technical Assistance Guide for Local School Systems and
Schools; Maryland State Department of Education, Mazyck, Lathroum, Romano,
Johnson, Bice, Taliaferro, Pescatore, Cellicci, Beck, Griffith, 2006.
- World Health Organization
http://w3.whosea.org/LinkFiles/Avian_Flu_Influenza_pandemic_phases_and_strategies.pdf
.Retrieved from the world wide web 8/1/06
Contributed by: 
Author of the article: Vicki Taliaferro RN, BSN, NCSN
.
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