Hillsborough County Schools Pandemic Flu Plan

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Hillsborough County Schools Pandemic Flu Plan

• Maria Russ ARNP, CPNP, Ph.D.

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Overview

• Define Key Terms
• History
• Identify Key Stakeholders
• Delineate Roles
• Delineate Responsibilities
• Plan Evaluation
• Questions

3
Epidemic vs. Pandemic

• Epidemic serious outbreak in a single community,
  population, or region
• Pandemic epidemic spreading around the world
  affecting hundreds of thousands of people, across
  many countries

4
Over the past 500 years

• Three to four pandemics have occurred per century
• The longest period of time between pandemics is
  42 years
• As of 2009, it has been 41 years since the last
  influenza pandemic

5
Historical Perspective

• Three influenza Pandemics in the last century
• 1918 1919 (Spanish Flu H1N1) about 500,000
  US deaths and up to 40 million deaths worldwide
• 1957 1958 (Asian Flu H2N2) about 70,000 US
  deaths and 1-2 million deaths worldwide
• 1968 1969 (Hong Kong Flu H3N2) about 34,000
  US deaths and 700,000 deaths worldwide

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Lessons from Past Pandemics

• Occurs unpredictably, not always in winter
• Great variations in mortality, severity of
  illness, and pattern of illness or age most
  severely affected
• Rapid surge in number of cases over brief period
  of time, often measured in weeks
• Tend to occur in waves subsequent waves may be
  more or less severe

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History

• Most Recent Panic Outbreaks
• Measles
• HIV
• Avian Flu Pandemic
• H1N1 also known as Swine flu

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Hillsborough County School District Key
Stakeholders

• School Health Services Coordinator
• School Registered Nurses
• LPNs and Health Assistants
• Director of Administrative Services
• Manager of Safety and Risk Management
• Manager of School Security

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Other Key Stakeholders

• Health Department
• University South Florida
• Tampa General and other local Hospitals
• Police and Sheriff department
• Paramedics
• Business

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School-Community Possible Surveillance Outcomes

• Social distancing, isolation, or quarantine may
  be needed
• Could involve school closures and sporting
  event/entertainment/social gathering
  cancellations
• Utility providers (electricity, water, sewer,
  telephone, Internet) could see service
  interruptions due to staffing shortages

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School-Community Possible Surveillance Outcomes

• Business community develops alternate service
  delivery methods to ensure their continued
  viability. Telecommuting and video conferencing
  will likely increase.
• Call-in orders, home delivery, and mail-order
  businesses could thrive.
• On-line banking will likely increase.
• Restaurants may convert to a home delivery model.

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Hillsborough County Pandemic Flu Plan begins

• Pandemic Summits
• Conferences
• Teleconferences/Webcasts
• Joint Hillsborough County School District Health
  Department meetings and teleconferences
• Subcommittee task force

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Pandemic Subcommittee

• Developed Pandemic Flu Response Plan
• Preliminary Pandemic Flu Response Plan presented
  to subcommittee members
• Pandemic Flu Action Plan customized for
  Hillsborough County School District

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Pandemic Influenza Summary

• Highly infectious virus
• May mutate to infect animals and humans
• Most of population has no immunity
• Easily transmitted from person to person
• Limited antiviral medications available
• Limited excess capacity in health care system
• No vaccine at onset/H1N1 vaccine piloting

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Pandemic vs. Epidemic Influenza

• Pandemic Flu
• New influenza virus
• More severe symptoms, more complications
• Entire population at risk of severe illness
• May cause social disruption

• Seasonal Flu
• Virus is similar to previous strains
• Usual symptoms
• Very young and very old people at greatest risk
• Modest impact on society

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Influenza

• Transmission from person to person
• Large-particle droplets
• Direct contact with infected secretions
• Incubation period 5 10 days

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Symptoms of Influenza

• Sudden fever/high fever
• Dry cough
• Sore throat
• Runny or stuffy nose
• Headache
• Muscle aches/body aches
• Stomach symptoms (generally no gastrointestinal
  symptoms, except children)

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Influenza Transmission

• Susceptible person
• Coughing and sneezing within three feet
• Touching a surface with the virus

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Influenza Complications

• Viral pneumonia
• Bacterial pneumonia
• Dehydration
• Otitis media (ear infection)
• Sinus problems
• Encephalitis (seizures, coma)
• Worsening of chronic conditions (asthma, diabetes)

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When Children Get Influenza

• Rates of influenza infection are highest among
  children
• Rapid spread through schools, day care
• Influenza spreads to families and amplifies
  throughout the community
• Serious illness and deaths in people lt 2 years of
  age and gt 65 years of age

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When Children Get Influenza

• Parents are absent from work
• Visit to the Pediatrician or Emergency Room
• Younger children may be hospitalized (especially
  infants under 6 months)
• (Inappropriate) antibiotics may be prescribed

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Newer Recommendations For Children

• Increased use of influenza vaccines
• Increased rapid testing for influenza infection
  in Physician offices, Emergency Rooms, and
  Walk-In Clinics
• Recommendations for limited use of antiviral
  medications (Tamiflu, Relenza)
• Emphasis on hand hygiene and cough etiquette

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Influenza Vaccines

• Inactivated vaccine traditional, injected
  vaccine. NOTE you cannot get the flu from the
  vaccine!
• Live, attenuated intranasal vaccine
  FluMist..for healthy people 5 to 49 years of age.

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What Can We Do Now To Prepare For Possible
Pandemic Flu?

• Hand washing wash hands frequently with soap and
  water
• Respiratory hygiene Coughs and sneezes causes
  diseases, use of social distancing
• Cover Your Cough
• Use tissues and dispose of them properly
• Stay home if you are ill
• Self-sufficiency Stockpile water and non
  perishable food, prescribed medication, and
  health supplies
• Stay informed

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How Will A Pandemic Affect Our Schools?

• Who coordinates decisions on closing schools or
  quarantining kids?
• If classes shut down for weeks, how will a
  district keep kids from falling behind?
• Who will keep the payroll running, or ease the
  fear of parents?
• Who will provide food to children who count on
  school meals?

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Closing Schools

• Severity of the Pandemic will determine a school
  closing.
• School closings are based on the characteristics
  of a pandemic and schools operation ability.
• The Superintendent of Schools and the Director of
  Hillsborough County Health Department will
  determine school closures.

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How Will The District Keep All Children From
Falling Behind?

• Distance learning for reading, math, and science
• Instructional TV
• Internet
• Radio
• Telephone
• Community outreach
• Virtual school
• Homework

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Anticipate Needs of Faculty and Staff

• How to help staff with health-care coverage and
  family concerns
• Ways to compensate for staff interruptions and
  work from home requests
• Faculty/staff leave requests, disability claims,
  medical leave policies
• Absentee policies, student attendance issues
• Transportation issues

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Food For Children

• Make preparations at home stock foods, water,
  and medicines.
• Be prepared for food supply disruption.
• Reliable communication within and across school
  communities (employees, parents, students,
  vendors, and community members) for food delivery
  if needed.

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What Can We Do Now To Prepare For Possible
Pandemic Flu?

• Staff and students that are sick should stay
  home!
• Cover nose and mouth with a tissue.
• Cough etiquette, Cover your cough.
• Wash hands often with soap and water.
• Try not to touch eyes, nose, or mouth.
• Disinfect keyboards, phones, and desks daily.

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Impact on School Personnel

• Increased risk of exposure
• Illness and death among children and staff
• Ethical dilemmas
• Frustration with business as usual
• Physical isolation associated with infection
  control

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Psychosocial Issues For School Personnel

• Concern about children and family
• Constant pressure to keep performing
• Domestic pressures caused by school closures
• Stress of working with symptomatic others
• Difficulty maintaining self-care
• Fear of contagion and transmitting to others

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Psychosocial Issues For Families Of School
Personnel

• Staff may be tired, worried, irritable, etc.
• Staff may be less optimistic and understanding.
• Increased emergency workload may complicate
  communication with family.
• Family members may be at risk of contagion.

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At The School Level

• Plan on a 30 reduction in work force and/or
  school closure for two months.
• An education plan for isolated and quarantined
  students who are sick for at least two weeks.
• Resource needs such as soap, masks, gloves, etc.
• Increased symptom and attendance monitoring to
  ensure accurate reporting.

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At The District Office

• Life/health/safety issues essential to
  accomplishing the mission of the school
  district.
• Standard Operating Procedures of critical
  functions/processes (payroll, insurance, etc.)
• Daily mission essential services and priorities

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At The District Office

• Assign key team leaders and alternates.
• Assign team members by location.
• Develop and implement task checklists.
• Assign critical functions to be performed via
  telecommuting and other technology needs.
• Look at flex scheduling shifts, longer hours of
  operations, alternate work days, etc.

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At The District Office

• Identify staff that can be cross trained to
  backfill critical function.
• Identify functions that can be suspended while
  staff is reassigned to more critical roles.
• Track department absenteeism daily and report the
  percentages to the Hillsborough County Health
  Department.

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Pandemic Preparation

• Train school health staff, teachers and
  administrators on how to implement the district
  plan.
• Teach students and inform families so they
  understand what to do in the event of any
  pandemic.

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Its Here And Its Bad!

• Is Hillsborough County Schools ready for a
  Pandemic Flu Outbreak?
• Questions?

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www.cdc.gov/flu/school/

• Recommendations for schools and child care
  providers
• Questions and answers Flu information for
  schools
• Stopping germs at home, work, and school
• School materials and posters

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www.PandemicFlu.gov

• One-stop resource for pandemic flu information,
  including school checklist to address.
• Planning and coordination
• Continuity of student learning and core
  operations
• Infection control policy and procedures
• Ongoing communication

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References

• Avian influenza fact sheet. (04, January 15).
  Retrieved November 22, 06, from World Health
  Organization Web Site http//www.who.int/csr/don/
  2004_01_15/en
• Avian influenza frequently asked questions.
  (n.d.). Retrieved November 22, 06, from World
  Health Organization Web Site http//www.who.int/c
  sr/disease/avian_influenza/avian_faqs/en/
• Carr, N. (2006). Bracing for bird flu. American
  School Board Journal, , 37-47.

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References Continued

• Chettle, C. C., Cohn, S. (2007). Are you
  prepared for a flu pandemic? Nursing Spectrum,,
  16-19. Retrieved January 22, 2007, from Nursing
  Spectrum Web Site http//www.nurse.com
• Dayton, L. V. (2006). Influenza concerns
  Increased awareness of avian, pandemic, seasonal
  flu. Advance for Nurses, , 19. Retrieved December
  25, 06, from http//www.advanceweb.com
• HHS Pandemic Influenza plan. (2005, November).
  Retrieved January 24, 07, from U.S. Department of
  Health and Human Services Web Site
  http//www.pandemicflu.gov

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References Continued

• How is Florida preparing for Avian Flu? (n.d.).
  Retrieved August 31, 06, from Department of
  Health Website Web Site http//www.doh.state.fl.u
  s/rw_Bulletins/panfluplanindex.html
• Influenza Are your schools ready? (n.d.).
  Retrieved October 30, 06, from Department of
  Homeland Security, Federal Emergency Management
  Agency, FEMA Independent Study Program (Emergency
  Management Institute) Web Site
  http//www.training.fema.gov/emiweb/is/crslist.asp
  

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References Continued

• Leavitt, M. O. (06, June 20). Department of
  Health and Human Services pandemic planning
  update ll, a report from Secretary Michael O.
  Leavitt. Retrieved December 1, 06, from
  PandemicFlu.govWebsite Web Site
  http//www.pandemicflu.gov/plan/pdf/panflureport2.
  pdf
• Lister, G. (2006). Chicken little, wash your
  hands. American School Board Journal, , 50-54.

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References Continued

• Osterholm, M. (2005). Preparing for the next
  pandemic. New England Journal of Medicine, 352,
  1839-1842.
• Pandemic Influenza. (06, December 1). Retrieved
  December 1, 06, from Center for infectious
  Disease Research and Policy. Pandemic influenza
  Web Site www.cidrap.umn.edu/cidrap/content/influe
  nza/panflu/biofacts/panflu.html
• Pandemic influenza. (2005, November 11).
  Retrieved January 23, 2007, from Homeland
  Security Web Site http//www.globalsecurity.org
• School district (K-12) pandemic influenza
  checklist and pandemic influenza planning
  Checklist for individuals and families. (n.d.).
  Retrieved September 9, 06, from Pandemic Flu
  Website Web Site http//www.pandemicflu.gov

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References Continued

• Taubenberger, J., Morens, D. (06, December 1).
  1918 influenza The mother of all pandemics.
  Retrieved December 1, 06, from CDC website Web
  Site http//www.cdc.gov/ncidod/EID/vol12no01/05-0
  979.htm
• U. S. Department of Education. (n.d.). Practical
  information on crisis planning A guide for
  schools and communities. Retrieved October 22,
  06, from PandemicFlu.gov. Website Web Site
  http//www.ed.gov/admins/lead/safety/emergencyplan
  /crisisplanning.pdf
• What is a Pandemic? (2007). Safer School News,
  107, 1-5.
• What is a Pandemic? (n.d.). Retrieved January
  25, 07, from World Health Organization Web Site
  http//www.who.gov