Title: Preparing for Pandemic H1N1 in the Fall: Best Practices from Recent Campus Experiences
1Preparing for Pandemic H1N1in the Fall Best
Practices from Recent Campus Experiences
- Jane Horton, MD, Director of Student Health and
Counseling - Dawn Watkins, Vice President of Student Affairs
and Dean of Students - Jeff Hanna, Executive Director of Communications
and Public Affairs
2Pre-Pandemic Planning
- A Pandemic Flu Preparedness and Response Plan was
adopted in 2006 as a component of our
institutional crisis management plan - Pandemic flu defined as an influenza outbreak
identified as pandemic flu by WHO, CDC and/or
state health agencies, or a local outbreak of
severe flu illness with an attack rate of greater
than 10, and/or mortality rate of greater than
1 - Key elements of the plan include
- Department-specific guidelines for pandemic flu
planning and response - Implementation of social distancing to reduce
spread of infection - Implementation of isolation of those affected by
illness - Public health education using effective
communication strategies - Coordination with VDH and local public health
officials, MOU to serve as POD for vaccines
and/or medications for the University community
3Pre-Pandemic Planning (contd)
- A five level plan was developed to serve as a
tool to support decision making in the event of a
pandemic flu outbreak. This plan outlines both
triggers and key responses at each level - Level 1 Planning, Communication, Surveillance
for pandemic flu - Develop Pandemic Flu Preparedness and Response
Plan - Communicate planning and general public health
information to University community - Monitor WHO, CDC, state health agencies for
information regarding influenza activity
4Pre-Pandemic Planning (contd)
- Level 2 Pandemic flu identified
- Monitor WHO, CDC, state health agencies for
information regarding influenza activity - Implement travel restrictions recommended by CDC
and US Dept of State - Communicate specific University and public health
information to University community - Increase stocks of supplies needed to provide
care in the event of a local outbreak
5Pre-Pandemic Planning (contd)
- Level 3 Pandemic flu present in Virginia
- Monitor WHO, CDC, state and local health agencies
for information regarding influenza activity - Increase stocks of supplies needed to provide
care in the event of a local outbreak - Monitor for flu activity and severity in the
University community - Participate in state and local health agency
efforts to distribute national stockpiles of
influenza vaccine and antiviral medication for
prophylaxis and treatment - Consider limitation and/or suspension of
University operations - Communicate disease recognition and management,
personal protection, social distancing,
quarantine and isolation information to
University community
6Pre-Pandemic Planning (contd)
- Level 4 Pandemic flu present at WL or in the
local community - Monitor WHO, CDC, state and local health agencies
for information regarding influenza activity - Monitor for flu activity and severity in the
University community - Participate in state and local health agency
efforts to distribute national stockpiles of
influenza vaccine and antiviral medication for
prophylaxis and treatment - Communicate disease recognition and management,
personal protection, social distancing,
quarantine and isolation information to
University community - Limit or suspend University operations and
communicate same - Implement quarantine and isolation measures for
those exposed/ill with influenza - Provide health care and essential services for
those who remain on campus
7Pre-Pandemic Planning (contd)
- Level 5 Recovery
- Monitor WHO, CDC, state and local health agencies
for information regarding influenza activity - Prepare for possible further waves of pandemic
flu activity, and return to Level 2 - Decide to (partially or fully) resume University
operations at Level 2 - Communicate specific University and public health
information to University community
8Monday April 20
- Classes resume after Spring Break.
- Several students have traveled to Mexico,
California or Texas during the break.
9Thursday April 23
- CDC announces human cases of swine influenza A
(H1N1) virus infection identified in California
and Texas, in addition to cases in Mexico
10Friday April 24
- CDC sends investigators into the field in
Mexico, California and Texas - VDH releases swine influenza virus infection
testing recommendations to clinicians - Clinicians should consider the possibility of
swine influenza virus infection in patients
presenting with febrile respiratory illness
(fever gt100 F plus a cough and/or sore throat, in
the absence of another known cause) who - Live in or have traveled to San Diego and/or
Imperial County, California or Guadalupe County,
Texas or - Have been in contact with ill persons from these
areas in the 7 days prior to their illness onset.
11April 19-25
- WL CLINICAL EXPERIENCE FOR THE WEEK
- 24 students seen with respiratory illnesses and
2 with ILI.
12Sunday April 26
- Public health emergency declared in U.S.
- CDC announces additional cases in CA, TX, KS, OH
and NYC. Testing shows virus is susceptible to
oseltamivir and zanamavir. Interim guidance
released on how to care for people who are sick
and the use of face masks in a community setting
where spread of swine flu has been detected. - Internal communications begin at WL about
assessing risk on campus and communicating with
the University community.
13Monday April 27
- CDC activates Emergency Operations Center and
issues travel warning to avoid non-essential
travel to Mexico - VDH declares public health emergency in Virginia
and activates Incident Command Center. - CDC and VDH recommendations are used to develop
communications to WL community regarding swine
flu outbreak.
14Monday April 27
- Current case definition any patient with ILI
who lived, traveled, or had contact with an ill
person from any area with confirmed swine
influenza cases. - SHC staff updated on swine flu outbreak, case
definition for ILI and swine flu, respiratory
precautions, management of ILI, etc. Signs,
masks, tissues and hand sanitizer placed at
patient check-in location. Swine flu information
from CDC placed in waiting room for patient
education.
15Monday April 27
- Case 1 presents to SHC with ILI past 48 hours,
no known contact with ill person or personal
travel to any area with confirmed swine flu
cases. Admitted to infirmary, private room,
respiratory isolation. Rapid influenza A test
positive, second swab obtained for swine flu
testing, oseltamivir treatment initiated, health
department notified. - Two other students with ILI have negative rapid
influenza tests.
16Tuesday April 28
Dean Watkins message appears in Campus Notices
17Tuesday April 28
- Dr. Horton notifies Dean Watkins of Case 1
student with ILI and positive influenza A test,
possible swine flu. VDH agrees to do swine flu
testing on our student even though case
definition was not met. - Dean Watkins alerts WL President Ruscio to the
potential of swine flu in a student. - Dean Watkins message is sent to the campus as a
broadcast email. - Emergency Management team receives an email
updating members on the situation. - CDC Swine Flu widget is added to the Student
Health and Counseling Web site.
18Tuesday April 28
- Case 2 presents to SHC with ILI past 24 hours,
no known contact with ill person or personal
travel to any area with confirmed swine flu
cases. - Three other students with ILI have negative
rapid influenza tests. - First positive swine flu case in a college
reported by Notre Dame. - WHO raises worldwide pandemic alert to Phase 4
(confirmed person to person spread of a new
influenza virus able to cause community-level
outbreaks)
19Wednesday April 29
- Case 2 influenza A test positive, respiratory
isolation and oseltamivir treatment initiated,
VDH and administration notified. Dr. Horton
notifies Dean Watkins of a second possible swine
flu case. Dean Watkins notifies President Ruscio
and Public Affairs Director Hanna of situation. - Two other students with ILI have negative rapid
influenza tests. - Initial internal email exchanges regarding
Alumni Reunions, which are scheduled to begin the
following day. - CDC posters distributed around the campus.
- General notice about swine flu is posted on the
alumni site and on the alumni reunion site. - Work begins on developing a special light
swine flu Web site.
20Wednesday April 29
- WHO raises worldwide pandemic alert to Phase 5
(strong signal that pandemic is imminentthe time
to finalize organization, communication, and
implementation of planned mitigation measures is
short)
21Thursday April 30
- Notified by VDH that case 1 now considered
probable swine flu since the influenza A strain
could not be typed by the state lab. Specimen
from case 1 sent to CDC for further testing. - Specimen from case 2 sent to VDH for further
testing. - First two cases of swine flu in Virginia are
confirmed neither is a WL case. - Dean Watkins issues an update to Emergency
Management team including general updates,
talking points and reminder to review Pandemic
Flu Plan and carry emergency USB at all times. - Draft of campus-wide communication re one
probable swine flu case is prepared and sent to
Central Shenandoah Health District Director Dr.
Douglas Larsen.
22Thursday April 30
- First conference call held with VDH officials to
discuss WL cases and response. - Decision is made to follow the states
established policy of not announcing probable
cases. - As part of conference call, VDH decides to
develop a special advisory on swine flu to
colleges and universities. - Report received from Council of Independent
Colleges of Virginia (CICV) Pandemic Advisory
Task Force 4/29/09 conference call, that included
Dr. Diane Woolard from VDH, recommending close
monitoring but no move to suspending classes or
canceling events on campuses.
23Friday May 1
- A special flyer is developed for alumni reunions
and is posted at registration desks, reminding
visitors of recommended personal respiratory
hygiene precautions and self-isolation for ILI. - CDC releases swine flu infections alert for
institutions of higher education. - Letter from Dr. Karen Remley, VDH State Health
Commissioner, to Virginia College and University
students. - Case 3 presents to SHC.
- Two other students with ILI have negative rapid
influenza tests.
24Friday May 1
- 630 p.m. Dr. Larsen informs that the two WL
cases are now probable swine flu swine flu
since the influenza A strain could not be typed
by the state lab. VDH intends to release
information to news media. - 830 p.m. VDH distributes news release
announcing two probable cases among Washington
and Lee students - 9 p.m. Blast email is sent to WL community.
Students are asked to forward the information to
parents. - 9 p.m. go.wlu.edu/health Web site goes live
with memo and other information. Home page now
features an alert box in red directing people to
the special page. - Dean Watkins and Dr. Horton begin receiving
emails of concern from faculty about students who
may have been in class with symptoms.
25Friday May 1
26Friday May 1
27Saturday May 2
- President Ruscio announces probable swine flu
cases at breakfast meeting of alumni reunions. - Four area TV stations arrive mid-morning to
report on situation. - Local and area print media call for information
and are directed to the swine flu Web page. - Message is sent to WL families from Dean
Watkins. - VDH makes announcement the first probable case
at WL has now been confirmed as swine flu,
making it the third case in Virginia. - Strategy meeting with Dr. Larsen and by phone
with VDH. - CDC releases interim guidance on school
closures.
28Saturday May 2
- Contact list developed for Case 2, who went to
class with fever and cough before diagnosis
faculty and students notified by email about
possible exposure, appropriate actions if
symptoms develop, and availability of anti-viral
prophylaxis for high-risk individuals. - One student with ILI has negative rapid
influenza test. -
29April 26May 2
- WL CLINICAL EXPERIENCE FOR THE WEEK
- 86 students seen with respiratory illnesses and
15 with ILI, including cases 1-3. -
30Sunday May 3
- Letter from Dr. Remley to health care providers
with updated case definitions (no longer requires
travel or exposure history), testing, isolation,
treatment, post-exposure prophylaxis for those in
high-risk groups. - Cases 4 and 5 present to SHC.
- Frequently Asked Questions are added to Web page.
31Monday May 4
- Cases 6-10 present to SHC.
- Council of Independent Colleges of Virginia
(CICV) hold follow up conference call on
pandemic. - Special communication is distributed to WL
students studying abroad. - An email update to the community adds a specific
warning to students about sharing cups. - Information is shared with faculty at the
regularly scheduled faculty meeting. - An additional update is given to the Emergency
Management Team
32Tuesday May 5
- Dean Watkins meets with individual classes and
groups, including education studies which has
student teachers in area schools. - Emergency Management Team meets to discuss
current status of the outbreak on campus. - New guidance forthcoming from CDC for colleges
and universities discussed during VDH conference
call, removes recommendation for school closings. - Dr. Horton consults with Athletic Department and
mens lacrosse team about a team member with
swine flu, as well as the upcoming NCAA mens
lacrosse and womens tennis tournaments scheduled
to be held on campus. - Athletic Director Jan Hathorn consults with NCAA
and with competing teams
33Wednesday May 6
- Cases 11-13 present to SHC.
- Four cases are moved from SHC infirmary to
on-campus apartment to complete 7 day isolation.
34Wednesday May 6
- Cases 11-13 present to SHC.
- Four cases are moved from SHC infirmary to
on-campus apartment to complete 7 day isolation. - Dean Watkins contacts local public school
superintendents. - Dean Watkins and Dr. Horton begin to develop a
campus-wide questionnaire with VDH. - VDH announces that there are seven confirmed
cases at WL. - Dean Watkins and Communications Director Hanna
hold news conference with local and area media. - WL mens lacrosse team hosts NCAA tournament
game without top player who is being treated for
H1N1.
35Thursday May 7
- New communication to WL parents from Dean
Watkins. - Two cases are moved from SHC infirmary to
on-campus apartment to complete 7 day isolation.
36Friday May 8
37May 3-9
- WL CLINICAL EXPERIENCE FOR THE WEEK
- 71 students seen with respiratory illnesses, and
20 with ILI, including cases 4-13.
38Monday May 11
- CDC releases interim guidelines for IHE, which
do not recommend that colleges or universities
cancel classes or other large gatherings.
39Tuesday May 12
- Dr. Horton meets with Facilities Management
staff for QA.
40Thursday May 14
41May 10-16
- WL CLINICAL EXPERIENCE FOR THE WEEK
- 70 students seen with respiratory illnesses, and
2 with ILI, including case 14.
42May 17-23
- CLINICAL EXPERIENCE FOR THE WEEK
- 59 students seen with respiratory illnesses, and
2 with ILI.
43May 24-30
- CLINICAL EXPERIENCE FOR THE WEEK
- 50 students seen with respiratory illnesses, and
0 with ILI.
44Thursday June 4
- Undergraduate Commencement at Washington and Lee
45Thursday June 11
- WHO raises worldwide pandemic alert to Phase 6
(global pandemic is underway).
46Lessons Learned / Considerationsfor Fall -
Winter 2009
- Things can change and develop quickly. We moved
from Level 1 to Level 4 of our pandemic flu plan
within 4 days of the first notice from CDC of
swine flu cases in the US and Mexico , within 1
day of a public health emergency being declared
in US. There may not be much time to revise or
finalize plans, increase stock of supplies, etc.
Communications must be constant, both within the
emergency management team and across the
community. - Most of our cases did not have exposure to known
cases of novel H1N1 influenza or clear
environmental connections. Many were first year
students living in residence halls or sophomores
living in Greek houses. Many reported extensive
social contacts that included sharing cups at
parties. - We presume that our students who traveled over
spring break in mid-April brought this virus back
to campus, and that those index cases were either
not severe enough for the students to seek
medical attention or were not recognized as
influenza.
47Lessons Learned / Considerationsfor Fall -
Winter 2009
- Colleges and universities will be on the front
line for influenza outbreaks this fall and winter
as students return to our campuses from all over
the world. Both seasonal and novel H1N1
influenza virus will likely be circulating. - Social distancing and personal protection
guidelines will need to be adopted early and
followed consistently by a significant proportion
of the University community to slow spread of the
virus. Effective education of all students,
faculty and staff will be a key to success. - Seasonal and novel H1N1 influenza virus
immunization programs for students, faculty and
staff will be important in trying to slow or
minimize the impact of influenza on the
operations of IHE for 2009-2010. Planning for
these immunization programs (in conjunction with
VDH) should begin now.
48Lessons Learned / Considerationsfor Fall -
Winter 2009
- Isolation of infected students for 7 days after
onset of illness will be a challengeconsider
plans for providing medical care, housing,
bathrooms, meals and appropriate education and
supplies to minimize spread of infection to
others. Stock up on masks, gloves, hand
sanitizer, tissues, etc. - Mandatory isolation strategies may keep students
from seeking appropriate medical care for ILI,
and most IHE do not have the facilities/services
available to cohort infected students
effectively. - Voluntary isolation in place will be more
effective in reducing spread for students living
off campus than for those living in residence
halls and/or taking their meals in congregate
settings. - Effective education of students, faculty and
staff will be a key to success of social
distancing and isolation strategies.
49Lessons Learned / Considerationsfor Fall -
Winter 2009
- Most people who have become ill with the novel
H1N1 influenza virus have recovered without
requiring medical treatment. Many may not
recognize they have the flu and therefore may not
follow isolation guidelines. - Treatment and post-exposure prophylaxis with
antiviral medication is recommended only for
those hospitalized with illness and those in
high-risk groups for flu complications. This
includes pregnant women, those with
immunosuppression and chronic pulmonary
(including asthma), cardiovascular (except
hypertension), renal, hepatic, hematological
(including sickle cell disease), neurologic,
neuromuscular, or metabolic disorders (including
diabetes mellitus). - Yet everyone will likely want antiviral
medication for treatment and/or post-exposure
prophylaxis. This will drain resources and may
increase the risk of the virus developing
resistance to current antiviral medications.
50Lessons Learned / Considerationsfor Fall -
Winter 2009
- This novel H1N1 influenza virus is capable of
causing widespread campus and community
outbreaks. It may be difficult to continue
operations for health services and other
university functions (including classes) in the
face of significant student, faculty and staff
absenteeism, which may be as high as 20-40. - Consider triggers for an institutional decision
to suspend/resume classes. Develop a business
continuity plan for the institution and
individual departments and operations if there is
a flu outbreak with a high prevalence of
influenza illness and associated disruption of
operations.
51Contact Information
- Jane T. Horton, MD
- Director, Student Health and Counseling
- jhorton_at_wlu.edu
- 540-458-8401
- Dawn Watkins, PhD
- Vice President of Student Affairs and Dean of
Students - dwatkins_at_wlu.edu
- 540-458-8751
- Jeff Hanna
- Executive Director of Communications and Public
Affairs - jhanna_at_wlu.edu
- 540-458-8459