Pandemic Influenza Why Schools Need to Be Proactive

Pandemic Influenza Why Schools Need to Be Proactive Diane Hargrove-Roberson, MSW Community Outreach Program Manager Pandemic Influenza Grant Building healthy communities through preparation, prevention and response!

Topics of Discussion • • Influenza Avian Flu Pandemic Flu History, Impact & Planning • Schools Role • Employee Role • Resources Prevention Recovery Preparedness Response

“There are only two types of school administrators; those who have faced a crisis and those who are about to!” Ron Stephens, Executive Director, National School Safety Center

What is influenza (flu)? • mild to severe respiratory illness of sudden onset caused by an influenza virus • highly infectious-spreads rapidly from person to person • some strains more severe than others • occurs every year killing 36, 000

How does influenza spread? • Breathing in droplets • produced when infected person talks/coughs/ sneezes • Touching an infected person or surface • contaminated with the virus and then touching your own or someone else’s face

Avian Influenza • Avian influenza or “bird flu” is an infection in birds caused by a variety of subtype viruses. • One such subtype is H 5 N 1. • Some strains of H 5 N 1 are highly pathogenic. • The severe strain of H 5 N 1 is killing birds in Asia and parts of Europe.

Avian Influenza cont…. • The H 5 N 1 strain has sickened about 359 people who came in contact with the sick birds in several countries – 226 people died. * (Approximately 62. 9%) *As of February 5, 2008

359 CASES - 226 DEATHS - 62. 9% MORTALITY RATE

Will H 5 N 1 become the next pandemic? • Avian Flu not yet Pandemic Flu • current outbreaks of H 5 N 1 Avian Flu in poultry and birds are the largest ever documented • Impossible to predict next pandemic flu event • If not H 5 N 1, then another • Plan now

Understanding Pandemic Flu • Epidemic: serious outbreak in a single community, population or region • Pandemic: an epidemic spreading around the world affecting hundreds of thousands of people, across many countries • Pandemic flu: a pandemic that results from an influenza virus strain that humans have not been previously exposed to

Putting Pandemic Flu into Perspective • 2001 terrorist attack with anthrax • killed five people • 2002 outbreak of West Nile Virus • killed 284 people nationally in six months • 2003 SARS outbreak • killed over 800 people world wide • froze Asian economies • frightened millions of people into wearing masks on the streets

History of Pandemic Influenza • 1968 -1969 • Worldwide 700, 000 deaths (34, 000 in US) • 1957 -1958 • Worldwide 1. 5 million deaths (70, 000 in US) • 1918 • Worldwide 40 -50 million deaths (500, 000– 650, 000 in US) • Typical Influenza Season

Caregivers in the Spanish Flu 1918

Personal Protective Equipment (1918)

Law Enforcement in the 1918 Flu

Public Health Measures in 1918 Some are unchanged in 2008

Lessons from Past Pandemics • Occurs unpredictably, not always in winter • Variations in mortality, severity of illness and pattern of illness • 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

Pandemic Influenza Global Outbreak Conditions Supporting Pandemic Influenza: 1. New influenza type emerges. (Mutates in human population) 2. Causes serious human illness. 3. Spreads easily from person to person.

Currently there is no pandemic influenza in the world. • However, experts from the World Health Organization (WHO) and the Centers For Disease Control (CDC) believe it is only a matter of time before it occurs.

Current Status Interpandemic Phase 1 No new virus in humans Phase 2 No new virus in humans Animal viruses low risk to humans Pandemic alert Pandemic Phase 3 Phase 4 Phase 5 Phase 6 New virus in humans Small clusters, localized Larger clusters, localized Little/no spread among humans Limited spread among humans Increased and sustained spread in general human population Current status Currentof H 5 N 1 status WHO Global Influenza Preparedness Plan, 2005. Available at: http: //www. who. int/csr/resources/publications/influenza/GIP_2005_5 Eweb. pdf

Pandemic Influenza Impacts in Louisiana • Estimated Impact in Louisiana • 3 Million infected • Between 600, 0001. 4 million clinically ill • Between 300 K-700 K requiring outpatient care • Between 10, 000 – 22, 500 hospitalized • Between 3, 000 – 6, 000 deaths • Impact on Infrastructure • Significant disruption of transportation, commerce, utilities, public safety and communications • Limited to no assistance from State and Federal governments due to nation-wide impact

How CCP and DOE are Working Together • "Pandemic Influenza Guidance to School Systems“ (working with DOE for three years) • Contract with DOE for Pandemic Influenza Planning • Statewide School Closure Tabletop • Tested state’s ability to close and reopen schools administratively • Education and Training with DOE teachers and staff

Influenza Prevention • • • Vaccination Stay at home when sick Cover your cough Wash hands regularly Avoid touching eyes, nose and mouth • Avoid close contact with people who are sick

Infection Control - Our Basic Protection • Hand Hygiene • Wash hands regularly with soap & water • If no water available: 60%-95% alcoholbased sanitizer • Cover your cough strategy • Environmental cleaning • 1: 10 bleach solution • EPA registered disinfectant • Gloves & surgical masks

Hand washing

Available Printed Media Resources • Family Readiness Guides (also online) • Get Ready, Stay Healthy! • Pan Flu Brochure • Counter Cards (two-sided; card stock) • “How You Can Be Prepared for a Flu Pandemic” • Online Fact Sheets: www. dhh. louisiana. gov (click pandemic flu information) • Pandemic Flu: The Facts • Pandemics in the United States

Increasing Community Awareness “How You Can Be Prepared for a Flu Pandemic” • Individual and Family Guide • Spanish, English, Vietnamese versions available • Audio version available through the State Library System • Braille version - Summer 2008 through the State Library System

Workforce Support • Psychological and physical strain on personnel responding in emergency situation • Psychological stress for families • Plan for staff to have adequate • Sleep • Food • Access to psychological and spiritual support

Guidance School Planning • Develop alternative procedures for learning in event of school closures • Develop plan for essential office functions • payroll, communication with students, families, and staff • Infection Control • educate & practice

OPERATIONAL PHASES FOR SCHOOL DISTRICT PANDEMIC INFLUENZA PLAN All planning initiatives and tasks identified in the plan are completed by November in anticipation of typical influenza season December to March (Confirmed Human Outbreak Overseas) Phase Yellow initiatives have been confirmed and tested. District is at “READY STATUS” to implement plan Plan Is Activated

What Can You Do Now? • Prepare your community – become involved in disaster training & volunteerism. • Remember to get enough sleep. • Exercise regularly. • Prevent the spread of infection – wash hands regularly, cough/sneeze into tissue, keep your hands away from your nose/mouth. • Put out cigarettes. • Annual flu shots. • Nutritious eating. • Family plan and kit. • Look for information about pandemic flu. • Utensils, food and beverages should not be shared.

Why We Need To Be Proactive: (PREPARATION!) • 30 -40% student, teacher and staff absences. • 30 -40% of school bus drivers ill. • Interruption of instruction and the instructional impact to the students. • Use of school buildings as overflow medical sites. • Maintenance of basic operations for central offices/administration. • CONT’D……

Why We Need To Proactive: Cont’d • Impact on families who will have 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 children. • Emotional responses that students, families and staff will be experiencing.

Public Health Issues… Ø An Influenza pandemic may emerge with little warning. Ø A vaccine will not yet be available. Ø The supply of anti-viral drugs will be limited.

Will we need to close schools and for how long? Severity of the Pandemic will determine a school closure decision.

P. I. P (Pandemic Influenza Planning) WHERE DO I BEGIN? Form a PIP Committee/Team

Planning and Coordination Who’s on the Team? • Senior Level Administrator • District Representative • School Nurse • Teachers • Health Dept. • OEM • Guidance / SAC • IT / MIS • Purchasing / Finance • Food Services • Facilities • PTO • Union Representative

Considerations for a Pandemic Influenza Plan • • Surveillance & Reporting Prevention Education Communication Continuity of Instruction School Facilities/Infection Control Student Transportation Employee Issues Emotional Preparation

Surveillance & Reporting • Monitoring increases in absenteeism among students & staff. • Documenting and communicating findings to the Department of Health and Hospitals (DHH). • Evaluating individuals who have symptoms, e. g. cough or fever.

Surveillance & Reporting (Cont’d) • Maintaining disease containment measures (isolation & quarantine). • Maintaining adequate supplies for infection control (soap, paper towels, etc. ) • Participating in any vaccine program implemented by DHH.

Prevention Education • Prevention education for Staff, Students & Families. • Who will be responsible for educating these groups about pandemic flu and the preparedness plan including individuals for whom English is a second language and students with special needs?

Prevention Education (cont’d) • District wide awareness program on disease prevention &infection control. ü Washing hands often with soap. ü Alcohol based disposable wipes/hand sanitizers. ü Respiratory etiquette, e. g. covering mouth and nose while sneezing and coughing.

Communication • Development of consistent clear messages for parents, students, staff and the community. • Coordinated messages with DHH, parish and state agencies. • Establishing phone hotlines and websites for media, school administrators, teachers, parents and others.

Communication (cont’d) • Prepare templates for press releases and media alerts. • Ensure that communications are accessible to the visually and hearing impaired and non. English speaking communities.

Continuity of Instruction • Interruption of instruction will impact testing, grades, assessments and graduation requirements. • Strategies to provide instruction in the face of staff absences: ü Restructuring the school calendar and school year ü Deliver only those courses needed for graduation and /or core subjects ü Utilize on-line instruction or other methods

School Facilities • What if schools are used as overflow medical sites? Special Considerations: ü Administrators will need authority to restrict access to certain areas of the building ü Special phone lines or communications for emergency responders üProvide storage space to stock infection control and PPE supplies

School Facilities (Cont’d) Special Considerations: üTraining of school maintenance and custodial staff for appropriate cleaning of schools before re -occupancy ü Designate space for public health providers for onsite vaccination clinics, medical clinics or shelter facilities.

Student Transportation • Policies and procedures for transporting ill students. • Maintain current list of contact persons, number of buses available, number of drivers available, staging areas for buses to transport students or adults home.

Student Transportation (cont’d) • Training for student transportation staff for appropriate cleaning of buses exposed to bodily fluids. • List of substitute bus drivers.

Employee Issues • As a result of increased staff absences and the length of illnesses in a pandemic, schools will need to consider the following: ü Provide identified staff with authority to act in the absence of supervisors/senior personnel. ü Reassess the scope of existing health plans and employee assistance programs to deal with the physical and emotional trauma of a pandemic.

Employee Issues (cont’d) üReexamine human resource policies. Sick leave and attendance policies may not address a major employee absence. üIt may be necessary to develop a policy to restrict access to the workplace to prevent spread of disease.

Emotional Preparation • Prepare school counselors to address staff, student and family concerns regarding illness and death, fear of contagion or transmitting disease, quarantine restrictions, etc. • Utilize school health professional, local health department staff to provide accurate information. • Have contingency plans to address school counseling shortages that may occur due to illness.

Crisis Planning: The Basic Steps • Mitigation/ Prevention • Preparedness • Response • Recovery Prevention Recovery Preparedness Response

Mitigation/Prevention Things we can do to reduce or mitigate risk to health or life caused by a pandemic influenza outbreak.

Preparedness Developing a plan to properly handle a pandemic situation prior to its occurrence. PANDEMIC INFLUENZA PLAN

Response Procedural actions and steps to follow during a pandemic event.

Recovery Restoring the learning and teaching environment following a pandemic event.

Implementation of the Plan • As with ALL emergency response plans- they need to be practiced and tested. • Participation in a Tabletop Exercise will help to strengthen planning efforts.

FLOWCHARTS PANDEMIC INFLUENZA FLOW CHART FOR: TEACHERS Government Response ► Stages PANDEMIC ALERT PERIOD 0 -New domestic animal outbreak in at-risk country • Suspected human outbreak overseas Measures identified in this column must be accomplished BEFORE November 1, 2007 PANDEMIC ALERT PERIOD (SUBSTANTIAL PANDEMIC RISK) 2. Confirmed human outbreak overseas READY STATUS PANDEMIC PERIOD 3 - Widespread human outbreak in multiple locations overseas 4 - First human case in North America 5 - Spread Throughout United States 6 - Recovery & preparation for subsequent waves ) TYPICAL FLU SEASON IS DECEMBER TO MARCH Communications o. Make sure Parent /Guardian contact information is current o. Keep lines of communications open and frequent to main office regarding current status of Pandemic o. Confirm contact lists are current/accurate o. Maintain communications with main office o. Review with Nurse/Health Services protocols on managing ill children o. Maintain close contact with parents/guardians providing reassurance for the health and safety of their children o. Remind parents to keep ill children home Continuity instruction & learning o. Begin lesson preparation/ homework strategies to assign students if schools were closed due to a pandemic ( 2 weeks up to 12 weeks) o. Hone lesson preparation / homework activities (District may provide prepackaged activities) o. Coordinate with District Technology Department for delivery of student assignments and activities. Prevention Education o. Central Administration will provide webbased Pandemic Awareness & infection control training on District website. Explore this activity. o. Begin reinforcement of proper hygiene & germ control strategies with classroom students (i. e. Hand washing, respiratory o. Post classroom signage that promotes hygiene and respiratory etiquette. o. HEIGHTENED reinforcement of proper hygiene & germ control strategies with classroom students (i. e. Hand washing, respiratory o. Promote vigilant classroom / school hygiene and respiratory etiquette practices and policies. o. Consider hand washing breaks with students

Summary of P. I. P. STEPS • Form P. I. P. Committee. • Identify Considerations for The Plan. (Core Issues) • Address Four Stages of Crisis Management • Test & Evaluate Plan. (Table Top Exercise) • Create Final Flow Charts. (Roles & Responsibilities)

Information Sources • Centers for Disease Control and Prevention, Website for Pandemic Influenza Available at: http: // www. pandemicflu. gov • Emergency Response and Crisis Management Technical Assistance Center, ERCM Express Volume 2, Issue 7, 2006, Schools Respond to Infectious Disease Available at: www. ercm. org • World Health Organization, Current WHO Phase of Pandemic Alert, Available at: http: //www. who. int/csr/disease/avian_influe

Get Informed. Be Prepared. • State Draft Pandemic Flu Plan • http: //www. dhh. state. la. us/offices/publications/pubs 145/Pandemic%20 Influenza%20 Plan_100906. pdf • Family Readiness Guide • http: //www. dhh. state. la. us/offices/publications/ • Official Pandemic Flu Web Site • http: //www. pandemicflu. gov/ • Centers for Disease Control and Prevention • http: //www. cdc. gov/flu/pandemicflu/ Even though local, state and federal agencies have plans to protect the public, you are responsible for your own safety, even in an emergency!

FOR PANDEMIC INFLUENZA PLAN CONSULTING OR MORE INFORMATION CONTACT: Diane Hargrove-Roberson, MSW Community Outreach Program Manager Phone: (225) 763 -3964 Email: droberso@dhh. la. gov Dr. Frank Welch Medical Director Phone: (504) 838 -5300 Email: fwelch@dhh. la. gov

QUESTIONS, ISSUES OR CONCERNS?

Special Acknowledgements • Joshua Wayne, Project Director. Safe School Healthy Students • Carl Mittelhammer, Emergency Management Specialist • Bergen County Technical Schools & Special Services • Paramus, New Jersey Public Health Emergency Preparedness Conference February 2008, Atlanta, GA