What other online resources are available?
Why is this a school board issue?
Faced with warnings of an impending influenza pandemic, some school districts across the nation began formulating policies requiring emergency response plans for a potentially devastating health crisis in 2005 when the threat of avian influenza (bird flu) was imminent. After an initial outbreak this spring, Illinois districts may be face an increase in flu cases this fall that could approach pandemic levels.
Without policies and an operational pandemic plan, a school district leaves itself vulnerable to the effects of a severe outbreak. With policies and a plan in place, a district gains the crucial ability to sustain itself through the crisis.
The task of drafting a plan is a challenge, requiring school districts to fully understand the pandemic threat and its implications for their community.
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What is the threat?
According to the Centers for Disease Control and Protection (CDC), the novel H1N1 is a new respiratory disease affecting humans. This virus was originally referred to as "swine flu" because laboratory testing showed that many of the genes in the new virus were very similar to influenza viruses that normally occur in pigs (swine) in North America. Further study has shown that this new virus is very different from what normally circulates in North American pigs. It has two genes from flu viruses that normally circulate in pigs in Europe and Asia and bird (avian) genes and human genes. (From CDC.gov)
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How is it transmitted?
The H1N1 virus spreads much like seasonal flu. It is passed from direct exposure from another human who has the influenza virus through coughing or sneezing, or by touching something with flu viruses on it and then touching the mouth or nose. The resulting illness can range from mild to severe. Younger people, from birth to age 24, seem to be more susceptible to H1N1.
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What are the symptoms of H1N1?
Symptoms are similar to regular seasonal influenza: fever, lethargy, lack of appetite and coughing. Some people also have reported runny nose, sore throat, nausea, vomiting and diarrhea.
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How is it diagnosed?
Official identification as novel H1N1 virus requires laboratory testing, and diagnostic test kits have been distributed to all states, the District of Columbia and Puerto Rico. A specimen needs to be collected within the first four or five days of illness, when an infected person would most likely be shedding the virus. However, some people, including children, may shed the virus for up to 10 days or longer. Because of the cost of testing, many cases were being reported as "probable," and the CDC discontinued release of case counts on July 24, 2009.
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Is there a vaccine for swine flu?
According to a press briefing on Aug. 21, 2009, five manufacturers are currently working on a vaccine and the CDC expects that somewhere between 45 million and 52 million does of the vaccine will be available by mid-October. Distribution to states initially will be base on population, with the following groups at high risk targeted for vaccination: pregnant women; children and young adults aged 6 months to 24 years; people 25 to 64 with medical conditions that put them at higher risk for influenza-related complications; health care workers; emergency medical personnel; and those with children younger than 6 months (too young to be vaccinated. The seasonal influenza vaccine will not provide any protection against the novel H1N1 virus.
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Is this a pandemic?
Officially as of June 11, 2009, the World Health Organization raised the worldwide pandemic level to a "Phase 6 alert." Raising the alert to "Phase 6" indicates the spread of the disease, not the severity of the illness, according to the WHO.
Health experts have been expecting a flu pandemic for a number of years, and preparation is the best defense. A pandemic, or global disease outbreak, begins when a new influenza virus emerges to which humans have little or no immunity and for which there is no vaccine. Once the virus is able to spread easily from person to person, it can sweep quickly around the world.
Pandemic planning requires school districts to anticipate scenarios beyond the scope of their experience. To prepare for an outbreak, districts need to plan for unprecedented self-reliance in the face of a national, state and local crisis.
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What can schools do immediately?
- Encourage students and staff to cover their noses and mouths with a tissue when they cough or sneeze. Throw the tissue in the trash after use.
- Encourage frequent hand washing with soap and water, especially after a cough or sneeze. Alcohol-based hands cleaners are also effective.
- Avoid touching the eyes, nose or mouth. Germs spread that way.
- If students and staff get sick, CDC recommends that they stay home from work or school and limit contact with others to keep from infecting them.
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Why should schools be concerned?
According to Michael O. Leavitt, who was U.S. Secretary of Health and Human Services under President George W. Bush, "… A pandemic is defined as a global event. In reality, a pandemic is a local crisis worldwide. It can happen in every state and every city and every town at almost the same time."
Leavitt's description of a pandemic as a "local crisis" pinpoints the cause for concern. With the strain it would put on global, federal and state resources, a pandemic would demand from local communities — prepared or not — an increased level of self-sufficiency. School districts could be expected to maintain operations without any outside assistance for long periods of time.
Despite the warnings, districts may be tempted to put off the task of pandemic planning. Some, faced with more immediate concerns, may deem it too time-consuming. Others may dismiss the predictions, associating them with the notorious hype of Y2K. Experts urge education communities to treat the pandemic threat seriously.
For school districts, mass absenteeism would spawn several major problems that, if not anticipated, could throw the community into turmoil. Districts need to consider, for example, how instruction would continue if schools were closed for weeks or even months. How would graduation requirements be met? How would employees be paid during closure? How would the district respond if surge capacity forced hospitals to use school buildings as staging areas for the sick?
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What is the role of the school board?
As a governance team, a school board has a responsibility to ensure that its district is equipped with policies to deal with a crisis situation, including an influenza outbreak. It is not the board's responsibility to build an operational pandemic plan for the district. Rather, planning is an administrative responsibility that is developed and presented to the board.
(Also see sample policy 4:180 and administrative procedures 4:180-AP1 and 4:180-AP2 that were listed at the top of this page.)
The first step for a board is to find out if the district has a pandemic plan. If such a plan exists, board members should review the policies and determine if the procedures offer a sufficient response. If no plan exists, the board must initiate the process by directing the superintendent to form a pandemic planning team, to include one or two board members. The superintendent should then provide the team with the district's existing policies for dealing with emergencies and infectious diseases. (If no such policies exist, this is an ideal time to draft them.)
Planning should occur in collaboration with community partners, especially the local health department. After the plan is complete, the board must ensure that the staff, students and community are made aware of the policies and the operational plan.
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What are the policy questions?
While some of the issues may be similar to a district's crisis plan, special policy, procedure and plan issues may exist, such as the following that have been adapted from "Preparing for Pandemic Flu," Inquiry & Analysis, NSBA, June 2006:
- Who is in charge of administering the district's operational pandemic plan, and what are the responsibilities of others who will implement parts of the plan?
- What steps will the district take to stop the spread of influenza? What measures will the district take to enforce social distancing? What products does a district need to have on hand to stop the spread of influenza?
- In a pandemic situation, how will sick students be identified? How will sick students be transported home? Where will sick students go if they cannot be transported home immediately? What are the risks to staff?
- Do privacy laws such as HIPAA affect what student health information school districts are able to disclose to the local health department and others?
- How will students, particularly those with or without access to technology at home, continue to be educated during a pandemic?
- What special requirements will English language learners and students with disabilities need? How will services be provided to students enrolled in the free and reduced meals program?
- How will graduation requirements be met if schools are closed? How and where will high school graduation take place during a pandemic?
- How will the district respond to community groups requesting the use of school facilities during a pandemic? What plans have to be made if the local health department intends to use the school as a medical facility during a pandemic?
- How will the district communicate with stakeholders during a pandemic?
- Will the school board adopt a more liberal employee leave policy during a pandemic? Will employees be paid if they are unable to work or if the school is closed? What effect will this have on state and federal laws and leave provisions of collective bargaining agreements?
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What can be predicted about a possible influenza pandemic?
Experts are unable to define the magnitude of the next pandemic, as they cannot predict the virulence of the virus, severity of infections, or risk groups for severe and fatal infections. To develop preparedness plans, school districts can use the same set of basic assumptions about the next pandemic that governments and other agencies have used. They include:
- There will be global susceptibility to the virus. Humans will not be immune to it, and availability of vaccinations will be limited.
- About 30 percent of the overall population will become ill.
- Illness rates will be highest among school-age children, reaching about 40 percent.
- Among working adults, an average of 20 percent will become infected. In the peak weeks of a pandemic, absenteeism could reach 40 percent.
- The typical incubation period (time between initial infection and onset of illness) will be about two days.
- Those infected will "shed" the virus and transmit infection for ½ to one day before the onset of illness. Viral shedding and the risk for transmission will be greatest during the first two days of illness.
- Children will play a major role in transmission of infection. They will shed the greatest amount of virus and therefore pose the greatest risk for transmission.
- Each infected person will transmit infection to approximately two other people. In a severe pandemic, there could be about three secondary infections per primary case.
- In an affected community, a pandemic outbreak will last about six to eight weeks. At least two pandemic disease waves are likely.
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Does a checklist exist to help with planning?
Pandemic preparedness and response plans will differ, as each school district needs to tailor its plans according to the unique set of circumstances it faces. The flu.gov website contains a number of checklists highlighting the major points that every district should consider when shaping its plan, plus checklists that schools could share with parents.
Planning and Coordination
Find out who's in charge.
Identify the state and local authorities responsible for officially declaring a public health emergency.
Establish a district team.
Form a committee of key district stakeholders to oversee the development of the district's emergency plan.
Set up an ICS.
Set up an Incident Command System to manage the execution of the district's plan. An ICS is a standardized organization structure that establishes a line of authority, common terminology and procedures to be followed.
Get everybody on the same page.
Coordinate with the local and/or state health department and state education agencies to ensure compatibility with their pandemic plans and ICS's.
Build accountability into the plan.
Define roles for those executing the district plan. Include timelines, deliverables and performance measures.
Learn about surge capacity plans.
Familiarize yourself with the local health department's plan for dealing with surge capacity, and learn if and how schools will be involved.
Anticipate special needs.
Consider how students' special needs will be met outside of school. Also work with the local health department to plan psychosocial support services for staff, students and families.
Develop a surveillance system.
Develop a district surveillance system that would alert the local health department to a substantial increase in absenteeism among students.
Review, revise and share.
Implement an exercise to test the district plan and revise it periodically. Share what your school district has learned with other districts.
Continuity of Student Learning and Core Operations
Consider all possibilities.
Develop different scenarios to assess how staff and student absences would impact learning, extracurricular activities and school closings.
Develop plans for outside-the classroom instruction.
Develop procedures to assure continuity of instruction in the event of school closures. Consider web-based distance instruction, telephone trees, mailed assignments, and instruction via local radio or television stations.
Anticipate essential functions.
Develop a continuity of operations plan for essential central office functions, including payroll and ongoing communication with students and parents.
Infection Control Policies and Procedures
Educate the district.
Work with the local health department to promote infection prevention procedures, such as hand hygiene and cough/sneeze etiquette, at schools.
Keep supplies well-stocked.
Provide sufficient and accessible infection prevention supplies, such as soap, waterless hand hygiene products, tissues and disposal receptacles.
Develop sick leave policy.
Establish policies for staff and student sick leave absences unique to a pandemic flu. Consider non-punitive, liberal leave to reinforce a stay-at-home policy for those with known or suspected illness.
Establish a send-home policy.
Develop policies for staff and students suspected to be ill or who become ill at school, and include a procedure for transporting ill students from school. Check that school-based health facilities conform to those recommended for health care settings.
Communication Planning
Develop a dissemination plan.
Determine how the district will communicate with staff, students and families. Develop platforms, such as hotlines, telephone trees, dedicated Web sites, and local radio or TV stations, for communicating pandemic status and actions. Identify district spokespersons and media liaisons.
Ensure accessibility.
Establish language, culture and reading level appropriateness in communications. Include community leaders representing different language and/or ethnic groups in the dissemination of public health messages.
Inform people in advance.
Be sure that all members of the district know who is legally authorized to execute the district's operational plan and what the plan is. Advise district staff, students and families where to find up-to-date and reliable pandemic information from federal, state and local public health sources.
Join the network.
Develop and maintain contact with key public health and education stakeholders, and use this network to obtain and provide regular updates as the influenza pandemic unfolds.
Promote a healthy and aware community.
Disseminate information from public health sources covering: routine infection control, such as proper hand hygiene and cough/sneeze etiquette; pandemic influenza fundamentals, such as signs and symptoms of infection and modes of transmission; and personal and family protection and response strategies, such as social distancing and at-home care of ill students and family members.
Assess the district's readiness.
Review, test and update communication plans regularly.
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What other online resources are available?
The authoritative site for U.S. government information on the pandemic threat: www.pandemicflu.gov
New recommendations to insure continuity of learning during a flu outbreak from the National School Boards Association: http://www.nsba.org/MainMenu/SchoolHealth/Updates/Swine-Flu.aspx
Information on pandemic preparedness developed by the U.S. Department of Education, including tools to assist schools: www.ed.gov/admins/lead/safety/emergencyplan/pandemic/index.html
FAQs on H1N1 flu with 'plain English' answers to questions: http://pandemicflu.gov/faq/swineflu/
For additional information on U.S. Department of Education resources on H1N1: www.ed.gov/h1n1flu.
The Illinois Emergency Management Agency site pulls together a number of different sites and includes a section with links to "family preparedness" information that might be helpful (personally) for board members: http://www.state.il.us/iema/
Information from a conference call on Swine Flu convened by the U.S. Department of Education for school officials: http://www.edgovblogs.org/duncan/2009/04/public-health-officials-offer-swine-flu-guidance-to-schools/
CDC H1N1 Flu information page is updated frequently and includes links to general info, guidance for professionals, reports and publications, travel updates, press briefings: http://www.cdc.gov/swineflu/?s_cid=swineFlu_outbreak_001
CDC Tips on Preventing the Flu has general prevention tips that applied to swine flu:
http://www.cdc.gov/flu/protect/habits.htm
World Health Organization (through the United Nations) coordinates international information, including disease outbreak statistics from around the world:
http://www.who.int/csr/disease/swineflu/en/index.html
IL Department of Public Health (IDPH) information site: http://www.idph.state.il.us/flu/swine_flu_mex.htm
Cook County Department of Public Health Swine Flu info update page: http://www.cookcountypublichealth.org/swine_flu
Transcript of CDC press briefing from Aug. 21, 2009: http://cdc.gov/media/transcripts/2009/t090821.htm
A sample comprehensive pandemic action kit created specifically for schools by Contra Costa (California) Health Services: www.cchealth.org/topics/pandemic_flu/school_action_kit/
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