A “Norwalk-Like” Outbreak at the U of Guelph

1. A “Norwalk-Like” Outbreak at the U of Guelph Lessons Learned and Issues to Consider

2. Goal of the Presentation • Outline the pattern of our outbreak • Identify issues that need to be addressed in an outbreak • Present lessons learned at Guelph • Introduce issues that still need discussion

3. Presentation Format • We expect you to participate – we have questions for you. We do not profess to be the experts in this area. Our expectation is that we will learn from each other. • We will present generalities in the session. We will be providing you with a disc that includes specific examples of letters, communications and a summary of the presentation. Feel free to use any of these in the future.

4. Outbreak Overview • Outbreak lasted 25 days (Jan.22 -Feb.15,2006). • Total Number of Probable Cases (reported and interviewed): 260 • 253 Students • 7 Staff • Total Number of Suspect Cases (reported but never interviewed): 80 • Total Number of Reported Cases: 340 • Vast majority of these cases became ill in a five day period

5. Outbreak Pattern

6. Day 1- Monday January 30 • Public Health calls Student Health Services in the morning. The Hospital had seen 11 cases of quite ill studentson the Sunday night (vomiting and diarrhea). They all appeared to have been clustered in one residence and eaten in one cafeteria. • Student Health Services had seen 5 students with similar symptoms in the hour it had been open and others were in the waiting room. They all appeared to be from the same residence. • YOU ARE THE DIRECTOR OF SHS. WHAT DO YOU DO?

7. What We Did • AVP Student Affairs called and informed of situation • Acting Director of Student Housing called • Informed Residence Assistants • Made provisions to provide liquids at Residence Front desks for ill students • Director of Hospitality Services called re possibility of food poisoning in the one cafeteria • Communications given a heads up that we had a possible case of food poisoning or influenza • Housekeeping, Campus Police, the First Response Team and Occupational Health informed

8. Day 2 – Tuesday January 31 • Cases are still climbing but difficult to confirm numbers as many students too sick to come in to Health Services. • Public Health has determined that it is not food poisoning but some form of influenza • Cases are still concentrated in the one residence but starting to see some spread to others • Rumours are rampant • It is food poisoning, avian flu, the pandemic, WHO is on campus, the water…

9. Action Taken • AVPSA asks that a response team be called. • Who should be invited and what are the issues that need to be addressed?

10. Response Team • AVPSA (chair) • Campus Police • Health Services • Residences • Occupational Health • Housekeeping • Communications • Public Health

11. Action Taken • Housekeeping • Meeting with housekeeping to enhance the cleaning schedule with continuous cleaning of washrooms and impacted areas • Ensured cleaning staff had appropriate protection when cleaning • Soap was placed in all washrooms in residence beginning with the impacted residence • Housekeeping and Housing put in place a process where housekeeping would respond immediately when a report of an ill student

12. RESIDENCES • Met with RA’s to explain what we had and to discuss dealing with sick students (getting them food and liquids, monitoring illness on the floor) • Discourage students from going to Emergency – use FRT • Campus Police to work with FRT on how to respond to sick students • REPORTING • Keeping track of numbers – Students told to let Health Services know if they had been or were sick. • Students asked to deliver a stool sample for verification purposes.

13. Communication • Crafted a communication message as to the nature of the outbreak and the steps being taken • To students in residence • House meetings • Letter to all students • Email • To faculty re absences from class • Formal letter from the Provost to accommodate and not require documentation • To the external community (press, parents) • Website message • Message on doors of all major buildings

14. Campus Police and FRT • Assessing illness • Transferring students to hospital • Containment Issues • Education • Told to avoid large gatherings (but didn’t cancel) • Hand washing Campaign • Support for staff in contact with sick students • Communication to RA’s, Housekeepers, Front-line staff, Doctors and nurses

15. Day 3 – Monday Feb 1 • Critical Day for us. If the outbreak was spreading, then we would have to consider more drastic measures • 20 new cases but now less concentrated – over more residences and off-campus • Public Health feels containment measures are working and we should continue with plans already in place.

16. Actions Taken • Committee meets again to discuss outstanding issues • Communication • Number of articles critical of university and its lack of soap in residences • Complaints of the handling of the situation • Housekeeping • Difficulty getting soap into affected areas as spreading • Difficulty keeping up with the calls • Reporting

17. Lessons Learned • Planning • Call the team immediately, even before an outbreak may be called and make sure public health is involved • Take notes of action items and distribute immediately • Don’t forget about the staff – keeping them well, communicating with them, listening to their concerns. • Rumours will be rampant. Get a message out right away!

18. Role of Public Health • Public Health does not clearly understand the nature of universities. They expected hospital-type infection control management • Want to keep people quarantined • No one entering residences • Students must stay “home” for 48 hours after symptom free (a residence room – need food, share showers) • Want to restrict all large gatherings and keep external community off campus • Classes • OUA championship basketball game • High Profile speaker • Want to use accurate language in all press releases • Can’t say flu

19. Communication • Communicate Early and think of communication vehicles • Students are more likely to read facebook than bulletins • Face to face meetings are more effective • Put info on your Parent’s webpage • Consider an information hot-line • The External press can be helpful but always looking for a good story • “No soap caused the problems”; “Students scared”. This is big news so will be picked up nationally • Students will not follow the rules • Stay away from classes when ill • Wash your hands • Faculty will not follow the rules • Require medical documentation

20. Ongoing Issues • Need vigilant tracking systems • Recording in Health Services • Good co-ordination with hospitals and off-campus clinics • Training of residence staff • Need continuous campaigns about hand washing • Signs, posters, displays • Alcohol stations at critical places • Establish strong relations with Public Health

21. Outstanding Issues – Potential for Pandemic • Expectations of RA’s • Reporting • Caring for the ill • Communication • Cancellation of Classes • What will be the trigger. There will be a significant resistance to cancel classes • Communication • Do you communicate if you are not sure what you have? Hospitality was angry that we were suggesting food poisoning. • Controlling behaviour – students, faculty, staff, parents