Understanding Pandemic Influenza: Why Schools Need to Be Proactive

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

2. Topics of Discussion • Influenza • Avian Flu • Pandemic Flu • History, Impact & Planning • Schools Role • Employee Role • Resources

3. “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

4. 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 people in U.S.

5. 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

6. Avian Influenza • Avian influenza or “bird flu” is an infection in birds caused by a variety of subtype viruses. • One such subtype is H5N1. • Some strains of H5N1 are highly pathogenic. • The severe strain of H5N1 is killing birds in Asia and parts of Europe.

7. Avian Influenza cont…. • The H5N1 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

8. 359 CASES - 226 DEATHS - 62.9% MORTALITY RATE

9. Will H5N1 become the next pandemic? • Avian Flu not yet Pandemic Flu • current outbreaks of H5N1 Avian Flu in poultry and birds are the largest ever documented • Impossible to predict next pandemic flu event • If not H5N1, then another • Plan now

10. 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

11. 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

12. 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 • 36,000 deaths in US

13. Caregivers in the Spanish Flu 1918

14. Personal Protective Equipment (1918)

15. Law Enforcement in the 1918 Flu

16. Public Health Measures in 1918Some are unchanged in 2008

17. 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 Lessons from Past Pandemics

18. Pandemic Global Influenza 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.

19. 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.

20. Current Status Interpandemic Pandemic alert Pandemic Phase 4 Phase 1 Phase 2 Phase 3 Larger clusters, localized Limited spread among humans Phase 5 Phase 6 No new virus in humans Animal viruses low risk to humans No new virus in humans Animal viruses low risk to humans New virus in humans Little/no spread among humans Small clusters, localized Limited spread among humans Increased and sustained spread in general humanpopulation Current status of H5N1 Current H5N1 status WHO Global Influenza Preparedness Plan, 2005. Available at: http://www.who.int/csr/resources/publications/influenza/GIP_2005_5Eweb.pdf

21. Estimated Impact in Louisiana 3 Million infected Between 600,000-1.4 million clinically ill Between 300K-700K 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 Pandemic Influenza Impacts in Louisiana

22. 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

23. 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

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

25. Hand washing

27. 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

28. 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

29. 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

30. 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

31. OPERATIONAL PHASES FOR SCHOOL DISTRICT PANDEMIC INFLUENZA PLAN

32. 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.

33. 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……

34. 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.

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

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

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

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

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

41. 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.

42. 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.

43. 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?

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

45. 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.

46. 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.

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

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

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

50. 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.