1 Pandemic Influenza and Schools: Preparing to Respond.

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Pandemic InfluenzaPandemic Influenzaand Schools: and Schools: Preparing to Preparing to

RespondRespond

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Learning ObjectivesLearning Objectives Understand the history and current status of

avian influenza and the potential for pandemic influenza

Describe the issues and efforts surrounding

preparations for pandemic influenza

Identify components to be included in your district's crisis management and/or pandemic influenza plan

Describe steps districts can take to develop their pandemic influenza plan

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OutlineOutline BackgroundBackground

Planning for Pandemic InfluenzaPlanning for Pandemic Influenza

How Can Schools Prepare?How Can Schools Prepare?

Developing Your PlanDeveloping Your Plan

Questions and DiscussionQuestions and Discussion

EvaluationEvaluation

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BackgroundBackground

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Influenza-SpeakInfluenza-Speak

Seasonal fluSeasonal flu

Avian fluAvian flu

Pandemic fluPandemic flu

What do they mean? How are What do they mean? How are they different?they different?

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Seasonal FluSeasonal Flu

Illness Illness in humansin humans caused every year caused every year by influenza virusesby influenza viruses e.g. H1N1, H1N2, H3N2 influenza A e.g. H1N1, H1N2, H3N2 influenza A

viruses, influenza B virusesviruses, influenza B viruses

5%-20% of the U.S. population gets 5%-20% of the U.S. population gets the flu every yearthe flu every year

Estimated 36,000 annual deaths in Estimated 36,000 annual deaths in U.S.U.S.

Adapted from CDC Influenza (Flu) Key Facts

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Seasonal FluSeasonal Flu

Spread by respiratory droplets Spread by respiratory droplets (coughing and sneezing)(coughing and sneezing) Usually person-to-person: can infect others Usually person-to-person: can infect others

from 1 day before getting sickfrom 1 day before getting sick to 5 days to 5 days after becoming sickafter becoming sick

Sometimes from touching infected Sometimes from touching infected surfacessurfaces

Vaccine offers effective protectionVaccine offers effective protection Vaccines are developed to match the viral Vaccines are developed to match the viral

strains expected to circulate each year strains expected to circulate each year Adapted from CDC Influenza (Flu) Key Facts

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Avian (Bird) FluAvian (Bird) Flu Illness Illness in birdsin birds caused by caused by avian avian

influenza virusesinfluenza viruses Low pathogenic typesLow pathogenic types Highly pathogenic types (e.g. H5N1)Highly pathogenic types (e.g. H5N1)

Illness Illness in humansin humans caused by caused by avian avian influenza virusesinfluenza viruses Spread by direct or close contact with Spread by direct or close contact with

infected poultry or contaminated surfacesinfected poultry or contaminated surfaces No vaccine currently commercially availableNo vaccine currently commercially available


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Pandemic FluPandemic Flu

Increased and sustained transmission of Increased and sustained transmission of influenza in the general population influenza in the general population

Generally Generally caused by a “new” influenza viruscaused by a “new” influenza virus to which few, if any, people have immunity to which few, if any, people have immunity New viruses result from new combinations on New viruses result from new combinations on

viral proteins: i.e. a major change in influenza A viral proteins: i.e. a major change in influenza A virus (“antigenic shift”)virus (“antigenic shift”)

Results in viruses that can spread easily from Results in viruses that can spread easily from person to person and can cause serious illness person to person and can cause serious illness due to low levels of immunity in a populationdue to low levels of immunity in a population

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Pandemics in the Past Pandemics in the Past 100 Years100 Years

1918-1919: H1N1 influenza A virus 1918-1919: H1N1 influenza A virus 500,000 U.S. deaths500,000 U.S. deaths 20-50 million worldwide deaths20-50 million worldwide deaths H1N1 still in circulation todayH1N1 still in circulation today

1957-58: H2N2 influenza A virus1957-58: H2N2 influenza A virus 70,000 U.S. deaths70,000 U.S. deaths

1968-1969: H3N21968-1969: H3N2 32,000 U.S. deaths32,000 U.S. deaths H3N2 still in circulation todayH3N2 still in circulation today


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WHO Pandemic PhasesWHO Pandemic Phases

Inter-Pandemic PeriodInter-Pandemic Period

Phase 1Phase 1: No new influenza virus subtypes : No new influenza virus subtypes have been detected in humans. An influenza have been detected in humans. An influenza virus subtype that has caused human virus subtype that has caused human infection may be present in animals. If infection may be present in animals. If present in humans, the risk of human present in humans, the risk of human infection or disease is considered lowinfection or disease is considered low

Phase 2Phase 2: No new influenza virus subtypes : No new influenza virus subtypes have been detected in humans. However, a have been detected in humans. However, a circulating animal influenza virus subtype circulating animal influenza virus subtype poses a substantial risk of human diseaseposes a substantial risk of human disease

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Pandemic Alert PeriodPandemic Alert Period

Phase 3Phase 3:: Human infection(s) with a new Human infection(s) with a new subtype, but no human-to-human spread, or at subtype, but no human-to-human spread, or at most rare instances of spread to a close most rare instances of spread to a close contactcontact

Phase 4Phase 4: Small cluster(s) with limited human-: Small cluster(s) with limited human-to-human transmission but spread is highly to-human transmission but spread is highly localized, suggesting that the virus is not well localized, suggesting that the virus is not well adapted to humans adapted to humans

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Pandemic Alert PeriodPandemic Alert Period

Phase 5Phase 5: Larger cluster(s) but human-to-: Larger cluster(s) but human-to-human spread still localized, suggesting that human spread still localized, suggesting that the virus is becoming increasingly better the virus is becoming increasingly better adapted to humans, but may not yet be fully adapted to humans, but may not yet be fully transmissible (substantial pandemic risk)transmissible (substantial pandemic risk)

Pandemic PeriodPandemic Period

Phase 6Phase 6: Pandemic occurring – increased and : Pandemic occurring – increased and sustained transmission in the general sustained transmission in the general populationpopulation

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Current StatusCurrent Status

Through February 2007, there have been Through February 2007, there have been 273 laboratory-confirmed cases of avian 273 laboratory-confirmed cases of avian influenza A/H5N1 among humans reported influenza A/H5N1 among humans reported to WHOto WHO 167 deaths167 deaths 11 countries – far and middle east, Indonesia, 11 countries – far and middle east, Indonesia,

northern Africanorthern Africa

Avian influenza A/H5N1 has been confirmed Avian influenza A/H5N1 has been confirmed in poultry and/or wild birds in these areas in poultry and/or wild birds in these areas as well as India, Russia and Europeas well as India, Russia and Europe

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Planning for Planning for Pandemic Pandemic InfluenzaInfluenza

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Planning GoalsPlanning Goals

Prevent/minimize morbidity and Prevent/minimize morbidity and mortalitymortality Limit disease spreadLimit disease spread Mitigate disease, suffering and deathMitigate disease, suffering and death

Minimize social disruptionMinimize social disruption

Minimize economic effectsMinimize economic effects

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Reducing Morbidity and Reducing Morbidity and MortalityMortality

Primary strategies for combating Primary strategies for combating pandemic flupandemic flu

VaccinationVaccination Antiviral medicationsAntiviral medications Community control measuresCommunity control measures

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Primary Strategies - Primary Strategies - VaccinationVaccination

Vaccination would be the single most Vaccination would be the single most effective intervention, BUT:effective intervention, BUT:

Unlikely that a well-matched vaccine will be Unlikely that a well-matched vaccine will be available when a pandemic beginsavailable when a pandemic begins

Current technology would require 4-6 Current technology would require 4-6 months for vaccine development after the months for vaccine development after the pandemic beginspandemic begins

Once developed, production capacity would Once developed, production capacity would limit availabilitylimit availability

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Primary Strategies - Primary Strategies - AntiviralsAntivirals

Antivirals could be used for both Antivirals could be used for both treatment and prophylaxis, BUT:treatment and prophylaxis, BUT:

Effectiveness of current antivirals Effectiveness of current antivirals against a future pandemic strain is against a future pandemic strain is unknownunknown

Quantities are limitedQuantities are limited

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Primary Strategies – Primary Strategies – Community Control Community Control

MeasuresMeasures Two approaches:Two approaches:

Decrease the probability that contact will Decrease the probability that contact will result in infectionresult in infection Cough etiquette, hand hygiene, infection Cough etiquette, hand hygiene, infection

controlcontrol

Decrease contact between infected and Decrease contact between infected and uninfected individuals uninfected individuals Isolation, quarantine, travel advisories, Isolation, quarantine, travel advisories,

cancellation of mass gatherings, social cancellation of mass gatherings, social distancing, school closuresdistancing, school closures

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MeasuresMeasures These “nonpharmaceutical These “nonpharmaceutical

interventions” willinterventions” will

Help buy time for production and Help buy time for production and distribution of vaccinedistribution of vaccine

Reduce the total number of cases, thus Reduce the total number of cases, thus reducing community morbidity and reducing community morbidity and mortalitymortality

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MeasuresMeasuresPandemic outbreak: no intervention

Dailycases

Pandemic outbreak: With intervention

Days since first caseCDC, 2007

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MeasuresMeasures1918 Death Rates: Philadelphia v St. Louis

0

2000

4000

6000

8000

10000

12000

14000

16000

9/14

/191

8

9/21

/191

8

9/28

/191

8

10/5

/191

8

10/1

2/19

18

10/1

9/19

18

10/2

6/19

18

11/2

/191

8

11/9

/191

8

11/1

6/19

18

11/2

3/19

18

11/3

0/19

18

12/7

/191

8

12/1

4/19

18

12/2

1/19

18

12/2

8/19

18

Date

Dea

ths

Rat

es /

100

,000

Po

pu

lati

on

(A

nn

ual

Bas

is)

Philadelphia

St. Louis

Collins SD, Frost WH, Gover M, Sydenstricker E: Mortality from influenza and pneumonia in the 50 largest cities of the United States First Edition Washington: U.S. Government Printing Office 1930.

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Primary Strategies: Primary Strategies: Community Control Community Control

MeasuresMeasuresSt. Louis

0

2000

4000

6000

8000

10000

12000

14000

9/14

/18

9/21

/18

9/28

/18

10/5/

18

10/12

/18

10/19

/18

10/26

/18

11/2/

18

11/9/

18

11/16

/18

11/23

/18

11/30

/18

12/7/

18

12/14

/18

12/21

/18

12/28

/18

Date

De

ath

Ra

te /

10

0,0

00

Po

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on

(A

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ua

l Ba

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)

Mayor closes “theaters, moving picture shows, schools, pool and billiard halls, Sunday schools, cabarets, lodges, societies, public funerals, open air meetings, dance halls and conventions until further notice”

Closing order withdrawn

Levins, H. What he knew in 1918 could save millions of lives. St. Louis Post-Dispatch Jul. 08 2006.

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MeasuresMeasures Mathematical modeling has shown Mathematical modeling has shown

that that closing schools at the outset of a closing schools at the outset of a pandemic could decrease attack rates pandemic could decrease attack rates in a community by about 33%in a community by about 33%

Compared to the attack rate when not Compared to the attack rate when not implementing any control measuresimplementing any control measures

School closures would likely occur in School closures would likely occur in concert with other control measuresconcert with other control measures

National Academy of Sciences, 2006

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MeasuresMeasures Recommendations for Recommendations for

closing schools will closing schools will depend upon the depend upon the severity of the severity of the pandemic. For pandemic. For example:example:

Category 1 – no closureCategory 1 – no closure Category 2 & 3 – short-Category 2 & 3 – short-

term closure (~4 weeks)term closure (~4 weeks) Category 4 & 5 – longer-Category 4 & 5 – longer-

term closure (~12 term closure (~12 weeks)weeks)

CDC, 2007

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Who will Who will implement these implement these

strategies?strategies?

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Public Health Officials Public Health Officials

Federal, state and local Federal, state and local public healthpublic health agencies maintain the lead role in preparing agencies maintain the lead role in preparing for and responding to pandemic influenzafor and responding to pandemic influenza

ExamplesExamples Federal – Centers for Disease Control and Prevention Federal – Centers for Disease Control and Prevention

(CDC)(CDC) State – Texas Department of State Health Services State – Texas Department of State Health Services

(TDSHS)(TDSHS) Local – Harris County Public Health & Environmental Local – Harris County Public Health & Environmental

Services (HCPHES)Services (HCPHES)

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Public Health’s AuthorityPublic Health’s Authority

Chapter 81 of the Texas Health and Safety Chapter 81 of the Texas Health and Safety Code establishes the role of the Code establishes the role of the health health authorityauthority, a physician appointed to , a physician appointed to administer laws related to public health administer laws related to public health within their jurisdictionwithin their jurisdiction

Including laws related to community control Including laws related to community control measuresmeasures

Such measures include isolation, quarantine, Such measures include isolation, quarantine, immunization, detention, restriction, disinfection, immunization, detention, restriction, disinfection, decontamination, disinfestation, chemoprophylaxis, decontamination, disinfestation, chemoprophylaxis, preventive therapy, prevention and educationpreventive therapy, prevention and education

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Public Health’s AuthorityPublic Health’s Authority

The authority to compel disease The authority to compel disease control measures is derived from the control measures is derived from the state’s inherent state’s inherent “police powers”“police powers”

Police powers refer to the authority of a Police powers refer to the authority of a state government to enact laws and state government to enact laws and promote regulations to safeguard the promote regulations to safeguard the health, safety and welfare of its citizenshealth, safety and welfare of its citizens

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Public Health’s AuthorityPublic Health’s Authority There are 172 local health authorities in There are 172 local health authorities in

Texas, many affiliated with local health Texas, many affiliated with local health departmentsdepartments

Areas without local health authorities are Areas without local health authorities are “covered” by TDSHS regional health “covered” by TDSHS regional health authoritiesauthorities

Contact TDSHS Region 6/5S for your Contact TDSHS Region 6/5S for your local health authoritylocal health authority (713) 767-3000(713) 767-3000

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Public Health Public Health and Pandemic and Pandemic

PlanningPlanning

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Roles and Roles and ResponsibilitiesResponsibilities

Federal Agencies (CDC, etc.)Federal Agencies (CDC, etc.) Supporting the establishment of stockpiles of Supporting the establishment of stockpiles of

vaccines and antiviralsvaccines and antivirals Facilitating (and funding) state and local planningFacilitating (and funding) state and local planning Providing guidance to the private sectorProviding guidance to the private sector Overall domestic incident managementOverall domestic incident management

TDSHSTDSHS Developing and exercising preparedness and Developing and exercising preparedness and

response plansresponse plans Managing federal pandemic preparedness grant Managing federal pandemic preparedness grant

funding to local agenciesfunding to local agencies Maintaining state-purchased stockpiles of Maintaining state-purchased stockpiles of

medicationsmedications

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Roles and Roles and ResponsibilitiesResponsibilities

Local Health DepartmentsLocal Health Departments

Developing and exercising preparedness and Developing and exercising preparedness and response plansresponse plans

Integrating non-health entities in pandemic Integrating non-health entities in pandemic planningplanning

Providing education to the public and other key Providing education to the public and other key stakeholders on pandemic influenzastakeholders on pandemic influenza

Monitoring local disease statusMonitoring local disease status Providing local incident managementProviding local incident management

In Texas, decision-making regarding In Texas, decision-making regarding pandemic influenza will be made at the pandemic influenza will be made at the local levellocal level

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AssumptionsAssumptions

30% of population may become ill30% of population may become ill

15% of population will seek outpatient 15% of population will seek outpatient carecare

0.3 to 3% of population will be 0.3 to 3% of population will be hospitalizedhospitalized

0.07 to 0.64% of population may die0.07 to 0.64% of population may die

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AssumptionsAssumptions The duration of illness for an uncomplicated case of The duration of illness for an uncomplicated case of

influenza is five daysinfluenza is five days

Medical care services may be severely taxed or Medical care services may be severely taxed or overwhelmedoverwhelmed

Illness rates may be up to 40% among school-aged Illness rates may be up to 40% among school-aged children and 20% among working adultschildren and 20% among working adults

30% or more of the workforce may be out of work due 30% or more of the workforce may be out of work due to illness at the peak of a major pandemic influenza to illness at the peak of a major pandemic influenza wave.wave. This includes work loss while caring for oneself or for ill This includes work loss while caring for oneself or for ill

family membersfamily members

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SurveillanceSurveillance

In addition to conducting year-round In addition to conducting year-round monitoring of influenza in the health-monitoring of influenza in the health-care sector, DSHS collaborates with care sector, DSHS collaborates with schoolsschools to track reports of influenza- to track reports of influenza-like illness among studentslike illness among students

Participating schools submit weekly Participating schools submit weekly reports of influenza-like illness activity reports of influenza-like illness activity to via faxto via fax

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Prevention/ContainmentPrevention/Containment

Discusses local plans for the three Discusses local plans for the three strategies of pandemic prevention strategies of pandemic prevention and containment:and containment:

VaccinesVaccines AntiviralsAntivirals Community Control MeasuresCommunity Control Measures

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Vaccines and AntiviralsVaccines and Antivirals

DSHS will coordinate decision-making DSHS will coordinate decision-making regarding regarding vaccinevaccine and and antiviralantiviral allocation allocation

Once Once vaccinesvaccines are available, DSHS 6/5S will are available, DSHS 6/5S will implement its implement its Mass Vaccination PlanMass Vaccination Plan to to provide flu vaccine to the publicprovide flu vaccine to the public

Once Once antiviralsantivirals are widely available, DSHS are widely available, DSHS 6/5S will implement its 6/5S will implement its Mass Dispensing PlanMass Dispensing Plan to provide public sector distribution of to provide public sector distribution of antiviralsantivirals

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Community Control Community Control MeasuresMeasures

DSHS in coordination with local health authorities will DSHS in coordination with local health authorities will develop and enact control measures within jurisdictions. develop and enact control measures within jurisdictions. Examples: Examples: Isolation and quarantineIsolation and quarantine Social distancingSocial distancing Cancelling mass gatheringsCancelling mass gatherings Closing schoolsClosing schools

The types of measures implemented will depend upon The types of measures implemented will depend upon the location of cases, size of clusters, availability of the location of cases, size of clusters, availability of vaccine, pandemic severity, etc.vaccine, pandemic severity, etc.

Measures will be undertaken in coordination with other Measures will be undertaken in coordination with other local, state and federal officialslocal, state and federal officials

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What’s Your Plan?What’s Your Plan?

Contact DSHS Region 6/5S to obtain Contact DSHS Region 6/5S to obtain your area’s pandemic influenza planyour area’s pandemic influenza plan (713) 767-3000(713) 767-3000

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How Can Schools How Can Schools Prepare?Prepare?

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School PlanningSchool Planning Schools face several unique challenges:Schools face several unique challenges:

Planning assumptions estimate that in the Planning assumptions estimate that in the absence of intervention, illness rates would be absence of intervention, illness rates would be highest among school-aged children (~40%)highest among school-aged children (~40%)

Children may be more likely to spread influenza Children may be more likely to spread influenza than adultsthan adults

Unlike many sectors, schools must focus upon Unlike many sectors, schools must focus upon protecting their workforce AND their studentsprotecting their workforce AND their students

Schools must address continuity of instructionSchools must address continuity of instruction

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School PlanningSchool Planning

Every Independent School District Every Independent School District (or the equivalent) should ensure (or the equivalent) should ensure plans to protect the health and plans to protect the health and safety of their staff and students safety of their staff and students during a pandemicduring a pandemic

Plans should build upon existing Plans should build upon existing Emergency Operations Plans (EOPs)Emergency Operations Plans (EOPs)

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The U.S. Department of Education’s The U.S. Department of Education’s Practical Information on Crisis Practical Information on Crisis Planning: A Guide for Schools and Planning: A Guide for Schools and CommunitiesCommunities is a useful tool for is a useful tool for developing and enhancing EOPsdeveloping and enhancing EOPs

www.ed.gov/emergencyplanwww.ed.gov/emergencyplan

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Four domainsFour domains must be considered must be considered when developing plans to prepare for when developing plans to prepare for and respond to pandemic influenza:and respond to pandemic influenza:

1.1. Planning and CoordinationPlanning and Coordination2.2. Infection Control Policies and ProceduresInfection Control Policies and Procedures3.3. Continuity of Core Operations and Continuity of Core Operations and

Student InstructionStudent Instruction4.4. CommunicationsCommunications

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1. Planning and 1. Planning and CoordinationCoordination

Planning and coordination refers to:Planning and coordination refers to:

Determining who is responsible for making Determining who is responsible for making decisions related to the response to a decisions related to the response to a pandemicpandemic

Carrying out activities before, during and Carrying out activities before, during and after a pandemicafter a pandemic

Developing and maintaining the response Developing and maintaining the response plan plan

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Key activities:Key activities:

Identify the authorities responsible for Identify the authorities responsible for executing community response plans and executing community response plans and activities, including case identification, activities, including case identification, isolation, quarantine and community isolation, quarantine and community control measurescontrol measures

On Page 1 of its Pandemic Influenza Plan, On Page 1 of its Pandemic Influenza Plan, Tomball ISDTomball ISD describes the role of HCPHES, describes the role of HCPHES, references the HCPHES pandemic influenza references the HCPHES pandemic influenza plan and lists HCPHES contact informationplan and lists HCPHES contact information

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Identify the authority responsible for Identify the authority responsible for activating the district’s pandemic activating the district’s pandemic influenza planinfluenza plan Provide the contact information for this Provide the contact information for this

person(s) to the public health authority so person(s) to the public health authority so that information regarding community that information regarding community control measures can be communicated control measures can be communicated efficientlyefficiently

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Address pandemic influenza preparedness Address pandemic influenza preparedness as part of your district’s crisis management as part of your district’s crisis management planplan

Involve all relevant stakeholdersInvolve all relevant stakeholders Delineate accountability and responsibilityDelineate accountability and responsibility Coordinate with other relevant response plansCoordinate with other relevant response plans Establish an organizational structure to manage Establish an organizational structure to manage

the execution of the plan, such as an Incident the execution of the plan, such as an Incident Command Structure – Command Structure – see page 6-19 of the DOE see page 6-19 of the DOE guideguide

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Test your pandemic planTest your pandemic plan Implement an internal exercise/drillImplement an internal exercise/drill Participate in exercises of the community’s Participate in exercises of the community’s

planplan

Periodically revise your planPeriodically revise your plan

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2. Infection Control 2. Infection Control

Infection control refers to:Infection control refers to:

Decreasing the probability that contact Decreasing the probability that contact will result in infectionwill result in infection

Decreasing contact between infected Decreasing contact between infected and uninfected individualsand uninfected individuals

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2. Infection Control2. Infection Control

Key activities:Key activities: Implement policies and procedures that Implement policies and procedures that

can limit the spread of influenza at schoolcan limit the spread of influenza at school Promote of hand hygiene and cough etiquettePromote of hand hygiene and cough etiquette Ensure appropriate supplies are available – Ensure appropriate supplies are available –

soap, tissues, hand sanitizer, waste basketssoap, tissues, hand sanitizer, waste baskets Limit face-to-face contact, when possibleLimit face-to-face contact, when possible

Making good hygiene a habit now can Making good hygiene a habit now can help protect children from many help protect children from many infectious diseases, including fluinfectious diseases, including flu

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Sample policy language from the Sample policy language from the HCPHES Occupational Health and HCPHES Occupational Health and Safety ManualSafety Manual::

““Following Centers for Disease Control Following Centers for Disease Control and Prevention (CDC) hand hygiene and Prevention (CDC) hand hygiene guidelines, all HCPHES staff will guidelines, all HCPHES staff will maintain hand hygiene including, but maintain hand hygiene including, but not limited to, hand washing. HCPHES not limited to, hand washing. HCPHES will ensure that hand hygiene facilities will ensure that hand hygiene facilities and supplies are readily accessible”and supplies are readily accessible”

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Houston’s Houston’s Grace SchoolGrace School has has permanently posted handwashing permanently posted handwashing and cough etiquette signs in each and cough etiquette signs in each restroom and classroomrestroom and classroom

The school nurse provides classroom The school nurse provides classroom instruction on proper handwashing instruction on proper handwashing techniquestechniques

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2. Infection Control2. Infection Control Hand hygiene and cough etiquette resourcesHand hygiene and cough etiquette resources

CDC/DHHS hand hygiene materials targeted to CDC/DHHS hand hygiene materials targeted to schools - schools - www.itsasnap.orgwww.itsasnap.org

CDC hand hygiene guidelines - CDC hand hygiene guidelines - www.cdc.gov/od/oc/media/pressrel/fs021025.htwww.cdc.gov/od/oc/media/pressrel/fs021025.htmm

CDC “Germstopper” campaign – CDC “Germstopper” campaign – www.cdc.gov/germstopperwww.cdc.gov/germstopper CDC “Cover Your Cough” campaign - CDC “Cover Your Cough” campaign -

www.cdc.gov/flu/protect/covercough.htmwww.cdc.gov/flu/protect/covercough.htm

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At this time, the benefit of wearing At this time, the benefit of wearing disposable disposable surgical maskssurgical masks by by asymptomatic persons in a community asymptomatic persons in a community setting (such as a school) has not been setting (such as a school) has not been demonstrated to decrease infections demonstrated to decrease infections during a community outbreakduring a community outbreak

However, you may anticipate that persons at However, you may anticipate that persons at risk may choose to obtain and wear such risk may choose to obtain and wear such masksmasks

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Establish special policies and Establish special policies and procedures regarding absenteeism that procedures regarding absenteeism that may be unique to a pandemic situationmay be unique to a pandemic situation Non-punitive absenteeism policies for Non-punitive absenteeism policies for

studentsstudents Relaxed and/or enhanced sick leave and Relaxed and/or enhanced sick leave and

absenteeism policies for employeesabsenteeism policies for employees

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2. Infection Control2. Infection Control Sample policy language:Sample policy language:

““During times of a declared public health During times of a declared public health emergency and/or large-scale disease emergency and/or large-scale disease outbreak, the district may suspend district outbreak, the district may suspend district policies that penalize students for excessive policies that penalize students for excessive student absenteeism”student absenteeism”

““During times of a declared public health During times of a declared public health emergency and/or large-scale disease emergency and/or large-scale disease outbreak, the district may suspend district outbreak, the district may suspend district programs regarding perfect attendance programs regarding perfect attendance achievement”achievement”

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Sample policy language:Sample policy language: ““During times of a declared public health During times of a declared public health

emergency and/or large-scale disease emergency and/or large-scale disease outbreak and school remains in session, outbreak and school remains in session, the district may suspend district policies or the district may suspend district policies or temporarily adopt alternate policies temporarily adopt alternate policies regarding staff sick leave and absenteeism”regarding staff sick leave and absenteeism”

Example - Harris County has a policy that Example - Harris County has a policy that allows 24 hours of sick leave per year to be allows 24 hours of sick leave per year to be used to care for ill family members. This type used to care for ill family members. This type of policy could be waived or expanded during a of policy could be waived or expanded during a pandemicpandemic

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2. Infection Control2. Infection Control Key activities:Key activities:

Establish special policies and procedures for staff Establish special policies and procedures for staff and students suspected to be ill or who become ill and students suspected to be ill or who become ill at school, including policies for returning to schoolat school, including policies for returning to school

Grace SchoolGrace School amended its policies to require that an amended its policies to require that an employee or student must be fever-free for employee or student must be fever-free for 24 hours without 24 hours without the use of fever-reducing medicinethe use of fever-reducing medicine prior to returning to prior to returning to schoolschool

Establish policies for transporting ill students and Establish policies for transporting ill students and staffstaff

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Sample policy language:Sample policy language:

““Staff and students with a known or Staff and students with a known or suspected communicable disease should not suspected communicable disease should not remain at school and should return only after remain at school and should return only after symptoms resolve and they are physically symptoms resolve and they are physically ready. Certification of fitness for duty by a ready. Certification of fitness for duty by a medical professional may be required”medical professional may be required”

Consider allowing for modification during a Consider allowing for modification during a pandemic to encourage home quarantine if a pandemic to encourage home quarantine if a family member is illfamily member is ill

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Ensure that school-based health Ensure that school-based health facilities follow national infection facilities follow national infection control guidelinescontrol guidelines See See

www.hhs.gov/pandemicflu/plan/pdf/S03.pdfwww.hhs.gov/pandemicflu/plan/pdf/S03.pdf for specific guidance regarding infection for specific guidance regarding infection control procedures for healthcare facilities control procedures for healthcare facilities during a pandemicduring a pandemic

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3. Continuity of Operations 3. Continuity of Operations and Instructionand Instruction

Continuity of operations refers to Continuity of operations refers to ensuring that the capability exists to ensuring that the capability exists to continue essential agency functions continue essential agency functions when faced with high absenteeism when faced with high absenteeism or temporary school closureor temporary school closure

Continuity of instruction refers to Continuity of instruction refers to minimizing the potential disruption minimizing the potential disruption to student learningto student learning

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Develop a continuity of operations plan Develop a continuity of operations plan (COOP) for essential central office functions(COOP) for essential central office functions PayrollPayroll Communication with staff, students and parentsCommunication with staff, students and parents

The basic elements of a COOP can be found The basic elements of a COOP can be found at at www.ready.govwww.ready.gov

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Develop scenarios describing the potential Develop scenarios describing the potential impact of a pandemic on student learning, impact of a pandemic on student learning, school closings and extracurricular school closings and extracurricular activitiesactivities

Based on various levels of illness and Based on various levels of illness and absenteeism, and different mandates from absenteeism, and different mandates from public health authoritiespublic health authorities

Brainstorm possible alternatives and solutions Brainstorm possible alternatives and solutions for each scenariofor each scenario

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Possible scenarios:Possible scenarios:

Your public health authority recommends Your public health authority recommends heightening adherence to hand hygiene and heightening adherence to hand hygiene and cough etiquette and limiting face-to-face contactcough etiquette and limiting face-to-face contact

Your public health authority recommends Your public health authority recommends cancellation of large group gatheringscancellation of large group gatherings

Your district is experiencing a 15% absenteeism Your district is experiencing a 15% absenteeism rate among staff and 20% among studentsrate among staff and 20% among students

Your public health authority recommends school Your public health authority recommends school closures for twelve weeksclosures for twelve weeks

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Tomball ISD’sTomball ISD’s plan contains a flow plan contains a flow chart describing action steps for chart describing action steps for each of the following scenarios:each of the following scenarios: Less than 10% of students absentLess than 10% of students absent

Letter to parents, heightened surveillance, Letter to parents, heightened surveillance, heightened infection control, etc.heightened infection control, etc.

10%-29% of students absent10%-29% of students absent 30% or more of students absent30% or more of students absent

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Brainstorm alternate methods to provide Brainstorm alternate methods to provide instruction to students in the event of high instruction to students in the event of high absenteeism or temporary school closureabsenteeism or temporary school closure

Tomball ISDTomball ISD plans to use its website and plans to use its website and “homework hotlines” to disseminate lesson “homework hotlines” to disseminate lesson plans, with tutorials conducted through its plans, with tutorials conducted through its website, emails and instant messagingwebsite, emails and instant messaging

Grace SchoolGrace School will extend the school year will extend the school year

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4. Communications4. Communications

Communications planning refers to Communications planning refers to ensuring accurate and timely ensuring accurate and timely information regarding the impact of the information regarding the impact of the pandemic on your operationspandemic on your operations

Also refers to assisting public health Also refers to assisting public health authorities with disseminating messages authorities with disseminating messages to the publicto the public Schools are a trusted source of information Schools are a trusted source of information

within their communitieswithin their communities

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Develop a plan to disseminate Develop a plan to disseminate information to staff, students and information to staff, students and familiesfamilies Designate a lead spokespersonDesignate a lead spokesperson Incorporate links to other communication Incorporate links to other communication

networksnetworks Ensure language, culture and reading level Ensure language, culture and reading level

appropriatenessappropriateness

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Develop and test any methods for Develop and test any methods for communicating to staff, students and communicating to staff, students and families during a pandemicfamilies during a pandemic

Tomball ISDTomball ISD has developed templates for press has developed templates for press releases, letters to parents and talking points releases, letters to parents and talking points for school officials in English and Spanishfor school officials in English and Spanish

Grace SchoolGrace School has developed templates for email has developed templates for email blast alerts and “canned” answering machine blast alerts and “canned” answering machine messagesmessages

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Maintain updated communication Maintain updated communication contacts of key public health and contacts of key public health and education stakeholderseducation stakeholders Provide updated status information to these Provide updated status information to these

contacts during a pandemic as necessary, contacts during a pandemic as necessary, including absenteeism rates due to including absenteeism rates due to influenzainfluenza

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Inform staff, students and families Inform staff, students and families where they can find up-to-date and where they can find up-to-date and reliable pandemic informationreliable pandemic information State website - www.dshs.state.tx.usState website - www.dshs.state.tx.us Federal website - Federal website - www.pandemicflu.govwww.pandemicflu.gov

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Disseminate information from public health Disseminate information from public health sources about important pandemic topics:sources about important pandemic topics:

Infection control (hand hygiene, cough etiquette)Infection control (hand hygiene, cough etiquette) Disease basics (signs and symptoms, modes of Disease basics (signs and symptoms, modes of

transmission)transmission) Personal and family protection strategies (family Personal and family protection strategies (family

preparedness, at-home care of ill family members)preparedness, at-home care of ill family members) Tomball ISDTomball ISD has developed templates of letters has developed templates of letters

to parents about family preparedness, caring for to parents about family preparedness, caring for ill persons at home and stress/crisis managementill persons at home and stress/crisis management

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Remember to anticipate the potential Remember to anticipate the potential fear, stress and anxiety of staff, fear, stress and anxiety of staff, students and familiesstudents and families

If possible, minimize rumors and the If possible, minimize rumors and the circulation of misinformationcirculation of misinformation

Share your plan with all stakeholders Share your plan with all stakeholders BEFORE a pandemic situationBEFORE a pandemic situation

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Developing Your Developing Your Plan: Next StepsPlan: Next Steps

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Developing Your Plan: Next Developing Your Plan: Next StepsSteps

Identify and engage stakeholders Identify and engage stakeholders (internal/ external) to be included in (internal/ external) to be included in planningplanning

Determine areas of overlap with EOPDetermine areas of overlap with EOP Develop action plan and timelines for Develop action plan and timelines for

new itemsnew items Share draft plan with your public health Share draft plan with your public health

department for feedback (if desired)department for feedback (if desired) Present completed plan to School Board Present completed plan to School Board

for approvalfor approval Communicate plan to others Communicate plan to others

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Identify and Engage Identify and Engage StakeholdersStakeholders

Director of Risk Director of Risk ManagementManagement

SuperintendentSuperintendent Director of Health Services Director of Health Services Director of Human Director of Human

ResourcesResources Director of Curriculum & Director of Curriculum &

InstructionInstruction Principals (elementary, Principals (elementary,

middle, high school)middle, high school) TeachersTeachers Counselors/Mental Health Counselors/Mental Health

professionalsprofessionals

Director of Administrative Director of Administrative ServicesServices

Director of TransportationDirector of Transportation Public HealthPublic Health Director of Child NutritionDirector of Child Nutrition Director of MaintenanceDirector of Maintenance Office of Public Office of Public

InformationInformation Local Emergency Response Local Emergency Response Local Law EnforcementLocal Law Enforcement Director of Technology Director of Technology Parent representativesParent representatives

Who will assist with preparing, Who will assist with preparing, responding and recovering from an responding and recovering from an event?event?

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Develop Action Plan & Develop Action Plan & TimelineTimeline

Key activities: Key activities:

Delineate roles and responsibilities for Delineate roles and responsibilities for key stakeholders engaged in planning key stakeholders engaged in planning and executing specific components of and executing specific components of the plan.the plan. Develop Action Plan using the Pandemic Develop Action Plan using the Pandemic

Influenza Planning Tool Influenza Planning Tool

Ensure timelines are determinedEnsure timelines are determined Completion by the beginning of the ’07-’08 Completion by the beginning of the ’07-’08

school year is recommended school year is recommended

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Mitigation and PreventionTask Responsible

Person(s)Existing

ResourcesNext Steps Timeline

Identify or create district committee to provide guidance to school sites regarding pandemic flu preparations

Example: Jim (Director of Risk Management)

EOP Strategic Planning Work Group developed EOP last year.

Identify and contact district stakeholders and schedule a time to meet.

March 14, 2007

Review district emergency response and communicable disease policies and procedure

Director of Risk Management & other key stakeholders

EOP developed last year with an existing communicable disease plan.

Stakeholders to review additional needs re: Pan Flu planning for their department.

April 2, 2007

Determine if any additional policies/procedures need to be in place

All key stakeholder stakeholders

EOPSuggested Pan Flu policies and procedures

Stakeholders will outline further areas for development.

April 2, 2007

Develop communications plan for possible school closures

Work with Human Resources regarding schools functioning with 30% of work force absent. Look at alternatives such as staggered school times, changes in bussing, and telecommunications

Assess financial impact of alternate scheduling or school closures

Pandemic Influenza Pandemic Influenza Planning ToolPlanning Tool

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ResourcesResources School District Pandemic Influenza Planning Checklist -School District Pandemic Influenza Planning Checklist -

www.pandemicflu.gov/plan/school/schoolchecklist.htmlwww.pandemicflu.gov/plan/school/schoolchecklist.html

Pandemic Influenza Community Mitigation Interim Pandemic Influenza Community Mitigation Interim Planning Guide for Elementary and Secondary Schools Planning Guide for Elementary and Secondary Schools (see p. 87) - (see p. 87) - www.pandemicflu.gov/plan/community/community_mitigwww.pandemicflu.gov/plan/community/community_mitigation.pdfation.pdf

Pandemic Flu: A Planning Guide for Educators - Pandemic Flu: A Planning Guide for Educators - www.ed.gov/admins/lead/safety/emergencyplan/pandemwww.ed.gov/admins/lead/safety/emergencyplan/pandemic/planning-guide/index.html ic/planning-guide/index.html

Practical Information for Crisis Planning: A Guide for Practical Information for Crisis Planning: A Guide for Schools and Communities - Schools and Communities - www.ed.gov/admins/lead/safety/emergencyplan/crisisplawww.ed.gov/admins/lead/safety/emergencyplan/crisisplanning.pdf nning.pdf

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ResourcesResources Contra Costa Health Services Pandemic Flu School Contra Costa Health Services Pandemic Flu School

Action Kit Action Kit –www.cchealth.org/topics/pandemic_flu/school_action–www.cchealth.org/topics/pandemic_flu/school_action_kit/_kit/

Texas A&M Center for Rural Public Health Texas A&M Center for Rural Public Health Preparedness Pandemic Flu Toolkit Training – Preparedness Pandemic Flu Toolkit Training – CD CD provided at registration tableprovided at registration table

HCPHES School Pandemic Flu Preparedness HCPHES School Pandemic Flu Preparedness PowerPoint Template – PowerPoint Template – http://www.hcphes.org/pandemicplan.htmhttp://www.hcphes.org/pandemicplan.htm

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RecognitionRecognition

Special thanks to Harris County Special thanks to Harris County Department of Public Health and Department of Public Health and Environmental Services for the use Environmental Services for the use of this presentation.of this presentation.

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Questions?Questions?

Brian Winegar, MPHBrian Winegar, MPH

Public Health Preparedness ProgramPublic Health Preparedness Program

713-767-3034713-767-3034

[email protected]@dshs.state.tx.us

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