Building healthy communities through

preparation, prevention and response!

Pandemic InfluenzaPandemic InfluenzaWhy Schools Need to Be ProactiveWhy Schools Need to Be Proactive

Diane Hargrove-Roberson, Diane Hargrove-Roberson, MSWMSW

Community Outreach Program ManagerCommunity Outreach Program ManagerPandemic Influenza GrantPandemic Influenza Grant

Topics of Discussion

• Influenza• Avian Flu • Pandemic Flu• History, Impact &

Planning• Schools Role• Employee Role• Resources

Preparedness

ResponseRecovery

Prevention

“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

• 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.

What is influenza (flu)?

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 H5N1.• Some strains of H5N1 are highly

pathogenic.• The severe strain of H5N1 is killing birds

in Asia and parts of Europe.

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

359 CASES - 226 DEATHS - 62.9% MORTALITY RATE

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

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• 36,000 deaths in US

Caregivers in the Spanish Flu 1918

Personal Protective Equipment (1918)

Law Enforcement in the 1918 Flu

Public Health Measures in 1918Some 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 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.

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.

Interpandemic

Larger clusters, localized

Limited spread among humans

Pandemic

Current Status

WHO Global Influenza Preparedness Plan, 2005. Available at: http://www.who.int/csr/resources/publications/influenza/GIP_2005_5Eweb.pdf

Pandemic alert

Phase 1 Phase 2 Phase 3 Phase 4 Phase 5 Phase 6

New virus in

humans

Little/no spread among humans

Small clusters, localized

Limited spread among humans

Increased and

sustained spread in general human

population

Current status of

H5N1

No new virus in humans

Animal viruses low risk

to humans

No new virus in humans

Animal viruses low risk

to humans

Current H5N1 status

Pandemic Influenza Impacts in Louisiana• 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

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% alcohol-based 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

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

PlanIs

Activated

OPERATIONAL PHASES FOR SCHOOL

DISTRICT PANDEMIC INFLUENZA PLAN

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…

An Influenza pandemic may emerge with little warning.

A vaccine will not yet be available.

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 CoordinationWho’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.

Washing hands often with soap.

Alcohol based disposable wipes/hand sanitizers.

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: 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

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

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.

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:

Provide identified staff with authority to act in the absence of supervisors/senior personnel.

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)Reexamine human resource

policies. Sick leave and attendance policies may not address a major employee absence.

It 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

Preparedness

ResponseRecovery

Prevention

Mitigation/PreventionThings 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.

FLOWCHARTSPANDEMIC INFLUENZA FLOW CHART FOR:TEACHERS

GovernmentResponse ►Stages

PANDEMIC ALERT PERIOD0-New domestic animal outbreak in at-risk country•Suspected human outbreak overseas

Measures identified in this column must be accomplished BEFORE November 1, 2007TYPICAL FLU SEASON IS DECEMBER TO MARCH

PANDEMIC ALERT PERIOD (SUBSTANTIAL PANDEMIC RISK)2.Confirmed human outbreak overseas

READY STATUS

PANDEMIC PERIOD3- Widespread human outbreak in multiple locations overseas4- First human case in North America5- Spread Throughout United States6- Recovery & preparation for subsequent waves )

Communications oMake sure Parent /Guardian contact information is currentoKeep lines of communications open and frequent to main office regarding current status of Pandemic

oConfirm contact lists are current/accurateoMaintain communications with main officeoReview with Nurse/Health Services protocols on managing ill children

oMaintain close contact with parents/guardians providing reassurance for the health and safety of their childrenoRemind parents to keep ill children home

Continuity instruction & learning

oBegin lesson preparation/ homework strategies to assign students if schools were closed due to a pandemic ( 2 weeks up to 12 weeks)

oHone lesson preparation / homework activities(District may provide prepackaged activities)

oCoordinate with District Technology Department for delivery of student assignments and activities.

PreventionEducation

oCentral Administration will provide web-based Pandemic Awareness & infection control training on District website. Explore this activity.oBegin reinforcement of proper hygiene & germ control strategies with classroom students (i.e. Hand washing, respiratory etiquette-i.e., cover mouth, using tissues)

oPost classroom signage that promotes hygiene and respiratory etiquette.oHEIGHTENED reinforcement of proper hygiene & germ control strategies with classroom students (i.e. Hand washing, respiratory etiquette-i.e., cover mouth, using tissues)

oPromote vigilant classroom / school hygiene and respiratory etiquette practices and policies.oConsider hand washing breaks with students

School Facilities oDiscuss with custodians the need for ample supply of sanitizers and tissues in the classroom in case of a pandemic event.

oEnsure classrooms will have an adequate supply of tissues, hand sanitizer wipes, etc.

oCheck and replace supplies as needed

Surveillance & Reporting

oDiscuss with Nurse protocol for monitoring ill children.

oReview with Nurse protocol for monitoring ill children. ( Symptoms of Pandemic Flu)

oClosely monitor classroom students for illness. Ill children must be identified, reported and mandatory arrangements made for influenza case isolation.

EmotionalPreparations & Actions

oBegin discussions with counselors, social workers and psychologists regarding age appropriate strategies for handling children dealing with pandemic associated loss/grief.

oReview mental health materials and strategies provided by mental health professionals

oRefer all students in need of professional counseling to appropriate and trained personnel

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_influenza/phase/en/index.html

Get Informed. Be Prepared.

• State Draft Pandemic Flu Plan• http://www.dhh.state.la.us/offices/publications/

pubs-145/Pandemic%20Influenza%20Plan_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:

Dr. Frank Welch

Medical Director

Phone: (504) 838-5300

Email: fwelch@dhh.la.gov

Diane Hargrove-Roberson, MSW

Community Outreach Program Manager

Phone: (225) 763-3964

Email: droberso@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