SARS “Outbreak” on a University Campus Management of a Confirmed Severe Acute Respiratory...

SARS “Outbreak”SARS “Outbreak”on a University Campuson a University Campus

Management of a Confirmed Management of a Confirmed Severe Acute Respiratory Syndrome Case Severe Acute Respiratory Syndrome Case

at the University of North Carolina at Chapel Hillat the University of North Carolina at Chapel Hill

Peter A. Reinhardt, DirectorMary C. Crabtree, Workplace Safety ManagerDepartment of Environment, Health & Safety

Peter A. Reinhardt and Mary C. Crabtree, University of North Carolina at Chapel Hill

About SARSAbout SARS• Case definition

– Fever of 100.4 F or greater (how it usually begins)– Respiratory symptoms (e.g., dry cough, shortness of breath; may develop

after 2-5 days)– Travel to affected area or exposure to someone with SARS

• Viable up to 72 hours in the environment• Develops into pneumonia, observable on a chest

X-ray. 10% mortality from respiratory failure.• International epidemic. Cases from 1 November 2002

to 31 July 2003:– 8,098 cases worldwide– 774 deaths

• In U.S., 74 Probable cases as of 31 July 2003, with no deaths or secondary transmissions within the U.S. Testing has been limited—only 8 cases have been confirmed by the CDC.


Where Did SARS come from?Where Did SARS come from?• A number of initial cases were

food handlers, so the epidemic may have started with them.

• Researchers were able to detect the SARS virus in two species found in local food markets.

• The virus may have been initially transmitted to man from those species (zoonosis).

• Those species may have acquired the virus from more exotic species


About SARSAbout SARS• Routes of transmission: Direct contact (within three feet)

—especially from cohabitation or in healthcare facilities. Work colleagues or others in the waiting room are not considered close contacts.

• Incubation period: Usually 5-7 days, but up to ten days. Some reports of 13-16 days.

• Control measures: Avoid endemic areas and their healthcare facilities. Avoid direct contact with a person who has SARS.– 100% protection of healthcare workers if proper PPE is used:

properly fitted N-95 respirators, gloves, goggles and gown.



Treatment for SARSTreatment for SARS• Currently, there is no treatment for SARS.

• Therefore, the symptoms (e.g., cough, fever) are treated and, hopefully, lessened.

• Due to the high risk of transmission in a healthcare setting, confinement in a healthcare facility is not indicated. Instead, patients are isolated at home unless respiratory symptoms necessitate hospitalization. 50% of the SARS cases in Singapore and Toronto were healthcare workers.

• Symptoms of residential patients are monitored frequently, and their environment is disinfected frequently.

• Family members/cohabitants are isolated with the patient, and their symptoms are also frequently monitored.


Tests for SARSTests for SARSexpensive, new, limited capacity

• Can’t afford to test everyone with a fever or respiratory symptoms.

• Rule out tests—influenza and mycoplasma.

• “Atypical pneumonia,” which is not uncommon, and for which there are no rule out tests, is very difficult to distinguish from SARS.

• Detection of antibodies in serum—usually develop 8-10 days from illness onset, but sometimes not until 28 days.

• PCR—like serology, is sensitive and specific, but not definitive early in the illness.

• Lung sample from autopsy– Detection of antibodies in lung tissue (most accurate)

– Histopathology via electron microscopy (characteristic tissue damage or virus morphology)

• Confirmatory tests (multiple tests, methods, labs) is critical before identifying an index case.


UNC’s Contingency Planning for SARSUNC’s Contingency Planning for SARSSpring 2003Spring 2003

• Establish a UNC SARS website, with recommendations, policies and informational links.

• Key administrators meet to decide University travel policies and communications for students, faculty, staff and visitors.

• Meeting of the University Emergency Warning Committee.

• Emails and Gazette (employee newsletter) article to inform travelers prior to the end of the semester.


UNC-Chapel Hill Travel GuidanceUNC-Chapel Hill Travel Guidance• Monitor WHO, CDC and State Department advisories and,

when they differ, err on the side of caution by following the most conservative advice.

• No UNC employee or student is required to travel to an area where a travel advisory or alert is in effect.

• Travelers from an affected area must monitor their health for SARS symptoms for at least 10 days after departure. Take your temperature daily.

• At the first sign of a fever or respiratory problems, telephone a healthcare provider for advice and to arrange a medical evaluation.

• Special announcement at May 2003 commencement.


Laws of Risk CommunicationLaws of Risk CommunicationHigh Perceived Risk• Exotic/new• Not knowable/uncertain• Controlled by others• Coerced• Catastrophic• Immediate effect• DreadedOther variables include responsiveness, openness and trust. In general, more information (rather than less) and taking action improves relations.


Response to UNC Travel GuidanceResponse to UNC Travel Guidance

“Married student housing is a hotbed of international travel to known SARS areas. One neighbor is planning a trip to Toronto and another is currently traveling in Taiwan, Vietnam, and other known SARS areas. Is anything being done as far as surveillance? There seems to be very little regard among the Asian community regarding the problem of SARS and travel to areas where the epidemic persists. Please advise.”

“What are you doing to protect my daughter from SARS? Telling people who have traveled in ‘affected’ areas to ‘take their temps’ isn't good enough for me. I think you should be monitoring these students for the incubation period when they come back to campus to keep all the students safe.”


Timeline of SARS on CampusTimeline of SARS on Campus

• Orange County Public Health (OCPH) interviews three coworkers with closest contact, as reported by the index case.

• OCPH drafts letter to coworkers, describing current knowledge and activities.

• OCPH letter distributed via email to 325 staff in building in which index case worked.

• UNC Emergency Warning Committee meets. An informational email is drafted to all faculty and staff for distribution that night.

3 June 2003: North Carolina reported its ninth case of suspected SARS, an Orange County man, to the Centers for Disease Control and Prevention (CDC).

Thursday 5 June 2003: 9:30 a.m. UNC first informed that suspect SARS case had worked as a contactor at UNC 21-23 May while asymptomatic. Case became symptomatic on 24 May, so risk to UNC staff was deemed to be very small or none.


Information Provided by OCPH Information Provided by OCPH to Employeesto Employees

• “Potential SARS suspect.”• “Symptoms developed after [5/23, his last day at

UNC]. The potential for transmission without symptoms is very low.”

• “It is now beyond the ten day incubation period.”• But…“Should you develop any of these

symptoms, contact a healthcare provider and advise them of your possible exposure to a SARS patient.”


SARS TimelineSARS TimelineSun Mon Tues Wed Thurs Friday Sat

May Direct Contact

Fly from Toronto

21IndexIndex

22patientpatient

23at UNCat UNC

Symptoms

25 Holiday 27 28 29 30 31

Ten days from 5/23

June 2 PH Officials 3determine Suspect SARS

4 UNC 5Notified

6 7

8 9Direct all calls to HealthLink

• 1st Employee Meeting

• Survey decision

• Special Interest cases

11• Order

thermometers

• Screening & site planning

• 2nd employee Meeting

• Thermometers

• Surveys

• Screening decision

13Screening

tents

• Screening tents

• Index case isolation ends


Potentially Affected UNC StaffPotentially Affected UNC Staff

• Three individuals with closest, longest contact• About 250 employees in the Giles Horney

Building– About 200 Facilities Services and Planning and

Construction Staff (150 of whom receive email)

– 40 Administrative Technical Network staff

• 135 Energy Services employees in Electrical Distribution, COGEN and North Chiller Plant


Employee Response to Initial NoticeEmployee Response to Initial Notice “Where’s Giles Horney? Was he on campus? Was he in my building?”

“Has he been seen at UNC Hospitals? Is it safe to go there?”

“A number of people have been sick here in the Giles Horney Bldg (who came in contact with this individual) before, during and after Memorial Day. I was sick the entire holiday weekend and beyond and so was one of my coworkers.

“Numerous people were sick the following week, etc. This individual even ate with all of us during an employee luncheon.

“I really think the University should close this building down and disinfect it. Also, why wasn't that done last weekend since we finally received information on 6/5/03.”


Friday 6 June 2003

• Suspect case was reclassified as “probable.”• EHS, Student Health Service and UNC Hospitals

plan daily teleconferences, starting on Tuesday 10 June at 8 a.m.


Public Health Interests and ActivitiesPublic Health Interests and Activities• Vigilantly prevent SARS outbreak—monitor for any sign of a

secondary transmission.• Practice epidemiology according to specific rules and procedures:

– Identify cases and interview high-risk contacts. Be prepared to order quarantine and isolation, when necessary.

– Preserve case privacy– Inform local healthcare facilities of risk and precautions

• Providing public information about risks and precautions. Established public information line 14 June.

• Prevent panic; reassure public.• Recognize that employer responsibilities may differ.• Concerned about implications to other affected parties and setting

precedent.


University InterestsUniversity Interests• Health and safety of its students, faculty,

staff and visitors• Contingency planning for best and worst

case scenarios• Employee relations• Student and parent relations• Business continuation for UNC Hospitals

and the University


UNC Hospitals InterestsUNC Hospitals Interests• Avoid experiences of hospitals in Asia and Toronto:

– Prevent SARS transmission to hospital staff, visitors and other patients—protect hospital facilities and staff.

– Prevent disruption of hospital clinics and services due to hospital outbreak control measures—preserve capacity to continue business of treating patients.

– Prevent from being labeled as a “SARS Hospital” with commensurate damage to reputation and business.

• Because so much is at stake, contingency planning for the reasonable worst case—a community outbreak. If an outbreak were to occur, UNC Hospitals must be ready to respond, rather than being incapacitated in managing SARS among its healthcare workers.


UNC Hospitals Protective Measures-UNC Hospitals Protective Measures-Monday Monday 9 June

• Signs on all doors, advising SARS-risk patients to go to the emergency department’s external door.

• Post guard at emergency department’s external door with surgical masks for potential patients.

• Development of internal policy and procedures for SARS-suspect patients, including staff PPE requirements.

• Directive to medical staff to get fit-tested– UNC Hospitals employees are fit-tested by Hospital– Physicians are UNC faculty, and are fit tested by

University Employee Occupational Health and campus Environment, Health and Safety



UNC Hospitals Protective Measures-UNC Hospitals Protective Measures-Monday Monday 9 June

• Establish special examination entrance and rooms.• Preparation of isolation rooms in the Hospital.• In case of epidemic, begin search for off-site

screening facility. Considered locations included:– Student Health Center (near UNC Hospitals)

– Football stadium first aid station

– Parking areas near Giles Horney


Monday 9 June 2003Monday 9 June 2003

• EHS clears schedule at University Employee Occupational Health Clinic (UEOHC) to fit test identified healthcare providers anytime during that week.

• Afternoon: After CDC laboratory tests were positive, the case was reclassified to “confirmed.”


Handling SARS Calls from the Handling SARS Calls from the University and CommunityUniversity and Community

• In the evening of Monday 9 June, an update email was sent to all UNC employees with the news that the case was “confirmed” and directed all information phone lines into UNC Hospitals HealthLink.

• The important message is: “Unless there is an emergency, call HealthLink. If you are symptomatic, do not go to a healthcare facility without calling first.”

• Community practices in Chapel Hill follow suit and referred SARS queries to HealthLink

• UEOHC, Student Health Service and OCPH also handled many calls.

• Calls received by Chamber of Commerce: “Is it safe to travel to Chapel Hill?”


UNCH HealthLinkUNCH HealthLink

• Added staff to handle SARS calls, including questions during daytime working hours—when normally they just make appointments.

• Referred worried well to information sources, the University Employee Occupational Health Clinic (UEOHC) or their primary provider.

• Referred symptomatic, potentially exposed callers to Infectious Disease for a phone evaluation. If necessary, arrange for examination at special examination entrance and rooms.

• When established, would refer symptomatic, potentially exposed callers to off-site screening facility.


Questions of Concerned PeopleQuestions of Concerned Peoplecalls and emails to EHS

“My staff and I pick up car fleet keys at the building. Should we use masks when entering the building? Are there chances of being infected via the use of a fleet vehicle?”

“Staff from the building are frequently in my building. Do they pose a risk to me?”

“I am concerned that a coworker frequently visits the building, yet has not been included in the potentially exposed group. I am also concerned because my job puts me all over campus and I could unknowingly become a vector to the rest of campus.”

“My daughter is scheduled for freshman orientation on campus next week. Will she be safe?”


Tuesday Tuesday 10 June 200310 June 2003

• Investigation begins on two “special interest” cases: an Orange County man seen as an outpatient at Duke University Medical Center (Durham County), and a Wake County man at Western Wake Medical Center. Both are UNC employees who worked in the same building as the SARS index case.

• At UNCH request, State Division of Public Health initiates a daily teleconference for public health, UNCH, and University technical staff.


Tuesday 10 June 2003Tuesday 10 June 2003• UNCH stations security guards to entrances of its

hospitals and clinics• Meeting of 150 Giles Horney employees.

– County and State Public Health Officials invited to attend and answer questions.

– Upon hearing reports of recent employee illnesses, State Division of Public Health commits to a health questionnaire for potentially exposed employees.


Good Questions about SARSGood Questions about SARSat the Tuesday 10 June employee meeting

“I’ve heard SARS is a virus similar to the common cold. The CDC lists personal contact as the suspected transmission method, but there is no mention of transmission from cough droplets on furniture, etc. Is SARS transmitted environmentally, like the common cold?”

“Can an asymptomatic patient transmit the disease?”

“Can a person get a mild case of SARS? If so, are they infectious to others?”

Among the technical experts and medical professionals, uncertainty about these issues created dissonance and raised their perception of the public health risks.


Toronto InterestsToronto Interests• Local economy• Reputation and public relations

– Is Toronto exporting SARS?– Are Toronto healthcare facilities taking appropriate

precautions to stop the spread of SARS?– Local Canadian Health Official on 11 June: “Case

defies the accepted understanding of the disease and method of spreading”

• Avoidance of a WHO or CDC travel alert or advisory


Wednesday 11 June 2003Wednesday 11 June 2003• Consideration of temporarily closing Giles Horney was tabled

by the UNC Emergency Warning Committee due to concern that:– If some employees had SARS, they would be dispersed to towns and

counties less prepared to identify and contain SARS.– How would UNC and UNCH continue its operations without Giles

Horney and its facilities services?

• Pre-work temperature monitoring procedure discussed and adopted. EHS orders 400 digital thermometers overnight.

• UNC Hospitals, EHS and UEOHC proceeds with plans for temporary screening facility, with Giles Horney employees becoming their primary concern.

• EHS orders N-95 respirators. (UNCH had one month supply for 24hr call.)


Thursday 12 June 2003Thursday 12 June 2003• 8 a.m.: At UNCH Grand Rounds, physicians ask,

“Why isn’t UNC closing Giles Horney?”• 3 p.m.: UNC and UNCH decides on the site of

screening facility:– Park and Ride lot near Giles Horney not used during that

time of year.– Public availability, if necessary.

• Employee screening is not sanctioned by OCPH as a public health action.

• EHS prepares mobile fit-testing facility and continues search for N-95 respirators.


Employee Meeting Employee Meeting Thursday 12 JuneThursday 12 June• Presentation by Chancellor

Moeser

• Announce, begin temperature program

• David Weber, M.D., announced screening facility

• SPH Dean Roper and PH Director discussed risks, answered questions

• Discuss cleaning the building

• Distribute health questionnaire


Should We Clean the Giles Horney Building?Should We Clean the Giles Horney Building?• Many employees demanded that we clean the building. Several

administrators supported this.• Public health officials told us that there is no environmental SARS

risk. Cleaning the building was unnecessary, of no material benefit, and would set a bad precedent for other affected parties (i.e., the confirmed case’ primary doctor’s office). It would cause undue community concern and provide false assurances to employees.

• Although SARS virus viability is only 72 hours, could virus be present if people in the building had “mild” case of SARS?

• Practical problems: No standards for cleaning buildings. How clean is clean? Where are the boundaries for cleaning?

• Consideration of a “peace of mind” cleaning.


Friday Friday 13 June 200313 June 2003

• Screening facility opens at 7 a.m. in tents erected overnight.

• UNC Hospitals prepares for lockdown of all hospital and clinic entrances.

• EHS continues distribution of surveys and thermometers.


Screening FacilityScreening Facility• To screen employees and family with symptoms. Capacity of about

6-12 persons per hour. Conveyance to UNC Hospitals, if necessary.• Multiple stations:

– Registration– History and counseling– Physician evaluation– Portable chest X-ray

• About 40 staff:– UNCH: screening (5), nurses (4), radiation technician (1), medical technician (1), UNCH EHS

(2), Van shuttle (1), Ground transport to Carolina Air Service (2)– UNC Physicians (4-5)– UNC Facilities Services (5)– UNC School of Nursing volunteers (5)– UNC EHS: reception (1), fit testing (3) radiation safety (2)– UNC Public Safety (2)– UNC Employee relations staff present to meet with employees

• It was handled extremely well and did not become the media circus that CDC feared.


Screening FacilityScreening FacilitySite Preparation by UNC Facilities ServicesSite Preparation by UNC Facilities Services

Thursday 12 June, 3 p.m.: Informed of need to a) set up black-out fencing and tents in park-and-ride lot near Giles Horney, b) procure fencing materials.

4 p.m.: Begin fence construction.

7 p.m.: Completed the installation of black-out fence. (Kept media at bay.)

Friday 13 June, 5 a.m.: Housekeeping delivery and set up of tables and chairs.

6 a.m.: Install wiring and receptacles. Install air conditioning for inflatable tents, powered by generators rented from Wilmington.

8 a.m.: Install locally purchased pop-up tents, water coolers, interior lighting and trash receptacles as needed.

9 a.m.: a) Sent mechanic to Garner to pick up domestic water storage tank, b) procured pump to supply domestic water, c) assembled and set temporary towel and hand sanitizer dispensers.

2 p.m.: Water pump and tank was set up and tied into hand washing sink.


Screening FacilityScreening FacilitySite Preparation by UNC HospitalsSite Preparation by UNC Hospitals• Tents, ordered overnight, erected with help of UNC Facilities

Services:– 3 inflatable tents from Charlotte Fire Dept.,

delivered 9 p.m. on 12 June.– “Decon” tents from OCPH– Waiting area tents from UNC

• Thermometers, sphygmomanometers, etc. bought overnight from Wal-Mart and area pharmacies. Gloves, gowns, etc. from UNCH Central Distribution.

• Rental trucks to hold supplies.• T1 connection by mid-day.


Screening FacilityScreening FacilitySite Preparation by University EHSSite Preparation by University EHS• For registration, created a report from EHS’

information system (HASMIS) of employee basic demographics and medical record numbers.

• Provided greeter/reception staff.• Established and staff a mobile fit-testing facility.• Procured of additional N-95 respirators.• Established external shielding for portable

X-ray unit.

















Employee and Family ScreeningEmployee and Family Screening

Friday

June 13

7 a.m.-5 p.m.

Saturday

June 14

9 a.m.-noon

Summary

Persons screened

36 6 42

M.D. Review 8 2 10

Referred to UNC Hospitals

2(not related to

SARS)

2


EHS Fit-Testing DemandsEHS Fit-Testing Demands

• 63 People fit-tested by EHS 9-13 June– 11 Facilities Services staff at UEOHC (regularly

scheduled)

– 32 Infectious Diseases, Neurology and Pathology staff at UEOHC

– 4 EHS staff

– 16 Staff at Screening Facility 13 & 14 June

• At the time, there were no 3M 1860 or 3M 1860S available in the U.S.







Health QuestionnaireHealth Questionnaire• 259 Questionnaires distributed; 184 returned

• Evaluated by NC State Dept. of Public with help by UNC School of

Public Health

• 11 had both fever and cough, but none had contact with the index case

• If not seen at screening tent, refer to Health Director in County in

which they live for follow-up

• State Division of Public Health: “It is unlikely that SARS was spread

in the Giles Horney building.”

• Offered confirmatory blood tests. 34 staff were voluntarily tested, and

all were negative for SARS. Tests were done by the NC State Public

Health Laboratory with some duplicates run by the CDC. To develop

an experimental procedure, UNC researchers also tested the blood

samples for SARS.



Pre-work Temperature Monitoring Pre-work Temperature Monitoring ProcedureProcedure

• EHS distributed 531 thermometers.

• Staff were asked to take their temperature before work and not come to work (deemed administrative leave) if fever or respiratory symptoms.

• UNC IT staff collect and report the data.

• Only two people reported temperatures between 99.8-100.4 F

• No abuse of administrative leave, as had been feared.


Pre-work Temperature Monitoring ProcedurePre-work Temperature Monitoring Procedure


Issues for Workers’ CompensationIssues for Workers’ CompensationIf an employee caught SARS from a coworker or student,

would s/he be covered?

• Communicable diseases are not covered under NC Workers' Compensation unless you are at a greater risk than the outside population.

• This means that the risk must be unique (proven to be to a cause or condition) to the employment (i.e., Healthcare provider, conducting research on a particular disease).

• The UNC Emergency Warning Committee was counseled on NC Workers’ Compensation law to make decisions on "leave" issues surrounding the situation.

• Even though there was no specific State policy or approval, UNC decided to grant Administrative Leave to employees with certain symptoms as part of the temperature monitoring program.

• After UNC's incident, "Leave for Exposure to Communicable Disease" policy was developed by the NC Office of State Personnel to assist all NC State Agencies in the event of an "outbreak."


Friday 13 June 2003Friday 13 June 2003• 1 p.m.: First state news conference conducted by State Division

of Public Health.• 1 p.m.: OCPH holds planning and coordination meeting with

UNCH and UNC officials.• 1:15 pm.: The Western Wake Medical Wake patient dies en

route to UNC Hospitals. Taken to NC Medical Examiner’s Office, located on UNC campus. The clinical cause of death was determined to be heart failure and pneumonia.

• At the end of the workday: Meeting with building supervisors to let them know of coworker’s death. Managers were asked to call their staff and let them know.

• Afternoon: SARS was ruled out in the case of the Duke University Medical Center patient, and the isolation orders for healthcare workers who were in contact with him were terminated.


Timeline of SARS on CampusTimeline of SARS on Campus• Evening of Friday, June 13: Emergency Warning Committee

meets. Email expressing condolences for deceased employee sent from Chancellor to all UNC Faculty and Staff. Included information about cause of death (not SARS).

• Saturday, June 14: The index case was out of isolation, and the index cases’ family was out of quarantine. All healthcare workers who had been exposed were past the monitoring period. None had developed symptoms. Screening continues at site until 1:00 p.m.

• Monday, June 16: Email to all building staff with Orange County Public Health notice that the Duke case is not SARS.


Cost of SARS Screening FacilityCost of SARS Screening Facilitycosts were minimized because most staff were exempt from overtimecosts were minimized because most staff were exempt from overtime

Facilities ServicesMaterials

AC Units

Labor

Communications

$ 6,516

8,950

11,133

1,880

$ 28,479

EHSN-95 Respirators

Thermometers

Overtime pay

$ 990

4,470

691

$ 6,151

UNC HospitalsSupplies

Equipment Rental

Other

$ 700

340

2-3,000

$3-4,000

Approximate Total = $38,000


Lessons LearnedLessons Learned• Advance planning makes a difference!• Communications protocols need to be established

ahead of time, and reviewed for effectiveness.• Emails to employees are not always effective

communication method. They are confused with previous SARS emails, attachments are not opened, some people don’t check their email frequently or give it only a cursory reading, and some employees don’t have email.


Lessons LearnedLessons Learned• Expect and plan for the “worried well,” “worried sick” and other

false positives. These include individuals who think or appear to have SARS, but instead have stress induced or unrelated health problems. These individuals may have similar or identical symptoms, and may be seriously ill.

• University Employee Occupational Health Clinic was easily and quickly overwhelmed with questions, fit-testing and regular business.

• The extent and speed of mobilizing University and Hospital resources can be impressive, as was the expertise and capabilities of the people who provided them. Within 24 hours, they established a sophisticated medical screening facility.


Lessons LearnedLessons Learned

• Include Public Health officials in University decisionmaking, planning and communications.

• Reduce dissonance of technical experts. • More active communication to improve responder

coordination.• Provide clear advice to “political” decisionmakers to

prevent decisions that are not supported technically.

Although Public health and University interests do not always coincide, it is important to rely on, utilize and engage County and State public health experts to make the best decisions.


Follow-up ActionsFollow-up Actions• Establish Chancellor’s SARS Task Force, chaired by SPH Dean

Roper– Provide guidance to faculty, staff, students and families (examples, new

SARS Travel Policy, Study Abroad policy).– Plan for possible quarantine of large numbers of students (tabletop

planning exercise conducted by Student Affairs).– Planning with Health Department.– Identify alternative sites for an off-site screening facility.– Vigorous promotion of flu shots for students, faculty and staff. Influenza is

difficult to distinguish from SARS.

• Discuss facilities services continuity possibilities with North Carolina State University.

• New UNCH infectious disease clinic that meets airborne isolation guidelines and can be accessed directly from outside.

• Advised other universities and State agencies.


““UNC Student with SARS” ScenarioUNC Student with SARS” Scenario• Direct all calls to Student Health Services. Tell students to

call and not come to SHS without calling first.• Lock down SHS and set up screening area under covered

loading dock.• If possible SARS suspect, direct to residential isolation if

possible, with further medical review scheduled later.• On campus resident (dorm)—transfer to vacant family student

housing with OCPH monitoring and UNC support.• Off campus resident—direct to residence with OCPH

monitoring and support.• If residential isolation is not appropriate, refer student to UNC

Hospitals.• If SHS screening is overcome, UNCH establishes a separate

screening facility.


Recommendations for Other InstitutionsRecommendations for Other Institutions• Establish emergency communications procedures—to quickly create,

approve and distribute risk communications. (UNC Emergency Warning Committee)

• Openly discuss contingency plans and responsibilities with public health officials—understand how your interests and needs may differ.

• Partner with a medical center that can provide emergency backup triage, screening and care.

• Utilize medical expertise, but engage public health officials in decisionmaking and risk communications.

• Draft a communicable disease policy to address leave for isolation and quarantine.

• Communicate, communicate, communicate!

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SARS “Outbreak” on a University Campus Management of a Confirmed Severe Acute Respiratory...

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