Is Your Campus H1N1-Ready?

It does little good to speculate about when and where an outbreak of the 2009 H1N1 ("swine flu") virus may occur. A chief concern is whether your institution is prepared to function normally if the virus hits your campus.

To address the many operational challenges a pandemic raises for higher education institutions, NACUBO, CUPA-HR, and ACHA recently presented the webcast "H1N1 Campus Management: Perspectives from Human Resources, the Business Office, and Student Health Services." James E. Lyons, Sr., secretary of higher education for the Maryland Higher Education Commission, moderated the September 15 event, which featured three Carnegie Mellon representatives: Anita Barkin, director of student health services; Barbara Smith, associate vice president and chief human resource officer; and Deborah Moon, vice president and chief financial officer. All three offered recommendations for managing and maintaining a safe and healthy campus and emphasized the need for effective communication across all levels of campus management.

H1N1 in Context

Barkin provided general background and historical context surrounding pandemics. On average, the seasonal flu causes approximately 36,000 deaths in the United States each year, with older Americans and children comprising the highest at-risk groups and accounting for a chart of infection that is typically U-shaped. By comparison, a pandemic occurs in waves and generally accounts for millions of deaths worldwide with disproportionate effects on young and healthy adults. Previous pandemics have taken their toll on the U.S. population:

• 1918 H1N1 (Spanish flu): 675,000 U.S. deaths.
• 1957 H2N2 (Asian flu): 75,000 U.S. deaths.
• 1968 H3N2 (Hong Kong flu): 34,000 U.S. deaths.
• 2006 H5N1 (bird flu): unknown; less than 100 deaths worldwide.

The 2009 H1N1 has all three criteria of a pandemic: It is a new or "novel" virus to which the general population has no immunity, it crosses species (bird, pig, and human), and it can be transmitted from human to human. While experts are uncertain about the potential impact of the current H1N1 virus, they contend that it appears similar in characteristics to the 1918 H1N1 virus. The first signs of the current H1N1 occurred from outside the United States, there was little time to act, and within three weeks there were simultaneous outbreaks throughout 42 states across the nation, resulting in two deaths among 849 probable cases.

Widespread concern exists that the outbreak during the summer (accounting for 477 deaths during a non-flu season) does not bode well for the 2009-10 flu season. Many campuses with camps, summer courses, and other events experienced outbreaks. Barkin noted that the World Health Organization and Centers for Disease Control will not give prescriptive guidance but instead are encouraging colleges and universities to make decisions based on local circumstances.

Availability of a vaccine that should be effective against the virus within eight days began its rollout during early October. A projected 40 million doses—a mix of sprays and shots—was to be available by mid October, with an additional 10 million to 20 million doses targeted for availability each week thereafter, eventually reaching a total of 250 million doses.

Social Distancing Practices

To help contain the H1N1 virus, Barkin encouraged postponement of large social gatherings where possible and offered techniques for social distancing practices such as refraining from hand-shaking and modifying work and classroom spaces by moving desks further apart. To make her point regarding the importance of early intervention, she cited examples of different responses taken by various cities during the 1918 outbreak and the effects of those decisions.

New York City′s early and sustained response, as advised by the NYC Public Health Response Team (PHRT), included strictly enforced isolation and quarantine and staggered business hours over a 10-week period, resulting in the lowest excess death rate for any city on the East Coast during the time period reviewed. Although the city did not officially close schools, absentee rates were greater than 45 percent during the peak of the pandemic.

EDR = excessive death rate. PHRT = public health response team. NPI = non-pharmaceutical intervention.

St. Louis had a positive effect in lowering the total death rate through non-pharmaceutical intervention (NPI) and layered and sustained interventions early in the pandemic, including school closures, public gathering bans, quarantines, and so forth.

EDR = excessive death rate. PHRT = public health response team. NPI = non-pharmaceutical intervention.

Pittsburgh, by contrast, was well into its outbreak before implementing interventions. As a result, it experienced the highest excess death rate of any of the 43 cities reviewed. While city officials executed a public gathering ban on October 4, 1918, they delayed implementing school closures until October 24. A week later the state rescinded the public gathering ban.

EDR = excessive death rate. PHRT = public health response team. NPI = non-pharmaceutical intervention.

The Case for Isolation

Barkin underscored how critical it is for students and faculty to understand the rationale for isolation and self-isolation, which is to flatten the surge of the illness. Campuses nationwide should prepare to offer sick students accommodations on campus with alternative, isolated living quarters and access to meals and health care, argued Barkin. Students who live in non-university housing should isolate themselves from others, including their roommates, but ask roommates or others for assistance in securing food, fluids, and over-the-counter cold medications. At Carnegie Mellon, ill students who live off campus have been asked to stay home and avoid contact with others, while students in residential housing who do not come from areas near Pittsburgh are being taken care of by staff members in student health services, housing, dining, and student affairs, explained Barkin.

Among other tips offered for caring for ill students:

• Determine a screening protocol for use by emergency personnel, and set up an H1N1 dispatch alert system with resident life employees.
• Make sure students and staff have documented fevers before isolating them.
• Secure a location for an infirmary and identify who will staff it.
• Determine if there are additional areas and resources within your community that can be used.
• Establish plans and procedures for remote learning.
• Develop a dining protocol and meal delivery method, and create simple, healthy menus for those who are ill.

Staffing Protocols

Smith noted that the impact of H1N1 on faculty and staff may mean an increased workload for all employees coupled with a reduction in the staff available to accomplish the work. She encouraged campuses to identify essential functions and key staff members, begin "depth charting" to determine backup staffing, examine short-term staffing solutions and the possibility for employees to work outside their job descriptions, and develop return-to-work requirements.

Smith also encouraged campuses to review internal policies surrounding emergency closings, flextime, working from home, and the family medical leave and fair labor standards acts. With regard to FMLA and FLSA in particular, are HR staff equipped to monitor and document these situations? Finally, campuses with child-care facilities require special protocols to limit exposure to young children and must establish concrete expectations among family and staff regarding the institution's response in the event of an outbreak.

Facilities and Financial Functions

Moon emphasized the need for sound facility planning, including developing temporary, permanent, or leased infirmaries for isolated students and making sure facilities are available for quick and deliberate repurposing. On the financial operations side, key areas of continuity (e.g., payroll and accounts payable) should be addressed sooner rather than later along with systems infrastructure. For instance, do students, faculty, and staff have remote access to university information? Who can replace the roles of functional and technical staff if they become ill? Practices regarding use of vendors must also be established to keep payments and payroll running and to meet regulatory and contractual obligations.

Moon also discussed the process for determining when deadlines may need to change, the impact on international operations, and the role of communication. Identifying critical staff roles and making sure staff are cross-trained during pandemic planning is vital. Don't leave important decision criteria to the last minute. Ask yourself early on when your institution should no longer stay open due to a high mortality rate or other factors (i.e., your tipping point).

Who should sit at the decision-making table during pandemic planning?

• Representatives from HR, student affairs, health center, business office, and environmental health and safety office.
• Content experts and external consultants who understand public health issues.
• Campus and community security personnel.

Ultimately, communication between your campus staff, students, and community remains essential for restraining a pandemic. Ensure that campus police and emergency personnel have the proper communication tools, training, and equipment. Create a phone bank using social media tools such as Twitter and Facebook. Develop strong messaging early, and distribute ongoing messages about good hygiene and emergency planning.

It is also extremely beneficial if your institution becomes a partner with the larger community in an effort to mitigate the spread of the virus. For instance, your campus can become a flu surveillance site and a point of distribution for the vaccine. Contact your local health department to find out how.

Finally, Barkin reminded participants not to overlook the obvious. Secure surgical masks, hand sanitizers, and other important supplies, since these items tend to become scarce once an outbreak hits, and since the prices only inflate with demand. For example, within days of the first H1N1 case, suppliers were out of the flu treatment Tamiflu, which immediately increased in price by about 20 percent.

Tadu Yimam is a policy analyst at NACUBO. E-mail: tadu.yimam@nacubo.org.

RESOURCES:

• CDC Guidance for Higher Ed
• ACHA Tracking Resource
• NACUBO Resource Page