Hillsborough County Schools Pandemic Flu Plan

1. Hillsborough County Schools Pandemic Flu Plan Maria Russ ARNP, CPNP, Ph.D.

2. Overview • Define Key Terms • History • Identify Key Stakeholders • Delineate Roles • Delineate Responsibilities • Plan Evaluation • Questions

3. Epidemic vs. Pandemic Epidemic: serious outbreak in a single community, population, or region Pandemic: epidemic spreading around the world affecting hundreds of thousands of people, across many countries

4. Over the past 500 years……… Three to four pandemics have occurred per century The longest period of time between pandemics is 42 years As of 2009, it has been 41 years since the last influenza pandemic

5. Historical Perspective Three influenza Pandemics in the last century 1918 – 1919: (“Spanish Flu” H1N1) about 500,000 US deaths and up to 40 million deaths worldwide 1957 – 1958: (“Asian Flu” H2N2) about 70,000 US deaths and 1-2 million deaths worldwide 1968 – 1969: (“Hong Kong Flu” H3N2) about 34,000 US deaths and 700,000 deaths worldwide

6. Lessons from Past Pandemics Occurs unpredictably, not always in winter Great variations in mortality, severity of illness, and pattern of illness or age most severely affected 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

7. History • Most Recent Panic Outbreaks • Measles • HIV • Avian Flu Pandemic • H1N1 also known as Swine flu

8. Hillsborough County School District Key Stakeholders • School Health Services Coordinator • School Registered Nurses • LPN’s and Health Assistants • Director of Administrative Services • Manager of Safety and Risk Management • Manager of School Security

9. Other Key Stakeholders • Health Department • University South Florida • Tampa General and other local Hospitals • Police and Sheriff department • Paramedics • Business

10. School-Community Possible Surveillance Outcomes • Social distancing, isolation, or quarantine may be needed • Could involve school closures and sporting event/entertainment/social gathering cancellations • Utility providers (electricity, water, sewer, telephone, Internet) could see service interruptions due to staffing shortages

11. School-Community Possible Surveillance Outcomes • Business community develops alternate service delivery methods to ensure their continued viability. Telecommuting and video conferencing will likely increase. • Call-in orders, home delivery, and mail-order businesses could thrive. • On-line banking will likely increase. • Restaurants may convert to a home delivery model.

12. Hillsborough County Pandemic Flu Plan begins… • Pandemic Summits • Conferences • Teleconferences/Webcasts • Joint Hillsborough County School District Health Department meetings and teleconferences • Subcommittee task force

13. Pandemic Subcommittee • Developed Pandemic Flu Response Plan • Preliminary Pandemic Flu Response Plan presented to subcommittee members • Pandemic Flu Action Plan customized for Hillsborough County School District

14. Pandemic Influenza Summary • Highly infectious virus • May mutate to infect animals and humans • Most of population has no immunity • Easily transmitted from person to person • Limited antiviral medications available • Limited excess capacity in health care system • No vaccine at onset/H1N1 vaccine piloting

15. Pandemic Flu New influenza virus More severe symptoms, more complications Entire population at risk of severe illness May cause social disruption Seasonal Flu Virus is similar to previous strains Usual symptoms Very young and very old people at greatest risk Modest impact on society Pandemic vs. Epidemic Influenza

16. Influenza • Transmission from person to person • Large-particle droplets • Direct contact with infected secretions • Incubation period: 5 – 10 days

17. Symptoms of Influenza • Sudden fever/high fever • Dry cough • Sore throat • Runny or stuffy nose • Headache • Muscle aches/body aches • Stomach symptoms (generally no gastrointestinal symptoms, except children)

18. Influenza Transmission • Susceptible person • Coughing and sneezing within three feet • Touching a surface with the virus

19. Influenza Complications • Viral pneumonia • Bacterial pneumonia • Dehydration • Otitis media (ear infection) • Sinus problems • Encephalitis (seizures, coma) • Worsening of chronic conditions (asthma, diabetes)

20. When Children Get Influenza • Rates of influenza infection are highest among children • Rapid spread through schools, day care • Influenza spreads to families and amplifies throughout the community • Serious illness and deaths in people < 2 years of age and > 65 years of age

21. When Children Get Influenza • Parents are absent from work • Visit to the Pediatrician or Emergency Room • Younger children may be hospitalized (especially infants under 6 months) • (Inappropriate) antibiotics may be prescribed

22. Newer Recommendations For Children: • Increased use of influenza vaccines • Increased rapid testing for influenza infection in Physician offices, Emergency Rooms, and Walk-In Clinics • Recommendations for limited use of antiviral medications (Tamiflu, Relenza) • Emphasis on hand hygiene and “cough etiquette”

23. Influenza Vaccines • Inactivated vaccine: traditional, injected vaccine. NOTE: you cannot get “the flu” from the vaccine! • Live, attenuated intranasal vaccine: FluMist…..for healthy people 5 to 49 years of age.

24. What Can We Do Now To Prepare For Possible Pandemic Flu? • Hand washing: wash hands frequently with soap and water • Respiratory hygiene: Coughs and sneezes causes diseases, use of social distancing • “Cover Your Cough” • Use tissues and dispose of them properly • Stay home if you are ill • Self-sufficiency: Stockpile water and non perishable food, prescribed medication, and health supplies • Stay informed

25. How Will A Pandemic Affect Our Schools? • Who coordinates decisions on closing schools or quarantining kids? • If classes shut down for weeks, how will a district keep kids from falling behind? • Who will keep the payroll running, or ease the fear of parents? • Who will provide food to children who count on school meals?

26. Closing Schools • Severity of the Pandemic will determine a school closing. • School closings are based on the characteristics of a pandemic and schools operation ability. • The Superintendent of Schools and the Director of Hillsborough County Health Department will determine school closures.

27. How Will The District Keep All Children From Falling Behind? • Distance learning for reading, math, and science • Instructional TV • Internet • Radio • Telephone • Community outreach • Virtual school • Homework

28. Anticipate Needs of Faculty and Staff • How to help staff with health-care coverage and family concerns • Ways to compensate for staff interruptions and work from home requests • Faculty/staff leave requests, disability claims, medical leave policies • Absentee policies, student attendance issues • Transportation issues

29. Food For Children • Make preparations at home: stock foods, water, and medicines. • Be prepared for food supply disruption. • Reliable communication within and across school communities (employees, parents, students, vendors, and community members) for food delivery if needed.

30. What Can We Do Now To Prepare For Possible Pandemic Flu? • Staff and students that are sick should stay home! • Cover nose and mouth with a tissue. • “Cough etiquette”, “Cover your cough”. • Wash hands often with soap and water. • Try not to touch eyes, nose, or mouth. • Disinfect keyboards, phones, and desks daily.

31. Impact on School Personnel • Increased risk of exposure • Illness and death among children and staff • Ethical dilemmas • Frustration with “business as usual” • Physical isolation associated with infection control

32. Psychosocial Issues For School Personnel • Concern about children and family • Constant pressure to keep performing • Domestic pressures caused by school closures • Stress of working with symptomatic others • Difficulty maintaining self-care • Fear of contagion and transmitting to others

33. Psychosocial Issues For Families Of School Personnel • Staff may be tired, worried, irritable, etc. • Staff may be less optimistic and understanding. • Increased emergency workload may complicate communication with family. • Family members may be at risk of contagion.

34. At The School Level • Plan on a 30% reduction in work force and/or school closure for two months. • An education plan for isolated and quarantined students who are sick for at least two weeks. • Resource needs such as soap, masks, gloves, etc. • Increased symptom and attendance monitoring to ensure accurate reporting.

35. At The District Office • Life/health/safety issues essential to accomplishing the mission of the school district……………………. • Standard Operating Procedures of critical functions/processes (payroll, insurance, etc.) • “Daily” mission essential services and priorities

36. At The District Office • Assign key team leaders and alternates. • Assign team members by location. • Develop and implement task checklists. • Assign critical functions to be performed via telecommuting and other technology needs. • Look at flex scheduling: shifts, longer hours of operations, alternate work days, etc.

37. At The District Office • Identify staff that can be cross trained to backfill critical function. • Identify functions that can be suspended while staff is reassigned to more critical roles. • Track department absenteeism daily and report the percentages to the Hillsborough County Health Department.

38. Pandemic Preparation • Train school health staff, teachers and administrators on how to implement the district plan. • Teach students and inform families so they understand what to do in the event of any pandemic.

39. It’s Here And It’s Bad! Is Hillsborough County Schools ready for a Pandemic Flu Outbreak? Questions?

40. www.cdc.gov/flu/school/ • Recommendations for schools and child care providers • Questions and answers: Flu information for schools • Stopping germs at home, work, and school • School materials and posters

41. www.PandemicFlu.gov • One-stop resource for pandemic flu information, including school checklist to address……………………. • Planning and coordination • Continuity of student learning and core operations • Infection control policy and procedures • Ongoing communication

42. References • Avian influenza – fact sheet. (04, January 15). Retrieved November 22, 06, from World Health Organization Web Site: http://www.who.int/csr/don/2004_01_15/en • Avian influenza frequently asked questions. (n.d.). Retrieved November 22, 06, from World Health Organization Web Site: http://www.who.int/csr/disease/avian_influenza/avian_faqs/en/ • Carr, N. (2006). Bracing for bird flu. American School Board Journal, , 37-47.

43. References Continued • Chettle, C. C., & Cohn, S. (2007). Are you prepared for a flu pandemic? Nursing Spectrum,, 16-19. Retrieved January 22, 2007, from Nursing Spectrum Web Site: http://www.nurse.com • Dayton, L. V. (2006). Influenza concerns: Increased awareness of avian, pandemic, seasonal flu. Advance for Nurses, , 19. Retrieved December 25, 06, from http://www.advanceweb.com • HHS Pandemic Influenza plan. (2005, November). Retrieved January 24, 07, from U.S. Department of Health and Human Services Web Site: http://www.pandemicflu.gov

44. References Continued • How is Florida preparing for Avian Flu? (n.d.). Retrieved August 31, 06, from Department of Health Website Web Site: http://www.doh.state.fl.us/rw_Bulletins/panfluplanindex.html • Influenza: Are your schools ready? (n.d.). Retrieved October 30, 06, from Department of Homeland Security, Federal Emergency Management Agency, FEMA Independent Study Program (Emergency Management Institute) Web Site: http://www.training.fema.gov/emiweb/is/crslist.asp

45. References Continued • Leavitt, M. O. (06, June 20). Department of Health and Human Services pandemic planning update ll, a report from Secretary Michael O. Leavitt. Retrieved December 1, 06, from PandemicFlu.govWebsite Web Site: http://www.pandemicflu.gov/plan/pdf/panflureport2.pdf • Lister, G. (2006). Chicken little, wash your hands. American School Board Journal, , 50-54.

46. References Continued • Osterholm, M. (2005). Preparing for the next pandemic. New England Journal of Medicine, 352, 1839-1842. • Pandemic Influenza. (06, December 1). Retrieved December 1, 06, from Center for infectious Disease Research and Policy. Pandemic influenza Web Site: www.cidrap.umn.edu/cidrap/content/influenza/panflu/biofacts/panflu.html • Pandemic influenza. (2005, November 11). Retrieved January 23, 2007, from Homeland Security Web Site: http//www.globalsecurity.org • School district (K-12) pandemic influenza checklist and pandemic influenza planning: Checklist for individuals and families. (n.d.). Retrieved September 9, 06, from Pandemic Flu Website Web Site: http://www.pandemicflu.gov

47. References Continued • Taubenberger, J., & Morens, D. (06, December 1). 1918 influenza: The mother of all pandemics. Retrieved December 1, 06, from CDC website Web Site: http://www.cdc.gov/ncidod/EID/vol12no01/05-0979.htm • U. S. Department of Education. (n.d.). Practical information on crisis planning: A guide for schools and communities. Retrieved October 22, 06, from PandemicFlu.gov. Website Web Site: http://www.ed.gov/admins/lead/safety/emergencyplan/crisisplanning.pdf • What is a Pandemic? (2007). Safer School News, 107, 1-5. • What is a Pandemic? (n.d.). Retrieved January 25, 07, from World Health Organization Web Site: http://www.who.gov