Lessons Learned in Online Sharing Conference: H1N1 Experiences from Big Ten+2 Universities

1. Big 10+2 Universities H1N1 Lessons Learned Online Sharing Conference • University of Illinois • Indiana University • University of Iowa • University of Michigan • Michigan State University • University of Minnesota • Northwestern University • The Ohio State University • Pennsylvania State University • Purdue University • University of Wisconsin • University of Chicago Edward P. Ehlinger, MD, MSPH Director and Chief Health Officer Boynton Health Service, University of Minnesota

2. University of Minnesota Project Team 2 • Dave Bender, CIDRAP • Paul Bernhardt, School of Public Health • Jill DeBoer, CIDRAP and Academic Health Center • Ed Ehlinger, Boynton Health Service • Kathleen Kimball-Baker, CIDRAP • Amy Becker LaFrance, CIDRAP • Elizabeth McClure, Academic Health Center • Joan Rambeck, Academic Health Center • Technical and other staff, volunteers

3. Other Collaborators Caroline Barnhill, MPH, Director, Emerging Infections, Association of State and Territorial Health Officials Lisa C. Barrios, ScM, DrPH Chief, Research Application Branch. CDC Division of Adolescent and School Health, Lead, 2009 H1N1 Flu Community Measures Guidance, Technical Assistance and Communications Group Marsha L. Vanderford, PhD Chief, Risk Communication Branch, CDC DEO/OPHPR Director, Emergency Communication System

4. Agenda for Online Sharing ConferenceMay 18, 2010 4 • Snapshots from interviews (all areas) • Preview of practices available online • Health services • Reports from the field (U of Ill, PSU) • Vaccine distribution • Reports from the field (IU, OSU, PU) • On-line polling • Dialogue with CDC partners • Federal guidance documents • Outreach to higher education • Challenges/issues needing further attention

5. Snapshots from Interviews 5 • Incident Management • Residence Halls • Health Services • Communications • Vaccine Distribution • Teaching Policies • Human Resources • Collaboration with Local and State Public Health • Issues Needing Further Attention

6. Incident Management 6 • Importance of NIMS structure and training • Planning and response group with broad representation • A variety of successful approaches were used • Importance of strong leadership and integration of health/public health personnel • Planning and decision-making • Various successful methods used to convene and communicate among response team members • Extended response time

7. Incident Management: Sample Practices 7 • Successful experience with Virtual EOC (University of Wisconsin) • Successful experience with Health DOC (University of Minnesota) • External EOC operations evaluation (Indiana University)

8. Residence Halls 8 • Early concerns about summer camps • Mismatch between plans and H1N1 reality • Many institutions had limited to no options to relocate students due to housing capacity • Those who implemented isolation housing reported mixed results • Standard approach: “If you have symptoms, go home. If you can’t leave, self-isolate.” • “We really dodged a bullet here.”

9. Residence Halls 9 • Important role for dining services partners • Online meal ordering systems • Meal delivery • Important role for student leaders • Resident Advisors • Community Advisors • Health Advocates • Some reached out to fraternities and sororities

10. Residence Halls: Sample Practices 10 • Alternate housing plan for international students (Michigan State University) • Student involvement in development of H1N1 housing plan (University of Chicago) • Online census and health survey (University of Minnesota)

11. Health Services 11 11 • Modified health service operations • Building entrance changes • Trained greeters • Triage protocols • Some suspended standard clinic operations for a time • Importance of phone-based information and triage (nurse lines) • Most reported being “busy but not overwhelmed”

12. Health Services: Sample Practices 12 12 • Online screening system for those with symptoms and those exposed (Northwestern University) • Flu nurse protocol (Purdue University) • Direct parent contact (University of Illinois) • Direct patient follow-up (Pennsylvania State University) • Infection control internship (Pennsylvania State University)

13. Communications: The Big Themes • Coordinating messages was crucial • Unified approach to vetting communications, importance of speaking “one message with one voice” • Streamlining information also helped • Heavy reliance on email communications and consolidated online information. Align all websites. Update information daily. • Finding multiple modes/media was beneficial • Approaches include signage, residence hall kiosks, tweet chats/podcasts with health experts, and many more.

14. Communications: The Big Themes 14 • Great media interest in higher education experiences and responses • Concerns about message fatigue over time • Overall, communication efforts were a success • “Our Housing Department had more complaints about bedbugs than H1N1.” www.tapirback.com www.giantmicrobes.com

15. Communications: Sample Practices • Student chapter of the American Red Cross created brochures on H1N1 that were distributed with hand sanitizer to city bus riders. They reached 5,000 people in two days.(Purdue University) • Rapid ‘triage’ of non-clinical questions e-mailed to a central “M-Hub.” Messages were forwarded to the right people for quick replies. (University of Wisconsin-Madison) From University of Michigan’s campaign http://www.vpcomm.umich.edu/flu/pdf/cover_cough.pdf

16. Vaccine Distribution 16 16 • Vaccine access and quantities available were a challenge • Complications of nasal and injectable product differences and availability • Mixture of mass walk-in clinics and scheduled appointment systems successfully used. • Many successes and lessons learned

17. Vaccine Distribution: Sample Practices 17 17 • Online appointment systems (Indiana University, Michigan State University, University of Minnesota) • Automated phone registration (Ohio State University) • Mass clinic operations (Purdue University, University of Minnesota) • Effective student assistance models (Pennsylvania State University, University 0f Iowa, University of Chicago) • Use of Medical Reserve Corps (University of Minnesota) • Effective FluMist protocol (University of Minnesota) • Effective use of incentives (University of Illinois)

18. Teaching Policies 18 • Spring 2009: Concerns about travel abroad programs in Mexico • Fall goal: Effective self-isolation for students and faculty with symptoms • Nearly all of us have an existing absence note policy which needed suspension • Formal suspension/informal suspension • Faculty concerns required follow-up • Reviewed alternate methods for completing courses should social distancing measures be implemented

19. Teaching Policies: Sample Practices 19 • Faculty webinar (Michigan State University) • Weekly classroom attendance monitoring through use of a convenience sample of classes (Pennsylvania State University)

20. Human Resources 20 • Great deal of communication to employees • Questions and concerns emerged about sick and vacation leave policies • Some enacted new HR policies • Some developed guidance documents • Business continuity plans revisited • Who are the essential employees during a pandemic?

21. Human Resources: Sample Practices 21 • Guidance documents (University of Illinois, Ohio State University) • Pandemic influenza policy (University of Minnesota) • Essential function staff designations (Purdue University)

22. Collaboration with Health Departments 22 • Great collaborations reported across the board with local health departments • Two-way partnerships • Good information sharing • Vaccine sharing • Some variability on direct relationships with state health departments • Vaccine distribution was the biggest area of conflict • Important partnerships with hospitals, medical centers, local emergency managers, and CBOs.

23. Collaboration: Sample Practices 23 • Memorandum of understanding with local public health (Purdue University) • Open letter to Athletic Directors from State Epidemiologist (University of Minnesota)

24. Challenges: Snapshots from Interviews 24 • Vaccine access and distribution • Residence halls • Plan activation triggers • Stockpiling supplies • Providing education when social distancing is recommended • Universities as communities • Need to establish an effective partnership with local and state health department

25. Challenges: Snapshots from Interviews 25 • Other • Use of antivirals • Designation of essential personnel and operational continuity plans • Compensation policies • Need for alternate methods to reach parents • Media coverage • Need for improvement redesign of plans based on this experience • Response price tag

26. Key Themes from CDC IHE Needs Assessment, Spring 2010Lisa C. Barrios, ScM, DrPH 26 26 • 2009 H1N1 was overblown; pandemic fatigue • Need clarity on “increased severity” • Need more information/special outreach for: • Rural and international students • Non-faculty staff (e.g., cafeteria workers) • Addressing parent concerns • Concerned with “increase social distancing” and “stay home when sick” recommendations • No formal policy change: students encouraged to stay home when sick; faculty encouraged to relax attendance requirements

27. Your Turn: What Should CDC Know About Communications? Marsha L. Vanderford, PhD, 27 27 • Do you agree or disagree with the themes from the needs assessment? • What information was missing from the CDC guidance? • Did you make any policy changes because of H1N1? • What information/tools would you need to change policy or practice? • Did your university make use of any social media channels to communicate with students? • If so, what were they? Text messages? Tweets? Blogs? Facebook? • What communications activities did you find most effective? • What communications activities did you consider ineffective? • Where did you find the information you communicated to others? • What impact, if any, did this have on your school policies? • What changed? Why?

28. Overarching Themes 28 28 • Colleges and universities were significantly impacted by H1N1 – nearly all campus operations were affected. • Uncertainties early on were a challenge – required preparation for all possibilities. • H1N1 response required an unprecedented level of community organizing over an extended period of time. • Multi-discipline response teams worked well. • Importance of student leadership and participation.

29. Big 10+2 Universities H1N1 Lessons LearnedNext Steps Publication of report for all Big 10 + 2 Institutions Summary report for ASTHO and its members CIDRAP’s Promising Practices web site expansion WWW.CIDRAPPRACTICES.ORGYou can now access an archived version of the Lessons Learned Conference. Later this summer specific university practices will be available.