School districts are planning for a pandemic

The Hickman Mills C-1 School District in Kansas City, Mo., is working on revamping its security plan to include information on a pandemic, says Judi Patrick, the district’s nurse coordinator.

The first line of defense is to publicize the wellness policies already in place, she says. Principals are sending information to parents to encourage hand washing and other healthy habits. The district also is considering setting up a trailer with water, food, and health supplies.

“We’re preparing for a pandemic the same way we prepared for Y2K,” says Donna Missimer, a school nurse in charge of coordinating teacher-health services at the Blue Valley school district in Overland Park, Kan.

School officials might hope the threat of a pandemic will turn out like the Y2K non-crisis, but health officials warn of a very real danger.

At a White House briefing in early May, Dr. Rajeev Vankayya, special assistant to the President for biodefense, said there definitely will be a pandemic, and it could arrive in the United States as soon as this year. It is “inevitable,” he says. The only questions are when, where, and how extensive it will be.

The spread of the H5N1 influenza virus in bird populations throughout Asia, Europe, and Africa has raised alarms about the possibility of a widescale epidemic that could affect millions of people worldwide. As of May 12, the disease has spread from birds to 208 humans, and 115 people have died, the CDC reports.

“If the bird virus undergoes certain genetic changes, it could develop the ability to infect and be transmitted between humans,” says Fran Townsend, assistant to the President for homeland security and counterterrorism. “If that occurs, it could spread across the globe.”

If the United States is hit by a pandemic, don’t expect the federal government to take sole responsibility for protecting the public. The President’s plan for dealing with a pandemic says businesses, communities, and the public should be prepared to be “on their own” for significant periods of time.

According to Townsend, “The best way to protect oneself from an outbreak is to take action at the community level to reduce the spread of the disease.” While the federal government “carries significant responsibility here,” she says, “all of our plans depend upon the collective action of individuals, families, businesses, schools, and state and local governments.”

The U.S. Health and Human Services Pandemic Influenza Plan says schools need to be prepared, because children are at great risk of spreading disease. The plan contains these assumptions about pandemics and their potential effect on school-age children:

• About 25 percent of the general population will be too sick to go to work or school. Among school-aged children, it will be closer to 40 percent.

• Children are more contagious than adults and are likely to pose the greatest risk for transmission.

• School districts should expect to have a work force absentee rate of about 30 percent.

• On average, about two secondary infections will occur as a result of transmission from someone who is ill.

• In an average community, a pandemic outbreak will last six to eight weeks. At least two disease waves are likely.

• Antiviral medications will be in extremely short supply.

• There is likely to be significant disruption of transportation, commerce, utilities, public safety, and communications.

The Implementation Plan for the National Strategy for Pandemic Influenza, released by the Homeland Security Council in May, offers guidance for K-12 schools and stresses the importance of “building a strong relationship with the local health department.”

The plan recommends that schools develop alternative procedures to ensure continuity of instruction if schools are closed, through such means as “web-based distance instruction, telephone trees, mailed lessons and assignments, and instruction via local radio or television stations.”

According to the plan, school leaders should adopt policies on staff absences, such as non-punitive, liberal sick leave; for sending students and staff home if they get sick at school or are suspected of being ill; and for transporting ill students. It suggests schools teach effective infection control practices, such as hand washing, and stock up on infection prevention supplies.

The document also includes recommendations on planning, coordination, and communications. And it says school leaders should “anticipate the potential fear and anxiety of staff, students, and families, as a result of rumors and misinformation and plan accordingly.”

“The Implementation Plan is like a road map,” says Brenda Greene, NSBA’s director of school health programs. “It shows where to go, but it doesn’t say how to get there. The how to’s have to be figured out at the local level in partnership with other key agencies.”

The Cherry Creek, Colo., school system, working with regional and state health departments, has drafted an extensive Pandemic Influence Response Plan, with these goals: limit the number of illnesses and deaths, preserve continuity of essential school functions, minimize educational and social disruption, and minimize academic and economic losses.

The plan is not quite final, says Richard Collier, executive director of facility support. “We are still working out a few details, and not all of the parties have signed off on it.”

The plan assumes that if a pandemic occurs, schools would likely be closed for at least two weeks and possibly as long as eight weeks.

“Some of our biggest concerns deal with school closings,” Collier says. “How do we make up that time? Or can we educate students remotely?”

The Cherry Creek plan calls for Tri-County Health, which serves Adams, Arapahoe, and Douglas counties, to be the lead agency in coordinating the local heath and medical response to a pandemic with state, federal, and local agencies.

The plan calls for the school district to:

• develop capabilities to implement non-medical measures to reduce the spread of disease;

• educate the school community about approved health practices and how each person can minimize health risks; and

• develop educational support plans for students who are isolated or quarantined.

The plan calls for each school to develop a response plan with these elements:

• identify a chain of command in case of illness with at least two back-ups;

• review and implement best practices for respiratory hygiene; train staff, students, and volunteers; and procure needed resources;

• review procedures for sending ill people home; and

• report the numbers of staff and students absent with the flu every day to the district’s health services coordinator.

According to the plan, “Communications with the public and health care providers will be one of the most critical strategies for containing the spread of the influenza.”

The district’s communications goals are to provide accurate, consistent, and comprehensive information about treatment options, infection control measures, and reporting requirements. The plan also addresses the need to share information among various agencies, quell rumors and misperceptions, and prevent the stigmatization of affected groups.

Under the plan, Tri-County Health would establish an influenza surveillance program that calls for schools to be “sentinel reporters,” meaning they would be required to report student absentee rates above 10 percent.

Noting the possibility that 25 to 35 percent of the work force could be absent during a pandemic, the document calls for the district to develop a continuity of operations plan that addresses a line of succession for the agency and the reassignment of staff to support essential services.

It also suggests further items to be considered, such as the need to educate students who are isolated or quarantined; the need to obtain supplies, such as soap, gloves, and masks; the identification of critical functions that could be performed through telecommuting or alternative scheduling; and technology needs, such as laptops, remote access, and information security.

Any plan on dealing with a pandemic should cover the provision of education if schools are closed for an extended time, and technology is likely to be a major part of this effort.

“If schools are closed, we need to provide options for continuing instruction and keeping critical functions going in school districts, such as payroll,” says Jerome Browning, an administrator at the Alabama Department of Education who is working on developing aspects of the agency’s pandemic plan dealing with technology.

Alabama already has a distance learning system designed to provide instruction in rural areas that could be adapted for wider use during an emergency, Browning says. The state also has various teleconferencing and web conferencing systems in place or under development that could be used to provide educational services to students unable to attend school.

The state agency is developing a list of options for school districts, he says. “Having experience with these systems now will be helpful if there is an emergency.”

Browning suggests a school district in an area where a pandemic has hit make arrangements to share resources with districts not affected. For example, if a district’s sole geometry teacher is out sick, the district could arrange for students to have access to a geometry class in another district via interactive video conferencing.

“This would require all kinds of teacher contracts to be relaxed,” he notes. “It would take tremendous collaboration.”

At the Blue Valley school district in Kansas, Dennis McCarthy, director of safety and security, is working on the technology aspects of the district’s pandemic plan.

Among the issues McCarthy is concerned with is determining the extent to which staff members will be able to work from home if schools are closed and the capacity of the district to quickly inform people of changing circumstances.

Blue Valley hopes to use voice mail, the district’s cable TV station, and its website to send messages to parents and announce school closures and activity cancellations.

Technology also will be needed to monitor what is going on in a metropolitan area in the throes of a pandemic. “We’ll need to know if it is growing or stable,” he says. “Things could be changing hour by hour.”

If schools are closed for a month or more, the district needs to know “if it is feasible to continue the education process with technology so we don’t lose that time,” McCarthy says. But first the district needs to survey families to see how many don’t have Internet access at home.

The Blue Valley school district, working with the Johnson County health and emergency management departments, identified two school sites -- a high school gymnasium and a district-owned facility not used for education -- as potential vaccination centers, McCarthy says.

There has been some talk that if the hospitals are overcrowded, schools could be converted into makeshift clinics, he says, and eventually, this possibility is likely to be incorporated into the plan. Another issue to be addressed is how to clean up a school after it has been contaminated by infection.