| It sounds like the plot of the next blockbuster | | | | broadcasting SMS text messages and e-mails and |
| movie. A third of the world's population is struck | | | | using an emergency Web page for mass |
| down by a deadly virus that spreads across the | | | | communication. |
| globe so rapidly that there is no time to develop a | | | | When you do know the scope of your resources, |
| vaccine. Up to half of those infected - even | | | | both human and financial, you can continue to |
| young, healthy adults - die. But as health | | | | flesh out your plan. Excellent resources can be |
| professionals know, this scenario is not just a | | | | found on ACHA's Web site: and A tip from the |
| flight of fancy. It could be the very real effects | | | | experts: be wary of developing your plan in a |
| of the next pandemic flu outbreak, particularly if | | | | vacuum. "I know of a school that didn't know |
| H5N1 (also known as highly pathogenic avian flu) is | | | | their gymnasium was being considered as a point |
| the virus in question, and it is this knowledge that | | | | of vaccination until they happened to find out in |
| is pushing not just federal and state government | | | | the course of an outreach program," Barkin |
| but organizations and businesses throughout the | | | | relates. "The local health department hadn't |
| world to develop a strategy to tackle it. | | | | informed them." This is very obviously a benefit |
| Within colleges and universities, the burden of | | | | of starting a dialogue with your local health |
| pandemic flu planning is likely to fall upon many | | | | services: you find out what they have planned |
| student health directors, even at institutions with | | | | and you can also coordinate your plans to add |
| environmental health and safety departments. | | | | value and decrease the number of unknown |
| John Covely, a consultant on pandemic flu planning | | | | factors. |
| and the co-author of the University of North | | | | Dr. Mary McGonigle, director of the student health |
| Carolina at Chapel Hill's pandemic plan, explains | | | | center at Villanova University, says that their |
| why this is so. | | | | dialogue with their local health department led to |
| "Traditionally, emergency planning originates from | | | | Villanova being assessed and labeled a "push" site, |
| public safety, or environment health and safety, | | | | a location that is self-sufficient in this type of |
| but a communicable disease poses the biggest | | | | emergency. She explains: |
| threat to students in group quarters. Thus, | | | | "In the event of a pandemic, we'd go and pick up |
| student health directors are often leading the | | | | supplies from the county and then administer |
| emergency planning effort for the whole | | | | medicine to our Villanova community. That includes |
| university, because the entire plan - not just the | | | | students, faculty and their families." |
| student health component - could be the | | | | Help from the county is a financial boon but being |
| difference in life or death for their students." | | | | self-sufficient and staying local also lowers the risk |
| The importance of having a campus-wide plan | | | | of spreading the virus so rapidly. The dialogue |
| that is ready - not just in the preliminary stages - | | | | helps your local health services too. If your local |
| when the pandemic strikes is all the more clear | | | | hospitals are likely to have a shortage of beds, |
| when you consider that, unlike seasonal flu, H5N1 | | | | they may want to use college dorms for surge |
| has an increased risk for the typical student | | | | capacity at the peak of a pandemic. In return, |
| demographic of young, healthy adults. The | | | | they may be able to offer you some resources, |
| startlingly high mortality rate of up to 60 percent | | | | although research suggests that most hospitals |
| is partly due to a protein, also found in the strain | | | | have not had the budget to be able to stockpile |
| of virus responsible for the 1918 pandemic flu | | | | effectively either. |
| outbreak, which causes a response in a healthy | | | | Once you have your plan together, it's important |
| immune system known as a "cytokine storm", | | | | not just to file it away and forget about it. |
| often leading to respiratory failure and death. | | | | "Planning for a pandemic is very much a work in |
| Planning for such a massive and yet unpredictable | | | | progress, but it is often hard to keep up the |
| event may seem a formidable task, but Dr. Anita | | | | interest in reviewing and updating plans, especially |
| Barkin, chair of the American College Health | | | | when H5N1 activity drops out of the news," |
| Association's pandemic planning committee, | | | | explains Covely. Tabletop exercises are one way |
| counsels that those universities and colleges that | | | | to test the effectiveness of a plan and a good |
| have yet to formulate a pandemic plan shouldn't | | | | way to maintain interest. Covely specializes in |
| feel overwhelmed by the work that lies before | | | | facilitating these tabletops and finds that they can |
| them. "Pandemic planning is about good | | | | significantly increase staff's buy-in as well as |
| emergency preparedness. The things we do to | | | | providing useful discussion points. |
| prepare for any emergency are the things we | | | | "Used before the planning begins, tabletops |
| would do to prepare for pandemic flu," she | | | | provide a way of educating employees and |
| explains. | | | | getting them interested in developing continuity of |
| Although the tragic Virginia Tech shootings this | | | | operations plans," he says. "They are excellent for |
| spring were a different kind of emergency, the | | | | post planning too, in order to test the plans. I am |
| issues are similar to the issues faced in the event | | | | always amazed at the creative analysis and insight |
| of a pandemic flu outbreak. Coordinating | | | | that comes from a tabletop." |
| resources, communicating with everyone on | | | | The ongoing and fluid nature of pandemic planning |
| campus and deciding at what stage classes should | | | | is very much evident in some of the complex and |
| be called off are questions that have to be | | | | thorny issues that have no definitive answer. |
| answered in most emergency situations. Take | | | | These may need to be revisited and rethought as |
| your pandemic planning one step at a time, | | | | scientific discoveries are made, as you approach a |
| advises Barkin. | | | | pandemic, and if your college's resources change. |
| "The first step is to find out whether there is an | | | | One such issue is the availability of expensive |
| existing emergency plan on campus," she says. "If | | | | antivirals. The federal government has announced |
| there is, who is in charge of it? Health providers | | | | that it is stockpiling them and coming up with a |
| on campus should then take charge and begin to | | | | strategy for distribution, which might seem to |
| formulate the plan." | | | | take some of the financial pressure off student |
| There are many unknown factors, but build the | | | | health services. Barkin however has a caveat. "I'm |
| framework of the plan first with the elements | | | | concerned that stockpiles would not be distributed |
| you can be sure of. Form a committee with all | | | | in enough of a timely fashion to make an impact |
| key areas represented, including executive | | | | on the community. Katrina is a situation that has |
| leadership. ACHA's Guidelines for Pandemic Planning | | | | to come to mind." |
| provides a list as an example that may help you | | | | Even if you did manage to persuade campus |
| collate this. Identify the functions that will be | | | | decision-makers to invest budget in stockpiling |
| critical in the case of a pandemic and the | | | | antivirals, a potentially challenging feat, there's a |
| personnel on campus responsible for each of | | | | chance that they would be ineffective by the |
| these, making sure there are enough people | | | | time a pandemic occurs, as overuse can cause |
| representing each function that should some | | | | the emergence of a resistant strain. Barkin |
| become sick, the plan is not compromised. | | | | explains that infectious disease experts are talking |
| Identify decision makers, a chain of command, | | | | about using a treatment cocktail - Tamiflu plus |
| and what channels of communication are to be | | | | one or two other agents - to protect against the |
| used. Finally, decide on the role of student health | | | | emergence of resistant strains, but this would be |
| services. Many campuses will have the student | | | | prohibitively expensive for the average college |
| health director as the key decision maker in the | | | | health center. |
| event of a pandemic, but for some it will be more | | | | Another ethical dilemma surrounding pandemic |
| appropriate for the student health director to | | | | planning concerns who should get prepandemic |
| have an advisory role instead. In any case, college | | | | vaccines. Scientists are developing vaccines based |
| health professionals will be crucial to the success | | | | on the strain of avian flu that has been circulating |
| of every plan. | | | | in Asia, hoping that the vaccine would be enough |
| The biggest question that is central to every | | | | of a match to combat the illness until a proper |
| campus-wide pandemic plan: when is the right | | | | vaccine could be developed six months after the |
| time to send students home? Covely warns that | | | | pandemic's emergence. But supplies of this |
| universities cannot necessarily wait for cues from | | | | prepandemic vaccine will be limited. |
| state public health departments before they make | | | | "Some of the conversations around who should |
| their decisions. "The university has to have its | | | | get these prepandemic vaccines are very |
| own in-depth criteria in advance of a pandemic, | | | | complex," says Barkin. "Should it be health care |
| and the student health director should be very | | | | workers that get it, or public safety workers such |
| involved in developing those criteria." | | | | as firemen? Should it be government officials, or |
| Barkin suggests looking back to the 1918 influenza | | | | the very young and elderly?" Recently, the federal |
| epidemic for context. | | | | government has announced a three-tiered |
| "In 1918, the virus spread across the country in | | | | approach to vaccination that it has developed in |
| three to four weeks. If you think about the fact | | | | consultation with public focus groups and ethicists |
| that the virus traveled from coast to coast in | | | | that places health care workers in the second tier. |
| that short a time when the primary means of | | | | Whether your health center staff will receive the |
| long-distance transport was the train, and then | | | | vaccine, whether it will be in a timely fashion, and |
| you think about how much more quickly we can | | | | how effective it will actually be, are all factors |
| travel today by plane, that timeline is going to be | | | | that will affect your pandemic plan greatly - and |
| compressed significantly." | | | | demonstrate how much of your planning has to |
| In other words, don't wait too long to send your | | | | leave room for the unknown. |
| students home. Nor should your trigger for this | | | | One thing that is beyond question is the |
| decision rely on the geographical proximity of the | | | | importance of student health services acting now. |
| virus to your campus alone. Covely explains: | | | | Formulating a pandemic plan may be a slow and |
| "Geographical proximity is not definitive enough in | | | | ponderous task, but there's one vital aspect that |
| this age when in a single day, there are 50,000 | | | | will slow the spread of a pandemic and can be |
| passenger flights throughout the world," he says. | | | | tackled by your department immediately without |
| "Because New York City and Hong Kong have | | | | getting tangled in red tape and endless meetings. |
| major international airports, epidemiologically, New | | | | Barkin elaborates: |
| York City is actually closer to Hong Kong than it is | | | | "Every single student health service needs to be |
| to Buffalo, so waiting to suspend classes until a | | | | involved in educational outreach efforts to |
| confirmed case gets to your region, or within 500 | | | | distribute information on the role of flu |
| miles, may be too late." | | | | vaccinations, cough etiquette, when to come to |
| The factors that will determine how early you | | | | work and when to stay at home if you are ill and |
| make the call to send students home will center | | | | the importance of creating a personal |
| on the composition of your student population. If | | | | preparedness plan in the event of a pandemic." |
| your students are mostly from in-state, they will | | | | This public health education can be a collaborative |
| probably be traveling home by car and so you | | | | effort with human resources and residence life |
| can wait slightly longer before canceling classes | | | | staff. Covely agrees and even suggests extending |
| and closing the campus down. If many students | | | | the scope beyond campus boundaries. "It's part of |
| live a long way away and are going to need to | | | | being a good and responsible neighbor to the |
| use mass transportation, you may have to act | | | | community, and it has tremendous public relations |
| more quickly or risk being swamped with very ill | | | | benefits to the university," he says. |
| students at a time when the local hospitals will not | | | | The collaboration required in pandemic planning can |
| have the resources to help. | | | | build bridges, but be prepared for it also to be |
| There are three main elements that will shape the | | | | particularly challenging. McGonigle relates: |
| logistics and the scale of your plan, and help you | | | | "At Villanova, we're still in the stages of planning. |
| figure out the best trigger to send students | | | | We've done a lot. But I would say the most |
| home. Remember that, as Barkin comments, | | | | difficult part is trying to connect and communicate |
| "The longer you wait, the higher the rate of | | | | with all the different departments on campus and |
| infection, the less chance of being able to get | | | | plan for all the different scenarios." |
| students home and the less likely you can | | | | Indeed, planning for all contingencies - not just the |
| manage the burden of disease." | | | | obvious problems of effectively treating the sick |
| These factors are as follows: | | | | and minimizing the mortality rate, but also coping |
| Student demographics, particularly the number of | | | | with disruptions to services and shortages of |
| students who live on campus and the number of | | | | supplies caused by huge absenteeism and the |
| non-local students who are likely to be dependent | | | | ensuing breakdown in the transportation system, |
| on care. | | | | and questions such as whether to pay staff if the |
| The size of your staff (taking into account that | | | | campus is shut down - has caused planning at |
| up to 50 percent may be sick at one time). | | | | many colleges and universities to take much |
| Your ability to stockpile enough basic supplies, | | | | longer than anticipated. |
| including medications, as well as personal | | | | Pandemic planning is also dogged by a sense of |
| protective equipment such as respirators. | | | | unreality: could something this vast really happen? |
| This is where things start to get more | | | | (The answer, as every health professional knows, |
| complicated, however. Most student health | | | | is "yes", and is a question of when and not if.) |
| services can't afford to stockpile many medical | | | | Media coverage of pandemic flu is patchy and |
| supplies. "ACHA is running a survey on pandemic | | | | focuses on sensational stories rather than the |
| planning," reveals Barkin. "Of the schools that have | | | | need for personal emergency preparedness. |
| responded, most have not stockpiled, or if they | | | | Because it's not an issue in the forefront of the |
| have, it's not a lot." This could clearly prove | | | | public's mind, it's sometimes hard to conjure up |
| disastrous, and for many colleges is a | | | | the necessary sense of urgency, particularly |
| manifestation of what Covely cites as one of the | | | | because there is always some issue on campus |
| biggest challenges of pandemic planning for some | | | | demanding more immediate attention. Barkin |
| universities: "getting buy-in from the executive | | | | sympathizes, but has some sobering last words |
| leadership." Pandemic planning is by no means a | | | | on the subject. |
| cost-free exercise. | | | | "Recently, the issue of pandemic flu has fallen off |
| One tip if you are facing resistance from campus | | | | the radar," she says. "We've been talking about it |
| decision-makers over spending money on | | | | for two years and now there are other pressing |
| pandemic planning is to emphasize the fact that | | | | issues that have pushed it to the back burner. But |
| once you've formulated a response to a possible | | | | the issue of pandemics is not going to go away. |
| pandemic, you will have a robust emergency | | | | We've had them throughout history and if you |
| response strategy that can be adapted to fit | | | | look at the patterns, we're due for a pandemic |
| virtually any emergency, whether it's evacuation in | | | | soon. It may or may not be H5N1, and it may or |
| the event of wildfires, such as Pepperdine | | | | may not be on the 1918 scale. What we cannot |
| University faced recently, a terrorist threat, or an | | | | ignore, however, is the planning that's needed, |
| "active shooter". Investment in, say, developing a | | | | because in a pandemic, health centers and heath |
| Web site with emergency information and | | | | care providers will be looked to and expected to |
| updates can be a public relations bonus and a | | | | know how to respond. |
| reliable resource. Villanova University's plan includes | | | | |