It's flu season, wash your hands
This article first appeared in the St. Louis Beacon, Sept. 4, 2009 - With the start of the school year comes a fresh to-do list for administrators like Lisa Harnacker, manager of health services at the Parkway School District. This year, unlike many others, prioritizing is easy: anything related to the H1N1 virus, commonly known as swine flu, comes first.
"It's right up there on top of the list because it's what's here and now," Harnacker said.
She's spent much of her time over the last month tracking federal health guidelines, coordinating with the St. Louis County Health Department, meeting with school nurses and communicating to parents everything that comes out of these conversations.
School health officials can't know exactly what to expect during fall flu season, which is being closely watched because of the possibility of widespread infection. But they can have some control over what message gets to students, parents and staff about ways to handle individual cases of swine flu and respond to possible outbreaks.
It's not as easy as reminding everyone to wash their hands and cover their mouths -- a message that never changes. The people in charge of crafting flu memos and policies face the challenge of spreading the word about the potential gravity of the situation while not causing a mass panic.
Striking that balance can be difficult for any organization or institution, says Jeffrey Lowell, senior adviser to the mayor of St. Louis for medical affairs who helped organize a regional medical response system that involves both health departments and hospitals.
The communication challenge starts at the top. With conflicting information about the expected number of casualties and some confusion about the different strands of the flu virus, there's plenty of information for government agencies to cover. And so far, Lowell said, they are doing it well.
"To the best of their ability they have to predict the future within a range of what people can expect, with solid messages such as, '[swine flu] will likely return sometime this fall, it will involve our country and the world rapidly developing a vaccine against this strain, developing a method to deliver the vaccine, and developing a system of prioritizing, because there likely won't be enough vaccine the day everyone wants it," Lowell said.
This type of mass immunization hasn't been done for years, said Lowell, who's also a professor of surgery and pediatrics at Washington University. Complicating matters is the fact that two different types of vaccines will likely be needed for two high-risk groups, health-care workers and children.
Both groups are found in schools -- from elementary classrooms up to teaching hospitals -- which is why people who work in education are paying such close attention to the health advisories and thinking about how to minimize damage in places where germs can spread quickly.
Reading, Writing and Risk Management
Unlike the seasonal flu, which often affects the elderly more severely, the H1N1 virus can severely affect people in younger age groups.
The Missouri Department of Health and Senior Services lays it out clearly for school officials: Among the groups who are most vulnerable to the H1N1 virus and should receive vaccine as soon as it is available are all people from 6 months to 24 years of age.
Getting vaccines to students will be an effort involving both regional health departments and the schools. Though the Centers for Disease Control and Prevention doesn't expect the H1N1 flu vaccine to be available until October, conversations about how to distribute the shots are already happening, said Rob Fruendt, CEO of the St. Louis Regional Health Commission.
Harnacker, the Parkway health services manager, said at the end of this month she's going to a St. Louis County Department of Health training session on how to administer the vaccine. The Parkway School District told parents in a letter that they can sign a consent form allowing their student to eventually get the vaccine free of charge at school.
Because young people don't always consider the flu to be a major health risk, Harnacker said she has made a special point to remind students about how the H1N1 virus is different. "We're telling them, 'This isn't your grandparents' flu,'" she said. "Our message is be prepared but don't panic. Don't share utensils, don't share water bottles. If students have flu-like symptoms, don't return to school for 24 hours after being fever-free. People are starting to understand that there's no difference in treatment for the types of flu."
Harnacker said the district has used principal newsletters, school websites and nurse appearances at parent group meetings to get this message across.
She said the district is expecting some students to be out for extended periods - already students in at least three schools there have been diagnosed with some type of flu, the parent letter says. (It also notes that Missouri health officials aren't testing for H1N1 - if a child is diagnosed with so-called type A flu, it's assumed that it's swine flu.)
The district is asking teachers to be flexible about work deadlines. It's also working to get extra substitute teachers in the event that teachers are out with the flu.
That's also the case in the St. Charles School District, said Kay Davis, director of special education and coordinator of health services. She said she wasn't aware of any staff members out yet with flu-like symptoms or any confirmed cases of swine flu among students.
But she said that "there's been a bit of concern from people" about how a bad flu season could affect schools. The district earlier this week sent a letter based off CDC guidelines home to parents alerting them that they will send home students who have a fever.
David said she didn't think students were having a difficult time understand that they are among the groups likely to be most affected by swine flu. "Our nurses and staff have kept that message out there," she said.
The Response on Campus
Colleges are also trying to find the right key in getting out the word about swine flu preparations. David McDonald, director of emergency management and safety at Southern Illinois University, Edwardsville, said his campus has been preparing for a potential pandemic flu outbreak for several years, though the stakes are higher this fall, he said.
SIU-E has established a swine flu website and put together a pandemic planning committee with people from different parts of campus to answer questions coming from students, faculty and staff.
McDonald said it's especially important to get the message to students in communal living spaces who aren't used to being concerned about the flu. "I want people to take this seriously," he said. "Even if it seems like it's not much more serious than the seasonal flu, [students] can still die. In some ways this is like the seasonal flu that we deal with every year, but they can't take it lightly because of that."
Like many other schools, SIU-E is asking that anyone with flu-like symptoms go home (for students that means their home away from campus) and not return until their fever has been gone for a day. Students who can't go home, McDonald said, are being asked not to go into public places.
The university is encouraging faculty to put as much course material online as possible so students can keep up on classes from afar. And, of course, there's the possibility of longer-than-necessary absences.
"We can't request documentation that people have had H1N1," McDonald said. "Doctors don't want everyone coming in to get a slip. But we don't want people to abuse the system - it's on the honor code."
At Washington University, where about half of students have permanent homes that are 600 miles or more away from campus, the message about what to do if you have flu-like symptoms is more complicated.
The university is asking students to either isolate themselves on campus or go to their away-from-campus homes, said Alan Glass, assistant vice chancellor and director of student health services, and co-chair of the campus' emerging infectious disease task force.
A block of rooms are set aside in one dorm -- as well as rooms scattered throughout campus -- for ill students who choose to stay on campus. Residential advisers will follow up on students in person, as other campus health officials will check in over the phone, Glass said.
"As much as we try during a more typical flu season to deal with students, this is a significant entity unto its own," Glass said. "Students don't usually have flu as being high on their priority list of concerns. We are as usual encouraging them to get vaccinated."
He said he expects there to be concern around this issue that for some people "might elevate to a level of greater concern or panic." But he said that having an emergency website and plans in place should quell their fears should they get sick.
The concerns are different at Barnes-Jewish Hospital, where many Washington University physicians and training students work. David Warren, an assistant professor of medicine and hospital epidemiologist who's in charge of infectious disease control, said his concern is raising awareness among health-care workers that anyone with fever or respiratory problems could have the flu.
Because the flu virus primarily spreads through coughing or sneezing, Warren said the hospital has posted signs asking patients who have flu-like symptoms to put on a mask as soon as they enter the building. It's a policy they follow every flu season but one that is being emphasized this year. The hospital is also asking that visitors who have a cough or fever and don't need to be there not enter the building.
Warren said it's a challenge to keep doctors and nurses away when they are sick. "There's a sense of altruism, that I need to take care of my patients, but one message we want to get out is sometimes the best way to take care of them, if you are possibly sick, is to not expose them to anything."
That means the hospital is working with physicians and per-diem nurses to be on call if there are staff shortages during the flu season. One of the advantages of being a hospital associated with an academic institution, Warren said, is that there is a pool of physicians to draw from that can see patients but who normally are doing research.
He said the hospital is prepared to handle a large load of swine flu patients.
"We just don't know how many patients will have influenza, but the assumption we have to make is that it'll be a bad season," he said.