It sounds like the plot
of the next block buster movie. A third of the world’s population is struck
down by a deadly virus that spreads across the globe so rapidly that there is
no time to develop a vaccine. Up to half of those infected – even young,
healthy adults – die. But as health professionals know, this scenario is not
just a flight of fancy. It could be the very real effects of the next pandemic
flu outbreak, particularly if H5N1(also known as highly pathogenic avian flu)
is the virus in question, and it is this knowledge that is pushing not just
federal and state government butorganizations and businesses throughout the
world to develop a strategy to tackle it.
Within colleges and
universities, the burden of pandemic flu planning is likely to fall upon many
student health directors, even at institutions with environmental health and
safety departments. John Covely, a consultant onpandemic flu planning and the
co-author of the University of North Carolina at Chapel Hill’s pandemic plan,
explains why this is so.
“Traditionally,
emergency planning originates from public safety, or environment health and
safety, but a communicable disease poses the biggest threat to students in
group quarters. Thus, student health directors are often leading the emergency
planning effort for the whole university, because theentire plan - not just the
student health component - could be the differencein life or death for their
students.”
The importance of
having a campus-wide plan that is ready – not just in the preliminary stages –
when the pandemic strikes is all the more clear when you consider that, unlike
seasonal flu, H5N1 has an increased risk for the typical student demographic of
young, healthy adults. The startlingly high mortality rate of up to 60 percent
is partly due to a protein, also found in the strainof virus responsible for
the 1918 pandemic flu outbreak, which causes a response in a healthy immune
system known as a “cytokine storm”, often leading to respiratory failure and
death.
Planning for such a
massive and yet unpredictable event may seem a formidable task, but Dr. Anita
Barkin, chair of the American College Health Association’spandemic planning
committee, counsels that those universities and colleges that have yet to
formulate a pandemic plan shouldn’t feel overwhelmed by the work that lies
before them. “Pandemic planning is about good emergency preparedness. The
things we do to prepare for any emergency are the things we would do to prepare
for pandemic flu,” she explains.
Although the tragic
Virginia Tech shootings this spring were a different kind of emergency, the
issues are similar to the issues faced in the event of a pandemic flu outbreak.
Coordinating resources, communicating with everyone on campus and deciding at
what stage classes should be called off are questions that have to be answered
in most emergency situations. Take your pandemic planning one step at a time,
advises Barkin.
“The first step is to
find out whether there is an existing emergency plan on campus,” she says. “If
there is, who is in charge of it? Health providers on campus should then take
charge and begin to formulate the plan.”
There are many unknown
factors, but build the frame work of the plan first with the elements you can
be sure of. Form a committee with all key areas represented, including
executive leadership. ACHA’s Guidelines for Pandemic Planning provides a list
as an example that may help you collate this. Identify the functions that will
be critical in the case of a pandemic and the personnelon campus responsible
for each of these, making sure there are enough people presenting each function
that should some become sick, the plan is not compromised. Identify decision
makers, a chain of command, and what channels of communication are to be used.
Finally, decide on the role of student health services. Many campuses will have
the student health director as the key decision maker in the event of a
pandemic, but for some it will be moreappropriate for the student health director
to have an advisory role instead. In any case, college health professionals
will be crucial to the success of every plan.
The biggest question
that is central to every campus-wide pandemic plan: when is the right time to
send students home? Covely warns that universities cannot necessarily wait for
cues from state public health departments before they make their decisions.
“The university has to have its own in-depth criteria inadvance of a pandemic,
and the student health director should be very involved in developing those
criteria.”
Don't wait too long to
send your students home. Nor should your trigger for this decision rely on the
geographical proximity of the virus to your campus alone.
The factors that will
determine how early you make the call to send students home will center on the
composition of your student population. If your students are mostly from
in-state, they will probably be traveling home by car and so you can wait
slightly longer before canceling classes and closing the campus down. If many
students live a long way away and are going to need to usemass transportation,
you may have to act more quickly or risk being swamped with very ill students
at a time when the local hospitals will not have the resources to help.
There are three main
elements that will shape the logistics and the scale of your plan, and help you
figure out the best trigger to send students home. Remember that, as Barkin
comments, “The longer you wait, the higher the rate of infection, the less
chance of being able to get students home and the less likely you can manage
the burden of disease.”
These factors are as
follows:
- Student demographics, particularly the number of students who live on campus and the number of non-local students who are likely to be dependent on care.
- The size of your staff (taking into account that up to 50 percent may be sickat one time).
- Your ability to stockpile enough basic supplies, including medications, aswell as personal protective equipment such as respirators.
This is where things
start to get more complicated, however. Most student health services can’t
afford to stockpile many medical supplies. “ACHA is running a survey on
pandemic planning,” reveals Barkin. “Of the schools that have responded, most
have not stockpiled, or if they have, it’s not a lot.”This could clearly prove
disastrous, and for many colleges is a manifestation of what Covely cites as
one of the biggest challenges of pandemic planning forsome universities:
“getting buy-in from the executive leadership.” Pandemic planning is by no
means a cost-free exercise.
One tip if you are
facing resistance from campus decision-makers over spending money on pandemic
planning is to emphasize the fact that once you’ve formulateda response to a
possible pandemic, you will have a robust emergency responsestrategy that can
be adapted to fit virtually any emergency, whether it’sevacuation in the event
of wildfires, such as Pepperdine University faced recently, a terrorist threat,
or an “active shooter”. Investment in, say,developing a Web site with emergency
information and updates can be a publicrelations bonus and a reliable resource.
Villanova University’s plan includes broadcasting SMS text messages and e-mails
and using an emergency Web page formass communication.
Dr. Mary McGonigle,
director of the student health center at Villanova University, says that their
dialogue with their local health department led toVillanova being assessed and
labeled a “push” site, a location that is self-sufficient in this type of
emergency. She explains:
“In the event of a
pandemic, we’d go and pick up supplies from the county and then administer
medicine to our Villanova community. That includes students,faculty and their
families.”
Help from the county is
a financial boon but being self-sufficient and staying local also lowers the
risk of spreading the virus so rapidly. The dialogue helps your local health
services too. If your local hospitals are likely to have a shortage of beds,
they may want to use college dorms for surge capacityat the peak of a pandemic.
In return, they may be able to offer you some resources, although research
suggests that most hospitals have not had the budget to be able to stockpile
effectively either.
The ongoing and fluid
nature of pandemic planning is very much evident in some of the complex and
thorny issues that have no definitive answer. These may need to be revisited
and rethought as scientific discoveries are made, as you approach a pandemic,
and if your college’s resources change. One such issue is the availability of
expensive antivirals. The federal government has announced that it is
stockpiling them and coming up with a strategy for distribution,which might
seem to take some of the financial pressure off student health services. Barkin
however has a caveat. “I’m concerned that stockpiles would notbe distributed in
enough of a timely fashion to make an impact on the community. Katrina is a
situation that has to come to mind.”
Even if you did manage
to persuade campus decision-makers to invest budget instockpiling antivirals, a
potentially challenging feat, there’s a chance that they would be ineffective
by the time a pandemic occurs, as overuse can cause the emergence of a
resistant strain. Barkin explains that infectious disease experts are talking
about using a treatment cocktail – Tamiflu plus one or twoother agents - to
protect against the emergence of resistant strains, but this would be
prohibitively expensive for the average college health center.
Another ethical dilemma
surrounding pandemic planning concerns who should get prepandemic vaccines.
Scientists are developing vaccines based on the strain of avian flu that has
been circulating in Asia, hoping that the vaccine would be enough of a match to
combat the illness until a proper vaccine could be developed six months after
the pandemic’s emergence. But supplies of this prepandemic vaccine will be
limited.
“Some of the
conversations around who should get these prepandemic vaccines are very
complex,” says Barkin. “Should it be health care workers that get it, orpublic
safety workers such as firemen? Should it be government officials, or the very
young and elderly?” Recently, the federal government has announced a three-tiered
approach to vaccination that it has developed in consultation with public focus
groups and ethicists that places health care workers in the second tier.
Whether your health center staff will receive the vaccine, whether it will be
in a timely fashion, and how effective it will actually be, are all factors
that will affect your pandemic plan greatly – and demonstrate how much of your
planning has to leave room for the unknown.
One thing that is
beyond question is the importance of student health services acting now.
Formulating a pandemic plan may be a slow and ponderous task, butthere’s one
vital aspect that will slow the spread of a pandemic and can betackled by your
department immediately without getting tangled in red tape and endless
meetings.
This public health
education can be a collaborative effort with human resources and residence life
staff. Covely agrees and even suggests extending the scope beyond campus
boundaries. “It’s part of being a good and responsible neighbor to the
community,” he says.
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