Flu Facts for Schools

The H1N1 influenza virus (commonly referred to as the swine flu) presents new challenges to the education community, especially if it becomes a pandemic influenza in the United States. Many scientist and medical personnel are taking great strides in ensuring that our nation is prepared for a pandemic outbreak of influenza. Generally speaking, a pandemic is a global outbreak whereas an epidemic is more localized or regionalized.

Influenza viruses are commonly spread from person to person through respiratory droplets through coughs and sneezes. Viruses can also be spread when a person touches respiratory droplets on an object or surface and then touches his/her own mouth, nose, or eyes before washing his/her hands. Scientific studies show that people can be contagious from one day, before developing symptoms, and up to seven days after getting sick — sometimes longer. In general, however, people are most contagious earlier in the illness than later. Public health authorities have identified characteristics and challenges unique to a pandemic such as the following.

  • When the pandemic influenza virus emerges, its global spread is considered inevitable.
  • Most people will have little or no immunity to a pandemic virus, and a significant percentage of the population will require medical care.
  • Death rates will be high due to the significant number of people who become infected, the virulence of the virus, the characteristics and vulnerability of affected populations (elderly, those with chronic disease, and children), and the effectiveness of preventative measures.
  • Past pandemics have spread globally in two, and sometimes three, waves.
  • Medical supplies will be inadequate. Vaccine for the virus will possibly not be available for six months.
  • Hospital beds and other supplies will be limited.
  • Pandemics also cause economic and social disruption such as schools and businesses closing, travel bans, and canceling of community events.
  • Care of sick family members and fear of exposure can result in significant absenteeism in the workforce.

It is equally important to note that according to the Centers for Disease Control and Prevention (CDC), the seasonal flu has a death toll average of 36,000 people per year and more than 200,000 people are hospitalized from complications (for more information, visit www.cdc.gov/flu). So it is very easy to see why an influenza pandemic poses great concern.

Preparing for a pandemic influenza (panflu) outbreak is an extremely daunting task. Common approaches to securing mutual aid assistance and furthering the ability to protect communities will be compounded by an anticipated loss of 30 to 40 percent of the local workforce and neighboring communities. With that in mind, it is essential that all school communities coordinate with other planning groups in preparation of a pandemic outbreak, and to establish operational protocols to help guide each school through common best practices.

Planning for the Pandemic Influenza Outbreak
First and foremost is the education of the school community (including parents and students). Everyone must be aware that the impact of a pandemic will affect the school system just the same as businesses, the home, or the workplace. While the message should not incite panic, the district as a whole should be aware of anticipated limitations in normal service and resources during a pandemic.

The following planning guidelines, with consultation through the local public health affiliates, will promote any school’s ability to meet the challenge of a pandemic:

  • Integrate the plan with the existing plans in a community and state. Be sure to include the school nurse, public health, emergency management, health care, and include janitorial staff/custodial staff in your meetings, as they are critical to ensuring that cleaning/disinfecting protocols are taking place. Ensure that all plans interface with each other, and that legal aspects are considered, so that unexpected conflicts do not occur during an outbreak.
  • Establish and implement a school-wide infection control plan in collaboration with public health and school nurses.
  • Anticipate a reduced workforce during the outbreak. It is anticipated that up to 30-40 peercent of the workforce will not be able to report to work, either because they have the influenza virus, or they are tending to the needs of a loved one. This may require you to establish alternative scheduling of the workplace and identify substitute teachers and parent volunteers.
  • Anticipate not having access to mutual aid or state/federal support during an outbreak. Local, state, and national response communities may be directly affected by the pandemic and not have the resources to send support to your community. 
  • Establish and practice disinfecting/decontamination guidelines for school buses and other transportation vehicles.

It is equally important to remember that a pandemic tends to unfold in waves, that is, periods of exponentially increasing disease separated by periods of declining disease activity. Subsequent waves tend to be more severe than the previous waves of a pandemic. Therefore, specific activities should be undertaken to prepare for the next wave should it happen. These activities should include the following.

  • Place posters on hand washing and infection control in schools and online.
  • Provide information to schools, parents, and staff about hand sanitizers, cough and sneeze etiquette, and the signs and symptoms of influenza.
  • Ensure custodial staff has appropriate training on proper cleaning and disinfecting work and play areas.
  • Ensure schools and departments have adequate supplies (soaps, hand sanitizers, and paper towels).
  • Check first aid kits and add N95 face masks for school nurses and other staff.
  • Establish and test an emergency communication protocol, including an internal communication staff tree.
  • Provide information to staff and parents on pandemic planning for families.
  • Develop Incident Command Center protocol, location, equipment, and assign staff.
  • Develop plans for operating with staff workforce reduction.
  • Develop plans to secure buildings, information technology, and finance.
  • Encourage employees to use direct deposit.
  • Encourage parents to have alternative child care plans.
  • Develop plans for educational continuity if schools close, including:
    • study packets, suggested educational activities, and Internet educational links for students and parents; and
    • Web-based education options such as On-line classes, virtual school, education blogs, and some educational Websites.
  • Find out if vendors in the supply chain have a pandemic or emergency plan for continuity or recovery of supply deliveries.
  • Plan for a full school closure or a partial school closure (i.e., some, but not all, schools are closed, or students are dismissed but staff works with local agencies to assist families).
  • Develop a mental health plan for students and staff, in conjunction with local mental health services staff, to implement during a pandemic event and during the recovery phase; the plan should include Post-Traumatic Stress Disorder counseling.
  • Develop Human Resources employee emergency contact lists and reciprocal contact procedures; Human Resources should conduct a study of critical infrastructure staff with young children (because they are more likely to remain home during a widespread illness event) to determine if redundancy plans are necessary; develop a Fitness for Duty checklist to determine if an employee is ready to return to work and under what conditions.
  • The local school superintendent should establish a command structure in the event that he or she is unable to continue work during the pandemic event or is unable to return to work during the recovery phase; develop central office teleconferencing protocols in the event that schools are closed.
  • Develop plans to conduct table-top exercises to practice and refine pandemic plan.
  • Apply all plans and procedures to after-school programs.

The potential of a pandemic outbreak of the influenza virus is real, but there are many other viruses and organisms that may initiate a chain of events leading to the next pandemic. During times of crisis, schools will rely heavily on the assistance of local community responders and agencies. Relationships with these groups need to be established and cultivated long before the crisis occurs. Working with local agencies before a pandemic will decrease fear, anxiety, and confusion and improve the response during a crisis.

Regardless of whether it is swine flu, avian flu, or another biological agent, the key to successfully meeting the challenge is to plan for the event, prepare to work the plan, and implement the plan when the event occurs. Schools should incorporate pandemic influenza planning into an overall biological incidents plan, especially since planning and preparedness performed for an influenza pandemic is also applicable to other emerging infectious disease outbreaks (i.e. SARS) or an act of bioterrorism.

Dr. Sonayia Shepherd has authored and co-authored 16 books on school safety, has worked full time on the School Safety Project of the Georgia Emergency Management Agency, the Georgia Division of Public Health, and worked at the Centers for Disease Control and Prevention (CDC). She oversees all school public health projects globally for Safe Havens International. For more information, visit www.safehavensinternational.org.