Lessons Learned from the H1N1 Pandemic

In the spring of 2009, some of Colorado-based Pueblo City Schools’ charter schools were ordered to close because of Influenza-Like Illness (ILI) and concern over the newly discovered H1N1 virus. So was a Marion County, Indianapolis, township school.

“It all comes through the health department,” says Rae Wallis, RN, MSN, head of Nursing and Health Services, and co-chair of the Pandemic Committee, for Indianapolis Public Schools (IPS), referring to the closure orders. And, all across the country, county health departments take their marching orders from their states, which take their marching orders from the Centers for Disease Control and Prevention in Atlanta.

As more was learned about H1N1, the CDC changed its recommendations. “Now, there has to be a large percentage of ill students in the school to close it,” says Wallis. “We haven’t closed any schools since then, even though we had numerous cases [of ILI and H1N1] in the fall.

“I think what they’re doing now makes much more sense,” Wallis continues. “The H1N1 virus lives on surfaces for two to eight hours. The health education programs that we stepped up helped reduce the disease’s transmission. Specifically, teachers stressed coughing in the sleeve, and hand washing, hand washing, hand washing.”

As H1N1 took hold, school district administrators spent the summer creating, or dusting off existing, pandemic plans, integrating instructions from county health departments. For example, IPS is recommending, per its health department, that students have to be fever-free without fever-reducing medication for 24 hours before returning to the classroom.

“It is a hardship for some parents, who have to take time off work to be home with a sick child,” says Wallis. “But parents often send their children to school with low-grade fevers and a dose of Tylenol and, once the Tylenol wears off at 10:30 a.m., the children have fevers of 101ºF, and that affects everyone. So, this policy has helped reduce the transmission of disease, too.”

Wallis is grateful to have a district pandemic plan, as well as the health department as a resource. “We call them for a lot of advice about a lot of different things,” she notes, “and they’re the legal entity in the county, so we do what they say. I’m glad they didn’t close schools this time (referring to the H1N1 outbreak last fall): The kids would go to the mall or the movies, where they would spread it anyway.”

Kevin Romero, chief officer of Student Support & Community Services for Pueblo City Schools (PCS) in Colorado, is also appreciative of the local health department. He says that the district has established a number of strong partnerships, and one of those is with the health department.

As news of H1N1 was released by the CDC, PCS administrators held a number of meetings with their health department to coordinate a pandemic response that focused on three areas: preparedness, response and follow up and recovery. Romero indicates that every district department — attendance, educational accountability, nutrition, athletics, transportation and more — was included, and every department had to create a specific plan for each of the three areas. “Not only was the plan shared with the local health department,” he points out, “it was shared with the community in a number of different venues. It has really paid off for us. And our health department shared it with other school districts in the area.”

Beyond partnering with and taking direction from their local health departments, administrators have learned a great deal from the H1N1 pandemic, generously sharing their lessons learned with others.

1. It’s critical to establish community partnerships.
The importance of establishing community partnerships cannot be overstated, as is the importance of developing those relationships before a crisis occurs. “You can’t do it yourself,” says Romero. “You need a collective community effort. We’ve learned that you need to do your very best to ensure everyone is on the same page with a community health issue like H1N1. For us, there was a high priority on ensuring delivery of instruction, with no interruption of critical services.”

2. In pandemic planning, details are as important as the large picture.
IPS was in the process of creating a state-mandated pandemic policy when Wallis stepped into her position last July. The district looked at guidelines provided by the CDC and at other districts’ policies, taking care to consider every issue down to the last detail. For example, they considered how to get lessons to students if a school closed, how to staff a school if half the teachers are out ill, how to get students home who are ill but have no one who can pick them up, how to isolate ill students from students seeing the nurse for routine treatments or medication administration and more.

“We were planning for any pandemic,” Wallis sums. “But, with H1N1, it became more pertinent to get things done.”

3. Develop a plan for every department, not just the district.
As stated earlier, PCS took a unique approach to its pandemic preparedness in that each department has its own plan. “Every department has a major part to play in terms of preparedness and supporting students and families for a continuity of critical operations across the district,” says Romero. “It’s not just the division of students, it’s also instruction, maintenance, transportation, food service — every department.”

4. Stay calm.
“Like any other pandemic,” says Wilma Steiner, director of Comprehensive Health Services for Miami-Dade County Public Schools in Florida, “the more emotional you become, the more frightened people become and the less you can handle things. You have to be able to see things with a clear head to get the information out there.” She points out that continuing to educate parents is critical to begin with, and the fact that the media is especially adept at hyping different issues, which tends to frighten parents, only makes the job of educating parents more difficult.

5. Educate every group.
Wallis notes that it’s been especially challenging to tackle old wives’ tales and misperceptions when educating parents about H1N1. For instance, she has spoken with parents who don’t want to send their children to school for fear that they will become ill or who don’t want their children to go outside for recess when it is 60ºF for fear that they will become ill.

Parents aside, every group requires education about the crisis at hand: the community at large; administration, which is in charge of working through the crisis; teachers (“God love them, they get very paranoid, too,” says Wallis); students; and every department (including, but not limited to, transportation, food service, maintenance and human resources).

6. Be confident of the safe environment you’re creating.
“Schools are the safest place you can be during a pandemic,” says Romero, “because of their ongoing sanitation.” Teachers sanitize their rooms. The maintenance department sanitizes such areas as restrooms and cafeterias. Buses are disinfected so that, when students are picked up in the morning, the handrails and seats are clean.

Wallis, however, cautions that all the disinfecting makes everyone feel better, but it’s largely for show because, if administrators find out on Wednesday that a student who was ill on Monday has H1N1, then exposure has already taken place, and the virus is long dead. Therefore, the best prevention is for ill students to stay home or be sent home as quickly as possible once they become sick.

No doubt, administrators will breathe a sigh of relief when the H1N1 pandemic ultimately passes. Until then, they’re staying alert and prepared. “The national word has been that, in January, there’s potential for an upswing in the number of cases of the outbreak we’ll see,” says Steiner. “It’s not that we’re anticipating it, but that it’s a possibility like anything else.”

Having come this far, working through another outbreak will seem almost routine. Almost.