Avian flu planning

Ramae Philippou needs to buy a bullhorn.

A nurse at The Bromfield School in Harvard, Philippou is also shopping for whistles for the teaching staff – and probably some more face masks.

These items all have been identified as essential equipment in her community's plan for dealing with a public health emergency, such as a flu pandemic.

With the specter of pandemic influenza looming, public health officials worldwide are making plans. In Massachusetts, four regional pandemic planning conferences were convened in May, with a fifth scheduled for June in Boston. School superintendents, school nurses and higher education administrators were invited, along with representatives from local government and public safety agencies and the business and religious communities. The regional meetings included working breakouts for special groups with particular interests, such as higher ed and preK-12.

The sessions come as the prospect of a pandemic is drawing increasing attention. In May, the delegates at the MTA's Annual Meeting voted to have the association prepare an advisory for locals on pandemic planning.

"MTA local and chapter leaders should contact superintendents and college administrators to find out what plan is in place," said MTA President Catherine A. Boudreau. "If they don't know, then we suggest you contact your town or city fire chief. Most important is that each local has a seat on any committee or task force, since it is the schools that would be most immediately affected if something were to occur."

Public health officials worldwide are keeping an eye on the H5N1 strain of Influence A, commonly called avian flu or bird flu. If this virus should become adapted for human-to-human transmission, a pandemic – a widespread or global outbreak – could occur. If not H5N1, another Influenza A strain could become so adapted, according to a Massachusetts Department of Public Health presentation prepared for the regional planning conferences.

Influenza is highly contagious. The time from exposure to symptoms (the incubation period) can be as short as two days. Adults may be infectious for 7 to 10 days and children under 5 for 2 to 3 weeks, according to the MDPH.

The MDPH estimates that in the Commonwealth, over the course of a six- to eight-week "wave" of influenza, 2 million may become ill. Of those, 80,000 could need hospital care and 20,000 could die. Estimates indicate that as much as 40 percent of the work force could be absent at a pandemic's peak, either because they themselves are ill or because they are caring for others.

"Whether or not this particular 'crisis' materializes, 'emergencies' seem to be increasing in number and importance. See the recent flooding in Massachusetts as an example." said Charles Levenstein, a retired UMass-Lowell professor and co-chair of MTA's Environmental Health and Safety Committee.

"Schools, teachers and students can be affected profoundly," Levenstein said, "so we are convinced that our union ought to be knowledgeable – and involved – in the planning processes at the state and local levels. Our work has included consideration of the range of collective bargaining issues that must be dealt with to have a reasonable emergency plan."

The Environmental Health and Safety Committee plans to discuss and disseminate flu planning information at the upcoming MTA Summer Conference in Williamstown.

Meanwhile, Massachusetts superintendents have been looking into an automatic phone bank that could deliver homework assignments to quarantined families, Tom Scott, executive director of the Massachusetts Association of School Superintendents, told the Associated Press. The Internet could also be used to communicate with students and parents. But Scott told the AP: "I don't think we're anywhere near having a systematic way of approaching this."

In Harvard, Philippou is well versed in emergency planning terminology and procedure. But pandemic planning has become a much larger endeavor.

"We really are getting the whole town involved," she said. "For me, that's the big deal."

The Bromfield, which is home to Harvard's high school students, has already been designated an Emergency Dispensing Site in Harvard's pandemic plan. "It's the largest building in the community – with computers and fax machines and a cafeteria," Philippou said. In other words, it's a good place to evaluate sick residents or distribute vaccinations or antibiotics.

"It's large enough so that we could divide the building," she added. "If you're sick, go this way. If you're not sick, go that way."

The first town-wide emergency preparedness meeting was held in Harvard on April 5, 2006.

"We looked at communications and transportation issues," Philippou said. Members of the planning team, which includes the fire and police chiefs, an EMT director, and others, are also collecting data on facilities and personnel that could be used in a public health emergency. What buildings could be used? Who has medical skills? Where are the pharmacists? Who can provide mental health services?

Philippou is also preparing in her building. Public areas, such as the computer lab, have been outfitted with dispensers for sanitizing students' and staff members' hands. "That's really important in the computer lab, where people have their hands on keyboards," Philippou said.

The sanitizing dispensers were ordered even before flu planning began as a common-sense measure that could cut down on the spread of virus in the building. (Nothing beats soap and water, Philippou said, but the sanitizers are a great alternative in locations where sinks do not exist.) Posters that promote and explain proper hand-washing hang throughout the building.

Other steps Philippou recommends that educators adopt:

Learn to spot and report symptoms. "Send sick students to the nurse so the nurse can make an assessment." Your school nurse will have a building-wide or even district-wide perspective and may also need to report data on confirmed and suspected cases of flu to health officials.
Have a good supply of tissues in your classroom.
Be prepared to teach students good health habits, such as covering the mouth while coughing.
Know your first aid kit. It should contain rubber gloves, face masks and other items you will need in an outbreak or other health emergency.