Hampton City Schools. Pandemic Influenza. Response Plan*

Transcription

1 Hampton City Schools Pandemic Influenza Response Plan* * Although the primary focus of this plan is pandemic influenza, it may be adapted and used to address other large-scale communicable outbreaks.

2 I. PURPOSE Hampton City Schools Pandemic Influenza Response Plan II. III. IV. GOALS PLANNING ASSUMPTIONS AUTHORITIES V. PHASES OF A PANDEMIC VI. VII. CONCEPT OF OPERATIONS A. OVERVIEW B. INTER-PANDEMIC PERIOD (Phases 1 and 2) C. PANDEMIC ALERT PERIOD (Phases 3, 4, and 5) D. PANDEMIC PERIOD (Phase 6) RESPONSE VIII: REFERENCES APPENDIX: A. Definitions B. School Health and Safety Work Team C. Policies D. Considerations for School Closure E. Organizational Chart F. Influenza-Like Symptoms G. Continuity of Instruction Chart H. Influenza Surveillance Report I. Sample Letters J. Approved Disinfecting Solutions Revised 7/30/2009 2

3 I. PURPOSE It is believed by scientists and health officials throughout the world that it is inevitable that a pandemic influenza (Appendix A) or some other communicable pandemic outbreak will occur in the 21 st century. In 2006, a report of human to human spread of the H5N1 virus in Indonesia increased public awareness and concern about a potential spread of a new influenza virus throughout the world including the United States. Because all influenza viruses have the ability to mutate, scientists are concerned that viruses including, but not limited to, the influenza H5N1 virus, could mutate so that it can easily spread from infected people to otherwise healthy people. If this were to occur and spread worldwide, it would be called a pandemic. The Virginia Department of Health (VDH) and Virginia Department of Education (VDOE) have recommended educational entities plan their response to a pandemic influenza. The purpose of the Hampton City Schools Pandemic Influenza Response Plan is to provide a framework for identifying, preventing, preparing for, responding to, and recovering from a pandemic influenza outbreak and any resulting life- threatening complications that impact Hampton City Schools (HCS). However, this plan may be adapted and used to address other large-scale communicable disease outbreaks. This plan was developed by a committee of stakeholders (Appendix B) from the school system in conjunction with the Hampton Health Department (HHD), Hampton s Emergency Management Coordinator, and community members and is compliant with the National Incident Management Systems (NIMS) (Appendix A) developed by the Federal Emergency Management Agency (FEMA). The annual review of this plan will be led by the Coordinator of Health Services and updates made as new information becomes available. Revised 7/30/2009 3

4 II. GOALS During a pandemic influenza event, HCS will implement this pandemic influenza plan, in collaboration with HHD, First Medical Group Langley Air Force Base, Fort Monroe, and other federal, state, and local agencies, as applicable, to achieve the following goals: Limit the number of illnesses and deaths Preserve continuity of essential school functions Minimize educational and social disruption Minimize academic and economic losses Revised 7/30/2009 4

5 III. PLANNING ASSUMPTIONS The U.S. Department of Health and Human Services (DHHS) Pandemic Influenza Plan contains the following information about pandemics, how they might affect school-aged children, and how state and local agencies should plan for them: A. The clinical attack rate (the percentage of people who will become so sick they won t be able to go to work or school) is predicted to be 30% of the overall population. Illness rates will be highest among school-aged children (about 40%) and decline with age. B. Individuals will become contagious 12 to 24 hours prior to onset of symptoms. Children will be more contagious than adults and therefore, are likely to pose the greatest risk for transmission. C. It is anticipated that the school district will need to plan to function with a 30% reduction in the work force. D. In an average community, a pandemic outbreak will last 6 to 8 weeks. At least two additional pandemic outbreaks are likely to occur within an 18 to 24 month period. Whether or not schools will be closed or for how long is impossible to say in advance, since all pandemics are different in their scope and severity. However, infectious disease outbreaks often start in schools and school closings are likely to happen early in a pandemic event. The duration of school closings can only be determined at the time of the event based on the characteristics of the pandemic. Other planning assumptions include: A. HCS, working closely with the HHD, will strive to maximize the health and safety of the school community. Understanding the roles of each agency and their responsibilities will promote coordination and communication. B. The emergence of a pandemic influenza virus will result in the rapid spread of the infection worldwide. Communities across the state and the country may be impacted simultaneously. C. There will be a need for heightened global and local surveillance (Appendix A) of influenza symptoms and infection rates. D. Death rates may be high depending on the number of people who become infected, the virulence (Appendix A) of the virus, the characteristics and vulnerability of affected populations (elderly, those with chronic disease, and children), and the effectiveness of preventative measures. E. Mutual aid resources (Appendix A), state, or federal assistance may not be available to support local response efforts. In the event of a pandemic influenza outbreak, the state will have minimal resources available for on-site local assistance. Therefore, local authorities and institutions will be responsible for community-specific pandemic response plans. F. The federal government has limited resources allocated for state and local plan implementation; therefore, the state may provide supplementary resources in the Revised 7/30/2009 5

6 event of a pandemic, which may include the redirection of personnel and monetary resources from other programs. G. Antiviral medications will be in extremely short supply and will be used for treatment and not prophylaxis (Appendix A). H. Due to vaccine production and distribution constraints, a vaccine for the pandemic influenza strain will likely not be available for 4 to 6 months following the emergence of a new virus. I. As vaccine becomes available, it will be administered to priority groups, as defined by the VDH and the Centers for Disease Control and Prevention (CDC) and ultimately to the entire population. J. Insufficient supplies of vaccine and antiviral medicines will place greater emphasis on social distancing (Appendix A) strategies such as closing schools, community centers, and other public gathering points and canceling public events, to control the spread of the disease. K. There could be significant disruption of public and privately-owned transportation, commerce, utilities, public safety and communications. L. It will be especially important to coordinate disease control strategies throughout the City of Hampton and the Commonwealth of Virginia due to the regional mobility of the population. M. The general public, health care partners, response agencies, elected leaders and school officials will need continuous updates on the status of the pandemic outbreak. The updates will guide the steps of the VDH, HHD, and HCS to address the incident and help the public to take necessary steps to protect themselves. N. Each school and department will have its own plan for continuing operations with significant absences of students and/or staff. Revised 7/30/2009 6

7 IV. AUTHORITIES In the Commonwealth of Virginia and in the City of Hampton, various public officials have overlapping authorities with regard to protecting public health and safety. During a pandemic influenza event, the presence of overlapping authorities will necessitate close communication and coordination between elected leaders, VDH, HHD and HCS to ensure decisions and response actions are clear and consistent. Moreover, the Virginia Department of Education (VDOE) works closely with the VDH and other state and federal authorities to provide guidance to public schools. The Code of Virginia, the Constitution of Virginia, and the Virginia Administrative Code provide the authority to close schools or institute quarantine as follows: The Governor of Virginia has the authority to declare a state of emergency when the safety and welfare of the people of the Commonwealth require the exercise of emergency measures due to a threatened or actual disaster. (Code of Virginia (7)). The State Health Commissioner has the authority to require quarantine and/or isolation (Appendix A) under exceptional circumstances involving any communicable disease of public health threat (Code of Virginia ). The Board of Health has the authority to close schools in order to prevent a potential emergency caused by a disease dangerous to public health (Code of Virginia ). The ability of local school boards and superintendents to close school is inherent in the power given to them in Article VIII, Section 7 of the Constitution of Virginia. In addition, School Board policies (Appendix C) will guide the Hampton City Schools response to a pandemic event. Many factors will be considered in making the decision to close school. These factors are covered in Appendix D. In the event that schools are closed, the Superintendent of Hampton City Schools (Appendix A) will determine reporting priorities of essential personnel according to the NIMS organizational chart as illustrated in Appendix E. In accordance with Virginia Code , the Superintendent will coordinate with appropriate state agencies to ensure continued financial support from the state during a division wide emergency closure or a school emergency closure. Revised 7/30/2009 7

8 V. PHASES OF A PANDEMIC (Table One) The World Health Organization (WHO), the medical arm of the United Nations, has developed a global influenza preparedness plan that has identified six phases of increasing public health risk associated with the emergence and spread of a new influenza virus subtype that may lead to a pandemic. For use throughout this plan, all references to the applicable phase and actions to be taken shall be based on conditions in the United States and Virginia. Pandemic Phases Inter-pandemic Period Phase 1 No new influenza virus subtypes detected in humans. An influenza virus subtype that has caused human infection may be present in animals. If present in animals, the risk of human infection or disease is considered low. Public Health Goals Strengthen influenza pandemic preparedness at all levels. Closely monitor human and animal surveillance data. HCS Goals Educate staff members about pandemic influenza and other potential outbreaks as necessary. Educate students and staff on preventative measures and universal precautions (Appendix A). Educate and provide families with updated information on outbreaks, communicable disease problems and health issues that would affect the safety of schools. Phase 2 No new influenza virus subtypes detected in humans. However, a circulating animal influenza virus subtype poses substantial risk of human disease. Pandemic Alert Period Phase 3 Human infection(s) are occurring with a new subtype, but no human-tohuman spread, or at most rare instances of spread to a close contact. Minimize the risk of transmission to humans; detect and report such transmission rapidly if it occurs. Ensure rapid characterization of the new virus subtype and early detection, notification and response to additional cases. Communicate appropriate information to staff, students, and parents. Update staff and families on preventative measures. Conduct periodic reviews to evaluate and revise as necessary the pandemic influenza response plan. Revised 7/30/2009 8

9 Phase 4 Small cluster(s) of human infection with limited human-to-human transmission but spread is highly localized suggesting that the virus is not well adapted to humans. Phase 5 Larger cluster(s) of human infection by human-tohuman spread is localized, suggesting that the virus is becoming increasingly better adapted to humans, but may not yet be fully transmissible (substantial pandemic risk). Pandemic Period Phase 6 Pandemic is declared. Increased and sustained transmission in the general population. Contain the new virus within limited foci or delay spread to gain time to implement preparedness measures, including vaccine development. Maximize efforts to contain or delay spread to possibly avert a pandemic, and to gain time to implement response measures. Implement response measures including social distancing to minimize the pandemic impacts. Ensure that best practices for infection detection and control measures are followed per Hampton City Schools Communicable and Infectious Disease Policy (HCS policy GBED). Ensure adequate resources for staff and student protection. Begin heightened surveillance. Increase communications with HHD, staff, students, and parents to communicate VDH and CDC guidance regarding best defense against the spread of the virus. Begin heightened surveillance. Ensure adequate resources for staff and student protection. Ensure that Hampton City Schools is implementing best practice for social distancing techniques per HHD guidelines, including reducing the school activity calendar if determined to be necessary. Continued heightened surveillance. HHD will be in close communications with Health Services and the Superintendent. Follow School Closure Policy and maximize communications. Rumors, misconceptions, and inaccuracies will be addressed as quickly as possible. Maintain continuity of student learning in periods of school closure or during prolonged student absences. Revised 7/30/2009 9

10 VI. CONCEPT OF OPERATIONS During a pandemic influenza, any guidance provided by the HHD that conflicts with this information will supersede these guidelines. A. Overview 1. HHD will be the lead agency in coordinating the local health and medical response to a pandemic with state, federal, and local agencies and officials. 2. HHD response actions will emphasize disease surveillance and investigation, social distancing measures to reduce the spread of infection, and continually informing and educating the public about the pandemic, the public health response, and steps the public can take to reduce the risks of infection. 3. HCS partnerships with local, state and federal response agencies such as HHD, VDOE, local military bases, and local public safety agencies will be developed and maintained. 4. HCS will maintain increased communications with HHD and VDH and will take under advisement any recommendations to implement procedures that increase the health and safety of the school community. 5. The pandemic response stages referenced below are based on the World Health Organizations Pandemic Phases as described in Table 1. B. Inter-pandemic period (Phases 1 and 2)-During this period, no new influenza subtypes have been detected in humans 1. Direction and Control a. During Pandemic Phases 1 and 2, where HCS is not directly affected, HHD will lead citywide preparedness and education efforts for pandemic response. b. HHD will assess the viability of community containment options and establish criteria for recommending their implementation to local elected officials. c. HCS assumes the following responsibilities: i. Form a pandemic influenza planning committee (Appendix B). ii. Review current district policies and determine if additions or revisions are needed to address pandemic influenza. iii. Develop capabilities to implement measures to decrease the spread of disease throughout the school community as guided by the epidemiology (Appendix A) of the pandemic, the HHD and the HCS School Health Advisory Board. iv. Develop and implement pandemic preparedness activities and a business continuity plan aimed at maintaining educational services and limiting, to the extent possible, the spread of disease throughout the duration of a pandemic. v. Communicate with and educate the school community about approved public health practices and what each person can do to prepare or respond to minimize health risks. Revised 7/30/

11 vi. Communicate with parents the need to make a family plan in case students must be sent home ill or if schools are closed. vii. Develop a recovery plan that provides for educational support and emotional support for staff and students. viii. Require schools and administrative departments to develop a response plan. d. As part of a documented response plan, each school and administrative department shall, as applicable: i. Identify Incident Commander (Appendix A), with a minimum of two (2) backups. ii. Identify other Incident Command positions with a minimum of two (2) backups for each position: a. Public Information Officer b. Safety Officer (Appendix A) c. Liaison Officer iii. Identify staff that would function in the following areas: a. Operations b. Planning (to include a recorder) c. Logistics d. Finance/Administration iv. Train all school staff, volunteers and students in best practice for personal hygiene and universal precautions and implement these practices. Identify resources and procure needed supplies. v. Review and implement procedures for sending ill individuals home. vi. Identify a separate room that will be designated as a sick room for individuals who have been determined to have influenza-like symptoms (Appendix F), if possible. vii. Communicate with parents the need to make a family plan in case students must be sent home. viii. Report the number of staff and students absent as outlined in the surveillance sections of this plan. 2. Communications a. HHD will educate providers, public officials, schools, and emergency responders about pandemic influenza and steps they should take to plan for pandemic outbreaks. b. Under the direction of the Superintendent, HCS will: i. Assess the information needs of the school community. ii. Provide information to students, parents and staff about HCS s Pandemic Influenza Response Plan. iii. Inform and update school staff, students, and parents about a pandemic influenza and preparedness measures, and the potential impacts of a pandemic influenza on essential services and city and school infrastructure. iv. Disseminate common health messages and educational messages as coordinated by the Coordinator of Health Services, HHD, and the HCS Public Information Officer (PIO) (Appendix A). Information may be disseminated via web site postings, television, radio broadcast and other school to home communication methods. Revised 7/30/

12 3. Prevention To prevent or temper the impact of a pandemic influenza or other communicable disease outbreak, mitigation (Appendix A) and prevention efforts need to take place during the early pandemic phases (Phases 1 to 3). HCS mitigation and prevention actions include but are not limited to: a. Conducting periodic practice exercises to evaluate and revise, as necessary, the Pandemic Influenza Response Plan. b. Educating staff, students, and parents about handwashing, covering cough, staying home when sick and other preventive measures that are recommended by public health officials. Education efforts will be led by the Departments of Health Services and Health and Physical Education. c. Encouraging influenza vaccination during the influenza season to reduce morbidity from seasonal influenza transmission. d. Stockpiling necessary equipment and supplies, such as gloves, masks, and disinfecting solutions, to respond to a pandemic. These needs will be assessed by the Health Services Department and the Operations and Maintenance Department in conjunction with the Finance Department. e. Providing supplies needed for handwashing and encouraging all classrooms to have alcohol-based hand-sanitizing products. Handwashing is extremely important after using shared keyboards, before and after eating, and after using the restroom. 4. Surveillance During all stages of a pandemic influenza outbreak, it will be essential to monitor and document the number of students and staff who are absent and meet the definition of influenza-like illness. Keeping track of these numbers will help school and health officials determine when and whether to close schools, whether to declare an epidemic and whether the epidemic is increasing in scope. a. The School Nurse will document clinic visits as usual and will analyze the data and notify the Health Services Coordinator of any increased trend in student absences due to suspected communicable diseases. b. Health Services will report weekly student absentee data to the HHD. c. Building administration will monitor employee absences and notify the Health Services Coordinator of any increased trend in staff absences due to suspected influenza-like symptoms. d. The Health Services Coordinator will monitor national, regional, and local data related to epidemic respiratory infections. 5. Containment a. HCS Health Services staff has the authority to restrict individuals (staff and students) who have fever and a new cough from work, class, or any Revised 7/30/

13 other group gathering. They also have the authority to send any student or staff member home that they suspect may have a communicable disease that puts others in the school at risk. The legal authority is found in the Code of Virginia (Appendix C). b. No student or staff member will be permitted to return to school until they are no longer considered contagious (which means fever-free for 24 hours without the aid of fever-reducing medication and no longer feeling ill with headache, chills, muscle aches, etc.). Fatigue, which commonly persists for a week or two after illness, would not be a reason, by itself, for exclusion. 6. Continuity of Instruction Refer to Appendix G for specific guidelines during this period. C. Pandemic Alert Period (Phases 3, 4, & 5)- During this period a pandemic has not yet occurred; however, a new virus is circulating that has the potential to lead to a pandemic. Activities are cumulative throughout the phases, and therefore, those activities from the Inter- Pandemic Period should be carried over to this phase and supplement the information below. 1. Direction and Control a. Upon reaching Pandemic Phase 3 (if local area is affected), Phase 4 (if local area is not affected), and throughout Phase 5 i. HHD will provide regular briefings to HCS and regional partners. Briefings will address the nature of the disease, its communicability and virulence (Appendix A), availability of vaccines and antivirals, actions that are being taken to minimize the impact, and health information being shared with the public and health care providers. ii. HCS will attend briefings or review electronic updates by HHD and provide information to staff, students and parents. HCS will take appropriate measures to reduce transmission. b. The HCS Superintendent, in consultation with the HHD, will review the need to restrict the use of school facilities and group activities within school buildings and to redirect school transportation as necessary. 2. Communications a. The HCS PIO will work in coordination with the Coordinator of Health Services and the HHD to disseminate media releases. b. HHD will assist in disseminating common health messages to students and families with specific barriers to communication, such as limited English speaking and homelessness. c. As the pandemic expands, the HHD will provide daily updates on the pandemic and will organize regular media briefings. d. HHD will keep the public informed about steps that should be taken to protect against infection, treatment options for individuals who are infected, the status of the spread of the outbreak, and the disease Revised 7/30/

14 control and containment strategies that are being implemented. e. The HCS PIO will evaluate the need to establish a school information call center or other strategies to respond to public inquiries. The HCS PIO will disseminate information by all means appropriate to the situation. f. Families of special needs students will be encouraged to register with the City of Hampton s Emergency Management Office and will be provided access to Emergency Preparedness Plan for Families with Special Needs.. 3. Prevention a. Influenza educational materials will be posted on the HCS web site and available for school newsletters. b. School administrator or designee will encourage the continuation of proper cleaning and disinfecting of commonly touched surfaces such as restroom fixtures, door handles, handrails, eating surfaces, desks, phones, etc. c. Schools will display handwashing posters and Cover your Cough posters (available at in high traffic areas. d. Proper handwashing procedures will be encouraged. These procedures include using soap and water to wash for at least 20 seconds. Alcohol-based hand sanitizers may be used when handwashing is not possible. It is recommended that all classrooms have alcohol-based hand sanitizers available for use by students and staff. All students should be monitored while using hand sanitizer. e. All staff will encourage students to practice proper cough etiquette and to wash their hands before eating and at other times as deemed appropriate. f. Training will be provided for school staff in procedures and protocols as they relate to pandemic influenza. 4. Surveillance a. The influenza surveillance program by HHD provides information on influenza activity for health care providers and the public. Although influenza is not a mandated reportable disease, HHD does track influenza-like illness to understand when influenza has arrived, is most active, and subsides in our community. HCS will continue to report student absenteeism each week or more frequently as requested by HHD. b. HCS nurses will record clinic visits daily to recognize increases in influenza-like illness. They will work with school administrators, social workers and attendance clerks to monitor absentee trends. Significant trends will be reported to the Health Services Coordinator, who will inform the Superintendent and HHD. c. The Health Services Coordinator will be notified by HHD regarding any change in recommendations about screening criteria and the Coordinator will communicate those changes to school nurses and administrators. d. Principals and Department Heads will be notified when to begin reporting absentee data (see Appendix H). Revised 7/30/

15 5. Containment--When a student or staff member presents with influenza-like symptoms (Appendix F), they should be considered a suspect influenza case and the school nurse will: a. Limit the person s contact with other students and staff to the greatest extent possible. b. Provide a surgical mask and instruct them to put it on to protect other students and staff. Note: wearing a surgical mask is not a guarantee of protection in a general setting. c. Instruct the person to cough or sneeze into a tissue and properly dispose of the tissue. d. Notify parent(s) to pick up their child immediately and instruct them to keep their child home until symptoms subside, and they are no longer considered contagious by the current Health Department guidelines. e. Inform ill staff members to go home and stay home until symptoms subside, and they are no longer considered contagious by the current Health Department guidelines. f. Recommend notification of student s or staff member s personal physician for further evaluation and possible treatment. 6. Continuity of Instruction Refer to Appendix G for specific guidelines during this period. D. Pandemic Period (Phase 6)- During this period a pandemic is declared. Activities are cumulative throughout the phases; and therefore, those activities from the Inter-Pandemic Period and Pandemic Alert Period should be carried over to this phase and supplement the information below. 1. Direction and Control a. HCS and all response partners will operate under the Incident Command System (Appendix A) throughout the duration of the pandemic response. The Superintendent of Schools will serve as the HCS Incident Commander and will hold briefings with essential staff as necessary (Appendix E). b. The City of Hampton may activate the Emergency Operations Center (EOC) (Appendix A) and/or HHD Emergency Coordination Center (ECC) for coordination of citywide public health and medical response during a pandemic. c. There may be some degree of suspension of activities, including sporting events, arts performances, and classes as determined by the Superintendent in consultation with HHD. d. HCS Transportation will be kept apprised of the current local pandemic situation and make adjustments to routes as necessary and may consider designating a bus (or buses) to transport ill children home if no one is available to pick them up at school. Note: no child will be left at home unattended. e. The Food and Nutrition Services Director will be kept informed of the current local pandemic situation. Through collaboration with HCS Deputy Superintendent for Facilities and Business Support, Health Services, and HHD, Food and Nutrition Services will develop a plan for delivery of meals to students and staff if social Revised 7/30/

16 distancing (Appendix A) is recommended. The delivery of bag meals to classrooms will be considered as a means of social distancing. f. In response to high student and/or staff absenteeism or as a means to prevent further spread of an epidemic, the decision to close any HCS school will be made by the Superintendent, in consultation with HHD and VDOE. (Appendix D) (See IV- Authorities) g. At the discretion of the Superintendent, penalties for student absences may be suspended during this time. 2. Communications a. Students and staff will be encouraged to notify the school nurse/health Services if they have been in contact with anyone having a confirmed case of the pandemic influenza, so that they may be screened daily for influenza-like symptoms. b. If HCS Transportation makes adjustments to routes, parents will be notified about the changes that would affect their student(s). c. If a person warrants immediate medical evaluation, the school nurse should alert the receiving medical resource that a suspect influenza case needs evaluation so that the referral center can make arrangements for infection control precautions. d. An information letter (Appendix I) will be available to instruct parents, students and staff regarding the status of the pandemic, school closure, and potential changes to the daily school routine. Distribution of this information will be at the direction of the Superintendent and may include but not be limited to, a letter, , and/or Connect-Ed. e. If school is closed, parents and students will be advised about assignments by a variety of communication methods. f. In the event of prolonged school closure or repeated school closures, parents and students will be notified about any changes that will occur in grading policies, testing, and graduations requirements, in a timely manner. g. If schools are closed, parents and students will be notified about reopening procedures as the information becomes available. h. All efforts will be made to notify HCS vendors about any change in the status of school opening. 3. Prevention a. All individuals will be referred to their health care providers for pandemic influenza vaccination, if available. b. In addition to the germ control measures listed in the Pandemic Alert Period, these additional steps will be taken: i. Handwashing is required of students and staff before eating and at other times deemed appropriate. ii. iii. Students and staff will be encouraged to carry and use hand sanitizer. School administrator or designee will ensure that commonly touched surfaces such as restroom fixtures, door handles, handrails, eating surfaces, desks, phones, keyboards, water fountains etc. are cleaned with disinfectant regularly. Revised 7/30/

17 iv. Nurse or designee will clean patient care areas using approved disinfecting solutions (Appendix J) after contact with each patient with influenza-like symptoms. v. HCS Bus Drivers will be encouraged to wipe rails and fronts and backs of seats vi. using approved disinfecting solutions after each route. Food and Nutrition Services will increase sanitation measures. These measures may include wiping tables and surfaces more frequently, and confining the use of the keypad to cafeteria staff. vii. If bag meals are delivered to classrooms, desks and other eating surfaces must be cleaned with an approved disinfecting solution prior to food consumption. c. If directed by HHD, the expanded use of protective supplies and equipment or any other new recommendations will be implemented, as available. d. HCS will consider HHD directives regarding exclusion of students and staff from school and cancellation of public gatherings and extracurricular activities. The HHD will advise the HCS Superintendent regarding school closures. e. To the greatest extent possible, symptomatic individuals will be kept separated from the general school population and will be dismissed from a designated area apart from the regular dismissal area. Those transporting symptomatic individuals will be directed to the designated dismissal area. f. When possible, spacing strategies may be employed to decrease contact with others who may be infected but not exhibiting symptoms. i. Recommend that students desks be spaced three (3) feet apart. ii. Discourage prolonged congregation in hallways and lunchrooms. iii. Stagger school schedules. iv. Limit group activities and interaction between classes. v. Cancel gym class, chorus/band, or other school activities that place individuals in close proximity. g. During the day, where operationally possible, schools will consider providing maximum air exchange by increasing the ventilation to the facility to decrease the spread of disease. 4. Surveillance a. During the first hour of school each day, a flu check should be conducted to screen those who report and/or show influenza-like symptoms. Teachers and staff will be provided with a list of influenza-like symptoms (Appendix F). Students and staff exhibiting these symptoms will be evaluated further by the school nurse and sent home if necessary. b. School nurse will document dismissals due to influenza-like symptoms. c. Designated staff will monitor and log daily attendance and contact parent/guardian to track absences due to influenza-like symptoms. d. Information Systems will prepare a detailed student absentee report daily. e. Building administrator or designee will monitor and log daily staff absences due to influenza-like symptoms and reports these numbers to Health Services (Appendix H). f. Health Services will compile absentee data and send daily reports to HHD. g. HCS will comply, to the best of its ability, with additional specific surveillance requests from the HHD. Revised 7/30/

18 5. Containment Containment measures included in Inter-Pandemic and Pandemic Alert Periods will continue to be followed. 6. Continuity of Instruction a. Refer to Appendix G for specific guidelines during this period. b. The Code of Virginia , and the Virginia Board of Education s regulations, 8 VAC through 8 VAC , address the requirements for making up instructional time when there is a declared state of emergency, or when there are other emergency situations presenting a threat to the health or safety of students, that result in the closing of schools. Revised 7/30/

19 VII. RECOVERY A. The goal of recovery is to resume regular school activities and events as soon as possible. B. Due to the unpredictable nature of a pandemic influenza, recovery activities may occur throughout all phases. C. HCS Support Services will be mobilized to provide emotional and psychological support as necessary. Community health and mental health resources will be utilized as necessary. D. Schools will be provided with information and materials for students and staff members to assist in the recovery process. This information may include, but is not limited to, signs and symptoms of post-traumatic stress, the extent of the pandemic flu in the community, and activities that might assist students in coping with grief and with constructive ways to cope with stress. E. The Employee Assistance Program will be utilized to assist staff members in coping with grief and stress. F. HCS leadership will assess the economic and educational impact of the pandemic. G. HCS will conduct an after-action evaluation of the pandemic response. The evaluation will include recommendations for amendments to this Pandemic Influenza Response Plan. H. Upon reopening, the school division should remain on heightened alert, replenish an adequate supply of all needed materials, and be prepared for additional waves of disease. Revised 7/30/

20 VIII: References Centers for Disease Control and Prevention (CDC), School District (K-12) Pandemic Influenza Planning Checklist, Cherry Creek Schools, Arapahoe County, Colorado, Pandemic Response Plan (draft). Chesapeake City Schools, Pandemic Influenza Response Plan. Virginia Department of Education, Dr. Billy K. Cannaday, Superintendent of Public Instruction, Pandemic Influenza Plan Guidelines for Virginia Public Schools. Cynthia Cave, Ph.D., Director of Student Services Tia Campbell, RN, BSN, School Health Specialist Virginia Beach City Public Schools, Virginia Beach City Public Schools Pandemic Influenza Continuity of Operations Guide. West Point Public Schools, West Point, Virginia. Division Wide Pandemic Preparedness Plan, Dr. Jane Massey Redd, Superintendent. Template-Pandemic Influenza Plan for Schools, prepared by the Thomas Jefferson Health District Pandemic Influenza Public Institutions Advisory Committee. Chief author: Eileen Gomez, RN State of New Hampshire, Department of Health and Human Services, Division of Public Health Services Guidance for Educational Institutions Pandemic Influenza Response New Jersey, Department of Health and Senior Services Frequently Asked Questions About Pandemic Influenza. Pandemic Flu Model Plan Planning Tool for Schools. Tacoma/Pierce County Health Department. World Health Organization Global Influenza Preparedness Plan, Virginia Department of Education (VDOE): Pandemic Severity Index by Epidemiologic Characteristics: Code of Virginia leg.1.state.va.us/000/src.htm Hampton City Schools Policy Manual Revised 7/30/

21 Appendix A Definitions Avian Influenza (or bird flu): According to the Centers for Disease Control and Prevention (CDC), avian influenza usually refers to influenza A viruses found chiefly in birds but infections can occur in humans. One type of bird flu, called avian influenza A (H5N1) has caused infections in birds and in humans. Emergency Operations Center (EOC): EOC s are the locations from which the coordination of information and resources to support incident activities takes place. EOC s are typically established by the emergency management agency at the local and state levels. Epidemiology: According to Webster s Ninth New Collegiate Dictionary, a branch of medical science that deals with the incidence, distribution and control of disease in a population. Finance and Administration (in ICS): This section is responsible for tracking incident costs for reimbursement accounting. This is important for tracking costs where a state or federal disaster area is declared. Incident Command System (ICS): According to FEMA, the ICS is a standardized on-scene emergency management construct specifically designed to provide for the adoption of an integrated organizational structure that reflects the complexity and demands of single or multiple incidents, without being hindered by jurisdictional boundaries. ICS is the combination of facilities, equipment, personnel, procedures, and communication operating within a common organizational structure, designed to aid in the management of resources during incidents. Incident Commander(IC): According to FEMA, the person responsible for all incident activities, including the development of strategies and tactics and the ordering and the release of resources. In a school system, the Incident Commander is the Superintendent for the district and in a school building it is the principal or designee. Isolation: When people who are already ill are separated from people who are healthy. Isolation is usually voluntary, but the Commissioner of Health has the power to order the isolation of sick people to protect the public. This order is enforced by local police or sheriff s departments. Liaison Officer( in ICS): According to FEMA, this is a member of the Command Staff responsible for coordinating with representatives from cooperating and assisting agencies. Logistics (in ICS): According to FEMA, this section is responsible for providing resources and other services to support incident management. Mitigation: Measures taken in advance of an influenza pandemic to prevent or temper its impact. National Incident Management System (NIMS): A comprehensive, national approach to incident management that is applicable at all jurisdictional levels and across functional disciplines. It provides a consistent nationwide template to enable all government, private sector, and nongovernmental organizations to work effectively and efficiently together to prepare for, respond to, and recover from domestic incidents, regardless of cause, size, or complexity. Revised 7/30/

22 Operations(in ICS): This section is responsible for the care of students and carrying out universal and specific procedures and protocols. This is the execution of the operational plan set forth in the specified Incident Action Plan (Pandemic Influenza Plan). Pandemic Influenza: According to the CDC, pandemic influenza is a virulent human influenza that causes a global outbreak, or pandemic, of serious illness. Because there is little natural immunity, the disease can spread easily from person to person. Planning(in ICS): This section is responsible for collecting and evaluating information as related to the development of an incident and the status of resources. According to FEMA, this is the area responsible for the collection, evaluation, and dissemination of information related to the incident, and for the preparation and documentation of the Incident Action Plan (Pandemic Influenza Plan). Prophylaxis: Measures designed to preserve health and prevent the spread of disease. Public Information Officer (PIO): Under the National Incident Management System, this person advises the incident commander on all public information matters, including media and public inquiries, emergency public information and warnings, rumor monitoring and control, media monitoring and other functions required to coordinate, clear with proper authorities, and disseminate accurate and timely information related to the incident. At the school level, the PIO must communicate with and clear all information through the district PIO. Quarantine: The CDC defines quarantine as the separation or restriction of activities of well persons who are not ill but who are believed to have been exposed to a communicable disease and are therefore at high risk of becoming infected. The Commissioner of Health has the power to order the quarentine of sick people to protect the public. This order is enforced by local police or sheriff s departments. Resources: According to FEMA, this is personnel and major items of equipment, supplies, and facilities available or potentially available for assignment to incident operations and for which status is maintained. Resources are described by kind and type and maybe used in operational support or supervisory capacities at an incident or at an EOC. Safety Officer: According to FEMA, this is a member of the Command Staff responsible for monitoring and assessing safety hazards or unsafe situations, and for developing measures for ensuring personnel safety. This position may have assistants. Social Distancing: Placing distance between individuals to reduce the spread of an illness. Superintendent of Hampton City Schools: The administrative head of Hampton City Schools or his/her designee. Surveillance: Procedures that are used to prevent the spread of infectious disease by involving close supervision during the incubation period of possible contacts of individuals exposed to an infectious disease. Surveillance procedures involve an ongoing and systematic collection, analysis, and interpretation of data about a disease or health condition. Revised 7/30/

23 Universal Precautions: Procedures to be followed to protect oneself from someone harboring a highly contagious disease/virus that can be transmitted in blood, blood products, and other body fluids. Virulence: The disease-producing power of a microorganism. Revised 7/30/

24 Appendix B Hampton City Schools School Health and Safety Work Team Facilitator: Dr. Linda Shifflette Deputy Superintendent for Instructional Support PreK-12 Linda Lawrence, RN, BSN Coordinator of Health Services, HCS James Bailey John Bailey Ann Bane Sherrie Bollhorst Dr. Julia Bryant Jeri Dunlap Jim Dunn Ann Fuhs Aileen Girard Tracy Hanger Dr. Victor Hellman Cort Jensen Dr. Patricia Johnson Dr. Patricia Leary Valencia Lewis Doug Manuel Katherine Messier Chad Ochsenfeld Penny Petersen Kathy Pfeiffer Tom Sawyer Karen Scarsdale Suzanna Scott Mariann Sedlak Dr. Mildred Sexton Christily St. Sauver Laura Thornton Jerry Tuero Sharon Warren David West Dr. Donna Woods Security Supervisor, HCS Principal, Bethel High School Director of Community and Legislative Relations, HCS Health and PE Curriculum Leader, Athletic Coordinator, HCS Director of Food and Nutrition Services, HCS Director of Information Systems, HCS Environmental Services Supervisor, HCS Administrative Secretary, Health Services, HCS Database Manager for Information Systems, HCS City of Hampton Emergency Management Coordinator Deputy Superintendent for Facilities & Business Support, HCS Emergency Preparedness and Response Coordinator, HHD Deputy Superintendent for Curriculum and Instruction, HCS Executive Director of School Leadership-Elementary, HCS Coordinator of Early Childhood Education, HCS School Operations Manager, HCS Health & Safety Officer, Hampton Fire Department Transportation Specialist, HCS Director of School Counseling, HCS Assistant Coordinator of Health Services, HCS Director of School Operations/Maintenance, HCS Database Manager for Information Systems, HCS Director of Business and Finance, HCS School Nurse-Phillips Elementary Executive Director of School Leadership-Elementary, HCS Epidemiologist, HHD Executive Director of Human Resources, HCS Pandemic Influenza Planner, HHD Director of Special Education, HCS Second Vice President, Hampton Council of PTAs Executive Director of School Leadership-Secondary, HCS Revised 7/30/

25 Hampton City Schools and Code of Virginia Relevant Policies and Regulations Appendix C BBA DL DLD EBBB EBCD EFB GBE GBEC GBED-R and JHCC-R GBEE GBEE-R and JHCCA-R GCBD GCBDA GCBDGB GCBDJ GDBD IJA JED JEDA JEDC JEG School Board Powers and Duties Payroll Procedures and Payday Schedules Overtime Compensation Accident and Serious Illness Report Emergency Closings Food and Nutrition Services Staff Health and Safety Working Conditions Communicable Diseases: the organisms that cause them and their routes of transmission Communicable Bloodborne Disease Body Fluids, their potential infective agents and concerns for transmission General Leave Absence (Employee) Sick Leave Family and Medical Leave Leave Donation and Transfer Support Staff Leaves and Absences Guidance and Counseling Program High School Attendance Policy Middle School Attendance Policy Elementary School Attendance Policy Exclusions and exemptions from school attendance REFERENCED CODES OF VIRGINIA Reduction of state aid when length of school term below 180 days or 990 hours Contagious and infectious disease Emergency Rules and Regulations Authority of State Health Commissioner to require quarantine, etc (7) Powers and Duties of Governor (declaration of state of emergency) Revised 7/30/

26 CONSIDERATIONS FOR SCHOOL CLOSURES Appendix D 1. Factors for consideration for school closures: Increased absenteeism Decreased instructional and support workforce Families keeping students at home out of fear The number and severity of cases of influenza in the community and surrounding area Inability to get needed supplies (i.e. food, heating oil, etc.) No public transportation The need to use school facilities for other purposes 2. Evidence for Closing Schools During a Pandemic Emerging Infectious Diseases (vol. 12, no. 1, pp ) published Non-pharmaceutical Interventions for Pandemic Influenza, National and Community Measures. The article is a product of the World Health Organization s Writing Group. An interesting statement in the article notes: Apparently no data or analyses exist for recommending illness thresholds or rates of change that will lead to considering closing or reopening schools. However, the article does note anecdotally that in 1959, the opening of school after the summer holiday seems to have played an important role in initiating the main epidemic phase. It also notes that simultaneous use of multiple measures (e.g., closing schools, public gathering places, sporting events, etc.) caused a reduction of influenza and other respiratory viral infections during the 2003 SARS epidemic in Hong Kong. In the discussion, it states that when there is increased and sustained transmission in the general public, measures to increase social distance will be considered in affected communities, depending on the epidemiology of transmission, severity of disease, and the risk groups affected. 3. CDC Pandemic Severity Index by Epidemiologic Characteristics Pandemic Severity Index Characteristics Category 1 Category 2 Category 3 Category 4 Category 5 Case Fatality Ratio (percentage) < < < <2.0 > 2.0 Excess Death Rate < < < <600 >600 Illness Rate (percentage of the population) Potential Number of Deaths(based on 2006 U.S. 90, ,00-900,00 - < population <90,000 <450,00 <900, million Seasonal Influenza (Illness rate 1857, th Century U.S. Experience 5-20%) Pandemic None None Revised 7/30/ >1.8 million 1918 Pandemic