- 1.Pandemic Influenza and Schools:Preparing to Respond
2. Learning Objectives
- Understand the history and current status of avian influenza
and the potential for pandemic influenza
- Describe the issues and efforts surrounding preparations for
pandemic influenza
- Identify components to be included in your district's crisis
management and/or pandemic influenza plan
- Describe steps districts can take to develop their pandemic
influenza plan
3. Outline
- Planning for Pandemic Influenza
4. Background 5. Influenza-Speak
-
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- What do they mean?How are they different?
6. Seasonal Flu
- Illnessin humanscaused every year by influenza viruses
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- e.g. H1N1, H1N2, H3N2 influenza A viruses, influenza B
viruses
- 5%-20% of the U.S. population gets the flu every year
- Estimated 36,000 annual deaths in U.S.
Adapted from CDC Influenza (Flu) Key Facts 7. Seasonal Flu
- Spread by respiratory droplets (coughing and sneezing)
-
- Usually person-to-person: can infect othersfrom 1 day before
getting sickto 5 days after becoming sick
-
- Sometimes from touching infected surfaces
- Vaccine offers effective protection
-
- Vaccines are developed to match the viral strains expected to
circulate each year
Adapted from CDC Influenza (Flu) Key Facts 8. Avian (Bird)
Flu
- Illnessin birdscaused byavian influenza viruses
-
- Highly pathogenic types (e.g. H5N1)
- Illnessin humanscaused byavian influenza viruses
-
- Spread by direct or close contact with infected poultry or
contaminated surfaces
-
- No vaccine currently commercially available
Adapted from CDC Influenza (Flu) Key Facts 9. Pandemic Flu
- Increased and sustained transmission of influenza in the
general population
- Generallycaused by a new influenza virusto which few, if any,
people have immunity
-
- New viruses result from new combinations on viral proteins:
i.e. a major change in influenza A virus (antigenic shift)
-
- Results in viruses that can spread easily from person to person
and can cause serious illness due to low levels of immunity in a
population
10. Pandemics in the Past 100 Years
- 1918-1919:H1N1 influenza A virus
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- 20-50 million worldwide deaths
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- H1N1 still in circulation today
- 1957-58: H2N2 influenza A virus
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- H3N2 still in circulation today
Adapted from CDC Influenza (Flu) Key Facts 11. WHO Pandemic
Phases
- Phase 1 : No new influenza virus subtypes have been detected in
humans. An influenza virus subtype that has caused human infection
may be present in animals. If present in humans, the risk of human
infection or disease is considered low
- Phase 2 : No new influenza virus subtypes have been detected in
humans. However, a circulating animal influenza virus subtype poses
a substantial risk of human disease
12. WHO Pandemic Phases
- Phase 3 :Human infection(s) with a new subtype, but no
human-to-human spread, or at most rare instances of spread to a
close contact
- Phase 4 : Small cluster(s) with limited human-to-human
transmission but spread is highly localized, suggesting that the
virus is not well adapted to humans
13. WHO Pandemic Phases
- Phase 5 : Larger cluster(s) but human-to-human spread still
localized, suggesting that the virus is becoming increasingly
better adapted to humans, but may not yet be fully transmissible
(substantialpandemic risk)
- Phase 6 : Pandemic occurring increased and sustained
transmission in the general population
14. Current Status
- Through February 2007, there have been 273 laboratory-confirmed
cases of avian influenza A/H5N1 among humans reported to WHO
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- 11 countries far and middle east, Indonesia, northern
Africa
- Avian influenza A/H5N1 has been confirmed in poultry and/or
wild birds in these areas as well as India, Russia and Europe
15. Planning for Pandemic Influenza 16. Planning Goals
- Prevent/minimize morbidity and mortality
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- Mitigate disease, suffering and death
- Minimize social disruption
- Minimize economic effects
17. Reducing Morbidity and Mortality
- Primary strategies for combating pandemic flu
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- Community control measures
18. Primary Strategies - Vaccination
- Vaccination would be the single most effective intervention,
BUT:
-
- Unlikely that a well-matched vaccine will be available when a
pandemic begins
-
- Current technology would require 4-6 months for vaccine
development after the pandemic begins
-
- Once developed, production capacity would limit
availability
19. Primary Strategies - Antivirals
- Antivirals could be used for both treatment and prophylaxis,
BUT:
-
- Effectiveness of current antivirals against a future pandemic
strain is unknown
20. Primary Strategies Community Control Measures
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- Decrease the probability that contact will result in
infection
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- Cough etiquette, hand hygiene, infection control
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- Decrease contact between infected and uninfected
individuals
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- Isolation, quarantine, travel advisories, cancellation of mass
gatherings, social distancing, school closures
21. Primary Strategies Community Control Measures
- These nonpharmaceutical interventions will
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- Help buy time for production and distribution of vaccine
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- Reduce the total number of cases, thus reducing community
morbidity and mortality
22. Primary Strategies Community Control Measures CDC, 2007
Pandemic outbreak:no intervention Daily cases Pandemic
outbreak:With intervention Days since first case 23. Primary
Strategies Community Control Measures Collins SD, Frost WH, Gover
M, Sydenstricker E:Mortality from influenza and pneumonia in the 50
largest cities of the United StatesFirst Edition Washington: U.S.
Government Printing Office 1930 . 24. Primary Strategies:Community
Control Measures Mayor closes theaters, moving picture shows,
schools, pool and billiard halls, Sunday schools, cabarets, lodges,
societies, public funerals, open air meetings, dance halls and
conventions until further notice Closing order withdrawn Levins, H.
What he knew in 1918 could save millions of lives.St. Louis
Post-Dispatch Jul. 08 2006. 25. Primary Strategies Community
Control Measures
- Mathematical modeling has shown thatclosing schools at the
outset of a pandemic could decrease attack rates in a community by
about 33%
-
- Compared to the attack rate when not implementing any control
measures
-
- School closures would likely occur in concert with other
control measures
National Academy of Sciences, 2006 26. Primary Strategies
Community Control Measures
- Recommendations for closing schools will depend upon the
severity of the pandemic.For example:
-
- Category 2 & 3 short-term closure (~4 weeks)
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- Category 4 & 5 longer-term closure (~12 weeks)
CDC, 2007 27. Who will implement these strategies? 28. Public
Health Officials
- Federal, state and localpublic healthagencies maintain the lead
role in preparing for and responding to pandemic influenza
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- Federal Centers for Disease Control and Prevention (CDC)
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- State Texas Department of State Health Services (TDSHS)
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- Local Harris County Public Health & Environmental Services
(HCPHES)
29. Public Healths Authority
- Chapter 81 of the Texas Health and Safety Code establishes the
role of thehealth authority , a physician appointed to administer
laws related to public health within their jurisdiction
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- Including laws related to community control measures
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- Such measures include isolation, quarantine, immunization,
detention, restriction, disinfection, decontamination,
disinfestation, chemoprophylaxis, preventive therapy, prevention
and education
30. Public Healths Authority
- The authority to compel disease control measures is derived
from the states inherentpolice powers
-
- Police powers refer to the authority of a state government to
enact laws and promote regulations to safeguard the health, safety
and welfare of its citizens
31. Public Healths Authority
- There are 172 local health authorities in Texas, many
affiliated with local health departments
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- Areas without local health authorities are covered by TDSHS
regional health authorities
- Contact TDSHS Region 6/5S for your local health authority
32. Public Health and Pandemic Planning 33. Roles and
Responsibilities
- Federal Agencies (CDC, etc.)
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- Supporting the establishment of stockpiles of vaccines and
antivirals
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- Facilitating (and funding) state and local planning
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- Providing guidance to the private sector
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- Overall domestic incident management
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- Developing and exercising preparedness and response plans
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- Managing federal pandemic preparedness grant funding to local
agencies
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- Maintaining state-purchased stockpiles of medications
34. Roles and Responsibilities
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- Developing and exercising preparedness and response plans
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- Integrating non-health entities in pandemic planning
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- Providing education to the public and other key stakeholders on
pandemic influenza
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- Monitoring local disease status
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- Providing local incident management
- In Texas, decision-making regarding pandemic influenza will be
made at the local level
35. Assumptions
- 30% of population may become ill
- 15% of population will seek outpatient care
- 0.3 to 3% of population will be hospitalized
- 0.07 to 0.64% of population may die
36. Assumptions
- The duration of illness for an uncomplicated case of influenza
is five days
- Medical care services may be severely taxed or overwhelmed
- Illness rates may be up to 40% among school-aged children and
20% among working adults
- 30% or more of the workforce may be out of work due to illness
at the peak of a major pandemic influenza wave.
-
- This includes work loss while caring for oneself or for ill
family members
37. Surveillance
- In addition to conducting year-round monitoring of influenza in
the health-care sector, DSHS collaborates withschoolsto track
reports of influenza-like illness among students
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- Participating schools submit weekly reports of influenza-like
illness activity to via fax
38. Prevention/Containment
- Discusses local plans for the three strategies of pandemic
prevention and containment:
-
- Community Control Measures
39. Vaccines and Antivirals
- DSHS will coordinate decision-making
regardingvaccineandantiviralallocation
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- Oncevaccinesare available, DSHS 6/5S will implement itsMass
Vaccination Planto provide flu vaccine to the public
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- Onceantiviralsare widely available, DSHS 6/5S will implement
itsMass Dispensing Planto provide public sector distribution of
antivirals
40. Community Control Measures
- DSHS in coordination with local health authorities will develop
and enact control measures within jurisdictions.Examples:
-
- Cancelling mass gatherings
- The types of measures implemented will depend upon the location
of cases, size of clusters, availability of vaccine, pandemic
severity, etc.
- Measures will be undertaken in coordination with other local,
state and federal officials
41. Whats Your Plan?
- Contact DSHS Region 6/5S to obtain your areas pandemic
influenza plan
42. How Can Schools Prepare? 43. School Planning
- Schools face several unique challenges:
-
- Planning assumptions estimate that in the absence of
intervention, illness rates would be highest among school-aged
children (~40%)
-
- Children may be more likely to spread influenza than
adults
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- Unlike many sectors, schools must focus upon protecting their
workforce AND their students
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- Schools must address continuity of instruction
44. School Planning
- Every Independent School District (or the equivalent) should
ensure plans to protect the health and safety of their staff and
students during a pandemic
-
- Plans should build upon existing Emergency Operations Plans
(EOPs)
45. School Planning
- The U.S. Department of EducationsPractical Information on
Crisis Planning:A Guide for Schools and Communitiesis a useful tool
for developing and enhancing EOPs
46. School Planning
- Four domainsmust be considered when developing plans to prepare
for and respond to pandemic influenza:
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- Planning and Coordination
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- Infection Control Policies and Procedures
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- Continuity of Core Operations and Student Instruction
47. 1.Planning and Coordination
- Planning and coordination refers to:
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- Determining who is responsible for making decisions related to
the response to a pandemic
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- Carrying out activities before, during and after a
pandemic
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- Developing and maintaining the response plan
48. 1. Planning and Coordination
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- Identify the authorities responsible for executing community
response plans and activities, including case identification,
isolation, quarantine and community control measures
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- On Page 1 of its Pandemic Influenza Plan,Tomball ISDdescribes
the role of HCPHES, references the HCPHES pandemic influenza plan
and lists HCPHES contact information
49. 1. Planning and Coordination
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- Identify the authority responsible for activating the districts
pandemic influenza plan
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- Provide the contact information for this person(s) to the
public health authority so that information regarding community
control measures can be communicated efficiently
50. 1. Planning and Coordination
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- Address pandemic influenza preparedness as part of your
districts crisis management plan
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- Involve all relevant stakeholders
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- Delineate accountability and responsibility
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- Coordinate with other relevant response plans
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- Establish an organizational structure to manage the execution
of the plan, such as an Incident Command Structure see page 6-19 of
the DOE guide
51. 1. Planning and Coordination
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- Implement an internal exercise/drill
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- Participate in exercises of the communitys plan
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- Periodically revise your plan
52. 2. Infection Control
- Infection control refers to:
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- Decreasing the probability that contact will result in
infection
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- Decreasing contact between infected and uninfected
individuals
53. 2. Infection Control
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- Implement policies and procedures that can limit the spread of
influenza at school
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- Promote of hand hygiene and cough etiquette
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- Ensure appropriate supplies are available soap, tissues, hand
sanitizer, waste baskets
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- Limit face-to-face contact, when possible
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- Making good hygiene a habit now can help protect children from
many infectious diseases, including flu
54. 2. Infection Control
- Sample policy language from theHCPHES Occupational Health and
Safety Manual :
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- Following Centers for Disease Control and Prevention (CDC) hand
hygiene guidelines, all HCPHES staff will maintain hand hygiene
including, but not limited to, hand washing. HCPHES will ensure
that hand hygiene facilities and supplies are readily
accessible
55. 2. Infection Control
- HoustonsGrace Schoolhas permanently posted handwashing and
cough etiquette signs in each restroom and classroom
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- The school nurse provides classroom instruction on proper
handwashing techniques
56. 2. Infection Control
- Hand hygiene and cough etiquette resources
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- CDC/DHHS hand hygiene materials targeted to schools
-www.itsasnap.org
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- CDC hand hygiene guidelines
-www.cdc.gov/od/oc/media/pressrel/fs021025.htm
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- CDC Cover Your Cough campaign
-www.cdc.gov/flu/protect/covercough.htm
57. 2. Infection Control
- At this time, the benefit of wearing disposablesurgical masksby
asymptomatic persons in a community setting (such as a school) has
not been demonstrated to decrease infections during a community
outbreak
-
- However, you may anticipate that persons at risk may choose to
obtain and wear such masks
58. 2. Infection Control
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- Establish special policies and procedures regarding absenteeism
that may be unique to a pandemic situation
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- Non-punitive absenteeism policies for students
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- Relaxed and/or enhanced sick leave and absenteeism policies for
employees
59. 2. Infection Control
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- During times of a declared public health emergency and/or
large-scale disease outbreak, the district may suspend district
policies that penalize students for excessive student
absenteeism
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- During times of a declared public health emergency and/or
large-scale disease outbreak, the district may suspend district
programs regarding perfect attendance achievement
60. 2. Infection Control
-
- During times of a declared public health emergency and/or
large-scale disease outbreak and school remains in session, the
district may suspend district policies or temporarily adopt
alternate policies regarding staff sick leave and absenteeism
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- Example - Harris County has a policy that allows 24 hours of
sick leave per year to be used to care for ill family members.This
type of policy could be waived or expanded during a pandemic
61. 2. Infection Control
-
- Establish special policies and procedures for staff and
students suspected to be ill or who become ill at school, including
policies for returning to school
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- Grace Schoolamended its policies to require that an employee or
student must be fever-free for24 hours without the use of
fever-reducing medicineprior to returning to school
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- Establish policies for transporting ill students and staff
62. 2. Infection Control
-
- Staff and students with a known or suspected communicable
disease should not remain at school and should return only after
symptoms resolve and they are physically ready.Certification of
fitness for duty by a medical professional may be required
-
-
- Consider allowing for modification during a pandemic to
encourage home quarantine if a family member is ill
63. 2. Infection Control
-
- Ensure that school-based health facilities follow national
infection control guidelines
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- Seewww.hhs.gov/pandemicflu/plan/pdf/S03.pdffor specific
guidance regarding infection control procedures for healthcare
facilities during a pandemic
64. 3. Continuity of Operations and Instruction
- Continuity of operations refers to ensuring that the capability
exists to continue essential agency functions when faced with high
absenteeism or temporary school closure
- Continuity of instruction refers to minimizing the potential
disruption to student learning
65. 3. Continuity of Operations and Instruction
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- Develop a continuity of operations plan (COOP) for essential
central office functions
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- Communication with staff, students and parents
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- The basic elements of a COOP can be found atwww.ready.gov
66. 3. Continuity of Operations and Instruction
-
- Develop scenarios describing the potential impact of a pandemic
on student learning, school closings and extracurricular
activities
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- Based on various levels of illness and absenteeism, and
different mandates from public health authorities
-
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- Brainstorm possible alternatives and solutions for each
scenario
67. 3. Continuity of Operations and Instruction
-
- Your public health authority recommends heightening adherence
to hand hygiene and cough etiquette and limiting face-to-face
contact
-
- Your public health authority recommends cancellation of large
group gatherings
-
- Your district is experiencing a 15% absenteeism rate among
staff and 20% among students
-
- Your public health authority recommends school closures for
twelve weeks
68. 3. Continuity of Operations and Instruction
- Tomball ISDsplan contains a flow chart describing action steps
for each of the following scenarios:
-
- Less than 10% of students absent
-
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- Letter to parents, heightened surveillance, heightened
infection control, etc.
-
- 10%-29% of students absent
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- 30% or more of students absent
69. 3. Continuity of Operations and Instruction
-
- Brainstorm alternate methods to provide instruction to students
in the event of high absenteeism or temporary school closure
-
-
- Tomball ISDplans to use its website and homework hotlines to
disseminate lesson plans, with tutorials conducted through its
website, emails and instant messaging
-
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- Grace Schoolwill extend the school year
70. 4. Communications
- Communications planning refers to ensuring accurate and timely
information regarding the impact of the pandemic on your
operations
- Also refers to assisting public health authorities with
disseminating messages to the public
-
- Schools are a trusted source of information within their
communities
71. 4. Communications
-
- Develop a plan to disseminate information to staff, students
and families
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- Designate a lead spokesperson
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- Incorporate links to other communication networks
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- Ensure language, culture and reading level appropriateness
72. 4. Communications
-
- Develop and test any methods for communicating to staff,
students and families during a pandemic
-
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- Tomball ISDhas developed templates for press releases, letters
to parents and talking points for school officials in English and
Spanish
-
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- Grace Schoolhas developed templates for email blast alerts and
canned answering machine messages
73. 4. Communications
-
- Maintain updated communication contacts of key public health
and education stakeholders
-
-
- Provide updated status information to these contacts during a
pandemic as necessary, including absenteeism rates due to
influenza
74. 4. Communications
-
- Inform staff, students and families where they can find
up-to-date and reliable pandemic information
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- State website -www.dshs.state.tx.us
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-
- Federal website -www.pandemicflu.gov
75. 4. Communications
-
- Disseminate information from public health sources about
important pandemic topics:
-
-
- Infection control (hand hygiene, cough etiquette)
-
-
- Disease basics (signs and symptoms, modes of transmission)
-
-
- Personal and family protection strategies (family preparedness,
at-home care of ill family members)
-
- Tomball ISDhas developed templates of letters to parents about
family preparedness, caring for ill persons at home and
stress/crisis management
76. 4. Communications
- Remember to anticipate the potential fear, stress and anxiety
of staff, students and families
- If possible, minimize rumors and the circulation of
misinformation
- Share your plan with all stakeholders BEFORE a pandemic
situation
77. Developing Your Plan:Next Steps 78. Developing Your Plan:
Next Steps
- Identify and engage stakeholders (internal/ external) to be
included in planning
- Determine areas of overlap with EOP
- Develop action plan and timelines for new items
- Share draft plan with your public health department for
feedback (if desired)
- Present completed plan to School Board for approval
- Communicate plan to others
79. Identify and Engage Stakeholders
-
- Director of Risk Management
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- Director of Health Services
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- Director of Human Resources
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- Director of Curriculum & Instruction
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- Principals (elementary, middle, high school)
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- Counselors/Mental Health professionals
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- Director of Administrative Services
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- Director of Transportation
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- Director of Child Nutrition
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- Office of Public Information
Who will assist with preparing, responding and recovering from
an event? 80. Develop Action Plan & Timeline
-
- Delineate roles and responsibilities for key stakeholders
engaged in planning and executing specific components of the
plan.
-
-
- Develop Action Plan using the Pandemic Influenza Planning
Tool
-
- Ensure timelines are determined
-
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- Completion by the beginning of the 07-08 school year is
recommended
81. Pandemic Influenza Planning Tool
- Assess financial impact of alternate scheduling or school
closures
- Work with Human Resources regarding schools functioning with
30% of work force absent. Look at alternatives such as staggered
school times, changes in bussing, and telecommunications
- Develop communications plan for possible school closures
April 2, 2007 Stakeholders will outline further areas for
development.
- Suggested Pan Flu policies and procedures
All key stakeholder stakeholders
- Determine if any additional policies/procedures need to be in
place
April 2, 2007 Stakeholders to review additional needs re: Pan
Flu planning for their department. EOP developed last year with an
existing communicable disease plan. Director of Risk Management
& other key stakeholders
- Review district emergency response and communicable disease
policies and procedure
March 14, 2007 Identify and contact district stakeholders and
schedule a time to meet. EOP Strategic Planning Work Group
developed EOP last year. Example:Jim (Director of Risk
Management)
- Identify or create district committee to provide guidance to
school sites regarding pandemic flu preparations
Timeline Next Steps Existing Resources Responsible Person(s)
Task Mitigation and Prevention 82. Resources
- School District Pandemic Influenza Planning Checklist -
www.pandemicflu.gov/plan/school/schoolchecklist.html
- Pandemic Influenza Community Mitigation Interim Planning Guide
for Elementary and Secondary Schools (see p. 87)
-www.pandemicflu.gov/plan/community/community_mitigation.pdf
- Pandemic Flu:A Planning Guide for Educators
-www.ed.gov/admins/lead/safety/emergencyplan/pandemic/planning-guide/index.html
- Practical Information for Crisis Planning: A Guide for Schools
and Communities
-www.ed.gov/admins/lead/safety/emergencyplan/crisisplanning.pdf
83. Resources
- Contra Costa Health Services Pandemic Flu School Action Kit
www.cchealth.org/topics/pandemic_flu/school_action_kit /
- Texas A&M Center for Rural Public Health Preparedness
Pandemic Flu Toolkit Training CD provided at registration
table
- HCPHES School Pandemic Flu Preparedness PowerPoint Template
http://www.hcphes.org/pandemicplan.htm
84. Recognition
- Special thanks to Harris County Department of Public Health and
Environmental Services for the use of this presentation.
85. Questions?
- Public Health Preparedness Program