APPENDIX D: PANDEMIC

D–1: Introduction

One of the greatest and most likely threats to the public’s health is a naturally occurring event – an influenza pandemic.  Influenza epidemics happen nearly every year (often called seasonal influenza), and cause an average of 36,000 deaths annually in the United States.  Influenza epidemics are caused by a few known virus strains that circulate around the world.  Over time, people develop immunities to these strains, and vaccines are developed to protect people from serious illness.

Influenza viruses experience frequent, slight changes to their genetic structure.  Occasionally, however, they undergo a major change in genetic composition.  It is this major genetic shift that creates a “novel” virus and the potential for a pandemic – a global epidemic.  The creation of a novel virus means that most, if not all, people in the world will have never been exposed to the new strain and have no immunities to the disease.  It also means that new vaccines must be developed and therefore are not likely to be available for months, during which time many people could become infected and seriously ill. 

During the 20^th century, three pandemics occurred that spread worldwide within a year.  The influenza pandemic of 1918 was especially virulent, killing a large number of young, otherwise healthy adults.  The pandemic caused more than 500,000 deaths in the United States and more than 40 million deaths around the world Subsequent pandemics in 1957–58 and 1968-69 caused far fewer fatalities in the U.S., 70,000 and 34,000 deaths respectively, but caused significant illness and death around the world.

The Centers for Disease Control and Prevention (CDC) estimates that in the U.S. alone, an influenza pandemic could infect up to 200 million people and cause between 100,000 and 200,000 deaths.  Scientists and health officials throughout the world believe that it is inevitable that more influenza pandemics will occur in the 21^st century.  Recent cases of human disease caused by a widespread and growing avian influenza outbreak suggest that a new pandemic could be developing at this time. 

There are several characteristics of influenza pandemic that differentiate it from other public health emergencies.  First, it has the potential to suddenly cause illness in a very large number of people, who could easily overwhelm the health care system throughout the nation.  A pandemic outbreak could also jeopardize essential community services by causing high levels of absenteeism in critical positions in every workforce.  It is likely that vaccines against the new virus will not be available for six to eight months following the emergence of the virus.  Basic services, such as health care, law enforcement, fire, emergency response, communications, transportation, public schools and utilities, could be disrupted during a pandemic.  The increased stress from a potential pandemic or actual pandemic will also increase the mental health service needs throughout the schools and community.  Finally, the pandemic, unlike many other emergency events, could last for many weeks, if not months.  School closures could last up to two months.

Schools tend to be affected by outbreaks more than other settings because their occupants—primarily children—easily transmit illnesses to one another as a result of their close proximity and their inefficiency at containing the droplets issued by their coughs and sneezes.  High susceptibility of students and staff to exposure to a mutated virus as result of proximity and a longer duration of the outbreak due to lack of immunity and vaccines could result in lengthy and widespread absenteeism.  In a worse-case scenario, the pandemic could force schools to close, potentially prompting administration to extend the academic year and expend additional resources for staff sick leave and substitute teachers.

D-2:  Summary of Emergency Management Principles

The goal of Emergency Management Planning will be to:

• Limit the number of illnesses and deaths
• Preserve continuity of essential school functions
• Minimize educational and social disruption
• Minimize economic and academic losses

Planning

The U.S. Health and Human Services Pandemic Influenza Plan contains the following information about pandemics, how they might affect school-aged children, and how states and local agencies should plan for them:

• The clinical attack rate (the percentage of people who will become so sick they won't be able to go to work or school) could be 20 to 30% of the overall population.  Illness rates will be highest among school aged children (about 40%) and decline with age.
• Children will shed the greatest amount of virus (they are more contagious than adults) and therefore are likely to pose the greatest risk for transmission.
• On average about 2 secondary infections will occur as a result of transmission from someone who is ill.
• In an average community, a pandemic outbreak will last 6 to 8 weeks.  At least two pandemic disease waves are likely. Following the pandemic, the newly circulating virus is likely to become a regularly occurring seasonal influenza.
• It is anticipated that the school district will need to plan to function with a total of 30% work force absentee rate for the entire pandemic outbreak. If staff absenteeism is sufficient to warrant the administrative closure of the school or district, the administrative procedures for temporary school closures are to be followed.

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, it is well established that infectious disease outbreaks most often start in schools and so the schools may be closed early in an event.  The duration of school closings can only be determined at the time of the event based on the characteristics of the pandemic, but it is unlikely that schools will be closed for less than two weeks (based on the incubation period of the disease and the length of time people are contagious) and could be as long as eight weeks, as mentioned above.  Other planning assumptions that are being used by the community include:

• Working closely with the government agencies will maximize the health and safety of the school community. Understanding the roles of each agency and their responsibilities will promote coordination and communications. 
• An influenza pandemic will result in the rapid spread of the infection with outbreaks throughout the world. Communities across the state and the country may be impacted simultaneously.
• There will be a need for heightened global and local surveillance of flu symptoms and infection rates.
• Local counties will not be able to rely on mutual aid resources, State or Federal assistance to support local response efforts.
• Antiviral medications will be in extremely short supply. Local supplies of antiviral medications may be prioritized for hospitalized influenza patients, close contacts of patients, health care workers providing care for patients, or other groups.
• Due to vaccine production and distribution constraints, a vaccine for the pandemic influenza strain will likely not be available for six to eight months following the emergence of a novel virus.
• As vaccine becomes available, it will be administered to eligible persons and ultimately to the entire population.
• Insufficient supplies of vaccines and antiviral medicines will place greater emphasis on social distancing strategies to control the spread of the disease.
• There could be significant disruption of public and privately owned critical infrastructure including transportation, commerce, utilities, public safety and communications.
• Social distancing strategies aimed at reducing the spread of infection such as closing schools, community centers, and other public gather points and canceling public events may be implemented during a pandemic.
• It will be especially important to coordinate disease control strategies throughout the State due to the regional mobility of the population.
• The general public, health care partners, response agencies, elected leaders and schools will need continuous updates on the status of the pandemic outbreak, the steps school district is taking to address the incident, and steps the public can take to protect themselves.

D–3: Authority

In Washington State, various public officials have overlapping authorities with regard to protecting public health and safety.  The Governor, the State Secretary of Health, County Executives, City Executive, and the Local Health Department each can implement authorities within the scope of their jurisdiction aimed at protecting public health, including increasing social distancing by closing public or private facilities.  During a pandemic, the presence of overlapping authorities will necessitate close communication and coordination between elected leaders, the Emergency Operations Center (EOC), the Local Health Officer (LHO) and schools to ensure decisions and response actions are clear and consistent.  The Director of Public Health Local Health Officer and may direct the isolation and quarantine of individuals or groups.  The Local law enforcement officials, have the authority to enforce the orders issued County Officials and Superior Court Judges within their jurisdiction.

A school district has the authority to close schools for emergency reasons.  A school district may close school for emergency reasons, as set forth in RCW 28A.150.290(2)(a) and (b), without complying with the requirements of RCW 28A.335.020 (a policy and citizen involvement prior to closing a school).  

The Superintendent of Public Instruction has established the following definitions related to emergency school closures:  

1)   A “district-wide emergency closure” means “that all school buildings in the school district are unsafe, unhealthy, inaccessible, or inoperable due to one or more unforeseen natural events, mechanical failures, or action or inactions by one or more persons.”  WAC 392-129-090. 

2)   A “school emergency closure” means “a school in the school district comprised of more than one school that is unsafe, unhealthy, inaccessible, or inoperable due to one or more unforeseen natural events, mechanical failures, or actions or inactions by one or more persons.”  WAC 392-129-100. 

The Superintendent of Public Instruction has established regulations for school district to follow to request continued financial support from the State during a district-wide emergency closure and a school emergency closure.  WAC 392-129.  For example, a school district may apply to the Office of the Superintendent of Public Instruction for continuation of state support during a school emergency closure under WAC 392-129-145.  Under WAC 392-129-150, the Superintendent of Public Instruction has the authority to determine if the district has conclusively demonstrated that unforeseen natural events prevented the operation of the school.  For a school closure, it appears that the Superintendent of Public Instruction can only excuse the school district for up to two scheduled days per incident.  

D–4: Phases of a Pandemic

The World Health Organization (WHO), the medical arm of the United Nations, has developed a global influenza preparedness plan that includes a classification system for guiding planning and response activities for an influenza pandemic.  This classification system is comprised of 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.  The Director General of WHO formally declares the current global pandemic phase and adjusts the phase level to correspond with pandemic conditions around the world.  For each phase, the global influenza preparedness plan identifies response measures WHO will take, and recommends actions that countries around the world should implement. 

Pandemic/Epidemic

If anyone within the school is discovered or suspected to have a communicable disease that may result in an epidemic/pandemic that person will be immediately quarantined pending further medical examination. Local health officials shall be notified immediately.

Any student or staff member found to be infected with a communicable disease that bears risk of pandemic/epidemic will not be allowed to attend school until medical clearance is provided by the individual’s primary care physician or other medical personnel indicating that the risk of that individual transmitting the disease no longer exists.

In the event of prolonged school closings and/or extended absences by staff or students as the result of a flu pandemic or other catastrophe the superintendent shall develop a pandemic/epidemic emergency plan that includes at a minimum: 

1. The chain of command for the emergency plan, and the individuals responsible for specific duties such as quarantine;
2. The specific steps the district will take to stop the spread of the disease;
3. The process for identifying sick students;
4. The transportation plan for sick students;
5. Disease containment measures for the district;
6. A continuing education plan for students, such a plan may include providing students with assignments via mail, local access cable television, or the school district’s Web site;
7. Procedures for dealing with student privacy rights; 
8. A continuity of operations plan for central office functions including employee leave, pay and benefits during a pandemic; and
9. An ongoing communication plan for staff, students and parents.

D–5: Planning

The School District will work with the Local, Federal, and State Government Agencies to develop a Pandemic Influenza Management Plan.

Responsibilities of Schools:

In the event of a pandemic,

1. School Districts assumes the following responsibilities:
   • Develop capabilities to implement non-medical measures to decrease the spread of disease throughout the school community as guided by the epidemiology of the pandemic.
   • Develop and implement pandemic preparedness activities and a business continuity plan aimed at maintaining the provision of educational services and limiting the spread of disease throughout the duration of a pandemic.
   • 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.
   • Develop and implement educational support plans for students who are isolated or quarantined and coordinate these plans with the social support plans developed by the Adams County Health District.
   • Develop and implement support plans for Teen Health Clinics designated to be used as “immunization clinics” or “flu clinics” to triage/evaluate and/or treat influenza patients not requiring hospital care. 
2. Othello School District assumes the following responsibilities - Develop a response plan that will:
   • Identify chain of command in case of illness with a minimum of two backups. 
   • Review and best practices for respiratory hygiene and universal precautions.  Train all school staff, volunteers and students.  Identify and procure needed resources. 
   • Review procedures for sending ill individuals home and make adjustments if necessary.
   • Report the number of staff and students daily absent with pandemic flu to the Health Department and Incident Commander.
   • Document actions taken.
   • Update staff and provide information on extent of infection at school site and potential changes that might take place at school.
   • Develop a recovery plan that provides for education support and emotional support for staff and students.  If there is loss of life, implement procedures located in the Quick Reference Guide.

D–6: Mitigation

Mitigation activities are taken in advance of an influenza pandemic to prevent or temper its impact.  Mitigation efforts will occur primarily during the early pandemic phases (Phases 1-3).  

Pre-event mitigation activities include:

1. Planning, exercising, evaluating and revising the Pandemic Influenza Management Plan.
2. Training and equipping staff to assure competencies and capacities needed to respond to a pandemic outbreak.
3. Developing strategic partnerships with local community health care institutions and providers, and local, state and federal response agencies and their staff.
4. Educating schools and parents about an influenza pandemic and recommend preparedness measures.
5. Informing and updating schools about the potential impacts of an influenza pandemic on essential services and city, county, and school infrastructure. Reviewing and updating district-wide business continuity plans and assuring essential business functions are adequately staffed.
6. Stockpiling necessary equipment and supplies that will be needed to respond to an influenza pandemic.
7. Establish ventilation (HVAC) standards to be used during each phase of the pandemic. 

D–7: Social Distancing Strategies

Social distancing strategies are non-medical measures intended to reduce the spread of disease from person-to-person by discouraging or preventing people from coming in close contact with each other.  These strategies could include closing schools; closing non-essential agency functions; implementing emergency staffing plans; to increase telecommuting, flex scheduling and other options; and closing all public assemblies or after school activities.

1. Social distancing strategies and current epidemiological data will be reviewed during each phase of the pandemic and recommendation will be made to key elected officials including County Executive, the City Executives, and Superintendents of public school districts regarding social distancing actions that should be implemented to limit the spread of the disease.
2. Decisions regarding the closing of all public and private schools, community colleges and universities will be made by the Local Health Officer after consultation with local school superintendents, school presidents and elected officials.
3. Decisions regarding the implementation of social distancing measures including suspending large public gatherings and closing stadiums, theaters, churches, community centers, and other facilities where large numbers of people gather will be made jointly and concurrently by the Local Health Officer and County Executives and coordinated with all executive heads of cities and town. 
4. Social Distancing Strategies
   • The County officials will:
     • Educate elected officials, government leaders, school officials, response partners, businesses, the media and the public about influenza pandemics and their consequences.
     • Coordinate with elected officials, government leaders, school officials, response partners, and businesses regarding the use of using social distancing strategies, the associated impacts they cause and the process for implementing these measures.
     • Confirm the decision making process and criteria for recommending social distancing strategies with key public officials.
   • Schools will:
     • Increase respiratory hygiene education for staff, students and parents.
     • Increase symptom monitoring and attendance monitoring to ensure accurate reporting.
5. Social Distancing Strategies During Phases 4, 5, 6.
   • The Local Health Officer will coordinate with elected officials regarding decision making and implementation of social distancing strategies that are commensurate with the severity of illness and societal impact of the pandemic.
     • Implement specific, county-wide social distancing strategies that may include
     • Encourage government agencies and the private sector to implement pandemic emergency staffing plans to maintain critical business functions while maximizing the use of telecommuting, flex schedules, and alternate work site options.
     • Encourage the public to use public transit only for essential travel; therefore transportation to schools may be interrupted.
     • Advise residents to defer non-essential travel to areas of the world affected by pandemic influenza outbreaks.
     • Suspend all public events where large numbers of people congregate including sporting events, concerts, and parades.
     • Close all public and private schools and colleges.
     • Suspend all government functions not dedicated to addressing the impacts of the pandemic or maintaining critical continuity functions.
     • Monitor the effectiveness of social distancing strategies in controlling the spread of disease and will advise appropriate decision-makers when social distancing strategies should be relaxed or ended.
   • Schools will follow guidelines as appropriate including:
     • Follow social distancing guidelines and emergency pandemic staffing plans; and,
     • Cancel extracurricular activities or close schools.

D–8: Maintenance of Essential Services

One of the critical needs during a flu pandemic will be to maintain essential community and business services.

1. With the possibility that 25-35% of the workforce could be absent due to illness, it may be difficult to maintain adequate staffing for certain critical functions.
2. There is the possibility that services could be disrupted if significant numbers of public health, law enforcement, fire and emergency response, medical care, transportation, communications, and public utility personnel are unable to carry out critical functions due to illness. Individual schools or the entire district may be adversely disrupted.

Schools will update and maintain continuity of operations plans and protocols that address the unique consequences of a pandemic.  These will include the following: 

1. Schools will follow best practice guidelines for return to work after an influenza illness. Current recommendations are based upon seasonal influenza recommendations.  Because experts do not know whether the mode of transmission, incubation period, or contagious period of pandemic strains of the influenza virus will be similar to those of seasonal influenza (recurring yearly), schools will update and follow specific recommendations from the Health Department during a pandemic) Current influenza recommendations include employees/volunteers who have become ill with influenza should stay at home until all of the following criteria are met
   • At least 5 days have passed since the symptoms of illness began; AND
   • Fever has resolved and has not been present for at least 24 hours; AND
   • Cough is improving (decreasing in frequency and amount of secretions with no associated chest discomfort or shortness of breath)
2. Upon returning to the work environment, employees should continue to follow cough etiquette and hand washing protocols.

The School District Base Plan will be updated and maintained.  The Base Plan should include a continuity of operations and business recovery plans detailing the following:

• Lines of Succession
• Identification of mission essential services and priorities.
• Continuity of operations and business recovery plans, including:
• Business Impact Analysis
• Critical “daily” functions that need to be provided even during an event, although at a reduced level
• Standard Operating Procedures for critical functions/processes including clearly documented protocols for adjusting staffing to maintain essential functions
• Human Resource policies including
• Staff policies for personal illness or care of family
• Policies for flexible work hours and working from home.
• Procedures for the reassignment of employees to support mission essential services.
• Maintenance of Essential Services During Phases 1, 2, 3
  • The school district will update plans for maintaining essential departmental services during a pandemic.
  • The district will educate central administration and the school community that provide essential services about the need for continuity of operations planning in advance of a pandemic.
• Maintenance of Essential Services During Phases 4, 5, 6
• The school district will update its continuity of operations plans and will request that its schools update their plans.
• The Incident Commander will determine the appropriate time to implement the continuity of operations plans and protocols.

D–9: Recovery

1. School recovery from an influenza pandemic will begin when school officials determine that normal supplies, resources and response systems can manage ongoing school activities.
2. The School District will assess the economic and educational impact of the pandemic.
3. Recovery plans will depend on the severity and duration of the pandemic but will include business recovery plans to mitigate education and financial losses, as well as emotional recovery plans.
4. The School District will recommend specific actions to be taken to return schools and district offices to pre-event status including environmental sanitation.
5. The School District will conduct an after-action evaluation of the pandemic response. The evaluation will include recommendations for amendments to the Pandemic Influenza Management Plan.