Schools prepare for deadly bird flu

By Molly Thompson

The mumps outbreak that hit Midwestern states, including Wisconsin, at the end of the 2005-06 school year was nothing compared to what some health experts call an impending avian flu pandemic. The mumps causes painful swelling of the salivary glands and fever, but is rarely fatal. Health experts say the bird flu could kill upwards of 2 million Americans.

As of early June, one type of the bird flu called avian influenza A (H5N1) has killed at least 127 people worldwide since 2003 when it began spreading from Asia, Africa and Europe.

And schools in Wisconsin are just beginning to prepare for what scientists say could be an unprecedented scale of an influenza infection with school-age children being prime spreaders.

"The mumps was just a miniscule example of how public health can have a tremendous impact on education systems, teachers and staff, and students," said Linda Caldart-Olson, DPI school nurse consultant. "Schools that dealt with the mumps are taking the threat of avian flu very seriously. Kids didn't die from the mumps. This will be very different.

"All schools have an emergency plan, but the avian flu would be a much different emergency. The mumps had a contamination period of a week or a few weeks at most. We don't know how long the avian flu would be a threat. If the schools were closed for a week, we could delay the end of the school year by a week. But what if it's a month? Or two months?"

Summer lull leaves time to plan

The U.S. Fish and Wildlife Service is spending the summer sampling birds for bird flu. Nationwide, the goal is to sample 75,000 to 100,000 wild birds. Meanwhile in Wisconsin, the state's education leaders at the Department of Public Instruction and health experts at the Department of Health and Family Services are teaming up to create action plans on how to deal with an outbreak of H5N1 avian influenza virus in schools.

Summer is an abeyance time for the avian flu because hot temperatures apparently slow the virus. Government agencies overseas and locally are using the lull to train, educate and prepare for possible outbreaks when the weather cools and birds that may carry the disease migrate.

Preliminary plans in Wisconsin include creating Web-based trainings to use internally for DPI staff and school leaders, including superintendents, principals and school nurses. Content for the seminars is based on the Centers for Disease Control and Prevention's "Pandemic Flu Planning Checklist for Individuals and Families," which urges pre-planning such as storing a two-week supply of water and food, talking with family members and loved ones about how they wish to be cared for if they get sick, and teaching children to wash hands frequently with soap and water, and cover coughs and sneezes with tissues (not their hands).

"The focus is how health and school officials can work together," Caldart-Olson said. "Health officials are in charge of communicative disease control, but educators know how schools operate. The scope of an avian flu pandemic is that everyone will be affected, and each organization will know best how to plan for contingencies in their organization."

Like the mumps, Hurricane Katina also served as a lesson for schools on how to deal with catastrophe.

"Actually, Hurricane Katrina showed us how not to plan for emergencies," Caldart-Olson said. "Katrina was helpful in a horrible way to get people to understand that you can't fail to plan or do your planning in a bubble.

"It's difficult to get people's attention because avian flu outbreaks closing schools and all gathering places and many deaths is not something you can see right now. Cynics say, 'It's not going to happen, why put up all the fuss?' And when people are feeling healthy, they don't think, 'What would it be like if I am sick?'"

Who's in charge?

President George W. Bush has outlined a $7 billion program to prepare the United States for an outbreak of the avian flu virus; states will receive about $250-million before the end of summer. But federals officials told states not to depend on them for help.

In the case of an outbreak, public health officials will have overall jurisdiction, including the decision about closing schools or any place where people gather. However, school officials will still have to decide at what point keeping schools open is a waste of resources, due to teacher and student absences.

Alabama has surveyed families to see if they have the technology to plug into online home schooling should schools close. Educators in Wisconsin are investigating online teaching possibilities.

"At the conceptual level, would it work? Is it realistic to think that a teacher could be in a remote place to set up a Web cam to instruct a class? But how do you organize it between several teachers and classes? It's possible, but it depends on the school, the size," Caldart-Olson said. "It's just very hard to plan for contigencies.

"One thing that's extremely useful is determining a formula to assess an absence threshhold," she added. "Even though health officials would be in charge, how do we know as educators when it's time to realize we don't have enough teachers or students anymore."

State officials are also working to take the CDC checklist and tweak it into a form that translates science-jargon into language that can be understood by everyone. The Division of Adolescent School Health, which is an arm of the CDC, is also working with key national professional groups to create a toolkit that will have sample plans and sample communication pieces. DPI will send the checklist and the toolkit to administrators and school nurses this fall. The state's Web seminars should also be online by fall and will be archived so that educators can access them anytime.

"The online seminars will likely be done by a combination of health department epidemiology experts and DPI staff," Caldart-Olson said. "We also want to highlight local success stories."

Networking, collaboration keys to success

The Wausau School District in Marathon County rolled out its avian flu plan in April.

"Our major initiative comes out of the Marathon County Health Department, which we had a proactive working relationship with before tackling the avian flu," said Mary Ellen Marnholtz, coordinator of Community Relations for the Wausau School District. "They took the lead and formed a group of people throughout the community who worked on the plan since last summer."

The Wausau Schools/Marathon County avian flu team includes the county administrator, emergency management director, the sheriffs department, health department epidemiology specialists, infection control experts from local hospitals, Red Cross volunteers, United Way 211 staff, and firefighters and police.

The team also includes representatives from the Wausau Hmong Association.

"It's important that information be available in all languages, and we have a large Hmong population," Marnholtz said. "We're also looking for ways to improve involvement for Spanish-speakers. So basically, we have a good outline in place, but we still have a lot to do."

Communicate, educate

A key provision of the Wausau plan is effective communication.

"Communications is key once we would go into an emergency management scenario," Marnholtz said. "One of the biggest things we did was sit down and have a really important conversation with local media. We needed them to understand they are an equal partner in this. They cannot look at us as 'the story.' They have a role to get this information out to the public. We invited news directors and anchors in to start educating them and making an emergency communication plan.

"Educating the media is important. We need them to stay with the story and give consistent, accurate information - lives depend on it," Marnholtz said. "They have been very responsive."

Wausau's plan lists all the available modes of communication, from media and web sites to letters and phone hotlines.

Incorporate 'preparedness' into curriculum

All districts may have emergency plans, but an avian flu outbreak is going to be very different, Marnholtz said.

"(Avian flu) is not a flash incident where it happens, and you respond. It builds, which is good because it gives you planning time, but it lasts and comes in waves," she said. "No one in our lifetime has ever had to deal with something like this. By the time a community goes through that first wave, it is going to learn a lot."

After an emergency preparedness plan is set, it's important to model behavior outlined in the plan.

"We are trying to stress now that everyone should have emergency preparedness kits," Marnholtz said. "Being prepared with things like extra water and non-perishable food gives a sense of control to a situation where they are so many unknowns."

Wausau educators are working emergency preparedness into the curriculum.

"Look what happened with anti-smoking and seatbelt safely; kids are very responsive to these kinds of things," Marnholtz said. "I'm good about wearing my seatbelt, but if my sons sees me even start to back up without my seatbelt on, he's fanatical. He learned that in school and understands that component of safety."

Information on how to create preparedness kits is available by contacting the Red Cross or going online to Redcross.org/services/disaster.

"It's wise to be prepared for the worse, but hope for the best," Marnholtz said. "If the most brilliant scientists in the world can't predict this, we certainly can't. We just have to make sure we have an emergency system in place."

Vaccine: who gets it?

Federal officials said in June that states will have to decide how to ration a vaccine if there is a pandemic, and it could be six months or longer until a vaccine is available after an outbreak.

A roadblock to the vaccine is that the virus may mutate as it spreads among people. Right now, the H5N1 strain is very difficult for people to catch. Most of the people who have died overseas caught the disease from direct contact with infected birds.

DPI has already fielded calls from concerned educators who want to know if they can have priority for a vaccine. So far, Bush has only given priority to vaccine factory employees and front-line health workers. But what about school-age children, the flu's prime spreaders, and senior citizens who may be at highest risk of death from the virus? Local officials also wonder who will keep order if police and firefighters do not get priority and all get sick.

"The federal government has a very important role, and we'll play it," Health and Human Services Secretary Mike Leavitt said in early June. "But when it comes down to managing the public health in a pandemic situation, it will be up to local public health authorities."

Local authorities aren't so sure about that. "We suspect that decisions about who gets the vaccine will be coming from even higher up than the county Health Department," Marnholtz said. "There will be guidelines from state and federal authorities that say at what level you must eliminate places where people gather. We suspect those directives will come from CDC."

The decision of who ultimately gets the vaccine is unknown.

"There are going to be difficult decisions, and those decisions will have costs," Marnholtz said. "It's our job to work around those decisions and do the best we can to provide information so there is not panic and the kind of behaviors that can lead to more disaster."

Health and school officials urge educators and families to educate themselves about bird flu.

"There are wonderful resources online at the World Health Organization and CDC," Marnholtz said. "You don't have to re-create the wheel; it's all there. Just get the right people from your community at the table."

Posted June 12, 2006