H1N1 Scenarios

WASHINGTON -- The U.S. Departments of Education and Health and Human Services on Thursday released their most detailed guidance yet on how colleges should prevent H1N1 outbreaks and what options should be considered if they take place despite such efforts. Given that the severity and size of outbreaks could vary widely, the guidance is more of a menu of options than a rulebook -- and the ideas cover everything from washing doorknobs to ending the requirements that students submit medical notes for absences to when to consider suspending operations.

Arne Duncan, secretary of education, stressed that the goal is to avoid colleges having to suspend operations. "The goal is to keep universities open as much as we can .... to keep students learning," he said. Duncan said that the guidance was designed to be "balanced" and "measured," reflecting "the best science." But he also said that officials can't be sure what they will face this fall.

Kathleen Sebelius, secretary of health and human services, noted that "college-age students are particularly vulnerable to this virus," and that the close quarters in which students on many traditional campuses live and learn may make prevention and treatment challenging.

Both Duncan and Sebelius stressed that they were not saying any one college should adopt all of these recommendations, but that these reflect the kinds of actions colleges may want to take. Some are preventive, while others focus on what to do when an outbreak occurs.

• Promote the "self isolation" of students who have H1N1 or symptoms, encouraging them to stay away from classes and other activities and to stay in their rooms or, if they have family members in the area, to travel there (not using public transportation).
• Create "flu buddy" systems in which healthy students may get food, assignments and medicine for ill students.
• Create systems so staff members can check on students in "self isolation."
• Modify absenteeism policies so both students, faculty members and others who are ill have no incentive to return to campus activities earlier than they should.
• End rules that require doctor's notes to excuse absences from class or work.
• Expand or create distance learning programs for those who need to be isolated.
• Encourage more cleanliness on campus both by adding cleaning schedules that may be performed by employees (bathrooms, doorknobs, shared keyboards, etc.), and by students in their rooms.
• Increase "social distances" between students by moving desks further apart (6 feet most of the time), and considering suspending or changing large events such as sporting events or commencement ceremonies.
• Plan vaccination programs when the vaccines are available and encourage students to get vaccinated. (With vaccines not expected in needed numbers until October, and with two vaccines required, officials said that it could be well into November before vaccine protection could be hoped for.)
• Develop special programs for groups on campus with special needs, such as students who are younger than traditional college but who may be attending "early college" or enrichment programs.

Sebelius, citing her personal experience as the mother of two men now in their 20s, said that she realized that getting college students to follow advice on such matters may not be easy. Many college students do not see medical professionals regularly, and many may not even have had all the vaccinations (or recent versions) that they should have, even before the arrival of H1N1. But she said it was essential for colleges to try to reach students, and recommended the use of Facebook, Twitter and other social media to do so.

One of the more sensitive issues facing colleges is whether to suspend operations in the event of an outbreak. When H1N1 first broke out on campuses in the spring, the University of Delaware had one of the larger outbreaks and controlled it without ever suspending operations -- while other campuses shut down for several days with only one or two suspected cases. The University of Alabama at Tuscaloosa is currently facing an outbreak with at least 21 students showing symptoms, and it has not shut down.

The guidance from the agencies appears to be striking a middle ground on suspending operations, urging colleges to "balance the risks of flu in their community with the disruption that suspending classes will cause in both education and the wider community." The government appears to be suggesting that if outbreaks do not surpass the levels experienced in the spring, suspending operations may not be needed. The guidance notes that the government "may recommend preemptive class suspension if the flu starts to cause severe decrease in a significantly larger population" than was seen earlier in the year.

In cases where classes are called off "preemptively," the guidance says that large gatherings such as sporting events, dances and commencement ceremonies should also be canceled or postponed.

The guidance also suggests that suspending operations can be quite complicated. Residential colleges are unlikely to see all students leave, and so would need to continue to provide services to students. Non-residential colleges would need to "consider whether they can allow faculty and staff to continue use of their facilities while classes are not being held. This may allow faculty to develop lessons and materials and engage in other essential activities."

How long to stay shut? "The length of time classes should be suspended will vary depending on the goal of class suspension as well as the severity and extent of illness," the guidance states. Colleges "that suspend classes should do so for at least five to seven calendar days. Before the end of this period, the [college], in collaboration with public health officials, should reassess the epidemiology of the disease and the benefits and consequences of continuing the suspension or resuming classes."

Anita Barkin, director of student health services at Carnegie Mellon University and chair of the American College Health Association's Coalition for Emerging Public Health Risks and Emergency Response Planning, said that the guidance was "very much on target," adding that it "outlines the key issues and the rationale while recognizing that implementation will have to be based on local circumstances and resources."