1

‘School Closing’as a

Potential Means to Counter

Pandemic Influenza

Table Top Exercise (TTX)

2

CDC GuidanceSupplemental Guidance to Cooperative Agreement

Grant Awardees:

Pandemic Influenza Guidance Supplement to the 2006 Public Health Emergency Preparedness

Cooperative Agreement Phase II

Date: July 10, 2006

(Planning and Response Exercises)

3

Public Health Measures

Categories of Interventions Pharmaceutical Non-Pharmaceutical

4

Public Health Measures

Pharmaceutical Interventions

Vaccines Antivirals

5

Public Health Measures

Individual Measures – ‘Hygienic’ Hand washing Cough etiquette Washing inanimate surfaces Masks & respiratorsCommunity-based Measures Self-isolation Self-Quarantine Social Distancing Measures

Work Place Policies Gatherings restrictions Travel restrictions School Closings

Non-Pharmaceutical Interventions

6

‘School Closing’as a

Potential Means to Counter

Pandemic Influenza

7

School Closing Warrants Special Consideration

Children among the highest at-risk population

Children among most likely to spread the disease

Poses an immediate community-wide impact from a single policy decision

Substantial adverse socioeconomic impacts

Pros & Cons of all stakeholders must be considered

8

Overview / Purpose

Provide a Public Information Exchange Forum for Pandemic Influenza Issues

Discussion to facilitate planning and to assess School Closing as a potential means to counter a Pandemic Influenza outbreak

Provide valuable feedback for policy formulation at all levels of government

9

Scenario Video 1

10

Exercise Scenario - 1 The World Health Organization (WHO) has

confirmed sustained human-to-human transfer of a virulent influenza virus in several Asian countries and has determined that an influenza pandemic is underway (WHO Phase 6).

CDC has advised that the pandemic influenza virus is likely to reach one or more contiguous 48 states in the next 30 days. (USG Stage 4).

HHS has issued guidance for State and Local governments to consider non-pharmaceutical measures as potential countermeasures.

11

Discussion Questions - 1

Realistic expected range of morbidity & mortality for the community? (Identify your Science Advisor!)

Likely healthcare demands upon hospitals & other healthcare facilities?

Expected quantity of antiviral drugs? Plans for use of antiviral drugs? How would school closings affect response plans? Other community-wide actions?

(Public Health Risks & Countermeasures)

12

Scenario Video 2

13

Exercise Scenario - 2 The World Health Organization (WHO) has confirmed

sustained human-to-human transfer of a virulent influenza virus in several Asian countries and has determined that an influenza pandemic is underway (WHO Phase 6).

CDC has advised that the pandemic influenza virus is likely to spread across all 50 states

(USG Stage 5). HHS has issued guidance for State and Local

governments to consider non-pharmaceutical measures as potential countermeasures.

14

School Closing Considerations Children are efficient transmitters of flu In Asian flu pandemic of 1957-58, the highest rates were

seen in school age children Data on School Closing is limited One published study found significant decrease in incidence

of disease as result of school closures Risk of infection & illness likely decreased with closures Mathematical modeling suggests reduction of transmission

due to School Closing Child Care arrangements will be required if School Closing School closures also have significant impact on the

community and the workforce

15

Discussion Questions – 2

Who has authority to close some or all of entire public school system? (similar to snow days?)

What is ‘procedure’ for routine closings? Is the locus of authority different if 4 - 6 weeks? Is there a state authority for resolving disagreements

between adjoining jurisdictions? Public school officials authority over private schools? Decision to ‘Re-open’ Schools? Who? When?

(Decision Making Process)

16

Break

17

Scenario Video 3

18

Discussion Questions - 3

What % of teachers / admin would be idled? Policy for compensation of idled workers? Program for continued ‘at home’ education? ‘Latch-key’ special needs? Status of ‘other school-based services’? If extended period (4 – 6 weeks), what is the

requirement for make-up days? (Longer?) Plans to preclude ‘unofficial mall’ gatherings?

(Impacts from Closing Schools)

19

Additional Information

20

Discussion Questions - 4

Parents away from jobs to supervise children? Employers ‘telework’ arrangements? Employers liberal leave policies? Employers Continuity of Operations Plans? Assistance from other public or private entities to

assist parents with their ‘at home’ children? Absentee Impact on community infrastructure?

(Other Public & Private Entities)

21

Final Comments

22

Conclusions from the Historical Record: 1918 Pandemic

“Swift, agile, decisive, and coordinated action based on accurate information and advanced preparedness planning, before the appearance of influenza in the local area, is critical.”

Howard Markel, MD, PhD www.dtra.mil/asco/DTRAFinalInfluenzaReport.pdf

23

End