Conversations Continued: H1N1
Editor’s Note: In the November+December 2009 issue of the Talking Stick we asked members to discuss how they are addressing H1N1 on their campus. As you would expect, they had plenty to say on the subject; so much that their ideas overflowed the magazine pages and onto this blog. So much that we’re even breaking it into three separate posts. Participating in the Conversation is Mike Krenz, assistant manager for risk management at Texas A & M University in College Station; Gary McLaughlin, business manager for housing at Flinders University of South Australia in Adelaide; Steve Palmer, director of residence life at Western Michigan University in Kalamazoo; Robert Tattershall, director of housing and conference services at Washington State University in Pullman; Dima Utgoff , director of residence services at the University of Alberta in Edmonton, Canada; Joe Gonzalez, associate dean of residential life at Duke University in Durham, North Carolina; Sean Duggan, managing director of university student housing at Texas Tech University in Lubbock; and Bes Liebenberg, coordinator for student support residences at the University of Pretoria in Gauteng, South Africa.
Question: How has your office responded to differences between the actions your office can take versus the actions expected by your students/parents?
Tattershall: The fact that we had a process in place to help residents pair up with a flu buddy, if needed, and a way for the residents to get food and know when they were well enough to resume their normal daily activities, helped us respond to the varying parent requests. Talking with the parents, getting people to understand the progress of H1N1 and that we had these other processes in place to help, made the conversation much easier.
Krenz: We have been holding to the “party line” and referring parents to how the university is responding and how residence life is responding . We have to keep explaining — like a broken record — that we will treat all of the students the same. No one is “special.” We have assured students and parents that we are taking our guidance from local health authorities and the university, and if things should get worse, we will modify our plan and respond appropriately.
McLaughlin: We had few questions from parents and they were advised exactly the same as residents of what procedures and safeguards we had put in place. Residents and parents were assured of continued occupancy if the resident caught H1N1. We would however isolate them but provide whatever they required.
Palmer: Education and more education has been our best bet. Our president is fully supportive of the directions we’re taking which is outstanding. We also discuss our limitations and continue to emphasize that if possible, students return home.
Utgoff: One such situation has just come up. The president of one of our residence associations has expressed his displeasure with the way we are responding to H1N1. Among other suggestions (and there are some good ones) he has asked us to provide small bottles of hand sanitizer to all residents (all 1,750 plus of them) in his residence. Our view is that this is unreasonable for many reasons and flies in the face of advice that the best personal hygiene involves washing ones’ hands with soap and water.
We have yet to hear from any parents, but I would expect to hear from some when they find out that we have made a conscious decision not to provide any isolation areas. In conversations with the Public Health Response Team, the University Health Centre, our Occupational Health Manager, our bio-hazards officer and one of our vice-provosts who, among other things, is a nursing professor, we have been advised that moving sick people to another area is likely to make things worse for the sick student. We also considered creating an isolation area for those who are healthy if they wanted to get away from a sick roommate. We understand that people who are infected with H1N1 may be contagious before they are even aware that they have the virus. Thus, someone who appears healthy could actually infect a large group of people. As well, because of the demand for residence space, we are not in a position to leave residence beds unoccupied. We could have consolidated the few empty spaces we do have (mostly as a result of “no-shows”) but for the reasons mentioned above we have chosen not to. Obviously, if Alberta Public Health directs us to do something different we will do whatever we can to comply.
Duggan: We are a pretty responsive department, within reason. We will try to accommodate requests or work toward compromised solutions. We have not really been up against an undo-able task. We will not force an ill student to relocate and have not been asked to, which has been somewhat surprising to me. We have encouraged responsibility, and taking care of each other which I think has dulled the “panic” somewhat.
Liebenberg: What we have done is 1) Sent the same literature to both student and parents, and 2) We assured students and parents that we are continually assessing the situation and will modify and respond accordingly. Unconfirmed reports in the media created the impression that our TuksRes team is not doing enough. This was however rectified by the students themselves who categorically denied any outbreaks of the virus in their residences.
Question: In what manners have you found responses to H1N1 have differed from your normal responses to ill students living in the residence halls?
Krenz: Typically, TAMU does not have a sick tray process. This was an additional step above and beyond normal procedures for students with infectious diseases. Other than that, this is a pretty normal response for TAMU when we have a report of an infectious disease in a residence hall.
Liebenberg: After reports in the media of the death of a student at another university in South Africa, students became more aware of the risks and reported even the slightest symptoms to the student health services or their private doctors. Our department is keeping a database of all reported cases (both confirmed H1N1 and other flu-related symptoms). We have never had to create isolated accommodation and serving of separate meals to infected students. Doing that would have created a challenge. Fortunately there were no needs to put these measures into practice.
McLaughlin: We found that there appeared to be an increased awareness and concern about becoming ill over and above any other year. In previous years residents would assume some would catch colds and/or the flu and not question it. This year the residents were more concerned and many sought medical attention whereas previously they would accept illness as a normal hazard of winter and be more likely to “suffer in silence.”
Palmer: The isolation issue is clearly the biggest challenge. That combined with the fact that the H1N1 and the university responses are so well publicized have put a fear factor/paranoia out there with folk that wouldn’t normally be there with the seasonal flu or other isolated incidents of sickness.
Tattershal: Our response has been more coordinated than in a typical flu epidemic because the public was going to expect it from us based on the publicity beforehand. During a typical flu season, we have no idea who is sick, or how many, or much of anything, other than lots of people are sick, as usually occurs during the winter months. However, a very good question to ask schools that have isolated residents is, what will their response be when seasonal flu arrives in full force and the symptoms are worse than H1N1? The low level of virulence and mortality with this wave of H1N1 informed our choice on this.
Duggan: We have provided more education regarding health and self-protection from germs. Our response to an ill student has always been the same, which is work with the student and the roommate to help the situation in any way we can. H1N1 has given us the opportunity to review our services, improve our communication with students, and to let students and parents know we are here to help them.
Question: Under what circumstances would you isolate students that have H1N1 or are suspected of having H1N1?
Tattershal: Here at Washington State University, we chose self-isolation over isolation due to the low level of virulence and mortality of this wave of H1N1. Self-isolation means stay in your room as much as possible, wash your hands, don’t touch your eyes, nose, and mouth and if possible, wear a mask, etc. We would chose isolation if the disease was more virulent and had a higher mortality rate; however, choosing isolation calls into question whether quarantine is also needed, and that requires a much greater amount of space. Stopping the spread of a more virulent disease would necessitate quarantine of healthy individuals for a period of time. This is all probably old news to you, but in case it isn’t, here’s a brief explanation of the difference.
Krenz: Excellent question. Glad you asked it. We asked the same question of our student health services. We don’t actually force isolation on our students. The isolation rooms are available should the students want to isolate. The biggest group of our students went home when they were ill. Probably the second biggest group voluntarily chose to isolate in a room we provided. The rest just stayed in the room with their roommate.
This is the wording we gave to students: “If you get sick, you are advised to return home for the recommended self-isolation period if you live near College Station and if you have someone who is not ill who can assist in driving you home. Residence Life staff will identify appropriate housing accommodations for ill students, in the event that self-isolation is not possible, and/or a student cannot return home. Please notify your resident advisor or hall director if you believe that you are experiencing flu-like symptoms.”
Gonzalez: After much back and forth, we decided that asking the student to isolate him or herself in the room was sufficient. We also decided we would not temporarily relocate roommates. Two main factors led to this decision. First, as well described by Robert, the virulence and mortality are quite low. Also, CDC guidelines evolved such that isolation in the student’s room was viewed as sufficient. The second factor that impacted this was the reality that we had very few empty rooms to use for such a purpose. If the need for isolation rose above twenty, we had no ability to do so with our residence hall resources.
Given this limitation and level of risk, we decided that the few rooms we did have available for isolation would be utilized for healthy students who were at increased risk of significant H1N1 illness due to other pre-existing health reasons and who had students with H1N1 near them (roommate, etc). The student health center is responsible for making this determination.
Liebenberg: If the student is diagnosed as having contracted H1N1 we advise that he or she return home for at least a week or until they have recovered. If the doctor diagnoses a mild degree of illness, the student will be asked to avoid contact with other people, refrain from any physical activity and get complete bed rest for up to seven days. If the doctor diagnoses a severe degree of illness the student will be hospitalized.
Palmer: If the students are not able to return to their homes and they do not currently live in a room by themselves with their own bathroom or if they live in a hall with community bathrooms on the floor, then they would be isolated.
McLaughlin: At Flinders we set up a furnished student common area with TV, magazines, internet and telephone access etc. to be used by any resident with H1N1. Preordered meals were delivered to that area as well. Residential and general staff kept tabs on all infected residents on a regular basis. We would only isolate residents if they shared a room or if other residents or parents specifically requested us to take that course of action. Of course if a resident showed a severe reaction to H1N1 we would definitely have them isolated and ensure appropriate medical treatment.
Duggan: Texas Tech is not isolating students who are ill. We thought this would make the problem worse. We thought it would be better for the student to be in their own home/room environment for getting better etc. Now if the state demands something, that would be a whole new ball game. Plus we do not have any available space to set up an isolation area without moving well kids off of a floor-to move sick kids in. What a mess!
