However, this article notes that there’s nothing in the bill that exempts student health care plans for certain stipulations in the bill, namely that pools of generally young, healthy people–such as college students–must be averaged with other, less-young, less-healthy people. These rules don’t take effect until 2014. Lobbyists for higher education have time to argue that colleges and university health care plans should be allowed to remain exclusive to students. Otherwise, the costs of those plans could go up.

Unnoticed in much of the hullabaloo, student loan administration was also changed as a part of the health care bill. Private lenders can no longer make federally-subsidized loans; only the federal government can.

Some groups have estimated the new bill will eventually result in an annual $3000-per-employee savings for colleges’ and universities’ faculty and staff health care costs. If they occur, those savings won’t appear for several years.

Increasing numbers of students have been arriving on college campuses with food allergies they are unable–or perhaps, unwilling–to manage by themselves. Perhaps their parents had done most of the work of coordinating doctors’ appointments, medications and keeping the illicit ingredient out of the way.  Despite the parent’s best intentions, their child arrives at college with limited ability to cope with their own condition. Some students may be reluctant to admit that their allergy limits them in any way. Some have never had a very severe reaction, and regard their allergy as a mere annoyance, rather than something that could be life-threatening.

The situation is difficult for dining halls as well; ensuring that adequate meals are created without allergens and making students aware of the ingredients of each dish, all the while creating delicious meals that appeal to everyone, providing a welcoming environment, and hopefully making a profit, or at least breaking even. Some institutions have opened special allergy-free kitchens and refrigerators to deal with the issue. The Food Allergy and Anaphylaxis Network introduced its College Network in 2009, a resource for students on institutions that can accommodate their diets.

Despite an institution’s best efforts, however, there’s no way of preventing an allergic student from eating an off-limits food, unknowingly or otherwise. And these are the sorts of things that keep administrators awake in the wee hours.

How has your institution dealt with this issue? Have food allergies affected the residence halls? Does a student who keeps a jar of peanut butter handy find it hard to live with a roommate who must avoid the stuff? Have allergies affected how the vending machines are stocked? Have you had to confront a student who is eating dangerously? Let us know.

Question: Under what circumstances, if any, would you not isolate students that have H1N1 or are suspected of having H1N1?

Tattershal: We chose self-isolation this time, so in this wave of H1N1 we chose not to isolate.  Some time ago, during SARS and H5N1, helping the university understand that true isolation was virtually impossible in a high occupancy residence hall system (over 80 percent of our residents live with a roommate and have to leave their rooms to go to the bathroom and most have to leave at some time to get food), made quite a bit of difference in the current H1N1 discussion.  We were successful in getting the committee to think not only of the first few cases of H1N1, so as not to tailor our response just for the beginning of the epidemic on our campus, but for the epidemic after a few weeks, when the numbers would be much larger and overwhelm any attempt to isolate people in the handful of empty spaces we had.

In our situation, we had one case during sorority recruitment, the week before school started. That one case, because of her contact with other students, and their contact with many more, became hundreds of suspected cases of influenza-like illness before we could have implemented an isolation program. Our health professionals stopped testing after the first few cases of H1N1 because of the time lag and cost, and the CDC statements that 98 percent of all influenza A illnesses were H1N1 at this time, which meant that we only knew people were sick, and it was probably H1N1. Therefore, isolation for us would have meant isolating hundreds of residents that had influenza-like illness, and doing so within days of the initial awareness that an outbreak was already here.

We knew last spring, that unless H1N1 mutated very quickly, and became much more lethal and the symptoms were much more severe, our response to H1N1 would be very different compared to what we were planning to do if SARS or H5N1 ever made it within 100 miles of our campus; i.e., recommending to our leadership to close the university.  Interestingly, of course, closing the university doesn’t necessarily mean that we could close the halls, as several hundred of our residents simply wouldn’t be able to go home in the face of a infectious disease with high virulence and mortality.

McLaughlin: We did not specifically isolate any residents because by the time a resident was diagnosed they would have infected close contacts (if they were to be infected)anyway. In addition we do not have shared rooms so each resident was in their own room and that made it much easier to keep them away from others. By using the common area specifically set up plus having meals delivered, the infected residents were isolated but were not forbidden going to other areas of the complex.

Duggan: We suggest that students go home if that is an option, or self isolate to their res hall room.

Liebenberg: Only if the diagnoses are not confirmed. Out of a possible 8,000 residents we had only 12 confirmed cases reported and they all went home. I’m convinced that a severe outbreak would necessitate alternative measures.

Question: Besides isolation of residents, do your plans assume that residents who can go home will go home as the first line of defense in stopping the spread of H1N1 in your halls?

Duggan: Over 50 percent of our students come from 300 miles or farther. Going home is not a reality for most of our students.  We are suggesting people to hunker down and take care of themselves and others when needed while protecting their health. I think some of the panic from last year has dissipated and people are treating this like a common illness.  Two of my children had it last week, and the symptoms were very mild. As a family, we stepped up the cleaning and hand washing etc.  Only two out of seven in my house got it this round.

Tattershal: We didn’t, but we knew that lots of residents would go home if they could.  The CDC suggests this as an option, and to some degree it makes sense, but in our Pandemic Committee’s opinion, requiring that a lot of sick students go home just spreads the disease to other places.  If we felt that the disease was more virulent and lethal, the primary method to prevent the spread of H1N1 in our halls is to close, but if we chose to close after we had a virulent H1N1 on campus then spreading the disease to other places is all the more relevant. In our case less than half our residents brought cars to school and 75 percent of them live 250 miles from here, so getting them home takes on a different dimension than it might at other universities.

Gonzalez: No, this is not part of our plan. Only about one-third of our students live in the vicinity of the university.

Krenz: Yes. Our first line of defense is to request that students return home.

McLauglin: It was entirely up to the residents and their families to decide if returning home was appropriate or desirable. Returning home however could have a detrimental effect in that it could spread H1N1 to other locations where it may not have spread had the resident remained at Flinders.

Question: Do you plan to isolate residents when seasonal flu hits your campus this year?  If not, why not?

Tattershal: No, we do not plan to isolate residents who have seasonal flu. Our messages on sanitation, etc. will be the same, but I doubt we will be keeping a log at the front desk like we have been for H1N1, unless H1N1 is the primary version of Influenza A in circulation at the time. We will do so then because of the heightened awareness and fear generated by H1N1 publicity. If H1N1 turns deadly in the 2nd or 3rd wave, I expect our response will be much more like our plans were for SARS and H5N1.

We would close the campus for a period of time, preferably before a more virulent and lethal H1N1 gets here, to prevent the halls from being a focal point for the spread of a lethal disease.

Gonzalez: No, we do not plan to do this nor have we done it previously.  In part this supported the approach we ultimately took with H1N1.  Many questioned the sense of taking additional steps (like isolation) for a flu that in many ways is less virulent than the seasonal flu we annually deal with.

Krenz: We plan to have set aside “isolation” rooms for the seasonal flu time of the year. However, this is normal as we made a decision last year to always have rooms set aside for isolation in case of any type of infectious disease that the student health services recommends isolation for. For example, last year we had some students with MRSA who asked to be isolated after returning from student health services (they lived in a building with public area bathrooms).  We used our pre-determined isolation rooms for this.

Palmer: No. However, with some of the symptoms overlapping, it could end up being challenging to differentiate.

McLaughlin: No we have not done it before and can see no reason to do it now. Vaccinations are available to our entire population for both the normal seasonal flu and H1N1.

Duggan: No we will just continue our current efforts.  We are also highly recommending both types of flu shots.  We will probably keep our ill student log going from now on, just so staff can track and touch base with students.  This has been one positive outcome and will help us in the future.  We have had students notify us they have chicken pox and staph infections so the communication channels have been established and crossed illnesses.  We will be following up with all staff regarding confidentiality of shared information etc.

Liebenberg: No. Seasonal flu is quite common with the change of the season and is not regarded as an epidemic disease. We do emphasize personal health and will keep on with awareness campaigns regarding the prevention and spreading of H1N1. If H1N1 fatalities are occurring then surely residences might be closed, isolated of evacuated, depending on the severity of the occurrence.

Question: Any final comments?

Krenz: I am curious how some of the schools reported in the news know how many cases of H1N1 they have on their campus. Therefore, this leads me to a 3-in-1 question. Is your school tracking H1N1 cases? Is your student health services tracking H1N1 cases? Is your housing/residence life department tracking H1N1 cases?

Tattershal: We were a leading H1N1 school in the media, which is probably why I was included in this conversation.  We don’t know how many cases of H1N1 we have, or I should say we have officially had three.  The test to verify it is somewhat costly and takes 72 hours, and by the time we could confirm someone had H1N1, they were over it.  In an epidemic, in Washington, the county health officer is God, and made the call not to test any more cases because the CDC was saying that 98 percent of the cases in which someone had Influenza A had H1N1.  So, our Health and Wellness Services (HWS) triaged people at the clinic, and only saw people that were at high risk of complications.  Anyone not at high risk, but with symptoms that indicated influenza, was told they probably had H1N1 and sent off to self-isolation.  HWS is counting contacts, and our halls are counting contacts if students tell us.

You may have read that WSU had “2500 cases of H1N1″, and that was an estimate based on the triage HWS did by phone and in person.  However, a key issue was, and is, that our HWS message was that students really don’t need to go to HWS, but instead take care of themselves in self-isolation. Going to HWS doesn’t mean student were going to get Tamiflu, because only high risk people will be getting flu medicine. HWS tried to balance the message that students were welcome to come to HWS, and no one would be turned away. But for most people there was no point. It was a tough thing to balance but we think they did a pretty good job. All a way of saying, HWS was counting, and they estimated 2500 students had flu-like symptoms, but there is no way to know for sure because not everyone called or contacted HWS.

As a side note, I currently have symptoms that are probably indicative of H1N1, but I’m not going to see a doctor. I’m not in a high risk category, and I have heard doctors say that the last thing we need is everyone going to medical centers and clogging up the system. Doing so results in doctors not having time to focus on the high risk cases. One other issue making WSU’s number seem so high is that we live in a small town and virtually all students go to HWS. In a big city, students have so many other options that big city university health clinics won’t see, and therefore count  all the students that have flu-like symptoms. Plus, we started school about as early as it is possible to start the fall semester, and we are the only state school in Washington on a semester schedule, meaning our state news media picked up our story, and then all of yours did, making us look like H1N1 central. In addition, we were reporting cases according to the ACHA guidelines, and a lot of schools weren’t at the time and still aren’t.  We think we “know” that our students have H1N1 more so than a lot of other schools for the reasons above, but every other school will be getting it just as much as we did, but reporting may be different, and it will be old news for most media outlets when all other schools have the same counts we have had, and certainly will when flu season starts in earnest here in a bit.

Krenz: Excellent answer.  Thanks for all of the detail.  The only thing I can say is … Ditto, ditto, ditto.  Everything you have explained below sounds exactly like Texas A&M University, except our Student Health Services has been estimating “several hundred” cases of “flu-like symptoms”.  In the residence halls, we have only been asked to report up the chain if the number of students and staff with flu-like symptoms becomes “disruptive to normal operations”.

Utgoff: Here is my answer to the question: Is your StudentHealth Services tracking H1N1 cases? It is but routine testing is not done for the reasons some members of our discussion group have already identified so it is still difficult to determine exact numbers. In response to: Is your Housing/Residence Life department tracking H1N1 cases? No, we have decided that any tracking that is done should be done by the University Health Centre.

Duggan: Our student health is tracking numbers, but they always have regarding the illnesses they are treating etc. They are seeing upwards of 250 patients a day.  The highest number of flu-like symptoms for a day has been 20, with about 200 flu-like symptoms so far this year. I think lots of students are not even going to the doctor based on what they have seen in the news etc. No telling how many are just staying home and getting better. We have not had any large amount of press regarding the issue on campus.

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!

Joe Gonzalez: What steps have your housing office taken to prepare for and respond to the H1N1 situation?

Mike Krenz: We had conversations with Texas A&M student health services, dining services, the vice president for student affairs office, and the university president’s office and came up with a unified solution. This was crucial. Before anything was issued to the public, we made sure we all agreed on the plan and all agreed on the wording of the messages being sent out. This went very smoothly with this approach: (1) Send messages to all faculty, staff, students, and parents; (2) Set up rooms for sick or well students for the purpose of isolation; (3) Set up a sick-tray process with dining services for sick students; (4) Work with student health services to have a flu vaccination clinic as soon as possible; (5) Check all stock piles of masks, gloves, and hand sanitizers, and (6) Educate, educate, educate, and educate some more.

Gary McLaughlin: In Australia we have just gone through our peak flu season, and at Flinders housing we did have several cases of H1N1, including one staff member. We had a meeting of senior management (as soon as we realized we were at risk), at which we determined the course of action we would take, which included identifying medical resources both at the university and off campus and setting up an isolation area, catering services, and ongoing monitoring procedures for infected residents. We ensured that we had a good and easily accessible supply of appropriate prevention items such as gloves, masks, and sanitary hand wash for use when dealing with infected residents. All residents were advised of arrangements that were in place.

Steve Palmer: Here at Western Michigan, we have collaborated with numerous offices including dining services, custodial, facilities, our health center, environmental health and safety, and the entire student affairs division, to name just a few. We have put out numerous educational fliers in the halls, offered programs, and placed information and links on our Web site. We have been able to identify our locales for having to isolate students if they are not able to return home. If students have been diagnosed with H1N1 and live in halls without community bathrooms, and we are able to, we keep them within their own halls where they live in rooms I have designated as conduct hold rooms. These rooms have their own bathrooms. If the student lives in one of our halls that has a community bathroom, we have been temporarily relocating them, isolating them in a hall where there are two floors that are currently offline. Once they are isolated, we have a detailed handout we walk through with them that highlights the importance of isolation, what we as a department can do for them (such as delivering meals, checking in by phone with them at least twice a day, and providing them with a micro-fridge). We have also installed wall-based hand sanitizers in each lobby. We are also keeping a limited supply of masks and forehead thermometers behind our front desks.

Robert Tattershall: I am on the university pandemic committee, so I was informed as the university discussed preparations, and I was able to influence the understanding of our capabilities, and limitations, within the university. Since we have limited space that can be used for isolation and didn’t think isolation made sense once very many people had H1N1 (it’s easy to isolate the first few, but isolating 50, 100, or 200 changes the dynamics entirely), our preparation was geared toward individual responsibility: taking care of yourself, instituting self-isolation, and serving as a backup for residents who didn’t have someone able or willing to help them during the time they were sick.

Our response has been the typical signage about sanitation and self-isolation, hall meetings, preparing our RA staff, buying flu kits, and cleaning touch surfaces. H1N1 hit our campus on August 18 at 2 p.m. when we heard of the first case in our halls. By 5 p.m. we knew of seven, and the number multiplied quickly from there. We developed a process by which residents could voluntarily tell their front desks they were sick, which alerted us to expect a call from them each day by 5 p.m., so we knew they had not taken a turn for the worse. We also had flu kits with thermometers at the front desks so residents could assess when they were well by the CDC guidelines; finally, we created a method for other residents to use the sick person’s ID to get food from the dining centers on the sick person’s card. Interestingly, not that many took us up on notifying the front desks or helping with food needs, in part because the symptoms were not severe (much less so than the average seasonal flu) and because, in most cases, residents already had friends who would go get them food, as needed.

Dima Utgoff: We have prepared a list of questions and answers that we have posted on the residence services� Web site. We developed this list after consultation with a wide variety of individuals, and it was approved by the university’s Public Health Response Team, a group I sit on and which is responsible for managing the university’s response to H1N1. We have in turn tied this list to the university’s main H1N1 Web site.

Gonzalez: In some ways, I feel we had a tremendous amount of dialogue throughout the university and in the end reached the conclusion that only a few steps needed to be taken or could be taken. The main plans that residence life and housing services has made include the following: (1) Setting up rooms to isolate healthy students who are more at risk for severe illness due to pre-existing health conditions rooms to be used if “healthy but at increased risk” students informed Student Health that students around them had become ill; (2) Collaborating with dining services to implement a meal order and delivery system; (3) Providing RAs and residential counselors with thermometers and masks to distribute to residents requesting one; (4) Posting informational posters throughout residence halls; (5) Training RAs about H1N1 (mostly informational in nature), and (6) Keeping hand sanitizer in the restrooms, which we had already put there during a drought two years ago.

Sean Duggan: We developed a one-page statement that was posted to our Web site. We have installed hand sanitizer dispensers throughout public areas in the halls, such as lobbies, entrances, elevator lobbies, and bathrooms. We are running educational public service announcements on our residence life cinema channel. We created bookmarks with the flu information from our Web site and then clipped a hand sanitizer pen (15,000 total) to the bookmark and provided these to all students on campus and also provided the information to others as well. We purchased face masks for anyone to use, as a way to prevent the spread of germs or keep germs away from mouth and nose. We created a packet of information, Q&A’s, for all professional and student staff so that everyone is providing the same information and answering questions appropriately.

We created an ill-student log, to help us with follow-up so that a sick student doesn’t fall through the cracks and not have anyone checking on them. Of course they have to let us know they are sick for us to be able to follow up. We also work closely with our student wellness center, student health, and other offices on campus to address concerns and help students. Since we are 99.5 percent full, we made the decision to work with students as individuals regarding their need to relocate due to roommate illness. If this is what they want to do, we will look to temporarily relocate them to an open space or will create temporary housing in lounges and other places. So far, this has not been needed and rarely requested.

Bes Liebenberg: We have done the following: (1) We had extensive conversations with advisors from the Department of Infectious Diseases in the School of Medicine and the faculty of Health Sciences; (2) Proposed an action plan for curbing the spread of H1N1 among students at the University of Pretoria the plan is subject to continuous review pending the severity of the anticipated epidemic; (3) The Department of Residence Affairs and Accommodation (TuksRes) launched an awareness campaign as well as establishing procedures that can be followed in case of possible infections; (4) Information supplied included clinical signs that can be associated with the disease and to which students should be sensitized; (5) Two dedicated nursing sisters at student health services took responsibility for the initial diagnoses of possible infections; (6) The Department of Infectious Diseases in the School of Medicine developed a scorecard for diagnostic purposes; (7) Resident students were encouraged to go to the doctor or nursing staff at health services at the first sign of flu, and (8) Positively diagnosed students were encouraged to go home for a period of seven days in order to minimize the spread of the infection. We made provisions for students who were not able to go home to stay in isolated facilities for the same period.

Gonzalez: What have been the most difficult challenges your office has faced in developing responses/responding to the H1N1 situation?

Krenz: The most difficult issue is the questions from parents (and some faculty/staff) asking, “What are we (residence life) going to do to protect everyone?” Very few people see the H1N1 response as a “university-wide” response. There are expectations that housing and residence life take care of all of the students, and make sure no one gets ill. Regardless of the answer, some people are not happy and expect more from us.

McLaughlin: Questions from residents (and the odd parent) asking for information on what procedures we had in place and what should they do if they felt ill. How to differentiate between ordinary flu and H1N1 became an often asked question. A medical check would be required to confirm H1N1 or otherwise was the response.

Palmer: A challenge has been, with so many offices involved, making sure that communication is ongoing and consistent. Additionally, with students that we temporarily relocate, the issue of transporting these students from the hall they live in to their relocation hall has been problematic. Finally, despite all of our education efforts, we have some students (and parents) who have shown concerns about ‘sick’ students being isolated in the same building where healthy students are. This has resulted in ongoing education and conversation with parents and students alike.

Tattershall: The public has been reading about H1N1 and assuming pandemic meant deadly, when it has not been to this date. The most difficult challenges have been around the public expectations.

Utgoff: Certainly, the most difficult task was developing the proper communication strategies and much thought went into how to word our FAQ document. We wanted to ensure the answers we were giving were consistent with the university�s main key messages and that we were being very careful to word our information in such a way that it could not be interpreted that we were giving medical advice (but rather referring to medical and other advice being given by Alberta Health and Wellness, our provincial health department). Alberta Health and Wellness in turn gets much advice from the Public Health Agency of Canada, but in Canada, the administration of health services is a provincial, not federal matter so we act on the basis of what our provincial public health authorities tell us to do.

Gonzalez: Responding to concerns, mainly from parents, that our efforts are not viewed as sufficient. Many demands for temporary relocation of sick/healthy students were made and holding to our decision to not do this was difficult at times.

The other challenge that had potential to become significant was unexpected costs that had not been included in the budget. To this point, this has not become problematic, but if circumstances change for the worse it could become so.

Duggan: Trying to keep everyone calm: students, parents, staff, other administrators. Listening to all of their ideas, and taking the time to formulate a reasonable response.

Liebenberg: The most difficult for us has been: 1) To get the seriousness of the matter through to the students; 2) Finding the most suitable way of communicating to the students and encouraging them to report incidents. Many students were so involved with their academics and other commitments that they would rather keep quiet and stay in residence than speak out and go home; 3) The over coverage of the issue in the media created paranoia amongst students and parents.

This may be an inadvertent mistake, and representatives of the American College Health Association have written to Senators requesting clarification.

The Government Accountability Office (GAO) reports that, in 2007, 67% of college students 18-23 received health insurance through employer-provided plans (likely their parents’ plans); 6% used Medicaid and the like; 20% were uninsured, and 7% had insurance through another private plan, such as an college-issued program.

Student insurance plans were offered at 71% of private institutions, 82% of public institutions and 29% of two-year public institutions in 2008, reported the GAO.

ACUHO-I has covered H1N1 in depth here on the blog (view stories in the “Health” category or search for the H1N1 tag), and also has established a resource page on our Web site for further information. ACUHO-I members are also encouraged to visit the Health & Safety forum on the ACUHO-I network to post questions for other members.

As stories continue to come out, we will utilize the “sticky” tag to keep this post at the top of our blog feed and simply update the post as necessary. Click on the link to read more of this post and look for updates.Here are some links to resources to get you up-to-speed on the issue.

• ACUHO-I Campus Housing Guidelines for Pandemic Planning (PDF)
• United States Department of Health and Human Services
• United States Government Pandemic Planning
• Centers for Disease Control and Prevention

All times are EST.

UPDATE, 9-8-09, 11:50 AM: Two student deaths linked to H1N1.

UPDATE, 9-10-09, 11:40 AM: 72% of surveyed institutions report H1N1 cases; most are minor.

UPDATE, 9-17-09, 1:15 PM:  American College Health Association updates survey findings. 83 percent of 253 participating campuses report cases of H1N1.

UPDATE, 9-17-09, 3:15 PM: Colleges Face Swine Flu Challenge as Number of Sick Students Surges. The Chronicle of Higher Education.

UPDATE, 9-29-09, 12 PM: Miami University (Ohio) student dies after contracting H1N1.

UPDATE, 10-14-09, 11 AM: Young Women More Susceptible to Swine Flu; Students Getting H1N1 Vaccine on College Campuses; RPI Warns Beer Pong Spreads H1N1.

UPDATE, 10-26-09, 11:35 AM: Why the H1N1 Vaccine Taking So Long, and How A Virus Takes Over.

UPDATE, 10-29-09, 11:45 AM: Fresh Surge of Flu Cases and Vaccine Shortages Raise Anxiety on Campuses.

Swine Flu

Some institutions have had more sickness than others; the University of Kansas had 319 affected students at one point, but that number is now decreasing. The institution has 30,000 students, so while the illnesses are disconcerting, they represent just over 1 percent of the student population. Colleges and universities nationwide are urging students to protect themselves from infection and offering instructions for ill students.

You will all be surely comforted, however, that this valiant crusader is on your side against H1N1.