Dec 7, 2010 (CIDRAP News) – During the 2009 H1N1 pandemic, when colleges faced unique challenges, a group of large US universities found that preparedness paid off and that students were able to play a key role in response efforts, according to a new report.
Novel H1N1 influenza emerged in Mexico during the 2009 spring break, putting college students in the early path of the virus, and illness patterns suggested that young people—including those of college age—were at greater risk of flu complications, similar to a pattern seen during the 1918 flu pandemic.
The report, released today, details the experience of the "Big 10 + 2" universities during the pandemic. It was prepared by the University of Minnesota's Center for Infectious Disease Research and Policy (CIDRAP), the publisher of CIDRAP News, and was sponsored by the Association of State and Territorial Health Officials (ASTHO) with funds from the Centers for Disease Control and Prevention (CDC).
The University of Minnesota team based its 60-page report on interviews conducted between March and July 2010, a May 18 online conference for the Big 10 + 2 universities along with federal and state health partners, and follow-up interviews. The report includes best pandemic H1N1 practices from colleges that appear on CIDRAP's Promising Practices site.
Jill DeBoer, MPH, CIDRAP's associate director and the report's principal investigator, said that as the group was gathering university pandemic experiences, they were heartened by all the success stories they heard. She said one of the big surprises was the important role students and student leaders played in response activities.
"We added an extra chapter to the report just to capture all of that," DeBoer said. As director of the University of Minnesota's Academic Health Center emergency response office, she was deeply involved in the school's pandemic response.
The report covers lessons learned on nine main topics: incident management, residence halls, university health services, communication, vaccine distribution, teaching, human resources, student engagement, and collaborations with public health.
One of the main lessons is that earlier pandemic planning was useful, not just for the planning documents but for the planning process itself, which produced strong teams that were able to solve problems and adjust quickly. This was especially important because the pandemic turned out to be significantly less severe than the scenario that formed the basis of many schools' plans.
Many colleges took advantage of the summer 2009 lull in pandemic activity to plan for the fall, which brought a surge in flu-like illnesses as soon as students returned to campus.
Universities reported that multidisciplinary response teams set up during previous pandemic and emergency planning were successful, because they had strong support from university administrations, represented a broad cross-section of the institutions, and included the health sector.
Overall, student health systems were very busy but not overwhelmed, because most successfully streamlined their operations. For example, a group of primary care nurses at the University of Wisconsin-Madison were reassigned as "flu nurses" who advised sick students by phone.
Isolating sick students was a challenge for universities, and some had to modify their plans as the pandemic progressed. Some schools had success designating isolation areas, but others had problems, such as when the sick and well students didn't like the arrangement.
Many schools had success with self-isolation systems, which needed support such as communication with sick students and delivery of meals and self-care supplies.
Students such as resident advisors, roommates, and health advocates were an invaluable resource when self-isolation was needed. University respondents said they helped care for their peers, suggested alternative housing plans, and helped build community partnerships.
The report found that student involvement expanded healthcare surge capacity, provided credible peer messaging, and improved support for university plans. For example, student volunteers at Purdue University rode campus buses for 2 days distributing education materials and hand sanitizer to more than 5,000 of their peers.
A big challenge related to self-isolation was managing student absences. Some faculty members were reluctant to adjust student absence policies. The report said school administrators were more successful at navigating self-isolation issues with faculty if provosts and deans supported and communicated the strategy, attendance policies were officially suspended, the media were covering the pandemic, and schools effectively highlighted the CDC's isolation recommendations.
DeBoer said the late arrival of the pandemic vaccine and unpredictable supplies presented the same challenge to universities as to communities, which wasn't a surprise. However, her team found that colleges rapidly developed online and phone systems to help them identify who should be vaccinated first, maximize available vaccine supplies, and streamline immunization paperwork. They also noted that collaboration between schools and public health agencies was crucial in coping with vaccine supply uncertainties.
New technology also helped schools expand their creativity in reaching students with H1N1 information. For example, The Ohio State University added a blog to its H1N1 site to answer student questions and to update information more quickly.
Schools represented in the report include the University of Chicago, University of Illinois, Indiana University, University of Iowa, University of Michigan, Michigan State University, University of Minnesota, Northwestern University, The Ohio State University, Pennsylvania State University, Purdue University, and the University of Wisconsin-Madison.
H1N1 and higher-ed lessons learned report
May 18 Big 10 + 2 pandemic lessons learned webinar
CIDRAP Promising Practices tools