Preparedness E-newsletter Archive - 2007

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Continuity of Operations Planning (COOP)

Published: December 2007
Written by: Patt Sweeney, JD, MPH, RN

 

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CONTINUITY OF OPERATIONS PLANNING MADE SIMPLER; or

“An ounce of preparation is better than a pound of confused response”

 

In recent years, natural disasters, terrorist attacks, and infectious disease outbreaks have dramatically demonstrated the need for government, business and industry, and public service providers to have plans in place that enable them to continue or resume operations as quickly and efficiently as possible during and immediately after an emergency.

Commonly called Continuity of Operations, or “COOP” plans, these serve as blueprints for organizational response when an emergency either threatens or incapacitates an organization’s facilities, employees, or both. COOP plans define the processes and procedures that are to be used to quickly deploy pre-designated personnel, equipment, vital records and supporting resources to an alternative site so that the organization’s critical functions can be sustained until normal operations are restored.

Creating such a plan, however, is often not the first item on an organization’s agenda. Personnel constraints and competing priorities may combine to block the allocation of scarce resources to emergency planning. However, maintaining mission critical operations following a fire that renders your organization’s building unusable or a flood that impacts an entire region will require the reconstitution of your organization’s operations at an alternate site. An ounce of prevention (in this case, planning ahead and preparing alternatives) may be worth much more than an pound of cure – i.e. scrambling to come up with solutions AFTER a disaster strikes, when communication, transportation, and coordination are all impaired. Therefore, it is imperative that every organization acknowledges its responsibility to maintain critical functions and provide a safe workplace, and thus, create a COOP plan to reduce the loss of life and property and mitigate disruptions to mission critical operations.

Faculty and staff at the Preparedness Center work with organizations to help build a culture of emergency preparedness and provide flexible and adaptable ways to maximize the organization’s ability to create a COOP Plan capable of being maintained at a high level of readiness and capable of implementation with little or no advance warning.

Briefly described below is one example of how COOP planning can be applied to a specific industry or system, in this case the Pennsylvania Court System:

Late in 2006, following the publication of the Pennsylvania Public Health Law Bench Book, the Administrative Office of Pennsylvania Courts (AOPC) deemed COOP planning as critical to the ability of courts to ensure access to justice at times when traditional methods of operation are compromised. Subsequently a committee of District Court Administrators, AOPC staff, and Center Law Program faculty was convened and developed a COOP planning toolkit for Pennsylvania Courts. Using a National Planning Guide as a model, the Pennsylvania Court COOP Planning Toolkit was developed. It is adaptable to local planning needs while incorporating the specific requirements which courts must meet in order to maintain the functions that are critical to the preservation of life, liberty, and safety.

The Toolkit provides a detailed review of COOP planning steps, a comprehensive series of worksheets for documenting vital plan details (see table below), a template for plan writing, along with several appendices that provide resource information regarding the current state of the law, employee health and employment related matters. Sequentially, beginning with the identification of the functions and staff that are essential to operations, the toolkit takes an organization’s COOP planning team through a step-by-step process that, upon completion, yields the information the organization needs to write a COOP plan.

Center faculty also developed an accompanying training curriculum consisting of PowerPoint slides, lecture notes, and print materials. This ½ day training provides planning teams with the information needed to efficiently create a COOP plan for their organization. Currently the training program is being used in every judicial district across Pennsylvania.

The COOP Planning Toolkit and the accompanying training materials currently being used by Pennsylvania courts are based upon universal COOP planning principles and adult learner needs. All materials are adaptable for any organization, business, or industry that would like assistance in meeting its responsibility for ensuring a safe workplace and sustaining critical operations during and following an emergency.

 

COOP plan element

Worksheet

Prioritize essential functions and designate essential function staff

Worksheet A: Prioritize Essential Functions and Identify Essential Staff

Identify related/affected offices

Worksheet B: Identify COOP staff

Delegate decision making authorities

Worksheet C: Delegate authority

Orders of succession

Worksheet D: Succession Orders

Designate alternate facilities

 

Worksheet E: Alternate work site requirements

Worksheet F: Alternate work site options

Worksheet G: Alternate work sites by disaster scenario

Identify communications methods

Worksheet J: Communication plan

Worksheet L: Staff directory

Ensure interoperable communications systems

Worksheet K: Communication system interoperability

Worksheet L: Staff directory

Identify vital records, forms & databases

Worksheet H: Vital records and forms

 

Protect vital records

Worksheet I: Restoration and recovery resources

 

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President orders transformation of public health and medical preparedness

Published: October 2007
Written by: Sam Stebbins, MD, MPH, Director, Center for Public Health Preparedness

 

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Overview

On October 18, 2007, the White House released Homeland Security Presidential Directive 21 (HSPD-21), titled “Public Health and Medical Preparedness”. There have only been 21 HSPDs since October of 2001, and this is the first one that includes “public health” in the title (click HERE for a complete list). In this document, the President establishes a “National Strategy for Public Health and Medical Preparedness” which is designed to “transform” the national approach to “protecting the health of the American people against all disasters.” The President has established a Public Health and Medical Preparedness Task Force (with the Secretary of HHS as chair) which will submit within 120 days an implementation plan for this strategy.

In HSPD-21, the President establishes a strategic vision that will enable a level of public health and medical preparedness sufficient to address a range of disasters. HSPD-21 describes an “all-hazards” approach, whether the catastrophic event is deliberate or naturally occurring. This includes a range of possibilities from a terrorist attack with a weapon of mass destruction (WMD) to an influenza pandemic to a major earthquake or hurricane.

Within this vision, the four main areas of focus are:

  • Biosurveillance, defined as “early warning and ongoing characterization of disease outbreaks in near real-time”;
  • Countermeasure Stockpiling and Distribution;
  • Mass Casualty Care; and
  • Community Resilience.

Other key activities are to:

  • Improve communication of risks and threats to local elected and public health officials;
  • Establish an academic Joint Program for Disaster Medicine and Public Health at USUHS in Bethesda, MD;
  • Commission the Institute of Medicine (IOM) to lead a forum regarding enhanced capacity and training;
  • Establish within HHS an Office for Emergency Medical Care.

HSPD-21 draws key principles from the recently released National Strategy for Homeland Security (October 2007), as well as other previously released strategies and guidelines. What makes it distinctive is a new focus on public health, all-hazards preparedness, community engagement, integrated medical response, and coordination of response both vertically and horizontally within and across a very wide range of entities. In addition, many of the activities have relatively short turn-around times, with the document calling for a variety of deliverables within 90-270 days.

Key Details

TOPIC Biosurveillance
DESCRIPTION

“The Secretary of HHS (SecHHS) shall establish an operational national epidemiologic surveillance system for human health…and create a networked system to allow for two-way information flow between and among Federal, State and local governmental public health authorities and clinical health care providers.”

METRIC(S)

SecHHS will establish within 180 days an “Epidemiologic Surveillance Federal Advisory Committee” with representatives from other Federal agencies as well as state and local public health and private sector health care.

TOPIC Countermeasure Stockpiling and Distribution
DESCRIPTION

Develop and share best practices regarding the rapid distribution of medical countermeasures in response to a catastrophic health event, and establish a formal system to measure and assess how well state and local jurisdictions are performing in this arena.

METRIC(S)

(1) SecHHS will publish within 270 days initial template(s) regarding minimum operational plans to enable community distribution & dispensing of countermeasures within 48 hours, establish standards and performance measures for States and locals, and establish a process to gather that performance data to assess readiness.

(2) SecHHS will begin using, within 180 days of completion of #1 above, said performance data and metrics as conditions for future public health preparedness grant funding.

(3) SecHHS will develop within 270 days Federal plans “to complement or supplement State and local government distribution capacity…if such entities’ resources are deemed insufficient to provide access to countermeasures in a timely manner in the event of a catastrophic health event.”

There are several additional metrics for which the reader is referred to the original document.

TOPIC Mass Casualty Care
DESCRIPTION

Develop a new way of re-orienting and coordinating existing medical capacity to “satisfy the needs of the population during a catastrophic health event.” This includes developing an operational concept which is “substantively distinct from and broader than” day-to-day medical activities in order to “transform the national approach to health care in the context of a catastrophic event.”

METRIC(S)

(1) SecHHS will engage a variety of partners to provide feedback on the review of the National Disaster Medical System and national medical surge capacity required by PAHPA.

(2) SecHHS will identify within 270 days after completion of #1 above high-priority gaps in mass casualty care capabilities and submit a concept plan to the White House that “identifies and coordinates all Federal, State, and local government and private sector public health and medical disaster response resources AND identifies options for addressing critical deficits.”

(3) SecHHS will within 120 days “identify any legal, regulatory or other barriers to public health preparedness and response…that can be eliminated by appropriate regulatory or legislative action.”

(4) SecHHS will within 180 days establish a Federal Advisory Committee for Disaster Mental Health. Within an additional 180 days, this committee will submit a report to SecHHS with “recommendations for protecting, preserving and restoring individual and community mental health in catastrophic health settings.”

There are several additional metrics for which the reader is referred to the original document.

TOPIC Community Resilience
DESCRIPTION

Develop a plan to promote resilient communities, with emphasis on education about threats, “empowerment” to mitigate risks, opportunities to practice local response, development of stronger social networks, and greater familiarity with local public health and medical response systems.

METRIC(S)

SecHHS will within 270 days develop a plan to promote comprehensive community medical preparedness.

Additional Topics

TOPIC Risk Awareness
 

(1) Make a briefing available to mayors and senior county officials from the largest 50 MSAs regarding risk to public health posed by relevant threats and catastrophic health events (within 150 days).

NOTE: In PA, this includes Philadelphia-Camden-Wilmington (5) and Pittsburgh (23). Of note, Allentown-Bethlehem-Easton is 62nd in size and Pike County, PA is included in the New York –Northern New Jersey-Long Island MSA.

(2) Share up-to-date and specific public health threat information with relevant public health officials at the State and local government levels (within 180 days).

TOPIC Education and Training
 

(1) Establish an academic Joint Program for Disaster Medicine and Public Health housed at a National Center for Disaster Medicine and Public Health at the Uniformed Services University of the Health Sciences (USUHS). The program will lead Federal efforts to develop and propagate core curricula, training and research related to medicine and public health in disasters (within 1 year).

(2) SecHHS and the Secretary of DHS shall develop and maintain processes for coordinating Federal grant programs for public health and medical preparedness (within 180 days).

(3) SecHHS will develop a mechanism to coordinate public health and medical disaster preparedness and response core curricula and training across executive departments and agencies (within 1 year).

TOPIC Disaster Health System
 

(1) SecHHS will commission IOM to lead a forum to facilitate the development of national disaster public health and medicine doctrine and system design and to develop a strategy for long-term enhancement of disaster public health and medical capacity and the propagation of disaster public health and medicine education and training (within 180 days).

(2) Create financial incentives to enhance private sector health care facility preparedness (within 120 days).

(3) Establish an Office for Emergency Medical Care within HHS to lead a variety of projects (within 180 days).

 

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September is National Preparedness Month Be Aware / Be Prepared / Volunteer

Published: September 2007
Written by: Sam Stebbins, MD, MPH, Director, Center for Public Health Preparedness

 

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Are you prepared? If you are like the rest of us, probably not. Now is the time to rethink your personal, family and work preparedness, with the overall goal of becoming MORE prepared than you are now.

Attached below are links to information that will help you improve your ability to respond to and help others prepare for a disaster. Please take a minute to look them over and update/upgrade your readiness. Please share them with others in your family, workplace, church, and community.

One brief recommendation. In our experience, the single most important item in preparedness is communication. This applies to your family and loved ones – if you don’t know they are safe, you will have a very difficult time focusing on the task at hand and helping others. It also applies to overall situational awareness – if you have no way of knowing which roads are open, which evacuation shelter to go to, where to go to avoid high water, etc, it becomes much harder to reach a safe haven. Thus, we recommend you start with two projects this month:

  • Develop and maintain a family communications plan
  • Purchase a hand-powered radio

There are many varieties out there. We recommend a radio that is weather proof, hand-powered, has a light and siren, and can tune into AM, FM, and NOAA weather information. Examples (not an endorsement!) include the Weather Channel Stormtracker, the Eton FR400, various models made by Freeplay and Radio Shack, the SIMA-CR-100 and others. Some of these can also charge your cell phone and others include the capacity for recharging via solar panels. Prices generally range from $20 - $50, depending on how fancy you wish to get.

 

Be Aware:

Pennsylvania Emergency Management Agency

http://www.pema.state.pa.us/

NOAA All-Hazards Monitor

http://www.noaawatch.gov/

National Weather Service Hazards Map

http://www.weather.gov/view/largemap.php

Airport Delays and Closures

http://www.fly.faa.gov/flyfaa/usmap.jsp

 

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Be Prepared:

Family Emergency Preparedness Guide:

http://www.dsf.health.state.pa.us/health/cwp/view.asp?a=333&q=234776

(English and Spanish versions available)

 

Volunteer!

SERV-PA (https://www.servpa.state.pa.us/)

SERV-PA is Pennsylvania’s new online registry for volunteers, whether your skills are medical or any other field. The registration site is up and running, and the process is well thought out and includes the information you will most want to know as you sign up – what background information is required, how to indicate the geographical scope of your interest, legal indemnification, compensation for accidental injury, and much more. It is simple to update your profile, send messages, and track your volunteer response activities! The site also links to local health departments and emergency response agencies, so your city or county can access local volunteers when needed.

 

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Pennsylvania to receive nearly $90 million for pandemic and other preparedness

Published: July 2007
Written by: Sam Stebbins, MD, MPH, Director, Center for Public Health Preparedness

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The federal government recently announced funding for 2007-08 for four major strategic priorities: $225 million for pandemic influenza preparedness; nearly $900 million for public health preparedness and emergency response; $430 million to enhance hospital and healthcare facility preparedness for public health emergencies; and nearly $1 billion for the Public Safety Interoperable Grants Program. Pennsylvania’s share of each is estimated at $8.6 million, $31.3 million, $16.2 million and $34.2 million for each program respectively.

In addition, the federal Department of Homeland Security recently announced $1.7 billion in funding to states, territories and urban areas to prevent, protect against, respond to and recover from terrorist attacks and other disasters through the Homeland Security Grant Program (HSGP). Written details for the country can be found online and state by state here. HSGP risk methodology considers a variety of factors, including intelligence assessments, population size and density, economic impacts, proximity to critical infrastructure, and other factors critical to national security such as proximity to international borders. HSGP is comprised of five separate grant programs:  Urban Areas Security Initiative (UASI), State Homeland Security Program (SHSP), Law Enforcement Terrorism Prevention Program (LETPP), Metropolitan Medical Response System (MMRS), and Citizen Corps Program (CCP).

Within this funding, a number of grant opportunities exist for local jurisdictions:

  1. The $15 million Healthcare Facilities Partnership Program. Congress asked HHS to award competitive grants or cooperative agreements to eligible health care partnerships to enhance community and hospital preparedness for public health emergencies. The $15 million will be awarded through a competitive process resulting in 6-30 cooperative agreement awards for regional partnerships that may range from $500,000 - $2.5 million. Applications are due August 6, 2007.
  2. The Public Safety Interoperable Grants Program is a one-time formula-based, matching grant program. This program provides public safety agencies with the opportunity to achieve meaningful and measurable improvements to the state of public safety communications interoperability through the full and efficient use of all telecommunications resources. Applications are due August 22, 2007.

 

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Traveling this summer? Be prepared.

Published: June 2007
Written by: Sam Stebbins, MD, MPH, Director, Center for Public Health Preparedness

 

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Transportation

Did you know that the leading cause of death for overseas travelers is motor vehicle-related? And in the US, "accidents" are the leading cause of death for people between the ages of 1 and 41. Almost all of these are preventable - so whether in a car or boat, on a motorcycle, or as a pedestrian, you should take care to maximize your safety. Visit "Make Roads Safe" for detailed recommendations. And, for community-level interventions that are proven effective, see CDC's Guide to Community Preventive Services.

Infectious Diseases - International

Many diseases can be avoided through prevention activities. If you are traveling overseas, check your destination first for any special recommendations or warnings. Many illnesses such as Hepatitis A, Hepatitis B, Typhoid, Tetanus and Measles are easily prevented through immunization, so please check CDC's routine, recommended, and required vaccines for overseas travelers. For a great source of information, please review CDC's Yellow Book.

Should you take antibiotics with you? And if so, which one(s)? The answer depends on where you are going, what you are doing, how long you will be there, what your general health status is, and other factors. In general, medication to treat diarrheal illness is recommended. To find a traveler's health clinic either in the US or overseas, visit the International Society of Travel Medicine.

Infectious Diseases - Local

Whether hunting, camping, boating, hiking, or strolling on the beach, it is important to know how to avoid and deter microorganisms and the insects and animals which may carry them. Click here for detailed information from CDC. Insect repellent is highly recommended both for comfort and for safety from mosquito and tick-borne diseases such as West Nile Virus and Lyme Disease. Click here for up-to-date information.

Safe Water

Ever wondered how long to boil water or how effective those iodine tablets are? Read about preparing your water so it is safe to drink.

 

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PEMA encourages Pennsylvanians to prepare for upcoming hurricane season

The start of hurricane season threatens to cause flooding in Pennsylvania. PEMA urges all Pennsylvanians to check if they live in an area prone to flooding and prepare for bad weather.

 

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The Pandemic and All-Hazards Preparedness Act (PAHPA)

"Public health emergency preparedness and response have been defining goals in the United States since the terrorist and anthrax attacks in the fall of 2001. The objective of emergency preparedness is to improve the nation's ability to detect and respond to an array of public health emergencies including bioterrorism, emerging infectious diseases, and natural disasters. Despite progress toward this goal, the public is skeptical about the government's capabilities, fueled by the perceived lack of leadership and accountability following Hurricane Katrina. On December 19, 2006, President George W. Bush signed the Pandemic and All-Hazards Preparedness Act (PAHPA), which is intended to improve the organization, direction, and utility of preparedness efforts." - James G. Hodge, Jr, JD, LLM; Lawrence O. Gostin, JD; Jon S. Vernick, JD, MPH, 2007. JAMA. Full Story

 

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Kickoff to Preparedness

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April 2 - 8, 2007
America's National Public Health Week

This year, the theme is preparedness, with a special focus on addressing the unique needs of vulnerable populations. See www.nphw.org for more!

Preparedness

Preparedness results from communication, collaboration, and community action. Communication must be timely, reach all audiences who need to get the message, and function in an emergency in order to be effective. Collaboration results in everyone knowing who is going to do what in a disaster. And because initial response is always local, community planning and readiness – whether that community is a family, a church, a business, a neighborhood, a city or a state – is what makes the most difference.

 

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Legal Patchwork

One of the challenges to preparedness is that Pennsylvania’s public health law is a patchwork of statutes and state and local regulations that predate contemporary standards and date back to the late 19th and early 20th centuries. The Center has recently completed a detailed analysis called the “Pennsylvania Public Health Law Bench Book” which provides concise responses to essential public health questions which courts may face, analyzes and provides background on key legal issues, and provides examples of model orders and previous case law.

Ice and Snow

A recent example of what not to do is detailed in the Witt Report about the severe traffic congestion in Pennsylvania resulting from the February 2007 snow and ice storm. In his response, the Governor noted the importance of recommended changes, including the following:

  • Ensure that emergency preparedness and management is a higher priority in the Commonwealth
  • Instruct PEMA to more clearly define the roles and responsibilities of each agency during emergencies, in accordance with Title 35 of the Pennsylvania Code, which outlines the agency's statutory powers and duties
  • Expedite the adoption and full implementation of the National Incident Management System
  • Establish a joint information center at the state emergency operations center that could coordinate messages to the public and media in times of emergency
  • Improve horizontal and vertical communications through an improved, formal notification process developed by the state police commissioner that maximizes situational awareness
  • Develop and implement ongoing training and exercises to test the state's system and employees
  • Appoint a team of state and local officials, lead by the secretary of Transportation, to develop written traffic diversion plans along primary interstate and state highways that will also serve the commonwealth in the event of a statewide evacuation.

The governor has sent letters to the Secretary of Transportation, State Police Commissioner, and PEMA Director describing the steps. These changes, when fully implemented, will help ensure that the Commonwealth is better prepared, whether the next disaster comes from ice and snow or any other cause.

 

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Non-Pharmaceutical Interventions (NPI)

Review of the CDC's Community Mitigation Strategy

The Centers for Disease Control and Prevention (CDC) released the Interim Pre-Pandemic Planning Guidance: Community Strategy for Pandemic Influenza Mitigation in the United States (“Community Strategy”) on February 1st, 2007. In this guidance, CDC has weighed in on the complex issue of what “non-pharmaceutical interventions” (NPIs) are considered essential to pandemic response.

This interim guidance introduces a “Pandemic Severity Index” to characterize the severity of a pandemic, provides planning recommendations for specific interventions that communities may use for a given level of pandemic severity, and suggests when these measures should be started and how long they should be used. 

 

Overall Goals and Measures

The recommendations in this guidance have three overarching goals – to delay exponential spread of the virus, decrease the peak number of cases, and reduce the total number of cases – with the intent to buy time for vaccine production and lessen demand on healthcare services.

 

 

Pandemic Severity Index

This guidance introduces, for the first time, a Pandemic Severity Index, which uses the case fatality ratio as the critical driver for categorizing the severity of a pandemic.  The index is designed to help assess the severity of a pandemic to allow better forecasting of the impact of a pandemic, and to enable recommendations to be made on which NPIs to use.

In this scale, the 1957-58 pandemic would be Category 2, and the 1918-19 pandemic would be Category 5. An outbreak such as SARS, which had a high case fatality rate but very low illness rate, isn’t described well by this index. The on-going small number of H5N1 cases in humans also does not fit in this index. However, the current H5N1 panzootic in birds, if a similar rating were being used for animals, would best be described as Category 5.

 

Non-Pharmaceutical interventions (NPIs)

NPIs are planned activities that do not involve medications or vaccinations. CDC’s guidance focuses on 4 major categories in homes, school, worksites, and community settings as follows:

  1. Isolation and treatment (as appropriate) with influenza antiviral medications of all persons with confirmed or probable pandemic influenza
  2. Voluntary home quarantine of members of households with confirmed or probable influenza case(s) and consideration of combining this intervention with the prophylactic use of antiviral medications.
  3. Dismissal of students from school (including public and private schools as well as colleges and universities) and school-based activities and closure of childcare programs, coupled with protecting children and teenagers through social distancing in the community to achieve reductions of out-of-school social contacts and community mixing.
  4. Use of social distancing measures to reduce contact between adults in the community and workplace, including, for example, cancellation of large public gatherings and alteration of workplace environments and schedules.

CDC recommends that all such community-based strategies should be used in combination with individual infection control measures, such as hand washing and cough etiquette.

Summary of the Community Mitigation Strategy by Pandemic Severity

Timing

Identifying the optimal time for initiation of these interventions will be challenging because implementation needs to be early enough to preclude the initial steep upslope in case numbers and long enough to cover the peak of the anticipated epidemic curve while avoiding intervention fatigue.

Commentary

The question of just how some of these recommendations will be implemented remains something of an open question, as do concerns about secondary effects from large-scale public health actions. Isolation (voluntary or otherwise) of people with contagious diseases is a standard part of medical care and public health recommendations. Quarantine of exposed but not ill contacts is less common but is still sometimes used, as with SARS and in some outbreak situations. Adult social distancing was also implemented quite widely during SARS.

School closure however, especially when combined with child social distancing activities, is the NPI least well understood, would likely cause the most societal disruption, and would certainly have unexpected secondary and tertiary consequences. Imagine trying to keep your daycare and school-age children out of school AND away from other children for up to three months – it would be quite a challenge. In addition to further development of the practical aspects of school closure, templates to help schools plan for possible school closure are sorely needed, as is further analysis of legal, economic, social, and other consequences.

 

By Sam Stebbins and Stacey Hoferka

 

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Schools Close Across the Nation Because of Influenza

More than a dozen cities and counties in Ohio, Kentucky, Tennessee, and Nebraska closed their schools this week (Jan 22-26) in response to outbreaks of influenza.   Scores of schools and thousands of students were affected.  This is a surprisingly high number, considering the relatively mild flu season so far (see detailed epidemiology in main article).  Full Story

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