Like a Rorschach inkblot test, merely mention college students and our first thoughts are of boisterous parties, out-of-control drinking and a "what, me worry?" attitude. Who would suspect that this healthy, invincible age group would also be the primary target of the avian flu, ominously poised on the horizon? "The 1918 flu attacked younger people," says Alan Bova, risk management director at Cornell University in Ithaca, N.Y., and author of a white paper on the official pandemic response by the University Risk Management and Insurance Association trade group.
People as young as 15 and up to age 40--not the usual vulnerable flu population--made up the bulk of the 675,000 people killed in the United States by the 1918 Spanish flu, the last major flu pandemic.
"It was not the flu itself but the body's powerful overreaction to the flu that wracked those with strong immune systems more than those with weak ones. . . . Paradoxically, the Spanish flu caused the healthiest humans' own immune reactions to kill them," Bova writes in the URMIA report. The avian flu that has already sickened more than 184 people in Asia, Europe and Africa is predicted to be even more deadly.
Exacerbating the situation, college campuses act like giant Petri dishes, with students living so close to each other in dorms, sitting in classrooms and eating in dining halls.
"It's the movement, the visitors, the close proximity, so much coming and going from sports teams, admissions tours, visiting scholars and so many other activities," says Janice Abraham, president and CEO of United Educators. Other complicating factors include student and faculty international travel and a campus accessible to the surrounding community. "Thinking about this has got to be on everybody's radar screens," she says.
Maybe it's not on everybody's screens yet, but a number of higher-education insurance brokers, university health officials and risk management people are dusting off any kind of emergency preparedness plans and business continuity strategies they have so they won't be left at the starting gate when the first U.S. cases are reported.
"The big question is how fast can they get their arms around this," says James Graves, vice president for Marsh Risk Consulting in Dallas. "There needs to be a huge sense of urgency for the education industry, especially with what they're seeing on the news. The nature of the universities makes them more vulnerable."
That's why A.J. Gallagher Risk Management Services' Higher Education Group in January convened a blue-ribbon group of risk managers and public health and Centers for Disease Control and Prevention officials to hammer out a 50-page document titled the "Blueprint for Pandemic Flu Preparedness Planning for Colleges and Universities," which Gallagher is distributing to its clients.
"Our goal is to provide a benchmark list that institutions should consider," says John E. Watson, executive director, Higher Education Practice Group in Gallagher's Glendale, Calif., office. "Like prior to Sept. 11, 2001, no one ever thought a high-rise office tower could be destroyed, but now that that has happened, people now have to acknowledge that it can occur," he explains. "The same can be said for Katrina and Rita. This (the avian flu) could also be a catastrophic issue," he says.
The Gallagher blueprint sketches out scenarios of what could happen should a pandemic occur, and then gives an extensive preparedness checklist that schools can follow to set up their own disaster plans. Presented in an outline format, the exhaustive lists of risk assessments, monitoring and campus considerations probably cover most every operation, situation, facility and issue that could surface in an emergency.
Watson acknowledges that it could take as long as an entire academic year to completely refine such a comprehensive emergency plan, "but if you aggressively attack it right now, there's enough in the outline format so in the fall (2006), you'll be able to take advantage of the timing, when all (new students, faculty and staff) are receptive to hearing about new knowledge and information," Watson says.
By the fall, it's quite possible that parents of new students may already start asking about the school's pandemic plan, along with the typical safety questions. In fact, last September students and faculty members at Carnegie Mellon University already started asking for Tamiflu, the six-year-old antiviral prescription drug that's expected to be effective against the current strain of avian flu, but is in short supply.
Apparently at Carnegie Mellon--where international students make up 25 percent of the entire student body--they were even ahead of most public acknowledgement that there was any perceived problem at all.
"I started checking with other schools and went on the listserv to see if anyone else was planning for this because the bird flu overseas was in the media, and very few were even thinking about it," recalls Dr. Anita Barkin, director of the Carnegie Mellon University Student Health Service.
Carnegie Mellon's emergency preparedness plan is based upon the strategy developed after Sept. 11, in terms of identifying who are the decision-makers, who has which role and responsibility, and how the emergency progresses as it evolves.
"In October (2005), we started pulling work groups together," she says, and in mid-March, they ran a "table-top" drill that went quite smoothly. Barkin's Avian Influenza Response plan identifies 18 different departments, individuals and locations--all considered essential services--laid out on a grid that includes responses broken down on three levels and built upon each other: Level One is for preplanning until the first human transmission case is reported; Level Two kicks in when suspected cases on campus or in the community are reported; and Level Three is reached when confirmed cases on campus are identified.
For example, the first identified group is the "Assessment Team," which is composed of the Facility Management Services, the Environmental Health & Safety department, the Student Health Center and University Police.
Barkin, as the director of the Student Health Center, serves as the incident commander, and "monitoring the situation" and "bringing in housing/dining for quarantine planning" are among her initial Level One duties. Level Two adds "essential personnel receive N95 respirators from the EH&S."
She also recommends training at least two additional people to do the jobs of each essential person in case the frontline people get sick.
Word of her extensive planning document has spread. "I've been inundated with requests for the plan, with well over 200 schools contacting me, including two requests from Canada," says Barkin, who also serves as chairwoman of the Task Force for Pandemic Planning for the American College Health Association. And well they should be contacting her because the health and the safety of the surrounding community, as well as the campus community, are at risk.
If you're not prepared, "what do you do if the CDC says, do this now?" asks Abraham of United Educators.
Universities should focus on contingency planning. Should the school continue to operate or should it shut down? Should you send the students home?
"Likely what we'll do is certainly close, if we have the opportunity," says Bova. "That will be one thing we'll be focused on, but we would still have a fairly large population who couldn't go home," he says, referring to the international students.
Marsh's Graves points to supply chain, food services and power as important considerations.
Battling the threat of an avian virus is also an opportunity for colleges and universities to brush up on their business continuity plans. Like contingency planning, continuity plans must address issues such as: How long might the school be shut down--a month, longer or only two to three weeks? How long can the school operate, especially if the personnel who typically operate the campus utilities--water, electricity, phone services--are unavailable?
"Somebody has to know how to turn on the switches," says Gallagher's Watson.
What about tuition--will you still charge it, or refund it? "You may not be able to operate, but are you still going to charge students for living at the school when it's not open?" asks Bova.
Online courses might be a long-term solution, but, as Bova points out, "it takes too long and many resources to develop a course." And there's another unknown--a school's response will depend upon when in the semester the disaster hits.
The liability risks to higher-education institutions make every risk manager cringe. "If you fail in contingency planning, and if the campus community is not prepared, the university could be held responsible," says Abraham. You don't want to look at your preparedness planning in hindsight, comparing your strategies with better practices of other schools. "If you find yourself sued, when you have to go before the judge and jury, what statements do you want them to be asking--how come your institution didn't do something?" asks Watson.
By thinking through these issues ahead of time, you stand a better chance of being prepared for a pandemic. "When you're ad-libbing, that's when you find yourself making serious mistakes," says Watson.
Abraham adds that there is no business-interruption insurance available for any school to buy for this kind of disaster. "The interruption has to be caused by a covered event, and a pandemic is not a covered event," she says. So get to work on your preparedness plan. Just wash your hands first.
SUSAN GUREVITZ lives in Philadelphia.
April 15, 2006
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