Pandemics of influenza are extreme infectious disease outbreaks. Although many infectious disease outbreaks (e.g. Severe Acute Respiratory Syndrome [SARS], Ebola, HIV, or West Nile Virus) can cause devastation, these infections are typically limited in their spread to either localized areas, regions, or to at-risk populations. Pandemic influenza, by contrast, is an explosive global event in which most, if not all, populations worldwide are at risk for infection and illness. In past pandemics,influenza viruses have spread worldwide within months and are expected to spread even more quickly today given modern travel patterns.

It is the sheer scope of influenza pandemics, with their potential to rapidly spread and overwhelm societies and cause illnesses and deaths among all age groups, which distinguishes pandemic influenza from other emerging infectious disease threats and makes pandemic influenza one of the most feared emerging infectious disease threats.

Although it is unpredictable when the next pandemic will occur and what strain may cause it, the continued and expanded spread of a highly pathogenic—and now endemic—avian H5N1 virus across much of eastern Asia, Russia, and eastern Europe represents a significant pandemic threat. Swine H1N1 virus could also represent a pandemic threat.

Level One - Mitigation/Prevention addresses what can be done to reduce or eliminate risk to life and property

Trigger: Any confirmed novel influenza A virus with human to human transmission.

District Goals:

  • Health Services Coordinator (appointed by Superintendent as Pandemic Manager) to communicate with Director of Health Department and will continue to attend meetings with the Health Department.
  • Assistant Superintendent of Operations will review, approve and oversee implementation of plan.
  • Maintenance Department to identify policies for Custodial Services cleaning procedures.
  • Transportation Department to identify policies for cleaning buses and transporting students to cluster schools.
  • Food Services to identify policies for Food Sanitation and Safety.
  • Health Services Coordinator to collaborate with Health Department regarding preparation of public service announcements and updates for distribution to school/site administrators via the Communications Department.
  • Communications Department to develop and tape information on awareness of influenza general precautions and pandemic preparation, with broadcast to schools and cable station. Collaborate with Health Services Coordinator to update broadcast information. Prepare news media release for Superintendent or designee.
  • Communications Department to establish link to www.pandemicflu.gov on District Home Page.
  • Payroll Department to identify policies to continue essential functions.
  • Student Services to establish plan for continuing plans for educational opportunities for students and addressing work force.

School Location Administrators Should:

  • Prepare with the information provided below to keep staff, students and parents well informed and help them understand their roles in preventing influenza spread. (Information provided by the Communications Department).
  • Review and inform staff on District Infection Control Practices.
  • Review food and facility safety administrative regulation in the Food Services Procedures Manual.
  • Update contact information for staff and students.
  • Brief key staff on roles and responsibilities.
  • Prepare and purchase recommended supplies from the District Warehouse to be added to the Crisis Box.
    • 2 boxes of gloves
    • 10 masks
    • Hand sanitizers
  • Identify isolation room.
  • Review payroll procedures with appropriate staff.

Influenza Transmission

Human influenza infection usually takes place within the respiratory tract. Preventing direct and indirect infection of the respiratory tract is of utmost importance for preventing person-to-person transmission of the disease.

  1. Contact
    • Direct-contact involves skin-to-skin contact and physical transfer of microorganisms to a susceptible host from an infected or colonized person, such as occurs when persons perform activities that require physical contact, e.g. playing sports or holding hands.
    • Indirect-contact involves contact of a susceptible host with a contaminated intermediate object in the environment.
  2. Droplet
    • Influenza is easily spread when droplets containing microorganisms are generated from a source person during sneezing, coughing or talking, make contact with the conjunctivae of the eye or mucous membranes of the nose or mouth of a susceptible person.
  3. Airborne
    • Although there is no evidence that influenza can occur across long distances such as through ventilation systems, transmission can occur through inhalation of small-particle aerosols particularly in shared air spaces with poor air circulation.

Recommendations for Infection Control

  1. Basic Infection Control for Preventing the Spread of Pandemic Influenza. The following apply to any setting where persons with pandemic influenza may congregate.
    1. Limit control between infected and uninfected persons.
      • Isolate infected persons (e.g., confine ill students, staff in designated area until they are able to leave school site.)
      • Promote spatial separation in common areas. Sit or stand as far away as possible – at least 3 feet- from potentially infectious persons.
    2. Contain infectious respiratory secretions.
      • Instruct persons with “flu-like” symptoms to use respiratory hygiene/cough etiquette.
      • Alert: Symptoms of influenza include fever, headache, muscle aches and pains, sore throat and cough. Children may also have earaches, nausea and vomiting.
  2. Management of Infectious Persons. Respiratory hygiene/cough etiquette has been promoted as a strategy to contain respiratory viruses at the source and to limit their spread. Elements include:
    • Education of staff, students and visitors on the importance of containing respiratory secretions to help prevent the transmission of influenza and other respiratory viruses.
    • Posted signs in appropriate languages with instructions to staff, students and parents to immediately report symptoms of respiratory infection to Clinic Assistant and/or School Nurse.
    • Hand hygiene after contact with respiratory secretions, and
    • Spatial separation, ideally, at least 3 feet, of persons with respiratory infections in common areas when possible.
  3. Infection Control Practices for District
    1. In schools, infection control should focus on:
      • Keeping sick students, staff and workers away while they are infectious.
      • Promoting respiratory hygiene/cough etiquette and hand hygiene as for any respiratory infection. The benefit of wearing masks in the school setting has not been established.
    2. School administrators should ensure that materials for respiratory hygiene/cough etiquette (e.g., tissues and receptacles for their disposal) and hand hygiene are available.
    3. Non-latex, disposable gloves should be available for all staff and employees.
      • A single pair of non-latex gloves should be worn for contact with blood and body fluids, including hand contact with respiratory secretions.
      • Gloves should fit comfortably on the wearer’s hands.
      • Wash hands after glove removal.
      • If gloves are in short supply (e.g., the demand during a pandemic could exceed the supply), reserve gloves for situations where there is direct contact with blood, body fluids or respiratory fluids in large quantity and use other barriers such as paper towels or paper napkins when there is limited contact such as in cleaning up used tissues. Hand hygiene should be strictly reinforced in this situation.
      • Alert: All persons should take special care not to touch their eyes, nose or mouth with contaminated hands, gloved or ungloved.
    4. Hand hygiene has been frequently cited as the single most important practice to reduce the transmission of infectious agents in any setting.
      • If hands are visibly soiled or contaminated with respiratory secretions, wash hands with soap and water.
      • Always wash hands between person contact and removing gloves.
    5. Cleaning and disinfection of student-occupied rooms should be done daily. EPA-registered disinfectant and District approved chemicals should be used on all frequently touched surfaces such as desks, telephones, lavatory surfaces, and doorknobs in addition to floors and other horizontal surfaces. Clinic areas should be given special attention.
  4. Recommendations for Preventing the Spread of Pandemic Influenza in Schools. The focus should be on keeping sick students, teachers and staff away while they are infectious and promoting respiratory/cough etiquette and hand hygiene.
    1. Keep ill persons separate from non-ill persons.
      • Excuse students, teachers and staff from their duties if they develop symptoms.
      • Each school should develop a plan to allow for coverage when teachers and other staff must be home.
    2. Identify illness early.
      • Training will be provided for students, teachers, parents and staff on influenza including routes of transmission, signs and symptoms, treatment and infection control strategies.
    3. Prevent exposure to student/staff and the spread of disease outside the school building.
      • Consider rescheduling extracurricular activities such as sports events, plays, dances, PTO meetings during pandemic.
      • Consider rescheduling field trips.
      • If absenteeism is high in certain classes, combine classes to limit exposure to/from substitute staff.
      • Superintendent approval required for all travel
    4. Encourage the use of infection control measures within the building.
      • Ensure that hand-washing supplies are available and an alcohol-based hand gel, if possible.
      • Have tissues and trash receptacles available in classrooms,
      • Use an EPA-registered disinfectant to clean environmental surfaces.
      • Review cleaning procedures with housekeeping staff.
    5. Communicate information.
      • Absences of 15% over the normal rate should be reported immediately to the Health Services Coordinator at 337 8244 or by e-mail. For example, if your daily absentee rate for any given day is 100, a report shall be made when absence exceeds 115 students.
      • Notify families of status and reinforce prevention strategies.
      • Post visual alerts on doors advising visitors to not enter a building if ill or report to the office if they exhibit symptoms of respiratory illness.
  5. General Health Information
    • All personnel should be educated on issues relative to pandemic influenza.
    • Symptomatic personnel should be sent home until they are physically able to return.
    • Personnel who have recovered from pandemic influenza should develop protective antibody against future infection with the same virus. These persons should be well suited to care for others who are infected with influenza.

Level Two - Confirmed Case in the United States, but not Florida Preparedness focuses on the process of planning for the worst-case scenario

Trigger: The World Health Organization or CDC reports a case of human to human transmission of avian flu within the United States, but not Florida.

District Goal:

  • Health Services Coordinator will update the Superintendent or designee, Assistant Superintendent of Operations and maintain links with relevant agencies and community support networks.
  • Superintendent or designee will initiate LEVEL TWO.
  • Heighten awareness and precautionary measures in schools, departments and school community.
  • Communications Department and ITV to update District Websites, broadcast information and parent notifications.

School/Location Administrators Should:

  • Ensure all contact information is current for staff and students.
  • Provide ongoing briefings for key staff on roles and responsibilities.
  • Ensure all Infection Control Practices for District are being followed. Remind staff, students and parents about:
    • The difference between symptoms of common cold and influenza.
    • The importance of good hygiene practices.
    • The importance of staying home when sick.
    • The gravity of the pandemic through scenarios/stories of historical pandemics, etc.
  • Initiate surveillance of staff, students, and other school visitors and personnel to assist the Lee County Health Department in close monitoring of influenza like incidents. Follow the Communications Department information provided and report abnormal rate of absences to Health Services Coordinator at 337-8244.
  • Ensure all food and facility safety administrative regulations are being followed.
  • Ensure adequate recommended supplies are added to the Crisis Box (recommended supplies: at least 2 boxes of gloves, 10 masks and hand sanitizers to be used during this event only and in the event there is loss of water).
  • Prepare isolation room indicated under recommendations for infection control.
  • Review payroll procedures with appropriate staff.
  • Review Student Services plan for continuing educational opportunities and address work force.
  • Send prepared District notices to Parents provided via the Communications Department.
  • Monitor recent domestic and international travel of staff, students and parents (as far as possible). Superintendent or designee approval required for all travel.

Level Three - Suspected case within the State of Florida Response is the steps to take during the crisis

Trigger: Lee County Health Department notifies District contact (Health Services Coordinator) warning of suspected case(s) of pandemic flu within the State of Florida.

District Goal:

  • Health Services Coordinator will update the Superintendent or designee, Assistant Superintendent of Operations and maintain links with relevant agencies and community support networks.
  • Superintendent or designee will initiate LEVEL THREE.
  • Health Services Coordinator to confirm role in local response plans with Lee County Health Department.
  • Communications Department and ITV to update District Websites, broadcast information and parent notifications. Endeavor to keep community calm and reduce panic.
  • Student Services Director shall prepare for possible school closure. Schools to be closed only by specific direction from the Superintendent or designee.
  • Student Services Director will prepare to mobilize the Crisis Intervention Response Team.
  • Security Services Coordinator to coordinate with EOC if schools are required for community use.
  • Prepare for another wave of influenza, a few weeks after the first.

School/Location Administrators Should:

  • Continue to ensure all contact information current for staff and students.
  • Continue briefings for staff on roles and responsibilities.
  • Continue to ensure all Infection Control Practices for District are being followed. Remind staff, students and parents about:
    • The difference between symptoms of common cold and influenza.
    • The importance of good hygiene practices.
    • The importance of staying home when sick.
    • The gravity of the pandemic through scenarios/ stories of historical pandemics, etc.
  • Continue surveillance of staff, students, and other school visitors and personnel to assist the Lee County Health Department in close monitoring of influenza like incidents. Follow the recommendations for preventing the spread of Pandemic Influenza in schools (section e) provided and report abnormal rate of absences to Health Services Coordinator at 337-8244.
  • Continue to ensure all food and facility safety administrative regulations are being followed.
  • Implement isolation room and supplies.
  • Implement payroll procedures.
  • Implement Student Services plan for continuing educational opportunities for students and addressing work force.
  • Send prepared District notices to parents provided by the Communications Department.
  • Monitor recent domestic and international travel of staff, students and parents (as far as possible). Superintendent or designee approval required for all travel.

ALERT: As the scope of the pandemic escalates, State and local officials may choose to close Lee County Schools either for short periods or for the duration of the pandemic.

Prepare for possible school closure:

  • When directed by the School Superintendent or Designee to close schools
    1. Make preparations for securing the premises.
    2. Keep staff, students and parents informed.
    3. Prepare staff and student contact lists for the Lee County Health Department in order to trace infected people. Make it clear that contact details will only be used for the purpose of pandemic management.
    4. Two emergency contacts for each student.
    5. Staffs home contact details.
    6. Should schools be used by the community, follow hurricane procedures.
    7. Provide notification to parents if another location will be available for students who are not sick.
    8. Post “Closure Notices” on entry points and main buildings.
    9. Collaborate with local agencies through Security Services Coordinator (EOC Liaison) if EOC is activated.

Level Four - Recovery deals with how to restore the learning and teaching environment after a crisis

Trigger: Lee County Health Department notifies District contact that the pandemic has been abated in Lee County and schools can be reopened.

District Goals if schools remained open:

  • Health Services Coordinator will update the Superintendent or designee, Assistant Superintendent of Operations and maintain links with relevant agencies and community support networks.
  • Schools/Departments ensure continued well-being of staff and students and education services are fully restored, recognizing possible work force reduction impact.
  • Communications Department to update Web and prepare media announcement for Superintendent or designee and prepare briefings, emails and newsletters.
  • Assistant Superintendent of Operations arranges debriefing for Administrators and Principals.
  • Student Services to mobilize the Crisis Intervention Response Team.
  • Assistant Superintendent of Operations and Security Services Coordinator will evaluate the success of the Pandemic Influenza Plan and make adjustments.

District Goals if schools were closed:

  • Health Services Coordinator will update the Superintendent or designee, Assistant Superintendent of Operations and maintain links with relevant agencies and community support networks.
  • Communication Department to update Web and prepare media announcement for Superintendent or designee and prepare briefings.
  • Assistant Superintendent of Operations arranges debriefing for Administrators and Principals.
  • Student Services to mobilize the Crisis Intervention Response Team.
  • Superintendent or designee reopens schools.
  • Assistant Superintendent of Operations and Security Services Coordinator will evaluate the success of the Pandemic Influenza Plan and make adjustments.

School/Location Administrators Should:
If School Remained Open:

  • Assess capacity of staff to continue normal school operations: report information to Assistant Superintendent of Operations.
  • Prepare for District debriefing.
  • Arrange for debriefing of staff and students, if appropriate.

School/Location Administrators Should:
If Schools Closed:

  • Assess capacity of staff to resume normal school operations: report information to Assistant Superintendent of Operations.
  • Arrange for cleaning, disinfecting of affected areas including school buses and remote locations.
  • Prepare for District debriefing.
  • Arrange debriefing of pandemic event for staff and students if appropriate.
    • Reassure parents/staff that the school environment, transportation vehicles are safe and have been inspected for proper cleaning/disinfection to resume operations.
  • Evaluate the success of the School Pandemic Influenza Plan and make adjustments. Provide suggestions to Security Services Department for the District Pandemic Influenza Plan.