Influenza Response Plan

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TABLE OF CONTENTS

1. General Overview
2. Influenza Response Plan
   1. Response Levels
   2. Communication and Surveillance
   3. Surveillance
   4. Preventive Measures
   5. Vaccination
   6. “High-Risk” Individuals –Definition
3. Medical Response-Recommendations
   1. If You Think You Have the Flu?
   2. Student Health Center Infection Control Protocol
   3. Management of Students with Acute Respiratory Syndrome
   4. Treatment – Student Discharge Instructions
   5. Confirmatory Testing for H1N1 Influenza
4. Department of Athletics Intercollegiate Athletic Policy
5. Recommendations for Faculty
6. Guidelines for Instructors
7. Howard University Campus Police Department
8. Physical Facilities Management
9. Evaluation of the IRP
10. Closing Remarks
11. Appendices
    1. Letter to the University Community
    2. General Student Recommendations
    3. Influenza Prevention
    4. Recommendations for Staff
    5. University Communications
    6. Campus Education Program
    7. Frequently Asked Questions
    8. Swine Flu Prevention Tips
    9. Influenza Fast Facts
    10. CDC Guidelines for Response to Influenza

I. General Overview

The goal of this report is to articulate a unified, comprehensive plan for Howard University in the event that the campus community is subject to an outbreak of seasonal influenza and/or H1N1 “Swine Flu” virus during the academic year.

Provisions contained in this report are for the health, safety and well being of all students, faculty, staff, visitors and members of the general public who come into the campus environment.

Howard University must be prepared for the management of a large number of students, faculty, and staff with symptoms of exposure to highly contagious agents and has established Influenza Response Plan, hereafter (the IRP). The Student Health Center has also adopted a Plan for the Management of Highly Contagious Students, Faculty, and Staff, an infection control plan that will help to identify, isolate, and treat individuals with symptoms of highly infectious diseases. This is a critical component of the IRP. In addition, the IRP will help establish a campus-wide educational campaign as well as a comprehensive communication plan to inform everyone regarding health promotion and disease prevention strategies to reduce the risk of individual’s contracting influenza or contributing to its spread. The plan also addresses emergency response strategies and contingencies to secure Howard University and its facilities in the unlikely event of a widespread influenza outbreak.

The information will be disseminated broadly through the University’s various communication mechanisms including: voice, text alerts, print, electronic, audio and video communications, WHUT-TV, WHUR-FM, WHBC-AM, the Hilltop and other publications as deemed appropriate.

Howard University ’s IRP designates four (4) levels of operation and contingency management. For the purposes of management of highly infectious agents such as influenza, these four levels are defined as:

• Level 1 – Normal operations and surveillance
• Level 2 – Heightened awareness, surveillance, preventive measures and treatment
• Level 3 – Conditions can be managed with University resources, but may require consideration of cancellation of University activities, classes and/or closure of University facilities and residence halls as deemed appropriate depending upon the size of the infected population and prevailing environmental factors
• Level 4 – Conditions are overwhelming University resources; a CDC recommendation for pre-emptive class/campus closure has been called. Level 4 operations may be implemented if a national, city or metropolitan alert is issued.

Level 1

This response level is defined as our normal institutional operational level. This will include our normal informational response to the campus community regarding seasonal influenza: education, surveillance, monitoring, prevention, vaccination and treatment as student cases are reported and faculty and staff incidence is monitored.

This plan outlines specific responses to Levels 2 – 4.

Level 2

The Influenza Response Team in consultation with the HU Student Health Center will lead the activity associated with this level of operation. As previously stated, this level is characterized by awareness education, surveillance, preventive measures and episodic treatment.

Specifically, the following actions will be initiated:

Communication and Awareness Education – University-wide communications detailing the specific health threat, planned actions, prevention and indications for treatment will be distributed. Various campus media will be utilized and may include, but are not limited to: email, flyers, postings, text alerts, voice messaging, and special influenza notifications in University publications as well as on the University’s website. Educational forums will be held throughout the University, inclusive of its residence halls, general information sessions, open to the University community and onsite forums in all schools and colleges. Signs and informational communications will be posted in all University buildings and residence halls campus-wide. Examples of such communications can be found in the Appendices of this document. In addition, specific staff education will be conducted to acquaint the University community with aspects of the IRP.

The University staff will be kept up to date on infection control bio-agents and safety protocols through ongoing in-service training. Student Health Center staff and other selected University personnel will be properly trained to detect signs and symptoms of infectious agents through educational updates.

Surveillance – the Student Health Center, with the assistance of key stakeholders and select University personnel campus-wide, will be responsible for monitoring and reporting infectious disease activity to the Senior Vice President for Health Sciences. Influenza cases involving students residing in University residence halls will also be reported to the Office of the Dean of Residence Life and the Office of the Vice Provost for Student Affairs. Specific procedures for the care of students with flu-like symptoms are contained in this document including indications for confirmatory testing for H1N1 influenza.

Preventive Measures – the following preventive measures will be used.

• General Measures include but are not limited to:
  • good hand hygiene, i.e., frequently washing hands with soap and water or using alcohol based hand sanitizers when soap and water is not available;
  • covering coughs and sneezes with tissues or coughing/sneezing into one’s sleeve, NOT one’s hand;
  • avoid touching the face, nose or mouth with the hands
  • Self isolation when signs/symptoms of flu are present until at least a 24 hour period, absent of fever;
  • wiping down community keyboards with disinfecting wipes; and
  • sanitizing key contact surfaces such as door handles, railings and other surfaces on a periodic basis to reduce the risk of contamination
• Residence halls
  • Masks, hand sanitizer and wipes should be given to all Community Directors, building managers, and made available to Resident Assistants and Graduate Assistants as needed
  • Common areas should be cleaned and disinfected on a regular schedule
  • Disposable wipes should be provided so that keyboards, remote controls, chairs and railings can be cleansed between users.
  • Flyers and informational posters should be placed near doors and at elevators and other high traffic areas
  • Students living together should frequently clean commonly-used surfaces such as doorknobs, refrigerator handles, remote controls, and countertops.
  • Resident students with flu-like symptoms must self-isolate as follows:
    • These students should consider going home if they live close enough to campus and can reach home without using public transportation; otherwise students should stay in their rooms except when going to the bathroom or to seek medical care.
    • Provisions shall be made to provide meals as needed to students that have flu-like symptoms to reduce risk of spread to others, as required.
    • Students with flu-like symptoms will be required to immediately contact the Student Health Center, to have their condition assessed and to receive specific instructions regarding self-isolation and treatment recommendations
    • Students with flu-like symptoms should wear a mask when leaving their room for any reason or when visitors are in the room

Vaccination – the following considerations will apply.

An attempt will be made to vaccinate all students for seasonal influenza. These vaccinations will occur at the Student Health Center or at designated “Flu Shot Clinics” organized and conducted at select campus locations. This effort is contingent upon the availability of the seasonal influenza vaccine. The University will vaccinate students for a nominal charge. The H1N1 vaccine is not yet available, but will also be made available to students as supplies are secured. Both the seasonal influenza vaccine and the H1N1 vaccine are strongly recommended for those individuals considered to be at “high risk” (as described below).

Those individuals deemed at “ high risk” of serious medical complications and illness as a result of contracting influenza include the following:

• Pregnant women and household contacts
• Caregivers of infants younger that 6 months
• Healthcare and emergency services personnel
• Age 6 – 65 year olds who are at greater risk for influenza related complications secondary to medical conditions (Chronic pulmonary conditions, including asthma); cardiovascular conditions except hypertension; renal disease; hepatic disease; cognitive and neurologic/neuromuscular diseases; hematologic or metabolic disorders, including diabetes mellitus; immunosuppression caused by medications or by human immunodeficiency virus

Individuals affected by any of the medical conditions listed above should be vaccinated immediately for seasonal influenza and H1N1 influenza. Faculty and staff members are strongly encouraged to see their personal health care provider for the seasonal flu vaccination and the H1N1 vaccination. Both the seasonal influenza vaccine and the H1N1 vaccine are strongly recommended for those individuals considered to be at “high risk.”

Treatment of students with influenza will occur as indicated by the most current Center for Disease Control (CDC) guidelines to prevent influenza complications. The Student Health Center will be the primary source of care for enrolled, financially validated students. The Student Health Center will work in conjunction with Howard University Hospital (HUH) in instances where the possible severity of influenza onset would necessitate hospitalization or treatment at HUH.

University faculty and staff members are urged to contact their personal primary care physicians at the first signs of flu-like symptoms.

Level 3

A Level 3 response is characterized by influenza infection rates that can be managed with the existing resources of the University, but may require consideration of the cancellation of campus activities, classes and/or closure of University facilities and residence halls. When deemed appropriate, additional medical assistance from the professional staff of Howard University Hospital will be enlisted.

Response to a Level 3 contingency will be led by the Office of the Senior Vice President ( SVP) for Health Sciences in conjunction with the Student Health Center. However, all decisions regarding the cancellation of University activities, classes and/or closure of the University or residence halls are vested with the President of the University. Decisions such as these will be based on the medical recommendations of the Office of the SVP Health Sciences in consultation with the Office of the Provost, in addition to any other University personnel that the President deems necessary to ensure the health and welfare of the University’s students, faculty and staff. In addition, the following surveillance data will be used in consideration of whether or not to suspend campus activities, classes and/or other University operations.

• Number of reported student influenza cases
• Frequency and location of influenza cases
• Seasonal influenza versus H1N1 incidence among reported student cases
• Student, faculty, and staff absenteeism rates
• Number of visits to the campus health service
• Bed availability for student self-isolation
• Severity of illness among affected staff and/or students
• Other information contributing to the campus environment
  • Numbers of and trends in outpatient visits, hospitalizations, and deaths for flu-like illness
  • Percentage of hospitalized patients requiring admission to intensive care units (ICUs)
  • Groups/populations being disproportionately affected
  • Ability of local health care providers and emergency departments to meet increased demand
  • Availability of antiviral drugs, hospital beds, staff, ICU space, and ventilators for flu patients

Outlined below are procedures the university will and, faculty, students and staff should follow to further reduce spread of influenza infection on campus.

• Permit individuals considered to be at “high-risk” of medical complications or severe illness as a consequence of influenza infection (inclusive of students, faculty, and staff) to stay home when flu is widespread within the campus community.This would include consideration of implementation of a liberal leave policy for University staff persons and special consideration of leave by affected faculty members through department chairpersons and Deans.
• If an influenza outbreak occurs or if the severity increases, people at “high risk” of influenza medical complications may consider staying home until the situation mediates. Such “high risk” individuals should make this decision in consultation with their doctor. 
• The University will encourage faculty members to continue the instructional process to students who may be required to stay home or away from classes through distance learning methods or other alternative electronic teaching methodologies such as “Virtual Backboard.” The University will also examine policy accommodations that might be necessary such as allowing students with influenza related medical complications to withdraw for the semester; review the administration of the sick leave policies in undergraduate, graduate and professional schools and colleges, where applicable, to address the urgent medical needs of affected students.
• Explore innovative ways to increase the distances between students (for example, moving desks apart or using distance learning methods) and reducing contact time. Ideally, there should be at least 6 feet between people at most times.
• Relocation of well students away from affected residence hall facilities with abnormally high incidences of influenza viral outbreaks. Recommendations for housing alternatives within residence halls for large numbers of influenza infected students.
• Campus events: Consider whether to suspend or modify public events such as lectures, concerts, conferences, sporting events or official ceremonies. Decisions would be made on a case by case basis depending upon prevailing environmental conditions.
• Suspending Classes: The Office of the President, Office of the Provost and Chief Academic Officer and the Office of the SVP Health Sciences will work closely to balance the risks of influenza outbreak, personal health and safety of students, faculty and staff in the campus community as well as the disruption that suspending classes will cause in both education and the wider community. This would be particularly true if the University would be unable to maintain normal operations due to a widespread outbreak of influenza on campus.

Level 4

This contingency level would be implemented in the event that University resources have been overwhelmed and compromised and high influenza infection rates necessitate the closure of the University.

University closure could be mandated due to an abnormally high level of influenza incidence on campus, an abnormally high percentage of reported faculty, staff and/or student influenza infection; a high percentage of influenza medical complications or mortality relative to the total population within the University community or the metropolitan Washington area, or if national or local officials declare an emergency situation necessitating the closure of schools, businesses and/or the initiation of travel restrictions or quarantine actions in the metropolitan Washington area.

This would include consideration of shelter-in-place plans and associated service provision for students unable to leave or evacuate from main campus or residence hall facilities. This would also include provision of care for large scale numbers of influenza infected students.

To decrease the spread of influenza, the CDC may recommend to the University, a preemptive class suspension if the influenza outbreak affects a disproportionate population on the Howard University campus. If a Level 4 emergency is declared, the Student Health Center operations will be assumed by Howard University Hospital under the direction of the Chief Medical Officer. The following actions would be implemented:

• Howard University’s Emergency Response plan will be activated.
• The Howard University Hospital Chief Medical Officer and the DC Department of Health will be notified of the need to cancel classes and/or close the University.
• All large events: (i.e.: sporting events, lectures, official ceremonies) will be cancelled or postponed.
• The University’s contingency plan for continued essential services such as student meals, residence life, physical facilities management, custodial services, security, and other basic operations for students who remain on campus will be activated.
• When possible, students who can get home – or to the home of a relative, friend of the family, or host family – by private car or taxi will be encouraged to leave campus. International students and others without easy access to alternative housing will stay on campus, but the distance between people will be increased as much as possible. Students affected by influenza will be identified and provided appropriate treatment and support services. Healthy students will also be relocated where possible, to buildings and campus facilities to minimize the possible spread of influenza virus.
• Classes will be suspended for a period of time deemed appropriate for the level of viral outbreak to dissipate.
• The decision to resume classes will be made in collaboration with public health officials and the issuing of an “all clear” notification after a reassessment of the epidemiology of the disease, prevailing conditions on campus and among the constituent populations(faculty, staff and students), and the benefits and consequences of either voluntarily continuing the closure or reopening the University.

Office of the Senior Vice President for Health Sciences
Student Health Center
Recommendations to all Howard University Students

“If You Think You Have the Flu”

• If you think you have the flu, experience flu-like symptoms, stay at home or in your residence hall and/orifyou have one of the medical conditions listed below and are considered to be at “high-risk” for possible medical complications due to influenza infection. Those persons should contact the Student Health Center immediately for assessment and evaluation or contact their personal health care provider as soon as possible. Do Not Wait.
• Drink plenty of clear fluids such as water, broth, sports drinks, and electrolyte beverages to keep from becoming dehydrated.
• Stay at home or at your place of residence if you are sick, for at least 24 hours after resolution of your fever, or signs of a fever (chills, feeling very warm, sweating, or being flushed). This must be determined without the use of fever reducing medications (ibuprofen containing medications or acetaminophen, or naproxen containing medications). Staying away from others while sick can prevent others from getting sick, too. Symptoms of flu can include fever, chills, cough or sore throat. In addition, symptoms of flu can include runny nose, body aches, tiredness, diarrhea, or vomiting.
• **If you develop symptoms of shortness of breath, confusion, pain or pressure in the chest or abdomen, severe or persistent vomiting, sudden dizziness or fever that is not relieved by fever reducing medications, seek immediate medical attention. Students should immediately contact the Student Health Center or call for emergency assist
• “High-Risk” Individuals - Persons with flu-like symptoms and one or more of the following criteria should seek medical help right away. Individuals in these categories are considered to be at high risk of medical compilations and possible severe illness if they contract the influenza virus - DO NOT WAIT.
  • Pregnant women and household contacts
  • Caregivers of infants younger that 6 months
  • Healthcare and emergency services personnel
  • AGE 6 – 65 year olds who are at greater risk for influenza related complications secondary to medical conditions (Chronic pulmonary conditions, including asthma); cardiovascular conditions except hypertension; renal disease; hepatic disease; cognitive and neurologic/neuromuscular diseases; hematologic or metabolic disorders, including diabetes mellitus; immunosuppression caused by medications or by human immunodeficiency virus
  • Age greater than 65
• Please call the Student Health Center at (202) 806-7540 during normal business hours, Monday through Friday 8am to 6pm. Again, if you are experiencing flu like symptoms and have one of the conditions listed above, DO NOT WAIT FOR THE STUDENT HEALTH CENTER TO OPEN. Seek medical attention immediately.

Student Health Center
Protocol for Students Presenting Flu-like Symptoms

• Students who think they have the flu should call the HU Student Health Center prior to presenting to the Student Health Center for assessment or treatment unless they meet the criteria for patients at “high risk” for influenza medical complications.
• Students will be phone triaged according to the HU Student Health Center Phone Triage protocol and should follow the instructions given to them by the Student Health Center staff.
• The Student Health Center will keep in contact with all students that have called or reported to the Health Center for care by phone or other means.
• “High risk” students will be advised to report as soon as possible for medical care at the Student Health Center or at Howard University Hospital- Emergency Room, when the Student Health Center is closed.
• Roommates/suitemates who are at “high-risk” for influenza medical complications will be considered for flu prophylaxis (immunizations and other medical treatment)
• Signs will be posted at the entrance to the Student Health Center requesting that all students with flu-like illness put on a mask.
• Masks will be kept at the security desk in the lobby of the building that houses the Student Health Center.
• Signs at the elevator entrance and at the Student Health Center entrance will direct students with flu-like symptoms to a separate entrance to the Student Health Center.
• Students will be placed in an exam room (preferably one containing a HEPA filter) immediately for assessment, examination and possible treatment.
• Students with flu-like illness Will NOT be allowed to sit in the main waiting room

Management of Students with Acute Respiratory Syndromes
At the Howard University Student Health Center

The following guidelines are based on current CDC and World Health Organization (WHO) recommendations for individuals suspected of having infectious respiratory illnesses.

Student Intake Procedure

1. STUDENTS IN THE WAITING ROOM or TRIAGE AREA
   1. A rapid Influenza assessment will be done on students who present with fever, cough and/or meet the CDC criteria for the suspected respiratory syndrome.
   2. Suspect or confirmed patients will be separated from the regular patients
   3. Patients will be given a mask and moved directly into a HEPA filtered room or quarantine area
   4. Student Health Care workers coming into contact with patients must wear N95 HEPA filter masks.
   5. Strict adherence to Standard, Contact and Airborne Precautions must be observed.
   6. Strict adherence to hand washing must be observed.
   7. Howard University Hospital infection control will be provided with a weekly tally of Influenza A infections diagnosed by the Student Health Center.
   8. The Student Health Center will provide the appropriate alerts to the District of Columbia Department of Health, the Office of the SVP Health Sciences, Office of the Provost and Chief Academic Officer and Office of the President.
2. INFECTED STUDENTS REQUIRING HOSPTIAL ADMISSION
   1. In general, students will be admitted to Howard University Hospital via an expedited admission procedure
   2. Students will be admitted to and transported directly to a Negative pressure HEPA Filtered Room
   3. Standard, Contact, and Airborne precautions will be maintained
   4. All health care personnel entering the room will wear gloves and N95 mask.
   5. Infection Control will be notified of the admission.
3. STUDENT HEALTH CENTER EMPLOYEES
   1. Employees must wear N95 masks and gloves when examining patients with flu-like symptoms
   2. Exclusion from duty is recommended for the employee if fever or respiratory symptoms develop during 7-10 days after exposure to the virus.
   3. Off duty Employees must report exposure and symptoms of illness to their primary care Physicians before reporting to work.
4. VENDORS, PATIENT VISITORS, CONSTRUCTION WORKERS & OTHERS
   1. If there is an outbreak of an acute infectious respiratory illness in the Metro Area visitors to the Student Health must be restricted.
   2. A system for screening visitors for fever and respiratory symptoms will be in activated.
   3. Public notices will be posted at entrances to the Student Health Center to guide the movement of the public.
   4. Visitor education handouts will be made available to the public.
   5. Entrances and exits to the Student Health Center will be restricted and monitored
5. TUDENT HEALTH CENTER SECURITY
   1. If there is a widespread outbreak in Metropolitan Area, HUPD officers assigned to the Student Health Center location will be issued masks and gloves.
   2. HUPD officers will be posted at the entrance at all times
   3. All Employees and visitors must present Identification to gain access to the facility containing the Student Health Center
   4. Visitors must identify at all times the patients they are accompanying so that they can be screened for possible exposure to the acute infectious respiratory illness.

These recommendations are based on current available CDC, WHO and District of Columbia Department of Health guidelines. Information varies depending on the current acute infectious respiratory illness crisis but is the same in the acute care setting for all of the current Influenza guidelines as provided by the WHO and CDC.

All required Personal Protective equipment (PPE) will be stocked in the Student Health Center.

Required Personal Protective Equipment

• N95 PFR ( Particulate Filter Respirator- Duckbilled) fit tested
• Surgical Masks
• Gloves

Required Equipment

• Portable HEPA filters

Adapted from the guidance produced by Angella P. Browne, HUH Infection Control Specialist, September 8, 2009.

Student Health Center
Student Discharge Instructions for Individuals

Diagnosed with Influenza Infection

1. Thank you for visiting Howard University Student Health Center. Today you have been diagnosed with Influenza A.
2. H1N1 influenza is one of many types of Influenza A. Testing positive for Influenza A does not necessarily mean that you have H1N1 influenza.
3. Please provide us with a valid telephone number as it is very important that the Student Health Center is able to contact you.
4. This illness should last approximately one week.
5. As for any influenza illness, it is important to:
   1. Practice good hygiene
      1. Wash your hand frequently
      2. Cover your mouth when coughing by coughing into your elbow or tissue
      3. Dispose tissues in the trash
      4. Avoid close personal contact such as kissing
      5. Do not share food or telephones with other people
   2. Avoid exposing other people
      1. Remain at home until you are fully recovered
      2. Avoid working until your symptoms clear – we will be happy to write you a note for your class and/or work
      3. Avoid public places such as school events, churches, shopping centers
      4. Avoid travel that involves public transportation such as buses, trains, and planes.
6. Report to the Howard University Emergency Department or call for emergency assistance if you develop symptoms of shortness of breath, confusion, pain or pressure in the chest or abdomen, severe or persistent vomiting, sudden dizziness, or fever that is not relieved by fever reducing medications.
7. Please call your primary care physician prior to going to his/her office to inform them of your Influenza A diagnosis.
8. If you live in one of Howard University’s residence halls and you home is close to Washington, DC, you may consider going home if you can get there without taking public transportation.

For further information on the Flu you may visit the www.flu.gov website.

Student Health Center
Indications for Confirmatory Testing for H1N1 Influenza
(General DC Department of Health Guidelines)

To remain consistent with CDC recommendations and local/regional practice, DC Department of Health will now only conduct laboratory testing and reporting for Novel Influenza A on hospitalized patients with influenza-like illness (ILI), clusters/outbreaks of ILI, deaths due to influenza, and ILI patients at risk for complications.

These changes were enacted, June 27, 2009.

At this time, the same age and risk groups who are at “high risk” for seasonal influenza complications should also be considered at “high risk” for H1N1 influenza complications.

Groups at “high risk” for seasonal influenza complications include:

• Children less than 5 years old;
• Persons aged 65 years or older;
• Children and adolescents (less than 18 years) who are receiving long-term aspirin therapy and who might be at risk for experiencing Reye syndrome after influenza virus infection;
• Pregnant women;
• Adults and children who have chronic pulmonary, cardiovascular, hepatic, hematological, neurologic, neuromuscular, or metabolic disorders;
• Adults and children who have immunosuppression (including immunosuppression caused by medications or by HIV);
• Residents of nursing homes and other chronic-care facilities.

Please use the attached updated microbiology and virology testing request form effective June 26, 2009.

Thank you for your continued partnership and cooperation.

Should you have questions or need further assistance please contact one of the following:

Laboratory: 202-741-7700
Epidemiology Disease Surveillance and Investigation: 202-671-0692
Department of Health: 202-671-4222.

Office of Residence Life
Protocol for Influenza Preventative Measures
Cleaning & Disinfection

Campus-wide, steps are being taken to protect the health, welfare and safety of our students. In residence halls, the University has instituted more rigorous sanitation procedures of public areas.  Additionally, influenza information sessions will be conducted for the students and staff in all of the residence halls regarding preventative hygiene to reduce the risk of influenza transmission.

Residential Cleaning Recommendations for Influenza Virus on Contact Surfaces (Adapted from the federal government's pandemic flu planning Website)

1. According to the CDC, influenza A viruses can live on hard surfaces for approximately seven hours, and on porous surfaces for shorter periods of time. Cleaning and disinfection can reduce the number of viruses present on environmental surfaces, which can help to minimize hand transfer of virus.
2. Students living in residence halls should use a two stepmethod and take special care to clean and disinfect their living spaces routinely with special focus on, door knobs, floors, window sills, phones, faucets, telephones, computer keyboard and mouse; phones, computer games, laptops which may be shared with other persons, desks, tables; etc, in order to mitigate the spread of the H1N1 flu.
   1. The first stepin surface treatment is cleaning with soap or detergent in water. Cleaning will remove soil and organic matter that would otherwise reduce the effectiveness of the disinfection step that follows. Any commercially available soap or detergent can be used following the manufactures instructions on the label.
   2. The second step is the use of a disinfectant, registered by the U.S. Environmental Protection Agency (EPA), that lists the control and inactivation of human influenza A and/or B on the product label (Note: the H1N1 influenza virus is a strain of the influenza A virus). Many of these disinfectants are available in the cleaning supply section of stores.

The Office of Residence Life environmental services department will increase its attention as it pertains to the cleaning and disinfecting of the common areas, i.e. Elevators, facility door handles, railings, lounge and study table, lobby phones and bathrooms. The staff will use a bleach solution or some other disinfectant solution to clean these areas every morning and 3 to 4 hours thereafter until the end of the day, this will aid in the prevention or spread of the germs that can cause influenza.

Staff advisories will be made to ensure observance of manufacturer’s label warnings when using commercial disinfectants for proper ventilation, usage, first aid measures and proper personal protective equipment such as gloves and eye protection. Specific cleaning guidelines will include the following measures: not using a spray or (fog) in residence hall rooms with an aerosol can or pump spray disinfectant; discouraging cleaning by dry dusting or sweeping as this may create dusts carrying viruses; using only damp cleaning methods; changingmop heads, cleaning rags, and similar items and disinfectant solutions frequently; promoting increased use of disposable cleaning items; clothing, bedding and towels should not be shaken or otherwise handled in a manner that may generate dust and bag securely before removing from the room; and washing hands after handling potentially contaminated laundry or consider wearing disposable gloves. 

What will happen in my residence hall if there is an influenza outbreak?

The Office of Residence Life will work in conjunction with the Student Health Center to assess the level of incidence, the number of students affected and initiate evaluation, assessment, treatment, and immediate self-isolation, for sick students. Immediate information regarding hygiene and preventive treatment will also be made available to healthy students living in close proximity to students affected by the flu. The residence hall will be monitored by Residence Life staff in conjunction with the Student Health Center to provide support services for both affected students and the healthy student population as well.

If the university closes, do I have to leave my residence hall? What if I can’t get home right away?

If a decision is made to close the University, consideration will first be given to the housing needs of all students presently in the residence halls. There will be continuity in essential services. Any evacuation or closure of any residence halls, if required, will only be done in a way which maximizes the safety and well being of students residing on campus.

If the University were required to close for an extended period of time, the University will ask students to move back to their permanent residence as soon as they can obtain transportation. If students cannot readily leave campus, Residence Life will continue to provide housing and essential services based on administrative mandates in accordance with the Influenza Response Plan.

If you were required to leave campus on an emergency basis, you would be allowed to leave your personal belongings in your rooms. The University will keep its residence halls secure and your belongings will be secured until the University resumes normal operations.

Howard University
Department of Intercollegiate Athletics Policy

Introduction

At this time the United States is monitoring an increase in the incidence and prevalence of seasonal influenza as well as H1N1 influenza. Howard University officials are carefully monitoring the progression of influenza, particularly as it relates to the campus community and have prepared an Influenza Response Plan as well as an educational campaign for students, faculty and staff.

The Department of Intercollegiate Athletics recommends that our students, staff and contingents follow the University’s guidelines prepared in conjunction with the Student Health Center at www.howard.edu/studenthealth/. In the event of an influenza outbreak on campus, the Influenza Response Plan delineates the action levels and recommended institutional response to safeguard the health and safety of all members of the University community.

Preventive Steps

It is important to note that influenza can spread easily from person to person. Therefore, we are taking steps to reduce the risk of influenza outbreaks at Howard University. Part of our University-wide educational campaign is to reinforce overall good health and hygiene:

• Hand Hygiene
  Wash your hands frequently with soap and water, especially after coughing or sneezing and before eating. The use of alcohol based sanitizers are also more effective.
• Cover when coughing or sneezing
  Cover your mouth and/or nose with a tissue when you cough or sneeze. If you do not have a tissue, practice using your sleeve (elbow or shoulder), it is not advisableto use your hands.
• Avoid touching your eyes, nose or mouth
  Germs are often spread when a person touches something that is contaminated with germs and then touches their eyes, nose or mouth.
• Avoid close contact
  Avoid close contact with people who are sick or show signs of illness. When you are sick, keep your distance from others to protect them from getting sick.
• Vaccination
  Vaccination for the seasonal flu is recommended. H1N1 vaccination is also recommended, it is highly recommended for those individual at “high-risk” of medical complications and severe illness if they contract influenza.

Individuals considered to be at “high risk” of medical complications if they contract influenza include the following select populations:

• Pregnant women and household contacts
• Caregivers of infants younger that 6 months
• Healthcare and emergency services personnel
• Age 6 – 65 year olds who are at greater risk for influenza related complications secondary to medical conditions (Chronic pulmonary conditions, including asthma); cardiovascular conditions except hypertension; renal disease; hepatic disease; cognitive and neurologic/neuromuscular diseases; hematologic or metabolic disorders, including diabetes mellitus; immunosuppression caused by medications or by human immunodeficiency virus

The University intends to make both the seasonal influenza and H1N1 vaccines available to all students.

Influenza Prevention for Student Athletes

The Athletics Director has requested the administrative staff to observe the level of missed practices or student-athlete(s) displaying flu-like symptoms in the coming weeks.

If a student-athlete or staff member experiences influenza-like symptoms, he or she should notify the Athletics’ Department Director and contact the Student Health Center immediately. The Student Health Center will evaluate and assess the student athlete’s condition, provide testing and treatment options as needed. If he or she has become exposed to influenza, or exhibits flu-like symptoms, he or she shall take preventive steps as to minimize contact with others. If possible the person should return home, apartment or residence hall for 24-48 hour isolation until they have fully recovered.

The student-athlete should not attend class, work or any athletic practice or competition. All student-athletes are required to notify their instructors via phone or email to make arrangements for any missed classes or assignments.

If a number of student athletes associated with the Athletics Department in a specific team sport, or several individuals across several team sports, are infected with influenza which requires cancellation of game day events or closure of the department, the appropriate University personnel, opposing team’s head coach or athletics director and conference office will be notified of schedule change and procedures will be followed.

Once the influenza outbreak has been identified, monitored for impact and brought under control, the department will begin its recovery process of continuing the years’ game schedule.

The Athletics Director will be designated as the emergency point person for communication of critical information from the department.

Game Day Change(s)

The following steps/process must be adhered to for conference schedule change(s):

The two (2) head coaches involved must agree among themselves on the proposed schedule within forty-eight (48) hours.

• If an agreement cannot be reached by the two (2) head coaches
  • The two (2) athletic directors must resolve the matter within twenty-four (24) hours.
  • If the two (2) athletic directors cannot resolve the matter. The Commissioner will review the situation and information, and render a decision. The Commissioner’s decision is final.
• If agreed upon, the host institution Athletics Director is responsible for submitting “the standard conference schedule change form” with the necessary signatures (host athletics director, visiting athletics director, host head coach and the visiting head coach) to the Commissioner.
• The Commissioner will respond to the host institution’s athletics director of his/her decision on the requested change with copies forwarded to the visiting athletics director, visiting head coach, the host head coach, MEAC Director of Championships, MEAC Media Relations Director and both institutions SIDs.
• If a schedule request change is granted, the conference office will make the necessary revisions on the present.

These administrative procedures for schedule changes will be followed as close as possible for non conference games in conjunction with any contractual agreements.

Recovery

Department wide announcements regarding operational procedures and timetable will be communicated via email, web, and media from the desk of the Athletics Director.

Information regarding Howard University’s Influenza Response Plan can be found on the University’s homepage.

Influenza Precautions - Recommendations for Faculty -Academic Affairs

The Office of the Provost and Chief Academic Officer will monitor all cases of student influenza that occur on campus throughout the academic year through the Student Health Center. The Provost will work in conjunction with the academic Deans and the other respective Cabinet members to monitor any outbreaks of influenza which disproportionately affects faculty and/or staff to the extent that it hampers critical University operations.

In the event that additional action needs to be taken to safeguard the campus community, all decisions relative to the academic operation of the University will be done in consultation with the President. Only the President of the University is authorized to cancel or suspend classes or close the University.

• We encourage all faculty members to take precautions to stay well, but also expect them to have back-up plans for covering their classes/essential job duties should they become ill.
• Faculty members should consider how they can adapt their courses if they have students who are sick. Faculty members are asked to consider how class attendance policies might be adjusted. Also, we are asking faculty members to consider how students can make up missed classes, assignments, and exams due to confirmed student illness. We ask faculty members to be specific about these matters relative to how they are articulated in their course syllabi.
• It is recommended that faculty members establish class e-mail listserves so they can communicate consistent messages. BISON web allows for broad communication with enrolled students via their University e-mail accounts. Online teaching platforms, alternate forms of instruction and contact (e.g., Blackboard, BANNER, blogs, podcasts, conference calls, etc.) should be pursued where feasible. Special workshops will be offered to faculty about the use of this technology.
• Be prepared to implement a "social distancing" protocol that allows only classes and essential group gatherings. The OPCAO will determine what activities are deemed essential.
• Deans and department chairpersons will work collaboratively with the Office of the Provost to assist units with their operations in the unlikely event that large numbers of faculty and/or staff persons are affected by influenza in order to maintain essential University services and academic operations.
• In the unlikely event of a widespread influenza outbreak on campus, involving large numbers of students, faculty and/or staff, additional consideration will be given to overall University operations and possible cessation of select activities or services in conjunction with procedures as outlined in the Influenzas Response Plan

Contingency Planning for Seasonal and H1N1 Influenza
Guidelines for Instructors

Flu season is well underway and because of the very real threat of seasonal influenza as well as the H1N1 influenza virus, for the remainder of the academic year, we must be prepared for possible disruptions in our courses due to illness among students and instructors. Our overall goal is to implement strategies that limit the number of people who become seriously ill from influenza, while also minimizing disruptions to the educational process and social aspects of the University.

The preparations involve considerations at the Decanal, department level and at the class level. Departments should prepare contingency plans that identify potential ways to assist or replace instructors who contract the virus and may be absent from classes for an extended period of time.

Contingency planning involves listing those who could substitute for other faculty members in the case of a health emergency, or developing online facilities for the class to operate using a distance model for a period of time. Instructors who develop flu-like symptoms are advised to stay home, seek medical intervention and contact their department to report their illness.

At the class level, each instructor should think creatively of ways to complete the semester in the face of potentially adverse circumstances. This would involve the preparation of course materials online, if possible. In addition to facilitating the distribution of course materials and developing teaching contingency plans, each instructor is encouraged to assist the University in our efforts to minimize the spread of influenza. The following guidelines are intended to help mitigate the negative impact of the virus on the academic mission of the University.

Guidelines for Instructors

Take time early in the semester to remind students about good hygiene practices and what to do if they contract flu-like symptoms. Most prominent issues to cover include: frequent hand washing, respiratory etiquette, and self-isolation.

It is recommended that ill students call the Student Health Center at (202) 806-7540 to report their illness and to receive medical advice. Ill students should contact their instructors directly, their academic advisors or the Office of the Dean of their school or college for class concerns or school-related issues. Ill students with disabilities who might require additional assistance should contact the Office of the Dean for Special Student Services.

Faculty members are asked to consider altering policies on class attendance, missed classes, examinations and the submission of late assignments so that students’ academic concerns do not prevent them from staying home when ill or prompt them to return to class or take examinations while still symptomatic and potentially infectious.

Faculty should consider suspending course policies that require a doctor’s note to validate a student’s illness. The Office of the Vice Provost for Student Affairs will maintain a list of students who have reported contracting influenza. The Dean’s office of each school or college will receive updates from the Office of the Vice Provost for Student Affairs with the list of students in their school or college who have flu-like symptoms. Instructors will then receive official notice of students’ absence through the Dean’s office in their respective schools and colleges.

Instructors should consider using distance learning or web-based technologies to facilitate student learning in order to allow ill students to maintain self-isolation.

You should consider making the following announcement in your classes:

In the event of disruption of normal classroom activities due to an incidence of influenza, the format for this course may be modified to enable completion of the course. In that event, I will provide an addendum to the syllabus that will supersede the original syllabus.

The plan itself need not be communicated to the students unless its implementation is deemed necessary by the instructor or recommended by University action.

Howard University
Campus Police Department

The Howard University Police Department is proud to be a member of the Influenza Response Team and an active participant in the development of the Influenza Response Plan.

The following is a list of actions that the HU Police Department will engage in as a partner to help minimize the impact of a potential influenza outbreak on campus which might adversely impact our students, faculty, and staff:

1. HU Police Department officers shall act as “first responders” in responding to all “calls for service” involving a sick person at all locations within our jurisdiction. For example, in the event of a call for a sick person at a residence hall, the officer on the scene, after consultation with the Residence Life Community Director, or Resident Assistant/Graduate Assistant, will make a preliminary assessment and determination as to whether or not a patient is in need of urgent medical assistance and can be transported by the officer or should be transported by ambulance due to the seriousness of the illness. A Police Supervisor will be consulted and authorize any transports made by the officer(s). All medical transports will be documented in the Daily Police Blotter.
2. The HU Police Department will work with the Student Health Center and HUH officials to provide any security assistance that may be necessary in the event a university or hospital location is designated as a local point of distribution (POD) for anti-viral medications.
3. The HU Police Department will implement health education measures for its officers and staff based on guidance from medical University medical professionals. This initiative is meant to inform police department staff to take appropriate preventive measures to minimize their risk of exposure during an influenza outbreak as well as minimize the shortage of personnel available for duty due to influenza.
4. The HU Police Department will designate a Command Official to coordinate these measures, and work with other University officials to provide any other Police Department resources that may be required as a part of the University’s overall emergency response strategy as outlined in the IRP.
5. .In the event that a Level-4 response is initiated, the HU Police Department will work with the Influenza Response Team as well as the Emergency Response Team to implement any and all actions in support of campus closure, shelter-in-place, quarantined/limited public access and/or evacuation as deemed necessary.

Physical Facilities Management

Material Acquisition

• Hand sanitizers
• Disinfectant
• Antibacterial Wipes
• Gloves

Several hundred hand sanitizers have been ordered along with the associated refills and will be deployed as soon as they arrive throughout campus.

Additional consideration would be given to:

• the location, placement, and maintenance of hand sanitizers campus-wide, particularly in academic buildings, residence hall, and the Blackburn Center, cafeterias and public locations where food is vended or consumed on campus.
• the creation of a site plan, distribution and maintenance plan for public hand sanitizer placement and maintenance for the duration of the academic year
• special training of housekeeping staff in disinfection, sanitization techniques, barrier protection to prevention contamination, special cleaning considerations in the residence halls, high traffic public areas of the campus community.
• Efforts will be made to increase the frequency of cleaning and sanitization in high traffic areas and contact surfaces in academic buildings, residence halls and student service facilities. One of the key features of fighting a University-wide influenza outbreak is the cleaning, disinfectant protocol in place for all public, classroom and residential facilities campus-wide
• Identify trained decontamination teams for emergency response in the event of a widespread outbreak in the residence halls or on campus - (IRP Level - 4 response)

Evaluation of the Influenza Response Plan

An evaluation of this plan will be conducted utilizing student, faculty and staff surveys, as well as a comprehensive analysis of infection rates, complications and deaths from influenza. The evaluation would also include evaluation and assessment of services provided by the Student Health Center, management of sick students in the residence halls through self-isolation, treatment protocols, and those students requiring treatment at HUH. An assessment of the education campaign, influenzas response and prevention plan and overall impact of influenza on the delivery of the academic program. There will also be an attempt made to assess whether or not existing budgetary and fiscal considerations are appropriate to meet the needs of the faculty, staff and students relative to managing influenza outbreaks on campus.

The Plan will be revised and updated based upon this assessment and evaluation.

Concluding Remarks

Every year, there is a new challenge of some kind impacting colleges and universities across the country. This year, the higher education community will be forced to contend with the realities, dangers, and risks of influenza A (H1N1) – “Human Swine Flu” and seasonal influenza. Howard University is confident that we will be able to rise to the challenge in our own way to ensure the continued health and safety of the entire University community. This document is by no means a “rule book” or meant to be exhaustive, but it does provide a thoughtful comprehensive emergency response and contingency strategy for prudent action. It represents prevailing proactive measures that should be taken in an effort to be diligent and vigilant in matters of health and safety in combating an urgent public health concern. The Influenza Response Team is to be commended for its efforts.

APPENDIX A  
Dear Students, Faculty and Staff of Howard University:

We are taking steps to prevent the spread of seasonal or H1N1 flu here at Howard University. We need your help to accomplish this. To date, the overwhelming majority of cases of new Influenza A (H1N1) viral infection occurring in the U.S. have been uncomplicated illnesses of limited duration.

The CDC (Centers for Disease Control) recommends the following ways you can keep from getting sick with either strain of flu:

1. Practice good hand hygiene by washing your hands often with soap and water, especially after coughing or sneezing. Alcohol based hand cleaners are also very effective.
2. Cover your mouth and nose with a tissue when you cough or sneeze. If you don’t have a tissue, cough or sneeze into your elbow or shoulder, not into your hands.
3. If you think you have the flu, stay at home or in your residence hall. Drink plenty of clear fluids such as water, broth, sports drinks, and electrolyte beverages to keep from becoming dehydrated.
4. Stay at home or at your place of residence if you are sick, for at least 24 hours after resolution of your fever, or signs of a fever (chills, feeling very warm, sweating, or being flushed). This must be determined without the use of fever reducing medications (ibuprofen containing medications or acetaminophen, or naproxen containing medications). Staying away from others while sick can prevent others from getting sick, too. Symptoms of flu can include fever, chills, cough or sore throat. In addition, symptoms of flu can include runny nose, body aches, tiredness, diarrhea, or vomiting.
5. **If you develop symptoms of shortness of breath, confusion, pain or pressure in the chest or abdomen, severe or persistent vomiting, sudden dizziness, or fever that is not relieved by fever reducing medications, seek immediate medical attention.
6. Talk to your healthcare provider to find out whether you should be vaccinated for seasonal flu and/or the 2009 H1N1 flu.
   1. Information regarding 2009 H1N1 flu vaccination may be found at: www.cdc.gov/h1n1flu/vaccination
   2. Information about seasonal flu vaccine may be found at www.cdc.gov/flu/protect/keyfacts.htm
7. Avoid touching your eyes, nose and mouth
8. The Student Health Center will have seasonal flu vaccine available in mid to late September for students. You will need one injection to get protection from seasonal flu. The H1N1 flu vaccine is expected to be available in late October/early November. The Student Health Center is attempting to get the vaccine and will notify you if/when it comes in.
9. Persons who should get the vaccine:
   1. Pregnant women and household contacts
   2. Caregivers of infants younger that 6 months
   3. Healthcare and emergency services personnel
   4. Age 6 – 65 year olds who are at greater risk for influenza related complicationssecondary to medical conditions (Chronic pulmonary conditions, including asthma); cardiovascular conditions except hypertension; renaldisease; hepatic disease; cognitive and neurologic/neuromuscular diseases; hematologic or metabolic disorders, including diabetes mellitus; immunosuppression caused by medications or by human immunodeficiency virus
   5. Persons over 65 years old

We are working closely with the Department of Health to monitor flu conditions and make decisions on the best steps to take concerning our institution. We will keep you updated with new information as it becomes available.

Students who are rotating through patient care areas should not report to their clinical rotations for at least seven (7) days or until all symptoms have completely resolved, whichever is longer.

APPENDIX - B
General Student Recommendations

• If you become ill with flu-like symptoms contact the Student Health Center at 202-806-7540, call the Student Health Center before you attempt to go there to be seen. They will provide you with important information. You may also contact your personal physician or an appropriate medical facility in your community. Follow your doctor’s or nurse’s instructions.
• After you are seen or have spoken to a medical professional, stay in your room or apartment. Leave home only if you need to seek additional medical attention. Follow the treatment and hygiene instruction of the Student Health Center. Do not go to class or to work, especially if you have a fever. Do not go to the lab, library or other public places where you might expose others. Contact your RA/GA or Community Director if you require assistance receiving meals during your illness.
• If you are ill, immediately contact your professors by phone or e-mail and make arrangements with them to make up missed work. Faculty members are very willing to work with you once they know you are ill.
• Do not resume your normal activities until you have been symptom-free, without benefit of medication, for at least 24 hours.

Remember to reduce your risk of contracting the flu:

• Always cover your mouth and nose with a tissue when you sneeze or cough, and dispose of the tissue in the trash immediately. If you have no tissue, cover your cough or sneeze with your arm rather than your hand.
• Wash your hands, thoroughly and often, with soap and water, especially after you cough or sneeze. Alcohol-based hand cleaners are also effective and can be carried with you for use when soap and water are not available.
• To help prevent spreading germs, avoid touching your eyes, nose or mouth.

APPENDIX - C
Influenza Prevention
Recommendations for Students

• If you exhibit any flu like symptoms, contact the Student Health Center as soon as possible, call the facility before you go. If you are not eligible to be seen at a Student Health Center, or if you prefer, go to your physician or an appropriate medical facility in your community. Follow your doctor’s or nurse’s instructions.
• Follow all of the treatment and hygiene instructions of the Student Health Center personnel. After you are seen, stay in your room or apartment. Leave home only if you need to seek additional medical attention. Do not go to class or to work, especially if you have a fever. Do not go to the lab, library or other public places where you might expose others. Ask friends to bring you your meals.
• If you are ill, immediately contact your professors by phone or e-mail and make arrangements with them to make up missed work. Faculty members are very willing to work with you once they know you are ill.
• Do not resume your normal activities until you have been symptom-free, without benefit of medication, for at least 24 hours.

There is, of course, at least a small possibility that the influenza virus could mutate this fall and become more dangerous and even more lethal. Or that there could be a widespread outbreak of influenza on campus or within the metropolitan Washington area. If that happens, we may need to act more aggressively to prevent infection of students by suspending classes and closing residence and dining halls.

In that eventuality, students will be asked to return home. If they cannot, we will ask that they go to the homes of relatives, friends or classmates for the duration of the emergency. A widespread outbreak of influenza may severely restrict individual’s ability to travel, especially via trains, planes, and busses, so plan accordingly. It is important -- if you have not done so already -- that you make a plan now for leaving campus in the unlikely event that classes are suspended for an extended period of time; take whatever steps are necessary to make that plan ready to be executed on short notice.

Where do you go to get help if you are sick with the flu on campus?

You may not need to see a physician if your symptoms are mild. When in doubt, contact the Student Health Center. The majority of people who become ill are getting mild to moderate cases of influenza and are recovering fully in a week or less, without any or minimal medical intervention.

For ill students staying in their residence hall rooms, the University will make arrangements to provide food to them in their rooms. Residence hall staff will be checking on students regularly and will asset with transportation via HU CPD to the Student Health Center for those who need to be seen by a physician.

What else do you need to know?

• The best way to stay healthy is to wash you hands regularly for 20 seconds with soap and water, cough or sneeze into your elbow, and to keep your hands away from your face.
• Students who are pregnant or who are at “high risk” for medical complications if they contract the flu will be among the first to be vaccinated with the H1N1 vaccine-when it becomes available later this fall.
• Following CDC guidelines Student Health Center clinicians will not be prescribing the antiviral medication Tamiflu unless there is an underlying health condition (severe asthma, diabetes, HIV disease, immune deficiency) or the individual is considered high risk (pregnant or otherwise considered to be at “high-risk”)
• Hand sanitizer will be made available in the common areas of campus buildings and facilities this year.

APPENDIX - D
Recommendations for Staff

Dear Staff Members:

We write to inform you of University preparations for the expected increase in cases of influenza this fall on campus.

We continue to see a low, but steady level of flu-like illness, and public health officials expect this to increase in the fall as students return to classrooms here and across the country. Members of the University administration and individual schools and colleges have been working diligently to prepare for a response to any possible contingency regarding an outbreak of influenza on our campus.

Students have been asked to stay in their rooms and away from class if they are ill. Faculty members have been encouraged to consider alternative teaching methods if they or a large number of their students are absent with the flu.

Because we expect the severity of the H1N1 strain of influenza to be similar to that of seasonal flu, we also expect the University will continue with all regularly scheduled classes and other activities. However, if staff members become ill with the flu, we ask them to immediately contact their supervisor, department administrator. We urge them not to come in to work to risk the possible infection of students or their co-workers.

We expect it will be “business as usual” on campus this fall and all current human capital management policies regarding sick time or paid time off remain in effect. If you or any of your co-workers become sick with a flu-like illness, the best thing to do is to call in sick as you normally would and use sick time or paid time off to stay home until you get better.

The U.S. Centers for Disease Control and Prevention defines flu-like illness this way: A fever of 100.4 F (38.0 C) or greater, plus a cough or sore throat and possibly other symptoms like runny nose, body aches, headaches, chills, fatigue, vomiting or diarrhea. It is important to note that most of those who become ill are getting mild to moderate cases of the flu and they are recovering fully in about a week, without any medical intervention.

Those of us working on influenza preparedness and response pledge to do our best to keep the University community healthy and safe and to keep you informed.

As developments warrant, you can expect additional e-mail messages. We also have developed a university web page where you can find links to the latest advice from medical experts at the Howard University Influenza website and from agencies like the CDC and the World Health Organization on topics such as vaccines, underlying conditions and restrictions of treatment with Tamiflu.

University messages and guidelines will be housed on the Web site (http://www.howard.edu/Influenza) for easy reference.

Information on Howard University’s response to the flu:
http://www.howard.edu

Information on the flu from U.S. health officials:
http://www.cdc.gov/h1n1flu/

Recommendations for colleges and universities:
http://www.cdc.gov/h1n1flu/guidance/guidelines_colleges.htm

Answers to frequently asked questions:
http://www.howard.edu

The message sent to students:
http://www.howard.edu

The message sent to Howard University faculty:
http://www.howard.edu

Flu-related questions are welcome at this e-mail address:
http://www.howard.edu

APPENDIX - E
University Communications

The Office of University Communications will play a pivotal role in informing the campus community regarding the dissemination of information relative to the Influenza Response Plan. The following are general information pieces which University Communications can prepare for mass distribution to the campus community through print, electronic media and our website.

The influenza education campaign will include:

• Flyers and posters
• General information pieces targeting students, faculty and staff
• Influenza website
• Activation of the Campus Alert system
• Crisis and Emergency Risk Communication: Pandemic Flu
• Use of WHBC-AM (student radio station)
• Use of RESNET (campus network)

General themes would include

• Facts About Seasonal Influenza and H1N1 Influenza
• How to Prevent Flu
• Treating the Flu
• Influenza – What You Can Do to Protect Yourself
• Clean Hands Campaign
• Workplace Safety
• Pandemic Influenza:

APPENDIX – F
Campus Education Program

University Communications will play a key role in assisting the Office of the Vice Provost for Student Affairs in disseminating vital influenza information throughout the campus community.

• Send an e-mail message to all faculty, staff and students encouraging them to, practice good hygiene and be more aware of influenza
• Provide educational posters relating to hygiene (e.g., hand washing, cough etiquette) for public spaces frequented by large numbers of faculty, staff and students. Have Student Health Center peer educators provide group educational sessions, e.g., G.A./RA training programs, Freshman Seminar/Orientation courses, student organizations, and residence hall floor meetings. Also, the Student Health Center will provide PowerPoint and/or video information on Influenza for use with various campus constituencies.
• Have peer educators at display tables in the Dining Halls, Blackburn Center, to distribute hygiene information and answer questions bi-weekly during the fall semester.
• Inform the University community regarding availability of vaccination opportunities for seasonal and H1N1 influenza

APPENDIX – G
FREQUENTLY ASKED QUESTIONS – What Students Need to Know

How can I tell if I have the flu?

The U.S. Centers for Disease Control and Prevention defines flu-like illness this way:

• A fever of 100.4 F or greater, plus a cough or sore throat.
• Possibly other symptoms, including a runny nose, body aches, headaches, chills, fatigue, vomiting or diarrhea.

How will I know if I have H1N1 flu?

You may not know, for sure, but if you have the symptoms listed above, you can be fairly confident you have influenza. State health officials have determined that it’s no longer necessary to test specifically for this novel strain of Influenza A in otherwise healthy individuals. Only those who are at high risk for complications will be tested for H1N1.

What are some things I can do to keep from getting the flu?

• Wash your hands regularly and thoroughly for at least 20 seconds (about the time it takes to sing, "The Victors") using soap and water or hand sanitizer.
• Avoid touching your nose and eyes directly.
• Cover your mouth and nose when you cough or sneeze with a tissue or your sleeve - not your hand.
• Use tissues and dispose of them properly.

Will Howard University offer H1N1 vaccinations to students?

At this time, we are unsure whether or not the vaccine will be made available to us. The earliest date of delivery of the vaccine is expected to be late October. The Student Health Center has ordered the vaccine, but supplies will be limited initially. If we do get the vaccine, we plan to offer it initially to all students that are at “high-risk” for complications from influenza. Therefore, it is important that you know if you are in this high risk category which includes: pregnant women and household contacts; caregivers of infants younger that 6 months ; healthcare and emergency services personnel; individuals age 6 – 65 year olds who are at greater risk for influenza related complications secondary to medical conditions (Chronic pulmonary conditions, including asthma); cardiovascular conditions except hypertension; renal disease; hepatic disease; cognitive and neurologic/neuromuscular diseases; hematologic or metabolic disorders, including diabetes mellitus; immunosuppression caused by medications or by human immunodeficiency virus; and individuals over 65 years old.

What about faculty and staff?

Plans announced by the CDC call for making the H1N1 vaccine free to everyone through the network of state and county health departments. What role Howard University might play in helping to distribute the vaccine to faculty and staff or the general public is still to be determined. The University encourages every faculty and staff member to obtain a seasonal influenza vaccination. We will make information available regarding the availability of vaccines on campus for faculty and staff via a “Flu Shot Clinic” if we are able to secure a nominal amount of vaccine and can make them available at cost.

Should students also get a seasonal flu vaccination?

Yes. While college students are not among those at high risk for the seasonal flu, the university always encourages students to get this vaccine. It will be offered on campus this fall and will entail a customary fee ($10). Details will be announced soon by the Student Health Center.

What about faculty and staff?

In the past, some units on campus have set up times when employees have the opportunity to get a seasonal flu vaccine if they choose. It’s too soon to say exactly what those plans are for this year. Check with your supervisor or Employee Health for information specific to your unit. It is anticipated that there will be an ample supply of the seasonal flu vaccine and will be offered in many places this year. You may want to check with your primary care physician about getting a flu shot.

What will happen if a student on campus gets sick with the flu?

At Howard University, we will be following the recommendations of the CDC for college students:

• Isolation until 24 hours after the ill student is free of fever (100 degrees F) without the use of fever-lowering medications. In most cases this will mean three-five days.
• This new recommendation is a reduction from the previous seven-day isolation period. Isolation helps to prevent the spread of the flu and rest may help students recover more easily.
• Students who are able, may wish to go home or to the home of a friend in the area for the isolation period. For those who are not, we will ask students to self-isolate themselves in their residence hall rooms or apartments until they are free of fever. It’s important to note that Howard University will have very limited housing spaces that might be used to separate well students from ill students.
• Treatment of ill individuals with the prescription drug Tamiflu is recommended by the CDC only if there is an underlying health condition (severe asthma, diabetes, HIV disease, immune deficiency) or the individual is considered high risk (pregnant, over age 65). The Student Health Center physicians will not prescribe Tamiflu for students who do not meet CDC guidelines.

If a student is isolated in a residence hall room, how will the student be able to eat?

The university will make arrangements to deliver food to their rooms. Residence hall staff will be checking on students regularly and transportation via HU Campus Police Department will be arranged to transfer the ill student to the Student Health Center or to HUH if they need to see a physician. Students who live in off campus residence halls will be supported by the staff at Student Health Center, but will need to make their own arrangements for food. If they are unable to do so, they should contact the Office of the Dean for Residence Life for assistance.

What should students do if they get sick with the flu and have to miss classes?

Should students become ill during the academic year and need to miss classes for several days, we ask that the students contact their instructors directly to seek possible accommodations for missed coursework and notify their academic advisers. If this is not possible, they may contact the Office of the Dean for Special Student Services.

Will classes or other activities be canceled if enough students get sick?

Because we expect the severity of the H1N1 strain of influenza to be similar to that of seasonal influenza, we also expect the University will continue with classes and other scheduled activities. The SVP for Health Sciences in conjunction with the Student Health Center and HUH will continue to collaborate with local, state and federal health officials and be prepared to follow any new recommendations.

Will the Student Health Service provide students with a medical excuse from classes for those who are sick with the flu?

No. Most individuals who get sick will not need to see a physician. Instead, we’ve asked faculty members to be understanding of students who are sick with the flu and may miss class. Many instructors also are making more of their class materials available online through the use of Blackboard so students who have to miss a class can keep up with assignments.

Should I be concerned about using keyboards in common computing areas?

Keyboards certainly are one way the flu can be transmitted from one person to another. Use a hand sanitizer before and after using a share keyboard and keep your hands away from your nose and mouth. You may also carry disinfectant wipes with you to wipe off contact surfaces that you may use.

Should I be concerned about handling term papers from students who may have the flu?

No. There are two courses of action you could take. First is to wash your hands thoroughly before and after handling the papers or using plastic gloves while handling the papers. The second approach would be to let the papers sit for 24 hours before handling them. The good thing about the H1N1 virus is that it dies very quickly on surfaces like term papers, counters or door handles. Even if one of your students was ill with H1N1 influenza and sneezed on his term paper before it was submitted, that virus would not survive more than 24 hours. The seasonal flu virus has an even shorter lifespan.

What about masks?

Outside of health care settings, Howard University recommends the use of surgical masks only for those who are sick with the flu, if they must go out in the public (to see a physician). Masks help to stop the spread of the flu virus by containing any sneezes or droplets that might spread the virus. We are discouraging the widespread use of masks by healthy persons as a possible preventive measure while on campus.

Will hand sanitizer be more widely available on campus?

Yes. You can expect to see hand sanitizer dispensers in common areas of campus buildings and facilities this fall. It’s also not a bad idea for all students, faculty and staff members to carry and frequently use personal hand sanitizer as they move from class to class and around campus throughout the day.

APPENDIX - H
SWINE FLU PREVENTIVE TIPS

Avoid close contact
Avoid close contact with those who are sick. When you are sick, keep your distance from others to protect them from getting sick, too.

Stay home when ill
If possible, stay home from work, school or errands when you are sick. You will help others from catching your illness.

Cover your coughs
Cover your nose with a tissue when sneezing and dispose of the tissues properly. When coughing, cover your mouth with your arm, not your hand. It may prevent those around you from getting sick.

Wash your hands
Washing your hands with soap and water often will help protect you from germs.

Avoid touching your face
Germs are often spread when a person touches something that is contaminated with germs and then touches his or her eyes, nose or mouth.

Practice good health habits
Get plenty of sleep, be physically active, drink plenty of fluids, manage your stress and eat nutritious foods.

Source: Centers for Disease Control and Prevention

APPENDIX - I

Influenza Fast Facts – What You Can Do to Prevent the Spread of the Flu

• Flu is spread by droplets from coughing or sneezing.
• Sometimes people may become infected by touching something – such as a surface or object – with flu viruses on it and then touching their mouth or nose .
• Wash your hands often with soap and warm water.
• Use alcohol-based hand sanitizer if soap and water is not available.
• Cover your nose and mouth with a tissue when coughing or sneezing and discard the tissue right away. Encourage others around you to do the same.
• Avoid touching your eyes, nose and mouth. The virus can spread this way.
• Clean commonly touched surfaces frequently by wiping them with house-hold disinfectant according to the directions on the label.

APPENDIX - J

CDC Guidance for Responses to Influenza for Institutions of
Higher Education during the 2009-2010 Academic Year

August 26, 2009 10:00 AM ET

This document provides guidance to help decrease the spread of flu among students, faculty, and staff of institutions of higher education (IHE) and post-secondary educational institutions during the 2009-2010 academic year. The guidance expands upon earlier guidance for these settings by providing a menu of tools that IHE and health officials can choose from based on conditions in their area. It recommends actions to take now (during this academic year), suggests strategies to consider if the flu starts causing more severe disease than during the spring/summer 2009 H1N1 outbreak, and provides a checklist for making decisions. Based on the severity of 2009 H1N1 flu-related illness thus far, this guidance also recommends that students, faculty, and staff with flu-like illness remain home until 24 hours after resolution of fever without the use of fever-reducing medications. For the purpose of this guidance, IHE will refer to public and private, residential and nonresidential, degree-granting and non-degree-granting institutions providing post-secondary education in group settings regardless of the age of their students. Portions of this guidance pertaining to dormitories and residence halls may serve as a useful supplement to residential (boarding) schools providing primary and secondary education, with adaptations as needed for their younger population. This guidance represents the CDC’s current thinking on this topic. It does not create or confer any rights for or on any person or operate to bind the public.

IHEs should tailor the guidance to account for the size, diversity, and mobility of their students, faculty, and staff; their location and physical facilities; programs; and student and employee health services. Decisions about strategies should balance the goal of reducing the number of people who become seriously ill or die from flu with the goal of minimizing educational and social disruption.

Although the severity of flu outbreaks during the fall and winter of 2009-10 is unpredictable, more communities may be affected than were affected in spring/summer 2009, reflecting wider transmission and possibly greater impact. CDC is working with state and local health departments to continually monitor the spread of flu, the severity of the illness it is causing, and changes to the virus.

If this information indicates that flu is causing more severe disease than during the spring/summer 2009 H1N1 outbreak, or if other developments require more aggressive mitigation measures, CDC may recommend additional strategies. Since severity may vary from community to community, IHEs should also look to their state and local health officials for information and guidance specific to their location.

The recommendations below are divided into two groups: 1) recommendations to use now, during this academic year, assuming a similar severity to the spring/summer H1N1 flu outbreak, and 2) recommendations to consider adding if the flu begins to cause more severe disease. 

Recommended responses to influenza for the 2009 – 2010 academic year

Recommended strategies under current flu conditions
(similar severity as in Spring/Summer 2009)

Facilitate self-isolation of residential students with flu-like illness

• Those with flu-like illness should stay away from classes and limit interactions with other people (called “self-isolation”), except to seek medical care, for at least 24 hours after they no longer have a fever, or signs of a fever, without the use of fever-reducing medicines. They should stay away from others during this time period even if they are taking antiviral drugs for treatment of the flu. (For more information, visit http://www.cdc.gov/h1n1flu/guidance/exclusion.htm.)
• Review and revise, as needed, policies, such as student absenteeism policies and sick leave policies for faculty and staff, that make it difficult for students, faculty, and staff to stay home when they are ill or to care for an ill family member,. Do not require a doctor’s note to confirm illness or recovery. Doctor’s offices may be very busy and may not be able to provide such documentation in a timely way.
• If possible, residential students with flu-like illness who live relatively close to the campus should return to their home to keep from making others sick. These students should be instructed to do so in a way that limits contact with others as much as possible. For example, travel by private car or taxi would be preferable over use of public transportation.
• Students with a private room should remain in their room and receive care and meals from a single person. Students can establish a “flu buddy scheme” in which students pair up to care for each other if one or the other becomes ill. Additionally, staff can make daily contact by e-mail, text messaging, phone calls, or other methods with each student who is in self-isolation.
• If close contact with others cannot be avoided, the ill student should be asked to wear a surgical mask during the period of contact. Close contact includes things like caring for or living with the ill person.
• For those who cannot leave campus, and who do not have a private room, IHEs may consider providing temporary, alternate housing for ill students until 24 hours after they are free of fever.
• Instruct students with flu-like illness to promptly seek medical attention if they have a medical condition that puts them at increased risk of severe illness from flu, are concerned about their illness, or develop severe symptoms such as increased fever, shortness of breath, chest pain or pressure, or rapid breathing.

Promote self-isolation at home by non-resident students, faculty, and staff

• Non-residential students, faculty, and staff with flu-like illness should be asked to self-isolate at home or at a friend’s or family member’s home until at least 24 hours after they are free of fever, or signs of a fever, without the use of fever-reducing medicines.
• Review, and revise if needed, sick leave policies to remove barriers to faculty and staff staying home when they are ill or caring for an ill family member. For students, consider altering policies on missed classes and examinations and late assignments so that students’ academic concerns do not prevent them from staying home when ill or prompt them to return to class or take examinations while still symptomatic and potentially infectious.
• Do not require a doctor’s note for students, faculty, or staff to validate their illness or to return to work, as doctor’s offices and medical facilities may be extremely busy and may not be able to provide such documentation in a timely way.  
• Distance learning or web-based learning may help students maintain self-isolation.  
• Visit http://www.cdc.gov/h1n1flu/guidance/exclusion.htm for more information on staying home while sick.

Considerations for high-risk students and staff

• People at high risk for flu complications who become ill with flu-like illness should speak with their health care provider as soon as possible. Early treatment with antiviral medications often can prevent hospitalizations and deaths. Groups that are at higher risk of complications from flu if they get sick include: children younger than age 5; people age 65 or older; children and adolescents (younger than age 18) who are receiving long-term aspirin therapy and who might be at risk for experiencing Reye’s syndrome after flu virus infection; pregnant women; adults and children who have asthma, other chronic pulmonary, cardiovascular, hepatic, hematological, neurologic, neuromuscular, or metabolic disorders such as diabetes; and adults and children with immunosuppression (including immunosuppression caused by medications or by HIV). People age 65 and older, however, appear to be at lower risk of 2009 H1N1 infection compared to younger people. But, if older adults do get sick from flu, they are at increased risk of having a severe illness.
• One of the best ways to protect against the flu is to get vaccinated against the flu. People under age 25 are one of the key groups recommended by CDC’s Advisory Committee on Immunization Practices (ACIP) to be among the first to receive the 2009 H1N1 flu vaccine. For more information, visit http://www.cdc.gov/h1n1flu/vaccination .
• Communicate with local health officials to determine where vaccine will be administered and to discuss the possibility of a vaccination clinic at the IHE.

Discourage attendance at campus events by ill persons: Events such as football games or concerts that bring large groups together may pose a high risk of exposure and transmission of flu. Use a variety of communication methods such as e-mail, posters, flyers, and media coverage to discourage people with flu-like illness from attending these events until they have been free of fever for at least 24 hours and to encourage hand hygiene and respiratory etiquette. Explore ways to modify events to reduce close contact and increase distances between participants. IHEs may need to consider cancelling some events if modification is not possible and there is a high level of influenza activity in the community.

Encourage hand hygiene and respiratory etiquette of both people who are well and those that have any symptoms of flu: Emphasize the importance of the basic foundations of flu prevention: stay home when sick, wash hands frequently with soap and water when possible, and cover noses and mouths with a tissue when coughing or sneezing (or a shirt sleeve or elbow if no tissue is available).

Routine cleaning

• Establish regular schedules for frequent cleaning of high-touch surfaces (for example, bathrooms, doorknobs, elevator buttons, and tables).
• Provide disposable wipes so that commonly used surfaces (for example, doorknobs, keyboards, remote controls, desks) can be wiped down by students before each use.
• Encourage students to frequently clean their living quarters, including high-touch surfaces.

Considerations for specific student populations

• Review policies for study abroad programs, including accessing health services abroad and reporting illness to the IHE.
• Communicate plans, policies, and strategies to partner K-12 schools regarding “early/middle college” students, prospective student tours, and other K-12 students regularly on campus.
• Determine if special communication strategies are needed to meet the needs of students with disabilities.
• Review policies for sports teams, bands, and other large groups of students who spend a lot of time together in close quarters. IHE may need to consider cancelling travel to off-campus activities.
• Remind health-care profession students to follow infection control guidance for health-care workers. Visit http://www.cdc.gov/h1n1flu/clinicians for guidance for health care settings.

Under conditions with increased severity compared to spring/summer 2009

CDC may recommend additional strategies to help protect IHE students, faculty, and staff if global, national, or regional assessments indicate that flu is causing more severe disease. In addition, local health or IHE officials may choose to use additional strategies. Although the following strategies have not been scientifically tested in the IHE setting, they are grounded on basic principles of infection control. Implementing these strategies is likely to be more difficult and to have more disruptive effects than the previously described strategies. These strategies should be considered if influenza severity increases and are meant for use in addition to the strategies outlined above.

Permit high-risk students, faculty, and staff to stay home when flu is spreading in the community

• If flu severity increases, people at high risk of flu complications may consider staying home while a lot of flu is circulating in their community. Such people should make this decision after consulting with their doctor. 
• IHEs should plan now for ways to continue educating students who stay home through distance learning methods. IHEs should also examine policy accommodations that might be necessary such as allowing high-risk students to withdraw for the semester, tailoring sick leave policies to address the needs of faculty and staff, or modifying work responsibilities and locations.

Increase social distances: Explore innovative ways to increase the distances between students (for example, moving desks apart or using distance learning methods). Ideally, there should be at least 6 feet between people at most times.

Campus events: Consider whether to suspend or modify public events such as films, sporting events, or commencement ceremonies.

Extend the self-isolation period: If flu severity increases, people with flu-like illness should stay home for at least 7 days after the onset of their symptoms, even if they have no more symptoms. If people are still sick after 7 days, they should stay home until 24 hours after they have no symptoms. See information above for self-isolation in different types of housing.

Consider suspending classes

• IHE and health officials should work closely to balance the risks of flu in their community with the disruption that suspending classes will cause in both education and the wider community.
• Use multiple channels to communicate a clear message about the reasons for suspending classes and the implications for students, faculty, staff, and the community.
• Reactive class suspension might be needed when IHEs cannot maintain normal functioning.
• To decrease the spread of flu, CDC may recommend preemptive class suspension if the flu starts to cause severe disease in a significantly larger proportion of those affected than occurred during the spring/summer 2009 outbreak.
• If classes are suspended preemptively, large gatherings (for example, sporting events, dances, commencement ceremonies) should be cancelled or postponed.
• IHEs with only nonresidential students should consider whether they can allow faculty and staff to continue use of their facilities while classes are not being held. This may allow faculty to develop lessons and materials and engage in other essential activities.
• IHEs with residential students should plan for ways to continue essential services such as meals, custodial services, security, and other basic operations for students who remain on campus. When possible, dismiss students who can get home – or to the home of a relative, friend of the family, or host family – by private car or taxi. International students and others without easy access to alternative housing should stay on campus, but increase the distance between people as much as possible.
• The length of time classes should be suspended will vary depending on the goal of class suspension as well as the severity and extent of illness. IHEs that suspend classes should do so for at least five to seven calendar days. Before the end of this period, the IHE, in collaboration with public health officials, should reassess the epidemiology of the disease and the benefits and consequences of continuing the suspension or resuming classes.  

Deciding on a course of action

CDC recommends a combination of strategies applied early and simultaneously. Strategies should be selected a) based on trends in the severity of disease, virus characteristics, feasibility, and acceptability and b) through collaborative decision-making with public health agencies, IHE faculty and staff, students, students’ families, and the wider community. CDC and its partners will continuously look for changes in the severity of flu-like illness and will share what is learned with state and local agencies. However, states and local communities can expect to see a lot of differences in disease patterns from community to community.

Every IHE has to balance a variety of objectives to determine the best course of action to help decrease the spread of flu. Decision-makers should identify and communicate their objectives, which might be one or more of the following: (a) protecting overall public health by reducing community transmission; (b) reducing transmission in students, faculty, and staff; and (c) protecting people with high-risk conditions. Some strategies can have negative consequences in addition to their potential benefits. The following questions can help begin discussions and lead to decisions.

Decision-Makers and Stakeholders

Are all of the right decision-makers and stakeholders involved?

• Local and state health, education, and homeland security agencies
• Campus health services and mental health services
• Campus emergency managers and security staff
• Student affairs and residential life staff
• Communications staff
• Physical plant staff
• Food services staff
• Students
• Faculty
• Students’ families

Information Collection and Sharing

Can local or state health officials determine and share information about the following?

• Numbers of and trends in outpatient visits, hospitalizations, and deaths for flu-like illness
• Percent of hospitalized patients requiring admission to intensive care units (ICUs)
• Groups being disproportionately affected
• Ability of local health care providers and emergency departments to meet increased demand
• Availability of antiviral drugs, hospital beds, staff, ICU space, and ventilators for flu patients

What does the IHE know about the following?

• Student, faculty, and staff absenteeism rates
• Number of visits to the campus health service
• Bed availability for student self-isolation
• Severity of illness among affected staff and/or students

Feasibility

Do you have the resources to implement the strategies being considered?

• Funds
• Personnel
• Equipment
• Space
• Legal authority or policy requirements
• Communication channels