Big 10+2 Universities
H1N1 Lessons Learned Online Sharing Conference
Edward P. Ehlinger, MD, MSPH
Director and Chief Health Officer
Boynton Health Service, University of Minnesota
 University of Illinois
 Northwestern University
 Indiana University
 The Ohio State University
 University of Iowa
 Pennsylvania State University
 University of Michigan
 Purdue University
 Michigan State University
 University of Wisconsin
 University of Minnesota
 University of Chicago
University of Minnesota Project Team
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 Dave Bender, CIDRAP
 Paul Bernhardt, School of Public Health
 Jill DeBoer, CIDRAP and Academic Health Center
 Ed Ehlinger, Boynton Health Service
 Kathleen Kimball-Baker, CIDRAP
 Amy Becker LaFrance, CIDRAP
 Elizabeth McClure, Academic Health Center
 Joan Rambeck, Academic Health Center
 Technical and other staff, volunteers
Other Collaborators
Caroline Barnhill, MPH,
Director, Emerging Infections,
Association of State and Territorial Health Officials
Lisa C. Barrios, ScM, DrPH
Chief, Research Application Branch.
CDC Division of Adolescent and School Health,
Lead, 2009 H1N1 Flu Community Measures Guidance,
Technical Assistance and Communications Group
Marsha L. Vanderford, PhD
Chief, Risk Communication Branch, CDC DEO/OPHPR
Director, Emergency Communication System
Agenda for Online Sharing Conference
May 18, 2010
4
 Snapshots from interviews (all areas)
 Preview of practices available online
 Health services

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Reports from the field (U of Ill, PSU)
Vaccine distribution

Reports from the field (IU, OSU, PU)
 On-line polling
 Dialogue with CDC partners
 Federal guidance documents
 Outreach to higher education
 Challenges/issues needing further attention
Snapshots from Interviews
5
 Incident Management
 Residence Halls
 Health Services
 Communications
 Vaccine Distribution
 Teaching Policies
 Human Resources
 Collaboration with Local and State Public Health
 Issues Needing Further Attention
Incident Management
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 Importance of NIMS structure and training
 Planning and response group with broad
representation

A variety of successful approaches were used
 Importance of strong leadership and integration of
health/public health personnel

Planning and decision-making
 Various successful methods used to convene and
communicate among response team members

Extended response time
Incident Management: Sample Practices
7
 Successful experience with Virtual EOC
(University of Wisconsin)
 Successful experience with Health DOC
(University of Minnesota)
 External EOC operations
evaluation
(Indiana University)
Residence Halls
8
 Early concerns about summer camps
 Mismatch between plans and H1N1 reality
 Many institutions had limited to no options to
relocate students due to housing capacity
 Those who implemented isolation housing reported
mixed results
 Standard approach: “If you have symptoms, go
home. If you can’t leave, self-isolate.”

“We really dodged a bullet here.”
Residence Halls
9
 Important role for dining services partners
 Online meal ordering systems
 Meal delivery
 Important role for student leaders
 Resident Advisors
 Community Advisors
 Health Advocates
 Some reached out to fraternities and sororities
Residence Halls: Sample Practices
10
 Alternate housing plan for international students
(Michigan State University)
 Student involvement in development of H1N1
housing plan (University of Chicago)
 Online census and health survey
(University of Minnesota)
Health Services
11
 Modified health service
operations

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Building entrance changes
Trained greeters
Triage protocols
Some suspended standard
clinic operations for a time
 Importance of phone-based information and triage
(nurse lines)
 Most reported being “busy but not overwhelmed”
Health Services: Sample Practices
12
 Online screening system for those with symptoms
and those exposed (Northwestern University)
 Flu nurse protocol (Purdue University)
 Direct parent contact (University of Illinois)
 Direct patient follow-up (Pennsylvania State University)
 Infection control internship (Pennsylvania State University)
Communications: The Big Themes
13
 Coordinating messages was crucial

Unified approach to vetting communications, importance
of speaking “one message with one voice”
 Streamlining information also helped

Heavy reliance on email communications and
consolidated online information. Align all websites.
Update information daily.
 Finding multiple modes/media was beneficial

Approaches include signage, residence hall kiosks, tweet
chats/podcasts with health experts, and many more.
Communications: The Big Themes
14
 Great media interest in higher education experiences
and responses
 Concerns about message fatigue over time
 Overall, communication efforts were a success

“Our Housing Department had more complaints about
bedbugs than H1N1.”
www.tapirback.com
www.giantmicrobes.com
Communications: Sample Practices
15
 Student chapter of the American Red
Cross created brochures on H1N1 that
were distributed with hand sanitizer to
city bus riders. They reached 5,000
people in two days.
(Purdue University)
 Rapid ‘triage’ of non-clinical questions
From University of
Michigan’s campaign
http://www.vpcomm.umich.
edu/flu/pdf/cover_cough.pdf
e-mailed to a central “M-Hub.”
Messages were forwarded to the right
people for quick replies.
(University of Wisconsin-Madison)
Vaccine Distribution
16
 Vaccine access and quantities available were a
challenge
 Complications of nasal and injectable product
differences and availability
 Mixture of mass walk-in
clinics and scheduled
appointment systems
successfully used.
 Many successes and
lessons learned
Vaccine Distribution: Sample Practices
17
 Online appointment systems (Indiana University, Michigan
State University, University of Minnesota)
 Automated phone registration (Ohio State University)
 Mass clinic operations (Purdue University, University of
Minnesota)
 Effective student assistance models (Pennsylvania State
University, University 0f Iowa, University of Chicago)
 Use of Medical Reserve Corps (University of Minnesota)
 Effective FluMist protocol (University of Minnesota)
 Effective use of incentives (University of Illinois)
Teaching Policies
18
 Spring 2009: Concerns about travel abroad
programs in Mexico
 Fall goal: Effective self-isolation for students and
faculty with symptoms
 Nearly all of us have an existing absence note policy
which needed suspension


Formal suspension/informal suspension
Faculty concerns required follow-up
 Reviewed alternate methods for completing
courses should social distancing measures be
implemented
Teaching Policies: Sample Practices
19
 Faculty webinar (Michigan State University)
 Weekly classroom attendance monitoring through
use of a convenience sample of classes
(Pennsylvania State University)
Human Resources
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 Great deal of communication to employees
 Questions and concerns emerged about sick and
vacation leave policies
 Some enacted new HR policies
 Some developed guidance documents
 Business continuity plans revisited

Who are the essential employees during a pandemic?
Human Resources: Sample Practices
21
 Guidance documents
(University of Illinois, Ohio State University)
 Pandemic influenza policy (University of Minnesota)
 Essential function staff designations (Purdue University)
Collaboration with Health Departments
22
 Great collaborations reported across the board with
local health departments



Two-way partnerships
Good information sharing
Vaccine sharing
 Some variability on direct relationships with state
health departments
 Vaccine distribution was the biggest area of conflict
 Important partnerships with hospitals, medical
centers, local emergency managers, and CBOs.
Collaboration: Sample Practices
23
 Memorandum of understanding with local public
health (Purdue University)
 Open letter to Athletic Directors from State
Epidemiologist (University of Minnesota)
Challenges: Snapshots from Interviews
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 Vaccine access and distribution
 Residence halls
 Plan activation triggers
 Stockpiling supplies
 Providing education when social distancing is
recommended
 Universities as communities
 Need to establish an effective partnership with
local and state health department
Challenges: Snapshots from Interviews
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 Other

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
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Use of antivirals
Designation of essential personnel and operational
continuity plans
Compensation policies
Need for alternate methods to reach parents
Media coverage
Need for improvement redesign of plans based on this
experience
Response price tag
Key Themes from CDC IHE Needs Assessment, Spring 2010
Lisa C. Barrios, ScM, DrPH
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 2009 H1N1 was overblown; pandemic fatigue
 Need clarity on “increased severity”
 Need more information/special outreach for:
Rural and international students
 Non-faculty staff (e.g., cafeteria workers)
 Addressing parent concerns
 Concerned with “increase social distancing” and “stay home
when sick” recommendations
 No formal policy change: students encouraged to stay home
when sick; faculty encouraged to relax attendance
requirements

Your Turn: What Should CDC Know About Communications?
Marsha L. Vanderford, PhD,
27
 Do you agree or disagree with the themes from the needs assessment?
 What information was missing from the CDC guidance?
 Did you make any policy changes because of H1N1?
 What information/tools would you need to change policy or practice?
 Did your university make use of any social media channels to
communicate with students?

If so, what were they? Text messages? Tweets? Blogs? Facebook?
 What communications activities did you find most effective?
 What communications activities did you consider ineffective?
 Where did you find the information you communicated to others?
 What impact, if any, did this have on your school policies?

What changed? Why?
Overarching Themes
28
 Colleges and universities were significantly impacted




by H1N1 – nearly all campus operations were
affected.
Uncertainties early on were a challenge – required
preparation for all possibilities.
H1N1 response required an unprecedented level of
community organizing over an extended period of
time.
Multi-discipline response teams worked well.
Importance of student leadership and participation.
Big 10+2 Universities H1N1 Lessons Learned
Next Steps
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P u b l i c a t i o n o f r e p o r t f o r a l l B i g 1 0 + 2
Institutions
S u m m a r y r e p o r t f o r A S T H O a n d i t s m e m b e r s
C I D R A P ’ s P r o m i s i n g P r a c t i c e s w e b s i t e
expansion
WWW.CIDRAPPRACTICES.ORG
You can now access an archived version of the
Lessons Learned Conference. Later this summer
specific university practices will be available.