Health Articles

Health Center Staff Take Lead Role In Preparing Their Campuses For Pandemic Flu
by: Cassie Harman

It sounds like the plot of the next blockbuster movie. A third of the world’s population is struck down by a deadly virus that spreads across the globe so rapidly that there is no time to develop a vaccine. Up to half of those infected – even young, healthy adults – die. But as health professionals know, this scenario is not just a flight of fancy. It could be the very real effects of the next pandemic flu outbreak, particularly if H5N1 (also known as highly pathogenic avian flu) is the virus in question, and it is this knowledge that is pushing not just federal and state government but organizations and businesses throughout the world to develop a strategy to tackle it.

Within colleges and universities, the burden of pandemic flu planning is likely to fall upon many student health directors, even at institutions with environmental health and safety departments. John Covely, a consultant on pandemic flu planning and the co-author of the University of North Carolina at Chapel Hill’s pandemic plan, explains why this is so.

“Traditionally, emergency planning originates from public safety, or environment health and safety, but a communicable disease poses the biggest threat to students in group quarters. Thus, student health directors are often leading the emergency planning effort for the whole university, because the entire plan - not just the student health component - could be the difference in life or death for their students.”

The importance of having a campus-wide plan that is ready – not just in the preliminary stages – when the pandemic strikes is all the more clear when you consider that, unlike seasonal flu, H5N1 has an increased risk for the typical student demographic of young, healthy adults. The startlingly high mortality rate of up to 60 percent is partly due to a protein, also found in the strain of virus responsible for the 1918 pandemic flu outbreak, which causes a response in a healthy immune system known as a “cytokine storm”, often leading to respiratory failure and death.

Planning for such a massive and yet unpredictable event may seem a formidable task, but Dr. Anita Barkin, chair of the American College Health Association’s pandemic planning committee, counsels that those universities and colleges that have yet to formulate a pandemic plan shouldn’t feel overwhelmed by the work that lies before them. “Pandemic planning is about good emergency preparedness. The things we do to prepare for any emergency are the things we would do to prepare for pandemic flu,” she explains.

Although the tragic Virginia Tech shootings this spring were a different kind of emergency, the issues are similar to the issues faced in the event of a pandemic flu outbreak. Coordinating resources, communicating with everyone on campus and deciding at what stage classes should be called off are questions that have to be answered in most emergency situations. Take your pandemic planning one step at a time, advises Barkin.

“The first step is to find out whether there is an existing emergency plan on campus,” she says. “If there is, who is in charge of it? Health providers on campus should then take charge and begin to formulate the plan.”

There are many unknown factors, but build the framework of the plan first with the elements you can be sure of. Form a committee with all key areas represented, including executive leadership. ACHA’s Guidelines for Pandemic Planning provides a list as an example that may help you collate this. Identify the functions that will be critical in the case of a pandemic and the personnel on campus responsible for each of these, making sure there are enough people representing each function that should some become sick, the plan is not compromised. Identify decision makers, a chain of command, and what channels of communication are to be used. Finally, decide on the role of student health services. Many campuses will have the student health director as the key decision maker in the event of a pandemic, but for some it will be more appropriate for the student health director to have an advisory role instead. In any case, college health professionals will be crucial to the success of every plan.

The biggest question that is central to every campus-wide pandemic plan: when is the right time to send students home? Covely warns that universities cannot necessarily wait for cues from state public health departments before they make their decisions. “The university has to have its own in-depth criteria in advance of a pandemic, and the student health director should be very involved in developing those criteria.”

Don't wait too long to send your students home. Nor should your trigger for this decision rely on the geographical proximity of the virus to your campus alone.

The factors that will determine how early you make the call to send students home will center on the composition of your student population. If your students are mostly from in-state, they will probably be traveling home by car and so you can wait slightly longer before canceling classes and closing the campus down. If many students live a long way away and are going to need to use mass transportation, you may have to act more quickly or risk being swamped with very ill students at a time when the local hospitals will not have the resources to help.

There are three main elements that will shape the logistics and the scale of your plan, and help you figure out the best trigger to send students home. Remember that, as Barkin comments, “The longer you wait, the higher the rate of infection, the less chance of being able to get students home and the less likely you can manage the burden of disease.”

These factors are as follows:

* Student demographics, particularly the number of students who live on campus and the number of non-local students who are likely to be dependent on care.

* The size of your staff (taking into account that up to 50 percent may be sick at one time).

* Your ability to stockpile enough basic supplies, including medications, as well as personal protective equipment such as respirators.

This is where things start to get more complicated, however. Most student health services can’t afford to stockpile many medical supplies. “ACHA is running a survey on pandemic planning,” reveals Barkin. “Of the schools that have responded, most have not stockpiled, or if they have, it’s not a lot.” This could clearly prove disastrous, and for many colleges is a manifestation of what Covely cites as one of the biggest challenges of pandemic planning for some universities: “getting buy-in from the executive leadership.” Pandemic planning is by no means a cost-free exercise.

One tip if you are facing resistance from campus decision-makers over spending money on pandemic planning is to emphasize the fact that once you’ve formulated a response to a possible pandemic, you will have a robust emergency response strategy that can be adapted to fit virtually any emergency, whether it’s evacuation in the event of wildfires, such as Pepperdine University faced recently, a terrorist threat, or an “active shooter”. Investment in, say, developing a Web site with emergency information and updates can be a public relations bonus and a reliable resource. Villanova University’s plan includes broadcasting SMS text messages and e-mails and using an emergency Web page for mass communication.

Dr. Mary McGonigle, director of the student health center at Villanova University, says that their dialogue with their local health department led to Villanova being assessed and labeled a “push” site, a location that is self-sufficient in this type of emergency. She explains:

“In the event of a pandemic, we’d go and pick up supplies from the county and then administer medicine to our Villanova community. That includes students, faculty and their families.”

Help from the county is a financial boon but being self-sufficient and staying local also lowers the risk of spreading the virus so rapidly. The dialogue helps your local health services too. If your local hospitals are likely to have a shortage of beds, they may want to use college dorms for surge capacity at the peak of a pandemic. In return, they may be able to offer you some resources, although research suggests that most hospitals have not had the budget to be able to stockpile effectively either.

The ongoing and fluid nature of pandemic planning is very much evident in some of the complex and thorny issues that have no definitive answer. These may need to be revisited and rethought as scientific discoveries are made, as you approach a pandemic, and if your college’s resources change. One such issue is the availability of expensive antivirals. The federal government has announced that it is stockpiling them and coming up with a strategy for distribution, which might seem to take some of the financial pressure off student health services. Barkin however has a caveat. “I’m concerned that stockpiles would not be distributed in enough of a timely fashion to make an impact on the community. Katrina is a situation that has to come to mind.”

Even if you did manage to persuade campus decision-makers to invest budget in stockpiling antivirals, a potentially challenging feat, there’s a chance that they would be ineffective by the time a pandemic occurs, as overuse can cause the emergence of a resistant strain. Barkin explains that infectious disease experts are talking about using a treatment cocktail – Tamiflu plus one or two other agents - to protect against the emergence of resistant strains, but this would be prohibitively expensive for the average college health center.

Another ethical dilemma surrounding pandemic planning concerns who should get prepandemic vaccines. Scientists are developing vaccines based on the strain of avian flu that has been circulating in Asia, hoping that the vaccine would be enough of a match to combat the illness until a proper vaccine could be developed six months after the pandemic’s emergence. But supplies of this prepandemic vaccine will be limited.

“Some of the conversations around who should get these prepandemic vaccines are very complex,” says Barkin. “Should it be health care workers that get it, or public safety workers such as firemen? Should it be government officials, or the very young and elderly?” Recently, the federal government has announced a three-tiered approach to vaccination that it has developed in consultation with public focus groups and ethicists that places health care workers in the second tier. Whether your health center staff will receive the vaccine, whether it will be in a timely fashion, and how effective it will actually be, are all factors that will affect your pandemic plan greatly – and demonstrate how much of your planning has to leave room for the unknown.

One thing that is beyond question is the importance of student health services acting now. Formulating a pandemic plan may be a slow and ponderous task, but there’s one vital aspect that will slow the spread of a pandemic and can be tackled by your department immediately without getting tangled in red tape and endless meetings.

This public health education can be a collaborative effort with human resources and residence life staff. Covely agrees and even suggests extending the scope beyond campus boundaries. “It’s part of being a good and responsible neighbor to the community,” he says.


Why Your Diet May Not Be As Rich In Iodine As You Assume
by: Steve Smith

The trace mineral iodine is well known for its crucial role in enabling the body's manufacture of vital thyroid hormones, but it is also important for the health of the immune system and for optimal brain function. It is widely believed by many authorities that iodine deficiency should never be seen in the affluent West, although this problem affects millions throughout the developed world.

Some nutritionists argue, however, that this conventional view is too optimistic, because the content of all minerals in foods is heavily dependent on the mineral content of the soil from which those foods are derived. The assumption must therefore be that the continuing de-mineralisation of farm soils has led to a reduction in the amount of dietary iodine commonly consumed.

Fish and other seafood, however, remain a relatively rich source because these ocean creatures concentrate the sea's iodine in their flesh. Though not commonly eaten in the West, seaweed, or kelp, is also an excellent source of iodine for this reason, and is readily available in the form of a dietary supplements. Dairy products and certain meats may also be a good source, particularly where iodine is routinely added to farm animal feed. But in countries, including most of Western Europe, where animals are grazing fields growing on iodine depleted soils, levels are likely to be much lower.

So even in the West, those not including fish or seafood in their diets, and not using iodised or sea salt, may be at real risk of deficiency. In an effort to compensate for low levels of dietary iodine, the mineral has been routinely added to ordinary table salt in the US for many years. But the practice is not as common in the UK and other European countries, where specially iodised or natural "sea-salt" has been marketed more as a luxury alternative. The problem of insufficient dietary iodine has been compounded on both sides of the Atlantic, however, by increasing concern about the possible adverse health consequences, particularly high blood pressure, of excessive salt intake. Many nutritionists, however, regard these fears as exaggerated, and believe that any such potential problems are far less serious than the consequences of an insufficiency of iodine, and may be easily resolved by the use of the low sodium salt alternatives available.

Iodine, however, cannot in any case be regarded as a luxury. Its essential function lies in the production of the vital thyroid hormones; thyroxine, sometimes known as T4, and tri-iodothyronine, or T3. And as is well known, these hormones are crucially important in ensuring a healthy metabolic rate and the release of energy from food; so an underactive thyroid gland is commonly the villain in cases of excessive weight gain, particularly where this of sudden onset, and in cases of difficulty in losing weight even when following a sensible reducing programme. A healthy thyroid gland is also crucial for the optimal functioning of the immune system.

But perhaps even more importantly, iodine deficiency is also known as a major cause of avoidable brain damage; a problem which the World Health Organisation has estimated to affect an astonishing 50 million people worldwide. Sadly, many of these cases occur in children whose mothers were iodine deficient in pregnancy, resulting in a condition of severely retarded brain development known as congenital hypothyroidism, or "cretinism". Even where such catastrophic consequences are avoided, iodine deficiency in childhood may also have serious effects on the developing brain, leading to low energy and motivation for learning, and measurable impairment of IQ scores.

Since 2001 the Food and Nutrition Board of the US Institute of Medicine (FNB) has prescribed a Recommended Dietary Allowance for iodine of 150 mcg for all individuals over 14, rising to 220 mcg for pregnant women and 290 mcg for those breastfeeding. Somewhat confusingly, however, an excessive consumption of iodine is also associated with a malfunctioning or enlargement of the thyroid gland, as well as mouth ulcers, headaches and gastric upsets, and the FNB therefore advises an upper safe limit for daily iodine consumption of 1,100 mcg for adults. Most people eating a conventional Western diet are unlikely to exceed this level.

With the possible exception of pregnant and breastfeeding women, people in the West who use liberal quantities of iodised salt as a regular seasoning are unlikely to need further supplements. But many commercial multi-mineral preparations contain iodine in reasonable quantities, usually in the form of potassium iodide, and whilst not perhaps strictly necessary, such supplementary doses will do no harm and may be regarded as a useful insurance policy given that, like all minerals needed by the body, iodine functions best in the presence of adequate supplies of all the others. And it should be particularly noted in this context that the effects of any deficiency of iodine may be intensified by any deficiency of selenium, iron or vitamin A.