Rensselaer Testimony Before the NY State Senate Committee Hearing on H1N1 Preparedness on College Campuses

New York State Senator Toby Ann Stavisky, Chairwoman of the Higher Education Committee, and members of the Higher Education and Health Committees convened a hearing on Monday, November 16th, 2009, to examine college campuses’ ability to cope with the H1N1 2009 influenza pandemic throughout the state of New York. Rensselaer sent two representatives (William Walker, Vice President for Strategic Communications and External Relations, and Dr. Leslie Lawrence, Medical Director at Rensselaer) to the hearing to outline the effect of H1N1 flu on the Rensselaer campus, measures being taken to quell outbreaks, plans to cope with future outbreaks, and increased susceptibility and risk among student populations.

November 16, 2009  |  Video of Oral Presentations (Rensselaer testimony starts at 1:31 and ends at 1:50)

Testimony from William Walker, Vice President for Strategic Communications and External Relations

Chairwoman Stavisky, members of the Senate Committee on Higher Education, thank you for the opportunity to share information on the extensive planning and communication that Rensselaer Polytechnic Institute utilized during the ongoing outbreak of 2009 H1N1 Influenza. I am William Walker, Vice President for Strategic Communications and External Relations. I will provide a brief overview of our pandemic planning process and describe our extensive communication outreach campaign, which we believe contributed to our success in mitigating the impact of the H1N1 outbreak at Rensselaer. Dr. Leslie Lawrence, Medical Director at Rensselaer, will then discuss how we handled the illness from a medical standpoint.

From the outset of the H1N1 outbreak in the United States, the leadership of Rensselaer has been committed to heavily monitoring the spread and severity of the illness, and to keeping our community of more than 9,000 students, faculty, and staff fully informed. At the very early stages, President Shirley Ann Jackson presented a clear mandate that our preparations should be thorough, that we should anticipate all of the potential consequences of a widespread outbreak among the various groups at the university, and that our communications processes would be a critical component of our preparedness.

Therefore, our open, honest, frequent, and direct communication on this illness has been paramount from the beginning of the outbreak in the U.S. We recognized from the outset, that complete and timely information, focused on prevention and treatment, was the best way for our community members to protect themselves from becoming severely ill. To date, our medical response and open communication have limited the impact of the illness on our campus, as compared to many of our counterparts in higher education, and have been strongly praised by our faculty, staff, students, and the families of our students.

Our campus Emergency Operations Committee, which is comprised of leadership from departments around the institution, was put on high alert as the first information regarding a “swine flu’, circulating in Mexico in early spring, came to our attention. After the first cases of influenza were confirmed on April 25, the Emergency Operations Committee began to meet regularly, and several important communication and planning elements immediately went into effect.

• First, a travel advisory to New York City, Mexico, and other potentially impacted areas was sent via e-mail to the entire Rensselaer community on April 29. This message was also our first opportunity to share our message of prevention that would be repeated in every single communication to follow.
• Second, the Emergency Operations Committee began to revise our Pandemic Response Plan, which at the time had been developed in response to the much more deadly Avian Influenza.
• Third, we developed a Web site linked from our homepage, dedicated to information on H1N1 influenza, that went live on April 30.
• Fourth, a large-scale prevention advertising campaign was developed and implemented the first week in May.

The Web site remains one of our primary communication vehicles. It can be found at www.rpi.edu/about/flu. It is branded under our “RPIAlert” system, which is the primary system that the Institute leadership uses to communicate with the community on a dangerous or potentially dangerous situation at Rensselaer. The Web site opens with a regularly updated message from Dr. Lawrence, who has remained our primary spokesperson throughout the outbreak, keeping a consistency of voice throughout the situation. The site also includes frequently asked questions on the flu, signs and symptoms, prevention information, information on the status of the campuses, links to other resources such as the Centers for Disease Control, a link to the Student Health Center Web site, and information specifically directed toward students, faculty and staff, and parents and families.

The outreach campaign took maximum use of all campus communication channels and technologies available to us. This included posters on prevention in every campus building, advertisements with information regarding the new Web site on our campus closed circuit television systems, our student-run television display system, articles in the student newspaper, e-mails, and our RPIAlert communication system.

During the month of May, we continued to track the spread of the illness. This allowed us to refine and implement the Pandemic Response Plan as more information became available. Our H1N1 Pandemic Response Plan is now divided into five response levels. This ranges from Level A, at which we monitor the international and national situation, to Level E, at which all operations of the Institute would be suspended in response to an outbreak that affected a high percentage of the population of the university. These levels are very closely correlated to the case fatality rate, as presented by the CDC. The plan encompasses every aspect of campus life and leadership including housing, food services, human resources, transportation, communication, health services, public safety, and environmental health and safety.

On June 29, we at Rensselaer experienced our first brush with the illness, when several visitors to the Troy campus were confirmed to have the illness several days after their visit. Each person who had attended the meeting at which those visitors were present received an e-mail with information on the illness and its signs and symptoms, as well as a phone call from Dr. Lawrence. A more general message was also sent via e-mail and posted to the H1N1 Web site for the entire community, alerting everyone of the exposure on the campus, describing the signs and symptoms to look for, and reminding them of ways to protect themselves from becoming ill. No known cases amongst the Rensselaer community occurred in the aftermath of that initial exposure to the illness.

To test our plan, we held a tabletop exercise on June 30, with leadership from across the Institute. This allowed us to find weaknesses in the plan and to address them prior to a major outbreak on the Rensselaer campus.

After an uneventful summer, thanks in large part likely to the strong drop in students on campus, our Director of Emergency Management began to send regular H1N1 situation reports to the senior administration of the university, detailing the national situation each week and, in particular, the situation being reported on other college campuses. This allowed us to stay abreast of the situation and adjust our planned response as needed.

As the students returned to classes at the beginning of the fall term, we began issuing a weekly memo to the entire community each week from Dr. Lawrence. These memos are sent via e-mail to every Rensselaer e-mail address, forwarded to parents, and then posted directly to the H1N1 Web site for the general public, including the news media, to view.

These weekly updates remain the focal point of our communication strategy. Each letter reinforces the prevention message, but also includes candid responses to questions or concerns raised by the community, and detailed information on the number of cases known on campus. When we learned of our first case on September 18, our communication strategy remained consistent and straightforward.

This approach resulted in some very high-level coverage by national and international media, even a spot on page 1 of the Sunday New York Times, after reporting that several students had contracted the illness after a weekend drinking game. While drinking games are in no way an activity that we condone at Rensselaer, we believed it was important to provide as much detail as possible on how and why people were getting ill. Without accurate or full information, we left students at a loss for how best to protect themselves. That one drinking game had led to the largest increase in the number of cases on the campus at that time, and its impact was something that we wanted the students to seriously consider.

In addition, before the start of the semester, our Provost, Dr. Lawrence, and our Director of Emergency Management met with all of the academic deans and department heads to discuss the Rensselaer planning and response to an H1N1 outbreak on campus. Each department head was asked to meet with every member of the faculty over the following week to discuss H1N1 education for their students during the first week of classes. As a result, professors around the campus reinforced the messaging of the Web site and other outreach in the classroom. They showed videos on prevention and reminded students of steps they should take to stay healthy.

In summation, we utilized extensive university-wide planning and outreach to help control the spread of the H1N1 illness on campus. We began planning early for an outbreak in our community. Unlike many of our academic counterparts in the Southern and Southeastern states, we had the luxury of more time to plan for an outbreak, and we used that time to the fullest extent. We continue to hold weekly meetings of the Emergency Operations Committee to continue to refine our processes and deal with new issues as they arise.

In total, our communication strategy has played a critical role in controlling the spread of the illness on our campus and in keeping our community exceptionally well informed on how to protect themselves. As we knew it would, our situation came to the attention of the news media, particularly locally, because we were diligent in diagnosing the true number of cases on the campus, and highly transparent in disclosing and sharing widely information with our community and the general public. The health and safety of our students, faculty, and staff were always of the utmost importance to us, and only with accurate and open communication could we enable them to do what they needed to do to protect themselves.

While we did not seek external media coverage, we believe that coverage may also have helped spread the word of prevention beyond the campus. In fact, several student newspapers from other universities interviewed Dr. Lawrence directly in order to obtain information that they felt their student body needed to deal with the illness.

While communication and planning have played a strong role in our response to 2009 H1N1 influenza, the extreme dedication and planning of our medical staff led by Dr. Lawrence was also a huge factor in our ability to control the spread and severity of H1N1 at Rensselaer. Dr. Lawrence will now provide further details on the medical planning and response.

Testimony from Dr. Leslie Lawrence, Medical Director at Rensselaer

Rensselaer’s overriding policy is to protect the health of all students and staff. To achieve this goal, it became a priority to be aggressive with our isolation procedures to attempt to reduce the daily number of cases during an outbreak (to slow the spread) and spread the cases out over a longer period of time. This is because we currently have only 2 physicians, 2 physicians’ assistants,  3 registered nurses and 1 medical assistant and 5 administrative and support staff and we serve 6200 plus students. 

Our goal was to have each student who became ill to be seen at the Student Health Center.  We also planned to have daily individual follow up on each student each day while they were ill and/or in isolation. We knew that, given the size of our staff, this could be a challenge during a large-scale outbreak. This is what made our strategy of slowing the spread of the disease critical to our plan.

We built off our seasonal influenza policy as we at Rensselaer have routinely suggested seven (7) days of isolation when we identify larger seasonal influenza outbreaks. The lengthy isolation has been facilitated by us issuing a note to the Dean of Students who would in turn notify all of that students professors that they would be out for as many as seven days. We had also routinely used Tamiflu or Relenza for the treatment of influenza in high risk individuals during our seasonal influenza outbreaks. Thus, the recommendations that came from the Centers for Disease Control were not foreign to our staff with the sole exception of the recommendation to isolate only until 24 hours after the patient no longer had a fever as most influenza viruses are thought to persist for at least a week in an infected patient’s respiratory tract.

But, to achieve the desired slowing of the spread of H1N1 we wanted even more control than we had in the past when we asked the student to isolate themselves with the seasonal influenza. So our plan in the H1N1 outbreak was that once a student has been diagnosed, they are either sent home (if they are from the Northeast and their parent consented) or sent to an isolation room. Isolation rooms were established in a residence hall that offers private bathrooms and an on-site dining facility to facilitate delivery of meals. Affected students would be compelled to go home, go to isolation or, if they refused both, they would be suspended under the student code of conduct that states that no student can put another student’s health in jeopardy. As students are diagnosed with the influenza, they are placed on a registry which generates notes informing professors that the student will be out for one week.

The Provost, Deans, and Department Chairs as well as myself, met at the beginning of the fall semester and discussed that students should not be penalized for missing a week of classes in order to help us control the spread of the disease. It was decided that all faculty give extra time to make up missed work. The Provost and faculty leaders asked to be given information on the H1N1 influenza and they each took time out of one of their classes to mention that there would be no punitive consequences from missing time for isolation and they also showed a short video on H1N1 that helped with our message on influenza prevention and containment.

We continually updated our protocols as new information became available. For example, we changed our isolation period from 24 hours after no fever off medications to 7 days or no fever for 24 hours whichever was longer. These changes were made after seeing what happened at the Air force Academy in July and the seeing the clinical research that came from the Institute of Public Health of Quebec in early September, both of which showed that viral particles were produced in infected individuals long after the original 24 hours after last fever mark. As these changes to our plan occurred we were able to communicate them in our weekly email announcements. We even included links to the scientific studies that had influenced our change of plans so that students and parents would understand why we were no longer recommending the same isolation period as the CDC.

As far as Personal Protective Equipment (PPE), the Student Health Center staff had previous training, but was re-trained by Rensselaers Employee Health and Safety staff at the beginning of our fall semester.

As guidance continued to come from the Centers for Disease Control (CDC) and as we re-wrote Rensselaers’ Pandemic Influenza Plan, the medical staff has had weekly meetings on any new plans or changed protocols.  We have also asked each of our providers to carefully interview each of the ill students to try to determine the most likely place they may have contracted their illness.  We continue to meet weekly to review our situation and discuss any new findings.

We planned to overcome space limitations at the Health Center, by opening an auxiliary Health Center just for influenza to accommodate the volume of students seeking treatment during the weeks when the highest numbers were afflicted with H1N1. We did have to open this auxiliary center from 10/14/09 to 11/12/09.

If efforts to slow the spread of the illness were ultimately unsuccessful, and a large outbreak developed, Rensselaer planned to suspend classes for two weeks and send all students home (unless they were from great distances away). In this context, a large outbreak was defined as 10-20% of students out of classes at one time, or 5-10% of our faculty out at any one time. We have handed out a decision matrix that was developed before the outbreak to guide us through some of our decision points.

As you can see from the decision matrix, depending on the severity of the outbreak, Rensselaer would suspend classes to interrupt the transmission of the influenza. If the outbreak had a low severity, the Institute would close for two weeks. With a higher severity, the Institute would close for up to 12 weeks. 

For the shorter suspension of classes, some classes could be taken on line, and the rest would be made up by using Saturdays and other off days to make up classes and labs. If the suspension were to last twelve weeks, the whole semester would be pushed back to the next semester and the summer would be used as an additional semester to get back on our usual schedule.

Obviously the best form of prevention is the H1N1 vaccine. The vaccine was and will be given in the order of the priority groups defined by the Centers for Disease Control (Pregnant Women, Persons who live with or are Caretakers of infants under 6 months, healthcare and emergency workers, children between 6 months and 24 years of age, and persons 25 to 64 who have high risk medical conditions). The vaccine will be given free of charge.  We are not presently planning to mandate the vaccine; we are discussing the best way to widely distribute the vaccine should we receive an adequate supply to inoculate all of our students. We have already began to notice decreased interest in the vaccine on campus as many of the students feel the worst is over or have the attitude that I have managed to avoid it this long so I won’t need the vaccine now. You may have noticed that right here in Albany there was a large H1N1 vaccination clinic over the weekend and only 2600 of the 4000 doses were given, again showing a decreased interest as the perception that nothing that bad is happening so I don’t need the vaccine.

We have seen some positive outcomes from our plan as it was implemented. We have been successful in slowing the progress of the outbreak compared to other Universities using our aggressive treatment and isolation procedures. We have been able to give each student that is ill and goes to isolation personalized follow up because of this slowed pace. We have been able to take lessons learned by interviewing our patients and effectively communicate them to our students, staff and faculty with our next weekly announcement. An example of this is when we learned that clusters of the influenza we be generated by drinking games at fraternity parties. We were able to communicate this in our next announcement and blunt the spread by this method. We also learned that almost all cases were contracted at social gatherings.  This is illustrated in the bar graph showing the number of suspected H1N1 cases per day, which shows a spike in cases following each weekend.

In summary, after our experience with H1N1 we believe the two most effective means of slowing the progress of disease before adequate vaccine is available are clear; honest and continued communication throughout the entire outbreak and a strict isolation plan that can slow the spread and allow for individual attention to each ill student, staff or faculty member.