1. 1 ‘School Closing’ as a Potential Means to Counter Pandemic Influenza Table Top Exercise (TTX)

2. 2 Public Health Measures Categories of Interventions  Pharmaceutical  Non-Pharmaceutical

3. 3 Public Health Measures Pharmaceutical Interventions  Vaccines  Antivirals

4. 4 Public Health Measures Individual Measures – ‘Hygienic’  Hand washing  Cough etiquette  Washing inanimate surfaces  Masks & respirators Community-based Measures Self-isolation Self-quarantine Social Distancing Measures  Work Place Policies  Gatherings restrictions  Travel restrictions  School Closings Non-Pharmaceutical Interventions

5. 5 ‘School Closing’ as a Potential Means to Counter Pandemic Influenza

6. 6 School Closing Warrants Special Consideration  Children among the highest at-risk population  Children among most likely to spread the disease  Poses an immediate community-wide impact from a single policy decision  Substantial adverse socioeconomic impacts  Pros & Cons of all stakeholders must be considered

7. 7 Overview / Purpose Provide a Public Information Exchange Forum for Pandemic Influenza Issues Discussion to facilitate planning and to assess School Closing as a potential means to counter a Pandemic Influenza outbreak Provide valuable feedback for policy formulation at all levels of government

8. 8 Exercise Scenario - 1 The World Health Organization (WHO) has confirmed sustained human-to-human transfer of a virulent influenza virus in several Asian countries and has determined that an influenza pandemic is underway (WHO Phase 6). CDC has advised that the pandemic influenza virus is likely to reach one or more contiguous 48 states in the next 30 days. (USG Stage 4). HHS has issued guidance for State and Local governments to consider non-pharmaceutical measures as potential countermeasures.

9. 9 Discussion Questions - 1 Realistic expected range of morbidity & mortality for the community? (Identify your Science Advisor!) Likely healthcare demands upon hospitals & other healthcare facilities? Expected quantity of antiviral drugs? Plans for use of antiviral drugs? How would school closings affect response plans? Other community-wide actions? (Public Health Risks & Countermeasures)

10. 10 Exercise Scenario - 2 The World Health Organization (WHO) has confirmed sustained human-to-human transfer of a virulent influenza virus in several Asian countries and has determined that an influenza pandemic is underway (WHO Phase 6). CDC has advised that the pandemic influenza virus is likely to spread across all 50 states (USG Stage 5). HHS has issued guidance for State and Local governments to consider non-pharmaceutical measures as potential countermeasures.

11. 11 School Closing Considerations Children are efficient transmitters of flu In Asian flu pandemic of 1957-58, the highest rates were seen in school age children Data on School Closing is limited One published study found significant decrease in incidence of disease as result of school closures Risk of infection & illness likely decreased with closures Mathematical modeling suggests reduction of transmission due to School Closing Child Care arrangements will be required if School Closing School closures also have significant impact on the community and the workforce

12. 12 Discussion Questions – 2 Who has authority to close some or all of entire public school system? (similar to snow days?) What is ‘procedure’ for routine closings? Is the locus of authority different if 4 - 6 weeks? Is there a state authority for resolving disagreements between adjoining jurisdictions? Public school officials authority over private schools? Decision to ‘Re-open’ Schools? Who? When? (Decision Making Process)

13. 13 Break

14. 14 Discussion Questions - 3 What % of teachers / admin would be idled? Policy for compensation of idled workers? Program for continued ‘at home’ education? ‘Latch-key’ special needs? Status of ‘other school-based services’? If extended period (4 – 6 weeks), what is the requirement for make-up days? (Longer?) Plans to preclude ‘unofficial mall’ gatherings? (Impacts from Closing Schools)

15. 15 Additional Information

16. 16 Discussion Questions - 4 Parents away from jobs to supervise children? Employers ‘telework’ arrangements? Employers liberal leave policies? Employers Continuity of Operations Plans? Assistance from other public or private entities to assist parents with their ‘at home’ children? Absentee Impact on community infrastructure? (Other Public & Private Entities)

17. 17 Final Comments

18. 18 Conclusions from the Historical Record: 1918 Pandemic “Swift, agile, decisive, and coordinated action based on accurate information and advanced preparedness planning, before the appearance of influenza in the local area, is critical.” Howard Markel, MD, PhD www.dtra.mil/asco/DTRAFinalInfluenzaReport.pdf

19. 19 End