printable versionCampus officials discuss emergency response tactics for flu pandemic
BY MICHAEL PEÑA
Ira Friedman
Larry Gibbs
Stanford has taken a proactive stance in the face of heightened concerns over an avian flu pandemic. A task force that includes the directors of campus community health services and emergency planning, infectious-disease physicians and representatives from other key university operations has been meeting over the past year to outline major issues that will guide the development of a comprehensive and coordinated emergency response to an outbreak.
Although there seems to be no immediate threat to humans of an avian flu pandemic—either in this country or elsewhere—a top priority for the university is to have plans for a decisive response in place well in advance of an outbreak.
"The main charge of the task force is to identify all of the issues and look at the business impact of a pandemic in the region, and then to develop mitigation measures to address any identified risks," said Larry Gibbs, associate vice provost for environmental health and safety. "There are still a lot of unknowns about what is going to occur. So what we're looking at is identifying as many potential issues as possible."
The task force, called the Infection Control Planning Group, has identified planning priorities and challenges, as well as assessed the campus population's vulnerability should the avian flu virus—influenza A (H5N1)—mutate and start spreading from birds to humans. The group also has prioritized methods for reducing transmission, such as educating the community about associated risks and wearing gloves and masks for protection. More serious measures—namely, separating the ill from the well, canceling classes and events, evacuating campus and administering antiviral medications and vaccinations—are being planned as well.
The task force includes many of the same members of the group convened to develop an emergency-response plan for the university in case of an outbreak of SARS (Severe Acute Respiratory Syndrome) a couple of years ago. The current group is an outgrowth of Stanford's overarching University Emergency Plan and is co-chaired by Gibbs and Dr. Ira Friedman, director of Vaden Health Center.
In April, a status report was given to the Board of Trustees by Friedman, who was joined by Dr. Lucy Tompkins, chief of the Division of Infectious Diseases at the School of Medicine and director of the Infection Control and Hospital Epidemiology Department for Stanford Hospitals and Clinics.
Two of the biggest concerns driving the university's emergency planning are the large young-adult population in residence at Stanford and the likelihood that health-care resources will be stretched extremely thin. In the report to the trustees, the task force cited data from the 1918 flu pandemic—the worst ever recorded in the world—that showed a high death rate among young adults in the United States.
A "pandemic" refers to a disease caused by a viral strain spreading globally among humans to which none of the people have antibodies, Tompkins said.
Although a different strain of influenza ran rampant that year, the avian-flu virus is "acting in many ways like the virus that caused the 1918 pandemic," Tompkins said. Among those who have contracted the avian-flu virus in recent years, the mortality rate is about 50 percent, Tompkins said. Studies indicate that the vast majority of those cases involved direct contact with infected birds, not humans.
Should a pandemic occur, the availability of outpatient services at Vaden and inpatient care at Stanford Hospital likely will be very limited, the task force is predicting. The likelihood that sufficient supplies of antiviral medication and vaccinations will be available on campus also appears unlikely, Friedman said.
Hence, the task force is examining the concept of "social distancing" as way of reducing transmission within the campus community. This would entail canceling events and gatherings, as well as reducing the campus population by suspending classes, closing undergraduate residences and suspending many normal university operations.
"We created a simple mathematical model," Friedman said. "By dispersing people, you start reducing the number of people who get ill, because the attack rate is determined in part by the closeness of people to each other."
Exactly what events would trigger an emergency response on campus is still to be decided, and not only by Stanford's task force. Tompkins said universities around the country are grappling with the same question.
"The so-called trigger for these responses is unknown," Friedman said. "Ideally, the goal would be to trigger the response before people get sick, but only right before. You don't want to trigger it too early, and you don't want to trigger it too late."
So at this stage, task force leaders say that the first and most logical way to prepare for a pandemic is by thoroughly educating the campus community. The Office of University Communications is involved in the pandemic planning and currently maintains a website with general information about the avian flu at http://www.stanford.edu/dept/ucomm/news/avianflu.html. That webpage also suggests people check the Pandemic Flu website maintained by the U.S. Department of Health and Human Services at http://www.pandemicflu.gov/ for up-to-date information and advisories.
More than 200 people have contracted the avian flu virus worldwide—mostly in Asia, where people traditionally live in close proximity to poultry, according to Tompkins. No infections have been reported in the United States, and since avian flu first came to the scientific community's attention in 1997, the virus has not undergone the genetic change that will enable easy transmission between people, Tompkins said.
As far as planning priorities identified by the task force, they include reducing the number of flu cases and deaths, providing essential care for ill students, maintaining critical operations and support services, housing and supporting students who cannot or do not plan to leave, and supporting the continuity of Stanford's research enterprise and essential operations. Other high-priority issues listed by the task force include the curtailing of international travel of undergraduates for overseas studies programs, informing faculty and researchers about travel advisories issued by the Centers for Disease Control and Prevention (CDC) and developing procedures for closely monitoring and investigating cases on campus.
In addition, the university will have to figure out a way to meet the mass health-care needs of ill students and communicate information to those on campus and off—such as parents, families and news organizations. Targeted vaccine distribution and the coordination of efforts across all of Stanford's offices and departments—and with entities off campus, such as the Santa Clara County Public Health Department—are other priorities.
University operations deemed by the task force as essential during an emergency response include critical infrastructure, such as water and electricity; support for personnel who must remain on campus; health-care services at Vaden Health Center and the Medical Center; housing, dining and support for students; and the capability for mass distribution of a vaccine or medications.
Although the guidelines for planning are in place, Gibbs said more issues will be identified as planning discussions continue. Next steps will be considering detailed impacts to the campus community under a variety of scenarios and then filling in details in the response plan. The task force will benchmark its progress by referring to the CDC and to what steps other universities are taking.
"We're getting down to the detail level," Friedman said. "This isn't just some broad creation of a plan that needs to be filled in. We really are making specific plans."
In addition to the directors of the Vaden Health Center and the department of Environmental Health and Safety, the planning group also includes representatives from the Department of Public Safety, Risk Management, Human Resources, the offices of the President and Provost, Student Affairs, Residential and Dining Enterprises, University Communications, the university's legal office, the Medical Center and infectious disease faculty, and the Santa Clara County Public Health Department.
Gibbs said the task force will request that units throughout campus conduct detailed analyses this summer on how a pandemic would impact campus programs and operations, in hopes that a well-developed emergency-response plan for the entire university can be completed by Sept. 15.