Health Center Staff In Lead Role Preparing Their Campuses for Pandemic Flu

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.”

Barkin suggests looking back to the 1918 influenza epidemic for context.

“In 1918, the virus spread across the country in three to four weeks. If you think about the fact that the virus traveled from coast to coast in that short a time when the primary means of long-distance transport was the train, and then you think about how much more quickly we can travel today by plane, that timeline is going to be compressed significantly.”

In other words, 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. Covely explains:

“Geographical proximity is not definitive enough in this age when in a single day, there are 50,000 passenger flights throughout the world,” he says. “Because New York City and Hong Kong have major international airports, epidemiologically, New York City is actually closer to Hong Kong than it is to Buffalo, so waiting to suspend classes until a confirmed case gets to your region, or within 500 miles, may be too late.”

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.

Don’t Experiment With Your Health

If you walked into your doctor’s office tomorrow with a minor complaint and she said “I would like to try this experiment with your health. There is no real proof it will work, but I read on the Internet that it should. It might not work at all, and it might actually damage your health. Are you in?”

What would you say? Most of us would say, I hope, “Are you KIDDING me!? My health is much to valuable!”

Yet I hear from people all of the time who do just that, and they aren’t even doing it under the advice of a doctor.

Weight loss can make us desperate. We are so bombarded with messages around us telling us that we are not attractive, not valuable, “less than” our skinny counterparts. Magazines tout bikini bodies and the “secrets of fast weight loss” used by the latest stars. I don’t know about you, but while I might admire Jennifer Aniston’s hair and easy demeanor on the screen, I’m not going to her for medical advice.

It is this desperation that leads us to sometimes do foolish things without thinking it all of the way through. I am not casting stones…I had a bad run in with a no carb diet at one point, and a very ugly month of eating no more than 800 calories per day. So I have BEEN there and like many of us, I didn’t think about long term ramifications.

I recently had a discussion with a woman who shared with some friends the “secrets” from a loser on one of those popular weight loss shows. He shared how he lost 12 pounds in 48 hours. His advice? I can’t even bring myself to repeat it because it was ridiculous and potentially dangerous that for me to even share it might border on malpractice! I begged this woman to please not take his advice (nor advice from anyone associated with that show) because it could damage her health. She countered that he had some good ideas, and declined to respond when I pointed out that his good idea left his body without a ready source of fuel over 18 hours of the day. I have a heart for her and for everyone who desperately wants to lose weight, including all of the contestants on those shows, but it scares me when people start to experiment with their health in order to conform to someone else’s idea of what is healthy.

Before you undertake any new health experiments, I would encourage you to ask yourself a few questions.

Is this a supplement and if so, what do I know about it and where did I get the information?

Supplements aren’t all bad nor all good. Natural doesn’t necessarily mean healthy. I’ve said it before, “Plutonium is natural, but you won’t catch me sprinkling it on my corn flakes.”

It is important to understand that supplements, unlike medications, are not tested by the FDA. In order for the FDA to approve a medication it must be safe and effective. If a supplement is certified by the United States Pharmacopeia (USP), NSF International, or the United Natural Products Alliance, it’s guaranteed to meet a certain standard of quality. (The USP’s screening process, for instance, ensures that a product will break down properly and effectively release its ingredients into the body.) Look for a certification seal from any of these organizations whenever you buy a supplement. Look for that on the label.

It is also very important to understand about how supplements may interfere with each other or with prescribed medications. ALWAYS tell your doctor about all supplements you are taking. You may also ask a pharmacist for information.

If you have done your homework, never start more than one supplement at a time without supervision. Check the labels for side effects and if you note any of them, stop taking the supplement. Trying more than one at a time will make it hard to figure out just which one is causing the problems.

If it sounds too good to be true, it’s too good to be true. You can’t burn fat in your sleep. There is no pill that will force your body to use fat for fuel over carbohydrates at any level that makes a real difference. A pill will not give you six pack abs. Sorry. I wish it were true…it’s not.

If a supplement is accompanied by a very low calorie diet, that should send up a huge red flag. If you’re taking an expensive pill and eating no more than 500 calories a day and losing weight…it’s because you’re starving your body. A very low calorie diet over a long period of time can actually damage your metabolism. (I don’t even want to hear of any of you intelligent people doing it over a short period of time!)

If a diet cuts out all of one category of food from your diet, be very wary. Our bodies need a variety of vitamins and minerals from a variety of foods. That doesn’t mean it isn’t okay to cut out refined sugars or flours if that’s what you desire, but don’t cut out all fruits or all vegetables or all (or even most) carbohydrates.

Be very wary of “a study shows…” articles in a Women’s magazine. Most of the times the information from these studies is picked up off the AP and the writer doesn’t understand or explain the entire study. When I read something that sounds completely different from what we’ve been told in the past, I go online to find the original abstract of the study. It is also important to remember that one study only sets down a path for more study, but doesn’t definitively prove or disprove a previous study. A study, to be valid, must be replicated and peer reviewed.

If you’re unsure, please ask someone who knows that you trust for good, solid advice. That can be your doctor, a nutritionist, or another health practitioner. I am always very happy to help as I have a degree in Health Education and never put forth information without researching it first.

Is “Spaced” Education an Effective Training Approach?

Harvard Medical School has created an online platform,, to deliver web-based health education courses in developing countries. The content is accessible via computer, laptop and mobile phone. The intention is a good one- to find a faster, more efficient, and less resource-dependent way to teach health workers in remote locations.

The approach is called “spaced” education and is entirely comprised of multiple-choice questions. Once a participant answers a question, the website provides a brief explanation of the correct and incorrect answers. It claims to deliver the questions to participants in an adaptive format and to reinforce those topics in which the participant needs additional help.

“Spaced” education is said to combine two core psychology research findings: the “spacing” effect (information that is presented and repeated over spaced intervals is learned and retained more effectively) and the “testing” effect (testing causes knowledge to be stored more effectively in long-term memory).

I first became aware of this instructional methodology when I was asked to review two “spaced” education courses, titled Innovative Financing of Health Professional Schools and Private Sector Participation in Pre-Service Health Education. Developed by CapacityPlus in collaboration with QStream, US AID was considering using the courses for private medical training institutions in Zambia.

There are a number of reasons why I advised US AID and its contracting agency, Banyan Global, against using these courses and this approach.

1. It takes the research on spacing and testing completely out of context. New learning has to be reinforced by revisiting it (we’ve known that for decades). However, each iteration should take the learning deeper- by having the learners do increasingly more complex things with what they have learned. Long term retention of information is significantly improved by testing learners… but only AFTER they have learned it!!!!

2. This is still providing standardized content- because everyone who answers incorrectly gets the very same response. [If this were truly adaptive, there would be an explanation as to why a specific answer is incorrect, sending the learners back to try again- not simply telling them the correct answer!]

3. Q &A is not adaptive to the needs of different learning styles. People who need to listen, or see a demonstration, or discuss, or test out new knowledge or skills would find this very ineffective and frustrating for them. This Q & A approach is simply a lecture in disguise.

4. This can be a very frustrating approach if the learner keeps getting the answers wrong. It could easily shut down the person’s interest in learning and do damage to the person’s confidence in his or her own competence.

5. Q & A is typically used to check comprehension- AFTER the learners have actually learned something.

6. This methodology is explicitly focused on comprehension as the highest level of its learning: the last three lines of the paragraph under Who Are the Target Learners says that the course “draws on practices and analyses to provide participants with an understanding of factors bearing on the success of private sector health education and training… ”

7. A training program where real learning occurs would start by ensuring learner comprehension and then give them real scenarios to work through (at the very least) so that they could get to analysis and evaluation levels of learning.

8.The answers to many of the questions are very obvious.

9. The answers to many questions are d, all of the above.

10. There is no learning happening, because for learning to occur, the participants need to be fully engaged and using their new knowledge or skills.

11. Learning also requires focused concentration, which is definitely not likely using a mobile phone.

12. Learning is also interactive, people learn from each other. Even good on-line courses have chat rooms and webinar interactions. This is a completely solitary approach.

13. Why should busy professionals waste their time with this Q & A when they could just read the content and be done with it?

14. The memory is emotional, that is why learners need to be emotionally engaged. Interactive participatory learning activities create full body memory, ensuring retention.

The only good thing I can say about this is that it provides a baby step away from lecture as the training methodology.

Deborah Spring Laurel has been a trainer and a consultant in the areas of workplace learning and performance improvement for over thirty years. She is the President of Laurel and Associates, Ltd,, an international human resource development training and consulting firm that specializes in enhancing interpersonal dynamics within organizations.

Pulse Oximeters and Health Education

Middle school kids all over the United States take on the challenge of learning various health related issues and cures for everyday challenges, but this year, they will have a new tool at their disposal, a pulse oximeter. Over the past 6 months, various school districts all over the U.S. have been adopting the use of pulse oximeters to demonstrate the importance of both pulse rate and oxygen saturation level in daily heath issues. Pulse oximeters will be used to show how quick and easily reading can be obtained, and then the readings will be used to show both normal and abnormal levels.

Health programs have shown that simple topics taught to kids at an early age are effective. The programs started out by teaching kids CPR, which provided positive results. The program then was expanded to include other topics in relation to poison control, which was becoming a growing problem in the U.S., and throughout the world. The initial program was revolved around first aid, and important tactics that are performed daily by emergency professionals. Pulse oximeters have been purchased at the rate of 5 oximeter per classroom. At a cost of under $40, the cost for the schools is not overwhelming for both the initial purchase or for replacement.

Kids are first taught the definition of both pulse rate and oxygen saturation, and also given the breakdown of ranges of readings. Kids are first taught to take their own pulse rate via old fashioned methods, before oximeters are employed for the task. Once the basics are taught to the kids, then oximeters are shown. Impressively, the accuracy for oximeters have been exceptional to traditional readings.

Landon Medical pulse oximeters were the ones that were issued to various school districts. They were chosen for their long positive track record. Landon Medical oximeters also come with an extensive 2-year warranty that covers all manufacturing defects.

Health Education – The Key to a Healthy Life

Have you ever wondered why in spite of all your efforts you cannot stay absolutely fit and healthy, the way you have always dreamt to be? The answer is simple, due to our lack of knowledge about health and the human anatomy system. The more knowledge and understanding of the human anatomy we will have the easier it would be for us to remain healthy and fit.

According to a recent study, a vast majority of the American population are health illiterate. They either do not have enough health information or they are unable to interpret the available health information to control their health and maintain optimum fitness. It also showed, lack of information to be the most important factor contributing towards the majority deaths. Moreover, it was also determined that our illness are primarily a result of stress, food, environment, attitude, emotions or beliefs that triggers certain unhealthy behavior. So, to stay fit we need to refrain from such unhealthy behaviors and that can be distinguished only when there is enough information for us to differentiate between a healthy and harmful behavior. From this, the easiest and most important conclusion that we can arrive at is that we need more information about our health and the human anatomy.