Canadian K-12 schools and the pandemic (H1N1) 2009 flu virus

Canadian K-12 schools and the pandemic (H1N1) 2009 flu virus Canadian Teachers Federation Research & Information Services According to the Public Health Agency of Canada (PHAC), the H1N1 Flu Virus has been reported around the world, and the World Health Organization has declared it a pandemic influenza virus. Swine influenza (sometimes called swine flu) is a strain of the influenza virus that usually affects pigs, but which may also make people sick. H1N1 flu virus is a respiratory illness that causes symptoms similar to those of the regular human seasonal flu. Some groups are more vulnerable to contracting it than others. PHAC notes that the pandemic (H1N1) 2009 influenza virus is thought to be spread from person to person in the same way as seasonal influenza where transmission occurs predominantly through coughing or sneezing. Indirect transmission can also occur through self-inoculation after contact with surfaces and objects contaminated with the virus from infected persons. Like seasonal influenza, the pandemic (H1N1) 2009 influenza infection in humans can vary from mild to severe, with the most severe disease occurring mainly in known and emerging risk groups such as the immuno-compromised and pregnant women. Children with underlying medical conditions may also be at greater risk of severe illness or complications. Most illness from the pandemic influenza H1N1 virus (especially in children) to date has been relatively mild and self-limiting with most cases recovering quickly. As the H1N1 flu virus can spread easily among young people, PHAC has developed guidelines for K-12 schools as well as child care programs and post-secondary institutions to help reduce the risk of transmission within school settings. These guidance documents were prepared in consultation with provincial and territorial health authorities. [see www.phac-aspc.gc.ca/alert-alerte/h1n1/interim-provisoires0819- eng.php] The PHAC guidelines make recommendations on teaching students and school staff about proper handwashing and covering coughs and sneezes, disinfecting common surfaces, taking increased measures in isolating those who are ill, and reporting outbreaks to local public health authorities. On the issue of reporting it recommends that schools and child care programs should establish mechanisms to monitor pandemic (H1N1) 2009 influenza virus activity in their setting and processes for reporting staff and student/child illness above normal expected absenteeism levels to local public health officials. In addition the guidelines make this recommendation on school closures: The Public Health Agency of Canada continues to recommend against the widespread proactive closure of schools. This measure may not be effective in preventing transmission, and the benefits of keeping schools open currently outweighs the risk of transmission in these settings. This recommendation will

continue to be reviewed based on the situation in Canada. PHAC does not recommend widespread proactive school closures, but in certain circumstances, the reactive closure of some schools might be necessary. This would be a local decision in accordance with provincial/territorial legislation. One situation where school closure might be considered is if the number of school absenteeism and/or staff shortages impacts the safety of school operations. In a Government of Canada news release issued in mid-august, Dr. David Butler-Jones, Canada s Chief Public Health Officer, said that schools, daycares and post secondary institutions can play a critical role in our pandemic response. Keeping schools open is an excellent way to educate and inform students and their families, minimize the impact of the virus on society and the economy, and it offers a good environment to administer the pandemic vaccine. [see www.phac-aspc.gc.ca/media/nr-rp/2009/2009_0819-eng.php] Any decision to use schools as mass vaccination sites (polling suggests that about 60% of Canadians may want pandemic flu shots) would need to consider the impact this would have on school settings and operations. The government expects to have vaccine ready for clinical trials by late September or early October, and to begin immunization in November. PHAC notes that those who need the vaccine most will receive it first, and that decisions around priority groups will be made closer to the time when the vaccine is available based on what is known about H1N1. Among the factors being considered in developing vaccine priority groups are the characteristics of the illness and the vaccine, its spread and severity among different populations and the logistics of administering the vaccine. Federal guidelines are expected in the coming weeks. H1N1 & pregnancy PHAC has also developed information on pregnancy and the H1N1 flu virus [see www.phac-aspc.gc.ca/alert-alerte/h1n1/pregnancy-grossesse-eng.php]. While pregnant women are not more likely to get the flu, if they do catch the H1N1 flu virus, they are more likely to suffer complications, like pneumonia and severe respiratory distress, which can put both mother and baby s health at risk. Severe complications from the flu could lead to early delivery or miscarriage. As the risk of complications is greater in the second and third trimesters of pregnancy, early treatment can help reduce this risk. In order to protect their health it is important for pregnant women to practice basic infection control, consider avoiding crowds, know what to look for regarding H1N1 flu virus symptoms, talk to a medical professional if they have flu-like symptoms and seek care if symptoms worsen. The H1N1 flu virus can be treated with drugs called antivirals such as Tamiflu and Relenza, both of which can be used for the treatment of influenza in pregnant women. Recent scientific evidence suggests Tamiflu may be more effective. A medical professional will decide if anti-virals are necessary, but in order to be effective, they must be administered within 48 hours of the onset of symptoms. PHAC doesn t recommend that pregnant women avoid going to work or community social events if they are healthy. In other crowded situations that cannot be avoided, extra precautions should be taken such as frequent handwashing to avoid picking up the virus.

Public health authorities in Quebec are recommending that pregnant women working in daycares, schools and hospitals take advantage of the provincial government s early maternity leave program to reduce the risk of catching the H1N1 flu virus; the provincial workplace, health and safety board (Commission de la santé et de la sécurité du travail) currently administers the Programme pour une maternité sans danger for pregnant women to qualify for early or preventive maternity leave, a doctor s certificate is required [ Early maternity leave urged to lower H1N1 risk; Recommended for women who work in daycares, schools and hospitals, The Gazette (Montreal), Sept. 3, 2009 -- www.montrealgazette.com/health/men/early+maternity+leave+urged+lower+h1n1+risk/ 1957054/story.html] The bulletin issued by the Quebec Ministry of Education in late August to school boards, CEGEPs, universities and private teaching institutions states that the schools thus do not have to automatically put all their pregnant employees on preventive leave. Rather, they should suggest that these employees consult their doctors, in accordance with the current procedure for pregnant workers who wish to benefit from the Safe Working Conditions for a Safe Maternity Experience program. [www.mels.gouv.qc.ca/sections/publications/publications/sica/bulletineducationgrippe A_H1N1_2009-08-28_a.pdf] Responses by provincial/territorial governments, school boards Provincial and territorial governments across the country have posted information on the H1N1 flu virus on their respective websites news releases, fact sheets, tool kits for schools, surveillance and monitoring activities, and pandemic response plans (see section on Resources below). Many school boards are working closely with public health authorities to monitor the H1N1 situation and provide updates on new developments (including tracking spikes in flu-related student and teacher absences). For example the Edmonton Public School Board as part of its Pandemic Response Plan has put in place the following strategies [www.epsb.ca/h1n1/index.shtml]: Schools and district buildings are posting signs asking people not to enter if they are experiencing flu-like symptoms. Pandemic kits are being distributed to schools to help establish sick rooms should students and staff become ill at school. Schools are reviewing with students proper handwashing and infection control practices such as sneezing and coughing in the sleeve. The daily tracking of student and staff absences will continue. Parents will now be asked to provide information about the reason for their child s absence such as an illness, injury or a medical/dental appointment. This information will help Alberta Health Services track the flu in our schools. We are encouraging all parents to develop family pandemic plans. This should include planning for your child s care if you or they become ill with the virus. Consider now who might be able to help you.

CTF Member organization responses to H1N1 concerns YTA reports that its territorial school board/department has provided a Checklist and Toolkit for administrators which they are busy using in their early/opening school assemblies (one of which has received broad media coverage). The Employer (YTG Public Service Commission) has offered to advance an additional 5 instructional days sick leave and personal needs leave as required for becoming sick with the flu. Any advance of sick or special leave would be recouped in the usual ways. The additional sick leave covers the employee in the event they become ill; the special leave is for the teacher to care for dependents. ETFO is not aware of any public board in Ontario that has advised pregnant teachers to stay away from work due to H1N1 concerns. Staff are advising locals that members concerns should be dealt with on a case by case basis. ETFO has posted guidance for members on its website (www.etfo.ca). OECTA has directed its unit presidents to hold discussions with their boards on a number of aspects of H1N1. Specifically for pregnant teachers, OECTA is taking the position that they be accommodated to a limited-exposure setting or that the use of work refusals will be utilized in the event of any student exhibiting signs of the flu. MTS reports that Manitoba Education has no specific policy on H1N1 and pregnant teachers. MTS has advised members to consult their doctor and has information on its website. School divisions in Manitoba are being asked by the government to complete their pandemic plans (outlining how organizational issues will be addressed in the event of a pandemic) by early September. The government has also forwarded information about H1N1 to all school principals and superintendents. In New Brunswick the NBTA reports that the Department of Education has sent out information kits to all schools in the province outlining the Department s plan concerning the possible outbreak of the H1N1 virus. As of now, there are no specific plans to close schools (unless an outbreak is identified or staff is unavailable to provide services), or to remove pregnant teachers from the classroom. Teachers have been asked to visit the NBTF web site frequently to receive updated information on this issue. The Federation will monitor the situation closely and advise teachers accordingly. NLTA also reports that currently there are no specific plans to close schools (unless an outbreak is identified or staff is unavailable to provide services), or to remove pregnant teachers from the classroom. In addition the Public Service Secretariat in Newfoundland/Labrador is undertaking the development of an All Hazards Human Resource Plan for Government to address human resource issues, develop human resource policies, and provide advice and guidance from an HR perspective to all Government departments, agencies and boards during an emergency or disruption (including a potential pandemic). While this initiative began a few months ago, it has been given some urgency due to the threat of an H1N1 influenza pandemic and its potential impact on public services. The Secretariat has invited all of its public sector unions to participate in discussions leading to the establishment of a Good Neighbour Protocol i.e. a framework for the employers and unions to enable them to work in partnership to address HR issues during an emergency event. This is the first in a series of CTF information pieces on elementary/secondary schools and the H1N1 flu virus that will be produced as this issue evolves.

Resources Ontario quick facts about H1N1; Ontario s health plan in the event of a flu pandemic http://www.news.ontario.ca/opo/en/2009/09/ontario-kids-learn-abcs-about-h1n1.html B.C. pandemic response framework in preparation for a possible resurgence of the H1N1 flu virus in B.C. schools this fall; pandemic plan includes new information and materials for parents, students and schools http://www2.news.gov.bc.ca/news_releases_2009-2013/2009educ0006-000250.htm Alberta H1N1 flu virus surveillance; information on virus including Alberta s pandemic response plan http://www.health.alberta.ca/ http://www.health.alberta.ca/health-info/pandemic-influenza.html Saskatchewan H1N1 information including Saskatchewan s Public Pandemic Influenza Response Plan http://www.health.gov.sk.ca/influenza-flu http://www.health.gov.sk.ca/influenza-monitor http://www.health.gov.sk.ca/pandemic-planning http://www.health.gov.sk.ca/default.aspx?dn=351caf7c-af8c-46ba-892b-2f9ab5e2489b Manitoba information about H1N1 flu virus for schools as well as pandemic influenza preparedness guidelines for Manitoba schools and school divisions http://news.gov.mb.ca/news/index.html?archive=&item=6458 http://www.gov.mb.ca/health/documents/pandemic_school.pdf Nova Scotia information on H1N1 for P-12 schools including an influenza tool kit for school administrators http://gov.ns.ca/stayinformed/h1n1.asp http://www.ednet.ns.ca/h1n1_toolkits.shtml New Brunswick H1N1 surveillance activities in the province; fact sheets; advice from Chief Medical Officer of Health http://www.gnb.ca/cnb/promos/flu/index-e.asp Newfoundland & Labrador surveillance protocols and H1N1 information for the public and health professionals http://www.health.gov.nl.ca/health/hsi/default.htm http://www.health.gov.nl.ca/health/hsi/h1n1.htm PEI public health alerts; Pandemic Influenza Contingency Plan for the Health Sector http://www.gov.pe.ca/health/index.php3?number=1021139&lang=e http://www.gov.pe.ca/photos/original/influenza121806.pdf Quebec information on H1N1 flu virus incl. education bulletin on the virus and pregnant women working in schools http://www.pandemiequebec.gouv.qc.ca/en/news/news.shtml http://www.mels.gouv.qc.ca/sections/publications/publications/sica/bulletineducationgri ppea_h1n1_2009-08-28_a.pdf http://www.pandemiequebec.gouv.qc.ca/en/effects/maternite.shtml

NWT resources for schools, general public, employers http://www.hlthss.gov.nt.ca/english/services/communicable_disease_control_program/h1 n1.htm http://www.hlthss.gov.nt.ca/english/services/communicable_disease_control_program/h1 n1_resources_schools.htm Yukon news releases; fact sheets; information for schools http://www.hss.gov.yk.ca/programs/nursing/health_officer/swine_influenza/ Nunavut H1N1 flu virus updates http://www.gov.nu.ca/english/news/ http://www.gov.nu.ca/news/2009/aug/aug5.pdf World Health Organization. Measures in school settings. Pandemic (H1N1) 2009 briefing note 10. http://www.who.int/csr/disease/swineflu/notes/h1n1_school_measures_20090911/en/