Swine Flu Plan

Caring for a Sick Person at Home with the Swine Flu

If you are taking care of someone at home who has novel H1N1 flu, you should protect yourself and other people in thehousehold.

• Avoid being face-to-face with the sick person. When holding small children who are sick, place their chin on your shoulder so that they will not cough in your face.
• If close contact with a sick individual is unavoidable, consider wearing a facemask or respirator, if available and tolerable. For more information, see Facemasks and Respirators .
• Ask the person’s health care provider about any special care that might be needed, especially if the person is pregnant or has a health condition such as diabetes, heart disease, asthma, or emphysema.
• Ask the patient’s health care provider whether the patient or you, as the caregiver, should take antiviral medications.
• Keep the sick person away from other people as much as possible, especially others who are at high risk of complications from influenza.
• Make sure everyone in the household cleans their hands often, using soap and water or an alcohol-based hand rub.
• Ask your healthcare provider if household contacts of the sick person—particularly those contacts who may have chronic health conditions—should take antiviral medications such as oseltamivir (Tamiflu®) or zanamivir (Relenza®) to prevent getting the flu.
• Get medical care right away if the patient
  • Has difficult breathing or chest pain
  • Has purple or blue discoloration of the lips
  • Is vomiting and unable to keep liquids down
  • Shows signs of dehydration, such as feeling dizzy when standing, being unable to urinate, or (in infants) crying without shedding tears
  • Has seizures (for example, uncontrolled convulsions), or
  • Is less responsive than normal or becomes confused.

The first thing most people feel with the swine flu is a simple case of just “feeling bad”. That ‘yucky’ feeling of tiredness. The next clue is the start of a fever. Most cases have a higher temp, in the 101 – 102 range, but many cases have reported to have started with a low grade fever as well, around 100.

The funny thing about this illness is that not all those infected, get ALL the same symptoms. Most however, due have the following:

..

1) Tiredness and overall lazy feeling.

2) Fever.

Here is a list of other symptoms that are common:

• unusual tiredness,
• headache,
• runny nose,
• sore throat,
• shortness of breath or cough,
• loss of appetite,
• aching muscles,
• diarrhea or vomiting.

Should you go to the doctor?

The answer to this question is mixed.  Right now they are saying, YES, go to your Doctor and he may prescribe an anti viral drug such as Tamiflu.  It will often lesson the effects or shorten the duration if taken EARLY on.  However, as the season takes hold and hospitals are over run, the answer might change.

Most people will be instructed to stay home, and watch for respiratory issues. Those seem to be the only serious threat from the swine flu.

Some people say that the swine flu is mild, others say that theirs was the worst illness they have ever had. While it does not appear there are multiple strains out now, it does appear that each individual is affected differently.

If you are still concerned you may have swine flu, stay at home and check your symptoms using the online National Pandemic Flu Service.

Call your GP directly if:

• you have a serious existing illness that weakens your immune system, such as cancer,
• you are pregnant,
• you have a sick child under one,
• your condition suddenly gets much worse, or
• your condition is still getting worse after seven days (five for a child).

Taking Care of Yourself If You Are Sick

If you have been diagnosed with H1N1 (swine) flu, you should stay home, follow your doctor’s orders, and watch for signs that you need immediate medical attention.

• The Centers for Disease Control and Prevention (CDC) recommends that you stay at home until you have been free of fever (100°F or 37.8°C), or signs of a fever, for at least 24 hours, without the use of fever-reducing medication.
• Avoid close contact with others, especially those who might easily get the flu, such as people age 65 years and older, people of any age with chronic medical conditions (such as asthma, diabetes, or heart disease), pregnant women, young children, and infants.
• Clean hands with soap and water or an alcohol-based hand rub often, especially after using tissues or coughing/sneezing into your hands.
• Cover coughs and sneezes.
• Wear a facemask when sharing common spaces with other household members to help prevent spreading the virus to others. This is especially important if other household members are at high risk for complications from influenza. See Interim Recommendations for Facemask and Respirator Use to Reduce Novel Influenza A (H1N1) Virus Transmission.
• Drink clear fluids such as water, broth, sports drinks, or electrolyte beverages made for infants to prevent becoming dehydrated.
• Get plenty of rest.
• Get medical attention right away if you:
  • Have difficulty breathing or chest pain
  • Have purple or blue discoloration of your lips
  • Are vomiting and unable to keep liquids down, or
  • Show signs of dehydration, such as feeling dizzy when standing or being unable to urinate

Many schools and local public health centers will be giving the swine flu vaccine. There is also talk about pharmacies giving it at many locations.

THE HSE has identified about 80 locations across the country that could be used as mass swine flu vaccination centres.

Community centres and schools as well as HSE properties such as health centres, hospitals and clinics have all been proposed by local health managers as potential venues where the vaccine could be administered to large numbers.

The HSE said yesterday it was talking to GPs about its vaccination programme and that nurses and dentists would also be able to provide the vaccine to members of the public, which is to be offered to frontline healthcare workers and at-risk groups initially.

About 7.7 million doses of the H1N1 vaccine have been ordered from two companies by the executive, and it expects to get “regular supplies” of the vaccine by the end of next month.

Further details of the vaccination programme were revealed as the World Health Organisation (WHO) called on governments to boost pandemic preparations and responses. The WHO said the global spread of swine flu is likely to speed up and endanger more lives in the coming months.

“At a certain point there will seem to be an explosion in case numbers,” the WHO’s western Pacific director Shin Young-soo said. “It is certain there will be more cases and more deaths.”

The HSE has started a five-week radio and television public information campaign outlining swine flu symptoms, how the virus is transmitted, and hygiene practice.

“The biggest single message is that there is a lot people can do to prevent the transmission of flu viruses,” HSE national director of population health Dr Pat Doorley said. “Parents should teach children to protect themselves by covering up coughs and sneezes using tissues, then disposing of the tissues and washing their hands.”

To date, two people have died from swine flu in the State and some 1,800 new cases of the virus were presented to GPs last week, at a rate of 42.2 cases per 100,000 of population.

Dr Doorley said there had been a slight increase in the level of the virus in the community last week, with some 350 additional cases, but that he was hopeful this was a blip and that the virus had reached a plateau. “It is possible [the rate] might come down . . . but it’s hard to predict exactly what is going to happen.”

He said planning the vaccination programme was a serious logistical exercise as everyone will be offered two doses of the vaccine, which will have to be taken three or four weeks apart.

“We have to look at establishing clinics, the scheduling of appointments, how we identify at-risk groups, uptake, and recording of the vaccinations.”

Introduction

The U.S. Department of Health and Human Services’ (HHS) Centers for Disease Control and Prevention (CDC), with input from the U.S. Department of Homeland Security (DHS), has developed updated guidance for employers of all sizes to use as they develop or review and update plans to respond to 2009 H1N1 influenza now and during the upcoming fall and winter influenza season. Businesses and employers, in general, play a key role in protecting employees’ health and safety, as well as in limiting the negative impact of influenza outbreaks on the individual, the community, and the nation’s economy. Employers who have developed pandemic plans should review and revise their plans in light of the current 2009 H1N1 influenza outbreak to take into account the extent and severity of disease in their community as outlined in this guidance.²

Planning for Fall and Winter Influenza Season

Businesses may have already been impacted by the spring and summer outbreaks of 2009 H1N1 influenza affecting their employees. CDC anticipates that more communities may be affected than were in the spring/summer 2009, and/or more severely affected reflecting wider transmission and possibly greater impact. In addition, seasonal influenza viruses may cause illness at the same time as 2009 H1N1 this fall and winter. In response to the anticipated spread of 2009 H1N1 influenza, the CDC has revised its recommendations to assist businesses and other employers of all sizes.

The severity of illness that 2009 H1N1 influenza flu will cause (including hospitalizations and deaths) or the amount of illness that may occur as a result of seasonal influenza during the 2009–2010 influenza season cannot be predicted with a high degree of certainty. Therefore, employers should plan to be able to respond in a flexible way to varying levels of severity and be prepared to refine their pandemic influenza response plans if a potentially more serious outbreak of influenza evolves during the fall and winter. More people and communities are likely to be affected as influenza is more widely transmitted. The CDC and its partners will continuously monitor national and international data on the severity of illness caused by influenza, will disseminate the results of these ongoing surveillance and will make additional recommendations as needed.

Considerations of Appropriate Response Strategies

All employers must balance a variety of objectives when determining how best to decrease the spread of influenza and lower the impact of influenza in the workplace. They should consider and communicate their objectives, which may include one or more of the following: (a) reducing transmission among staff, (b) protecting people who are at increased risk of influenza related complications from getting infected with influenza, (c) maintaining business operations, and (d) minimizing adverse effects on other entities in their supply chains.

Employers should expect to see a wide range of disease patterns across the country. Employers should base their strategies and response to influenza outbreaks on local information from local and state public health authorities. Some of the key indicators that should be used when making decisions on appropriate responses are:

• Disease severity (i.e., hospitalization and death rates) in the community where business is located;
• Extent of disease (number of people who are sick) in the community;
• Amount of worker absenteeism in your business or organization;
• Impact of disease on workforce populations that are vulnerable and at higher risk (e.g., pregnant women, employees with certain chronic medical conditions that put them at increased risk for complications of influenza); and
• Other factors that may affect employees’ ability to get to work, such as school dismissals or closures due to high levels of illness in children or school dismissals.

Employers need to plan now to be able to obtain updated information on these indicators from state and local health departments in each community where they have a business presence and to respond quickly to the changing reality on the ground. Employers with more than one business location are encouraged to provide local managers with the authority to take appropriate actions outlined in their business pandemic plan based on the condition in each locality.

Preparedness and Response Recommendations

Planning for 2009 H1N1 and the 2009–2010 influenza season

This guidance is designed to help employers plan for and respond to two possible conditions: 1) a continuation of the current level of severity of influenza as was observed during the spring and summer of 2009 and 2) a more severe outbreak. The first situation is what is being experienced in some communities now—an outbreak of similar severity of 2009 H1N1 to the spring. However, even if the severity of the virus does not change, planners should expect that there will be more people who are ill in the fall and winter as 2009 H1N1 outbreaks coincide with the seasonal influenza season, and this level of absenteeism may impact business operations. A second situation involves an outbreak of greater severity including more people with severe illness and thus, more people hospitalized for influenza complications; more deaths from influenza; and a probable escalation of absenteeism.

Businesses should have an understanding of their normal seasonal absenteeism rates and know how to monitor their personnel for any unusual increases in absenteeism through the fall and winter. Business continuity planners should assess their essential business functions now to determine at what threshold of absenteeism those functions would be threatened if absenteeism escalates. Planners can then prepare to take more aggressive measures to protect continuity as absenteeism escalates towards those thresholds.

Even employers in communities that have not yet felt effects from 2009 H1N1 influenza should plan for an influenza outbreak this fall and winter, and be ready to implement strategies to protect their workforce while ensuring continuity of operations. During an influenza pandemic, all sick people should stay home and away from the workplace, hand washing and covering coughs and sneezes should be encouraged, and routine cleaning of commonly touched surfaces should be performed regularly. If the severity of illness increases, employers should be ready to implement additional measures while continuing to rigorously implement the interventions recommended for an outbreak similar to the spring/summer 2009 H1N1 outbreak. If severity increases, public health officials may recommend a variety of methods for increasing the physical distance between people (called social distancing) to reduce the spread of disease, such as school dismissal, child care program closure, canceling large community gatherings, canceling large business-related meetings, spacing workers farther apart in the workplace, canceling non-essential travel, and recommending work-from-home strategies for workers that can conduct their business remotely.

Please remember: employers should develop capabilities to respond to both scenarios and these two conditions serve only as a planning framework. Businesses and other employers should develop flexible capabilities to respond to either situation given the difficulties in accurately predicting the extent and severity of 2009 H1N1 as it unfolds during the 2009–2010 influenza season. Individual businesses may implement additional actions if they experience high absenteeism or business continuity is compromised. In addition, employers should be aware that other emergencies such as hurricanes or other natural disasters may happen during the fall and winter, creating additional challenging problems for businesses and communities.

Work with State and Local Public Health Partners
Coordination with state and local health officials is strongly encouraged for all businesses so that timely and accurate information can guide appropriate responses in each location where their operations reside. Since the intensity of an outbreak may differ according to geographic location, local public health officials will be issuing guidance specific to their communities. Also, businesses could work with public health and community leaders to explore ways of improving accessibility of vaccination for the workforce and in the community.

Keep Sick Workers Home

One of the best way to reduce the spread of influenza is to keep sick people away from well people. However, in the fall and winter, it will not be possible to quickly determine if workers who are ill have 2009 H1N1, seasonal influenza, or any number of other different conditions based on symptoms alone. Local and state health department surveillance information can be helpful to know when influenza is circulating in the community, although the availability, timeliness, and amount of local information on when influenza is circulating may vary substantially from community to community.

Workers who have symptoms of influenza-like illness³ are recommended to stay home and not come to work until at least 24 hours after their fever has resolved.⁴ Regardless of the size of the business or the function or services that you provide, all employers should plan now to allow and encourage sick workers to stay home without fear of losing their jobs. CDC recommends this strategy for all levels of severity. Employers should plan now for how they will operate if there is significant absenteeism from sick workers. However, employers should know that some persons with influenza, including those ill with 2009 H1N1, do not have fever. Therefore it will not be possible to exclude everyone who is ill with influenza from the workplace.

Be Prepared if Schools Dismiss Students or Child Care Programs Close

In some communities, schools may dismiss students and childcare programs may close, particularly if the severity increases. Officials will make these decisions to protect public health, but they will affect your business’s functioning, especially affecting absenteeism. Plan now to determine how you will operate if absenteeism spikes from increases in sick workers, those who stay home to care for ill family members, and those who must stay home to watch their children if dismissed from school. Businesses and other employers should prepare to institute flexible workplace and leave policies for these workers.
Actions Employers Should Take Now

• Review or establish a flexible influenza pandemic plan and involve your employees in developing and reviewing your plan;
• Conduct a focused discussion or exercise using your plan, to find out ahead of time whether the plan has gaps or problems that need to be corrected before flu season;
• Have an understanding of your organization’s normal seasonal absenteeism rates and know how to monitor your personnel for any unusual increases in absenteeism through the fall and winter.
• Engage state and local health department to confirm channels of communication and methods for dissemination of local outbreak information;
• Allow sick workers to stay home without fear of losing their jobs;
• Develop other flexible leave policies to allow workers to stay home to care for sick family members or for children if schools dismiss students or child care programs close;
• Share your influenza pandemic plan with employees and explain what human resources policies, workplace and leave flexibilities, and pay and benefits will be available to them;
• Share best practices with other businesses in your communities (especially those in your supply chain), chambers of commerce, and associations to improve community response efforts; and
• Add a “widget” or “button” to your company Web page or employee Web sites so employees can access the latest information on influenza: www.cdc.gov/widgets/ and www.cdc.gov/SocialMedia/Campaigns/H1N1/buttons.html

Important Components of an Influenza Pandemic Plan

• Be prepared to implement multiple measures to protect workers and ensure business continuity. A layered approach will likely work better than using just one measure.
• Identify possible work-related exposure and health risks to your employees. The Occupational Safety and Health Administration (OSHA) has developed tools to determine if your employees are at risk of work-related exposures and, if so, how to respond – (see www.osha.gov/dsg/topics/pandemicflu/index.html).
• Review human resources policies to make sure that policies and practices are consistent with public health recommendations and are consistent with existing state and federal workplace laws (for more information on employer responsibilities, employers should visit the Department of Labor’s and the Equal Employment Opportunity Commission’s websites at www.dol.gov and www.eeoc.gov).
• Allow employees to stay home if they are ill, have to care for ill family members, or must watch their children if schools or childcare facilities close.
• Explore whether you can establish policies and practices, such as flexible worksites (e.g., telecommuting) and flexible work hours (e.g., staggered shifts), when possible, to increase the physical distance among employees and between employees and others if local public health authorities recommend the use of social distancing strategies. Ensure that you have the information technology and infrastructure needed to support multiple workers who may be able to work from home.
• Identify essential business functions, essential jobs or roles, and critical elements within your supply chains (e.g., raw materials, suppliers, subcontractor services/products, and logistics) required to maintain business operations. Plan for how your business will operate if there is increasing absenteeism or these supply chains are interrupted.
• Set up authorities, triggers, and procedures for activating and terminating the company’s response plan, altering business operations (e.g., possibly changing or closing operations in affected areas), and transferring business knowledge to key employees. Work closely with your local health officials to identify these triggers.
• Plan to minimize exposure to fellow employees or the public if public health officials call for social distancing.
• Establish a process to communicate information to workers and business partners on your 2009 H1N1 influenza response plans and latest 2009 H1N1 influenza information. Anticipate employee fear, anxiety, rumors, and misinformation, and plan communications accordingly.

Over the past several years, HHS, CDC, DHS, OSHA, EEOC, and other federal partners have developed guidelines, including checklists, to assist businesses, industries, and other employers in planning for a pandemic outbreak. Review these resources to assist in your planning efforts: www.flu.gov/plan/workplaceplanning/index.html.

The recommendations that follow provide guidance on how employers can develop strategies and respond to two levels of severity. Local conditions will influence the decisions that public health officials make regarding community-level strategies; employers should take the time now to learn about plans in place in each community where they have a presence.

Recommended Employer Responses for the 2009-2010 Flu Season

Recommended Action Steps under Current Flu Conditions
(Similar Severity as in Spring/Summer 2009)

If the severity of illness in the fall and winter is similar to that observed in the spring and summer of 2009, the effects of 2009 H1N1 influenza may not have substantial impacts on absenteeism, though some increase in absenteeism over the spring season is anticipated. When larger numbers of people become ill, correspondingly larger numbers of people will become seriously ill and may require hospitalization.

Sick persons should stay home

• Advise workers to be alert to any signs of fever and any other signs of influenza-like illness before reporting to work each day, and notify their supervisor and stay home if they are ill. Employees who are ill should not travel while they are ill.
• CDC recommends that employees with influenza-like illness remain at home until at least 24 hours after they are free of fever (100° F [37.8° C] or greater), or signs of a fever, without the use of fever-reducing medications.
• Expect sick employees to be out for about 3 to 5 days in most cases, even if antiviral medications are used.
• Ensure that your sick leave policies are flexible and consistent with public health guidance and that employees are well aware of these policies.
• Talk with companies that provide your company with contract or temporary workers about the importance of sick workers staying home and encourage them to develop non-punitive leave policies.
• Do not require a doctor’s note for workers who are ill with influenza-like illness to validate their illness or to return to work, as doctor’s offices and medical facilities may be extremely busy and may not be able to provide such documentation in a timely way.
• Employees who are well but who have an ill family member at home with influenza can go to work as usual. However, these employees should monitor their health every day, and notify their supervisor and stay home if they become ill. Employers should maintain flexible policies that permit employees to stay home to care for an ill family member. Employers should be aware that more workers may need to stay at home to care for ill children or other ill family members than is usual.

Sick employees at work should be advised to go home

• CDC recommends that workers who appear to have an influenza-like illness upon arrival or become ill during the day be promptly separated from other workers and be advised to go home until at least 24 hours after they are free of fever (100° F [37.8° C] or greater), or signs of a fever, without the use of fever-reducing medications.
• Those who become ill with symptoms of an influenza-like illness during the work day should be:
  • Separated from other workers and asked to go home promptly. (For recommendations on personal protective equipment for a person assisting the ill employee see Interim Recommendations for Facemask and Respirator Use to Reduce Novel Influenza A (H1N1) Virus Transmission; www.cdc.gov/h1n1flu/masks.htm)
  • When possible and if they can tolerate it, workers with influenza-like illness should be given a surgical mask to wear before they go home if they cannot be placed in an area away from others.
• If an employee becomes ill at work, inform fellow employees of their possible exposure in the workplace to influenza-like illness but maintain confidentiality as required by the Americans with Disabilities Act (ADA). For more information on privacy issues, please refer to: http://www.flu.gov/faq/workplace_questions/equal_employment/index.html#PrivacyIssues. Employees exposed to a sick co-worker should monitor themselves for symptoms of influenza-like illness and stay home if they are sick.

Cover coughs and sneezes

• Influenza viruses are thought to spread mainly from person to person in respiratory droplets of coughs and sneezes. Provide employee messages on the importance of covering coughs and sneezes with a tissue or, in the absence of a tissue, one’s sleeve. Place posters in the worksite that encourages cough and sneeze etiquette.
• Provide tissues and no-touch disposal receptacles for use by employees.

Improve hand hygiene

• Influenza may be spread via contaminated hands. Instruct employees to wash their hands often with soap and water or use an alcohol-based hand cleaner, especially after coughing or sneezing. Place posters in the worksite that encourage hand hygiene.
• Provide soap and water and alcohol-based hand sanitizers in the workplace. Ensure that adequate supplies are maintained. If feasible, place hand sanitizers in multiple locations or in conference rooms to encourage hand hygiene.

Clean surfaces and items that are more likely to have frequent hand contact

• Frequently clean all commonly touched surfaces in the workplace, such as workstations, countertops, and doorknobs.Use the cleaning agents that are usually used in these areas and follow the directions on the label.
• No additional disinfection beyond routine cleaning is recommended.

Encourage employees to get vaccinated

• Encourage your employees to get vaccinated for seasonal influenza. For information on groups prioritized for seasonal influenza vaccines please, see http://www.cdc.gov/flu/protect/keyfacts.htm.
• Encourage your employees also to get vaccinated for 2009 H1N1 influenza when vaccines are available to them. Different groups are prioritized for 2009 H1N1 influenza than for seasonal influenza. For information on groups prioritized for H1N1 influenza vaccine please see http://www.cdc.gov/h1n1flu/vaccination/acip.htm.
• Offer opportunities at your worksite for influenza vaccination. Consider granting employees time off from work to get vaccinated if not offered at the worksite.
• Review the health benefits you offer employees and work with insurers to explore if they can cover the costs of influenza vaccination.

Take measures to protect employees who are at higher risk for complications of influenza

• People at higher risk for complications from influenza include pregnant women; children under 5 years of age; adults and children who have chronic lung disease (such as asthma), heart disease, diabetes, diseases that suppress the immune system and other chronic medical conditions; and those who are 65 years or older.⁷
• Inform employees that some people are at higher risk of complications from influenza and that if they are at higher risk for complications, they should check with their health care provider if they become ill. Early treatment with antiviral medications is very important for people at high risk because it can prevent hospitalizations and deaths.
• Encourage employees recommended for seasonal influenza vaccine and 2009 H1N1 vaccines to get vaccinated as soon as these vaccines are available. For information on groups prioritized for seasonal and H1N1 vaccines, please see http://www.cdc.gov/flu/protect/keyfacts.htm and http://www.cdc.gov/h1n1flu/vaccination/acip.htm.
• Employees who become ill and are at increased risk of complications from influenza and ill employees who are concerned about their illness should call their health care provider for advice. Their health care provider might want them to take antiviral medications to reduce the likelihood of severe complications from the influenza.
• See www.cdc.gov/h1n1flu/qa.htm for more information.

Prepare for increased numbers of employee absences due to illness in employees and their family members, and plan ways for essential business functions to continue.

• Employers should plan to monitor and respond to absenteeism at the workplace. Implement plans to continue your essential functions in case you experience higher than usual absenteeism. Elevated absentee rates can be due to sick workers, those who need to stay home and care for others, or from workers with conditions that make them at higher risk for complications from influenza and who may be worried about coming to work.
• Cross-train personnel to perform essential functions so that the workplace is able to operate even if key staff are absent.
• Assess your essential functions and the reliance that others and the community have on your services or products. Be prepared to change your business practices if needed to maintain critical operations (e.g. identify alternative suppliers, prioritize customers, or temporarily suspend some of your operations if needed).

Advise employees before traveling to take certain steps

• Advise workers to check themselves for fever and any other signs of influenza-like illness before starting travel and notify their supervisor and stay home if they are ill.
• Advise employees who will be traveling or on temporary assignment about precautions they may need to take to protect their health and who to call if they become ill.
• Employees who become ill while traveling and are at increased risk of complications from influenza and others concerned about their illness should promptly call a health care provider for advice.
• Ensure employees who become ill while traveling or on temporary assignment understand that they should notify their supervisor.
• If outside the United States, ill employees should follow your company’s policy for obtaining medical care or contact a health care provider or overseas medical assistance company to assist them with finding an appropriate health care provider in that country, if needed. A U.S. consular officer can help locate health care services. However, U.S. embassies, consulates, and military facilities do not have the legal authority, capability, and resources to evacuate or give medications, vaccines, or medical care to private U.S. citizens overseas.
• See CDC’s Travel Website (www.cdc.gov/travel) for more information for travelers.

Prepare for the possibility of school dismissal or temporary closure of child care programs

• Although school dismissals or closures of child care programs are not likely to be generally recommended at this level of severity, they are possible in some jurisdictions.
• Be prepared to allow workers to stay home to care for children if schools are dismissed or child care programs are closed.
• Strongly recommend that parents not bring their children with them to work while schools are dismissed.
• Ensure that your leave policies are flexible and non-punitive.
• Cross-train employees to cover essential functions.
• Read CDC’s Guidance for State and Local Public Health Officials and School Administrators for School (K-12) Responses, which can be found at www.cdc.gov/h1n1flu/schools/schoolguidance.htm, to better understand the conditions under which schools may be dismissed.

Under Conditions with Increased Severity Compared to Spring/Summer 2009

If 2009 H1N1 becomes more severe than during spring/summer 2009, absenteeism will likely be far greater, and additional protective measures to slow the spread of influenza may be considered. Check with your local health department for the extent and severity of disease activity in your community and for recommendations for necessary measures. Decisions about what tools should be used during a severe 2009 H1N1 outbreak should be based on the observed severity of the event; its impact on specific subpopulations; the need to protect workers; the expected benefit of the interventions; the feasibility of success of implementing these measures; the direct and indirect costs of different interventions; and the effects on critical infrastructure, health care delivery, and society. The following are measures that should be considered if influenza severity increases, and are meant for use in addition to the measures outlined above.

Consider active screening of employees who report to work

• If influenza severity increases, at the beginning of the workday or with each new shift, all employees should be asked about symptoms consistent with an influenza illness⁸, such as fever or chills AND cough or sore throat. If the severity or the impact of influenza increases, CDC recommends that persons with an influenza-like illness not come to work or travel and remain at home for at least 7 days, even if symptoms resolve sooner. Individuals who are still sick 7 days after they become ill should continue to stay home until at least 24 hours after symptoms have resolved. If influenza severity increases, CDC recommends that people stay home at least 7 days whether or not antiviral medications are used.
• Make sure your sick leave policies are flexible and consistent with public health guidance, and that your employees are aware of these policies.
• Do not require a doctor’s note for workers who are ill with influenza.
• Continue to advise workers to check for any signs of illness before reporting to work each day.
• Make contingency plans for increased absenteeism caused by illness in workers or illness in workers’ family members that would require them to stay home. Planning for absenteeism could include cross-training current employees or hiring temporary workers.

Consider alternative work environments for employees at higher risk for complications of influenza during periods of increased influenza activity in the community

• Employees with an underlying chronic medical condition or who are pregnant should consider calling their health care provider for advice about how to reduce their risk of exposure to influenza and, if they get sick, how best to get early treatment for influenza.
• If influenza severity increases and if influenza transmission is high in the community, employers may want to evaluate their work environment to see how they can reduce the number of people that high-risk employees come in contact with, such as exploring options for telecommuting from home (if feasible). Employers can also think about how workers at higher risk for influenza complications could be reassigned to duties that have minimal contact with other employees, clients, or customers. If these workers cannot be reassigned duties to reduce contact with others, are concerned about their ability to avoid influenza at the workplace, or will be in crowded conditions at work or while commuting to work, then consider allowing employees at higher risk for influenza complications to stay home from work.
• CDC recommends that ill workers at higher risk of complications from influenza seek early treatment if they become ill.
• See www.cdc.gov/h1n1flu/qa.htm for more information.

Consider increasing social distancing in the workplace

• If influenza severity increases, local public health officials may recommend that employers implement measures to increase the physical distanc between people in the workplace to reduce the spread of influenza. The goal should be for there to be at least 6 feet of distance between people at most times. This is not a simple or easy strategy and would typically require considerable flexibility. These measures may include avoiding crowded work settings, canceling business-related face-to-face meetings, spacing workers farther apart, canceling non-essential travel, increasing use of teleworking, and using staggered shifts to allow fewer workers to be in the workplace at the same time.⁹
• If appropriate for your type of business and feasible, review or develop policies for teleworking including an assessment of the capabilities and gaps of your current computer systems and availability of technical support. Take remedial steps if needed, and test your system in advance to assure it can handle an increase in remote users.
• Recommendations to increase social distancing may affect community functioning. Because supply chain issues may be affected, make sure you have plans for back-up suppliers.

Consider canceling non-essential business travel and advising employees about possible disruptions while traveling overseas

• If the severity of the outbreak worldwide increases in the fall or winter, public health officials may recommend social distancing strategies which include canceling non-essential travel and travel restrictions may be enacted by some countries which may limit the ability of employees to return home if they become ill while on travel status.
• If influenza severity increases, travelers should also be prepared for travel delays, health screenings, and other activities targeted towards travelers. Provide information to travelers about contingency plans and how their travel can be rebooked for these possible delays.

Prepare for school dismissal or closure of child care programs

• School dismissals and closure of child care programs are more likely at higher levels of severity. Be prepared to allow workers to stay home to care for their children if schools are dismissed or child care programs are closed. If dismissal is needed, schools are being advised to dismiss students for at least 5 to 7 calendar days or longer if necessary.
• Encourage employees who perform essential functions and who have children to plan for contingencies should local child care programs close or schools dismiss students.
• Be prepared for prolonged absenteeism if schools dismiss students for an extended time. Make sure your leave policies are flexible and non-punitive.
• Employers should strongly recommend that parents not bring their children with them to work while schools are dismissed.
• Implement flexible workplace policies like teleworking and staggered shifts.
• Cross-train employees to cover essential functions.
• Read CDC’s school guidance, which can be found at www.cdc.gov/h1n1flu/schools/schoolguidance.htm, to better understand the conditions under which schools may be dismissed.

Other considerations

• As part of their comprehensive pandemic planning, some public and private sector employers have stockpiled or otherwise arranged for influenza antiviral drugs to be available for their employees during a pandemic. To guide these efforts, HHS released guidance to businesses in 2008 entitled Considerations for Antiviral Drug Stockpiling by Employers in Preparation for an Influenza Pandemic (www.flu.gov/vaccine/antiviral_employers.html). See updated interim guidance on the use of antiviral agents for treatment and prophylaxis of 2009 H1N1 influenza infection at www.cdc.gov/h1n1flu/recommendations.htm.
• Employers should be aware that the severity of 2009 H1N1 influenza could change rapidly; therefore, local public health recommendations to communities and businesses could be revised quickly. Planners should identify sources of timely and accurate information so they are aware of changes to recommendations and can promptly implement revised or additional measures recommended by local public health officials.

Resources
Additional tools and guidance documents have been developed by the federal government to assist employers in their planning. These resources are available online at: www.flu.gov/plan/workplaceplanning/index.html.

One-Stop Access to U.S. Government Information on Pandemic Influenza
(www.flu.gov)

• 2009 H1N1 Influenza Information
  www.cdc.gov/h1n1flu/
• 2009 H1N1 Influenza Resources for Businesses and Employers
  www.cdc.gov/h1n1flu/business/
• Worker Safety and Health Guidance for a Pandemic
  www.osha.gov/dsg/topics/pandemicflu/index.html
• OSHA’s Guidance on Preparing Workplaces for an Influenza Pandemic
  www.osha.gov/Publications/influenza_pandemic.html
• CDC/NIOSH Occupational Health Issues Associated with 2009 H1N1 Influenza Virus
  www.cdc.gov/niosh/topics/h1n1flu/

¹ This guidance was developed for use by employers that do not provide health care services or have “high and very high exposure risk tasks and operations.”  Please see : https://www.osha.gov/Publications/influenza_pandemic.html#classifying_exposure for more information about levels of occupational risk and exposure. Special considerations need to be included for these employers. Resources for health care entities can be found at: http://www.cdc.gov/h1n1flu/clinicians/

² In 2006, to help businesses and employers with pandemic planning, the United States government (USG) created response stages to guide actions for state and local government and the private sector. Until the 2009 H1N1 influenza outbreak, the planning was based on the assumption that the next pandemic would start overseas and would be high in severity and therefore the stages served as a guide for planning and response. However, because of the unique characteristics of the 2009 H1N1 influenza outbreak, the stages will no longer be used as a planning and response framework.
³ Symptoms of influenza-like illness include fever or chills and cough or sore throat. In addition, symptoms of flu can include runny nose, body aches, headache, tiredness, diarrhea, or vomiting.
⁴ Fever is usually described as 100°F [37.8°C] or greater.
⁵ For more information about CDC’s recommendations for schools, see http://www.cdc.gov/h1n1flu/schools/schoolguidance.htm.
⁶ Symptoms of flu include fever or chills and cough or sore throat. In addition, symptoms of flu can include runny nose, body aches, headache, tiredness, diarrhea, or vomiting.
⁷ People older than 65 years of age and older are at lower risk of getting infected with 2009 H1N1 than younger persons. However, similar to seasonal influenza, when people 65 and older do get infected with 2009 H1N1, they are at increased risk of severe illness.
⁸ Symptoms of flu include fever or chills and cough or sore throat. In addition, symptoms of flu can include runny nose, body aches, headache, tiredness, diarrhea, or vomiting.

IHEs should tailor the guidance to account for the size, diversity, and mobility of their students, faculty, and staff; their location and physical facilities; programs; and student and employee health services. Decisions about strategies should balance the goal of reducing the number of people who become seriously ill or die from flu with the goal of minimizing educational and social disruption.

Although the severity of flu outbreaks during the fall and winter of 2009-10 is unpredictable, more communities may be affected than were affected in spring/summer 2009, reflecting wider transmission and possibly greater impact. CDC is working with state and local health departments to continually monitor the spread of flu, the severity of the illness it is causing, and changes to the virus. If this information indicates that flu is causing more severe disease than during the spring/summer 2009 H1N1 outbreak, or if other developments require more aggressive mitigation measures, CDC may recommend additional strategies. Since severity may vary from community to community, IHEs should also look to their state and local health officials for information and guidance specific to their location.

The recommendations below are divided into two groups: 1) recommendations to use now, during this academic year, assuming a similar severity to the spring/summer H1N1 flu outbreak, and 2) recommendations to consider adding if the flu begins to cause more severe disease.

Recommended responses to influenza for the 2009 – 2010 academic year

Recommended strategies under current flu conditions
(similar severity as in Spring/Summer 2009)

Facilitate self-isolation of residential students with flu-like illness

• Those with flu-like illness should stay away from classes and limit interactions with other people (called “self-isolation”), except to seek medical care, for at least 24 hours after they no longer have a fever, or signs of a fever, without the use of fever-reducing medicines. Some people with influenza will not have fever; therefore, absence of fever does not mean absence of infection. They should stay away from others during this time period even if they are taking antiviral drugs for treatment of the flu. (For more information, visit http://www.cdc.gov/h1n1flu/guidance/exclusion.htm .)
• Review and revise, as needed, policies, such as student absenteeism policies and sick leave policies for faculty and staff, that make it difficult for students, faculty, and staff to stay home when they are ill or to care for an ill family member,. Do not require a doctor’s note to confirm illness or recovery. Doctor’s offices may be very busy and may not be able to provide such documentation in a timely way.
• If possible, residential students with flu-like illness who live relatively close to the campus should return to their home to keep from making others sick. These students should be instructed to do so in a way that limits contact with others as much as possible. For example, travel by private car or taxi would be preferable over use of public transportation.
• Students with a private room should remain in their room and receive care and meals from a single person. Students can establish a “flu buddy scheme” in which students pair up to care for each other if one or the other becomes ill. Additionally, staff can make daily contact by e-mail, text messaging, phone calls, or other methods with each student who is in self-isolation.
• If close contact with others cannot be avoided, the ill student should be asked to wear a surgical mask during the period of contact. Examples of close contact include kissing, sharing eating or drinking utensils, or having any other contact between persons likely to result in exposure to respiratory droplets.
• For those who cannot leave campus, and who do not have a private room, IHEs may consider providing temporary, alternate housing for ill students until 24 hours after they are free of fever.
• Instruct students with flu-like illness to promptly seek medical attention if they have a medical condition that puts them at increased risk of severe illness from flu, are concerned about their illness, or develop severe symptoms such as increased fever, shortness of breath, chest pain or pressure, or rapid breathing.

Promote self-isolation at home by non-resident students, faculty, and staff

• Non-residential students, faculty, and staff with flu-like illness should be asked to self-isolate at home or at a friend’s or family member’s home until at least 24 hours after they are free of fever, or signs of a fever, without the use of fever-reducing medicines.
• Review, and revise if needed, sick leave policies to remove barriers to faculty and staff staying home when they are ill or caring for an ill family member. For students, consider altering policies on missed classes and examinations and late assignments so that students’ academic concerns do not prevent them from staying home when ill or prompt them to return to class or take examinations while still symptomatic and potentially infectious.
• Do not require a doctor’s note for students, faculty, or staff to validate their illness or to return to work, as doctor’s offices and medical facilities may be extremely busy and may not be able to provide such documentation in a timely way.
• Distance learning or web-based learning may help students maintain self-isolation.
• Visit http://www.cdc.gov/h1n1flu/guidance/exclusion.htm for more information on staying home while sick.

Considerations for high-risk students and staff

• People at high risk for flu complications who become ill with flu-like illness should speak with their health care provider as soon as possible. Early treatment with antiviral medications often can prevent hospitalizations and deaths. Groups that are at higher risk of complications from flu if they get sick include: children younger than age 5; people age 65 or older; children and adolescents (younger than age 18) who are receiving long-term aspirin therapy and who might be at risk for experiencing Reye’s syndrome after flu virus infection; pregnant women; adults and children who have asthma, other chronic pulmonary, cardiovascular, hepatic, hematological, neurologic, neuromuscular, or metabolic disorders such as diabetes; and adults and children with immunosuppression (including immunosuppression caused by medications or by HIV). People age 65 and older, however, appear to be at lower risk of 2009 H1N1 infection compared to younger people. But, if older adults do get sick from flu, they are at increased risk of having a severe illness.
• One of the best ways to protect against the flu is to get vaccinated against the flu. People under age 25 are one of the key groups recommended by CDC’s Advisory Committee on Immunization Practices (ACIP) to be among the first to receive the 2009 H1N1 flu vaccine. For more information, visit http://www.cdc.gov/h1n1flu/vaccination.
• Communicate with local health officials to determine where vaccine will be administered and to discuss the possibility of a vaccination clinic at the IHE.

Discourage campus visits by ill persons: Use a variety of communication methods such as e-mail, posters, flyers, and media coverage to discourage people with flu-like illness from visiting the campus or attending IHE events such as football games or concerts until they have been free of fever for at least 24 hours.

Encourage hand hygiene and respiratory etiquette of both people who are well and those that have any symptoms of flu: Emphasize the importance of the basic foundations of flu prevention: stay home when sick, wash hands frequently with soap and water when possible, and cover noses and mouths with a tissue when coughing or sneezing (or a shirt sleeve or elbow if no tissue is available).

Routine cleaning

• Establish regular schedules for frequent cleaning of high-touch surfaces (for example, bathrooms, doorknobs, elevator buttons, and tables).
• Provide disposable wipes so that commonly used surfaces (for example, doorknobs, keyboards, remote controls, desks) can be wiped down by students before each use.
• Encourage students to frequently clean their living quarters, including high-touch surfaces.

Considerations for specific student populations

• Review policies for study abroad programs, including accessing health services abroad and reporting illness to the IHE.
• Communicate plans, policies, and strategies to partner K-12 schools regarding “early/middle college” students, prospective student tours, and other K-12 students regularly on campus.
• Determine if special communication strategies are needed to meet the needs of students with disabilities.
• Remind health-care profession students to follow infection control guidance for health-care workers. Visit http://www.cdc.gov/h1n1flu/clinicians for guidance for health care settings.

Under conditions with increased severity compared to spring/summer 2009

CDC may recommend additional strategies to help protect IHE students, faculty, and staff if global, national, or regional assessments indicate that flu is causing more severe disease. In addition, local health or IHE officials may choose to use additional strategies. Although the following strategies have not been scientifically tested in the IHE setting, they are grounded on basic principles of infection control. Implementing these strategies is likely to be more difficult and to have more disruptive effects than the previously described strategies. These strategies should be considered if influenza severity increases and are meant for use in addition to the strategies outlined above.

Permit high-risk students, faculty, and staff to stay home when flu is spreading in the community

• If flu severity increases, people at high risk of flu complications may consider staying home while a lot of flu is circulating in their community. Such people should make this decision after consulting with their doctor.
• IHEs should plan now for ways to continue educating students who stay home through distance learning methods. IHEs should also examine policy accommodations that might be necessary such as allowing high-risk students to withdraw for the semester, tailoring sick leave policies to address the needs of faculty and staff, or modifying work responsibilities and locations.

Increase social distances:

• Explore innovative ways to increase the distances between students (for example, moving desks apart or using distance learning methods). Ideally, there should be at least 6 feet between people at most times.
• Consider whether to suspend or modify public events such as films, sporting events, or commencement ceremonies.

Extend the self-isolation period: If flu severity increases, people with flu-like illness should stay home for at least 7 days after the onset of their symptoms, even if they have no more symptoms. If people are still sick after 7 days, they should stay home until 24 hours after they have no symptoms. See information above for self-isolation in different types of housing.

Consider suspending classes

• IHE and health officials should work closely to balance the risks of flu in their community with the disruption that suspending classes will cause in both education and the wider community.
• Use multiple channels to communicate a clear message about the reasons for suspending classes and the implications for students, faculty, staff, and the community.
• Reactive class suspension might be needed when IHEs cannot maintain normal functioning.
• To decrease the spread of flu, CDC may recommend preemptive class suspension if the flu starts to cause severe disease in a significantly larger proportion of those affected than occurred during the spring/summer 2009 outbreak.
• If classes are suspended preemptively, large gatherings (for example, sporting events, dances, commencement ceremonies) should be cancelled or postponed.
• IHEs with only nonresidential students should consider whether they can allow faculty and staff to continue use of their facilities while classes are not being held. This may allow faculty to develop lessons and materials and engage in other essential activities.
• IHEs with residential students should plan for ways to continue essential services such as meals, custodial services, security, and other basic operations for students who remain on campus. When possible, dismiss students who can get home – or to the home of a relative, friend of the family, or host family – by private car or taxi. International students and others without easy access to alternative housing should stay on campus, but increase the distance between people as much as possible.
• The length of time classes should be suspended will vary depending on the goal of class suspension as well as the severity and extent of illness. IHEs that suspend classes should do so for at least five to seven calendar days. Before the end of this period, the IHE, in collaboration with public health officials, should reassess the epidemiology of the disease and the benefits and consequences of continuing the suspension or resuming classes.

Deciding on a course of action
CDC recommends a combination of strategies applied early and simultaneously. Strategies should be selected a) based on trends in the severity of disease, virus characteristics, feasibility, and acceptability and b) through collaborative decision-making with public health agencies, IHE faculty and staff, students, students’ families, and the wider community. CDC and its partners will continuously look for changes in the severity of flu-like illness and will share what is learned with state and local agencies. However, states and local communities can expect to see a lot of differences in disease patterns from community to community.

Every IHE has to balance a variety of objectives to determine the best course of action to help decrease the spread of flu. Decision-makers should identify and communicate their objectives, which might be one or more of the following: (a) protecting overall public health by reducing community transmission; (b) reducing transmission in students, faculty, and staff; and (c) protecting people with high-risk conditions. Some strategies can have negative consequences in addition to their potential benefits. The following questions can help begin discussions and lead to decisions.

Decision-Makers and Stakeholders
Are all of the right decision-makers and stakeholders involved?

• Local and state health, education, and homeland security agencies
• Campus health services and mental health services
• Campus emergency managers and security staff
• Student affairs and residential life staff
• Communications staff
• Physical plant staff
• Food services staff
• Students
• Faculty
• Community representatives
• Students’ families

Information Collection and Sharing
Can local or state health officials determine and share information about the following?

• Numbers of and trends in outpatient visits, hospitalizations, and deaths for flu-like illness
• Percent of hospitalized patients requiring admission to intensive care units (ICUs)
• Groups being disproportionately affected
• Ability of local health care providers and emergency departments to meet increased demand
• Availability of antiviral drugs, hospital beds, staff, ICU space, and ventilators for flu patients

What does the IHE know about the following?

• Student, faculty, and staff absenteeism rates
• Number of visits to the campus health service
• Bed availability for student self-isolation
• Severity of illness among affected staff and/or students

Feasibility
Do you have the resources to implement the strategies being considered?

• Funds
• Personnel
• Equipment
• Space
• Time
• Legal authority or policy requirements
• Communication channels

Acceptability
Have you determined how to address the following challenges to implementing the strategies?

• Public concern about flu
• People who do not feel empowered to protect themselves
• Lack of public support for the strategy
• Secondary effects of strategies (for example, job security, financial support, health service access, and educational progress)

The Swine Flu Plan Center is designed to give the average person an easy to use and easy to understand place for facts and information on the Swine Flu also known as H1N1.