Many Schools Unprepared For Next Pandemic

Reported by Tiffany Chao, M.D., and Shari Barnett, M.D., ABC News Medical Unit:

During the school day, you leave your children's health in the hands of the school nurse - but it's hard to know if they are prepared for everything. Some forms of preparedness training, like fire drills and tornado drills, are mandated in schools. Yet readiness for infectious outbreaks is surprisingly low. Fewer than half of U.S. schools are prepared for the next pandemic, according to new research.

Biosecurity researchers surveyed approximately 2,000 school nurses at elementary, middle, and high schools about their preparations for pandemics, like swine flu or SARS, and published their results on Thursday in the American Journal of Infection Control.

The results showed that since the swine flu pandemic in 2009, less than half of schools had updated their crisis plans or had developed a plan to address biological events. Only a third of schools had instructed children on how to protect themselves from infection, only a third had stockpiled personal protective equipment, and only half of schools coordinated their relief plans with local and regional agencies.

Almost no schools ever ran school disaster exercises that included infectious disease scenarios. And nearly one in four schools had no staff members who were trained in the disaster plan.

Study author Terri Rebmann, associate director for curricular affairs at the Institute of Biosecurity at Saint Louis University, said she believes more emphasis should be placed on planning for the next pandemic.

"Disaster preparedness - including planning for bioterrorism, pandemics, and outbreaks of emerging infectious diseases - is essential for all academic institutions," Rebmann wrote in the study. "It is vital that schools become more actively involved in disaster preparedness and coordinate these efforts with regional response agencies, to increase their ability to respond effectively to a future event."

Rebmann points out that although the Centers for Disease Control and Prevention (CDC) and the American Academy of Pediatrics have both released recommendations for disaster management for schools, there is limited data regarding their execution. In fact, until now, no study has examined whether these guidelines have been implemented in schools or included in school disaster plans, even though schools are important places for disaster preparedness.

"Schools are an important place for preparedness for pandemics," said Dr. Kristi Koenig, director of public health preparedness at the University of California at Irvine. "Not only do we need to protect our children, but those same children can learn how to prepare for disasters and bring this knowledge home to their families. This can be for all types of disasters whether it is a pandemic, hurricane, earthquake or terrorist attack."

Although many people think that schools should emphasize the basic tenets of disaster and pandemic preparedness, the reason for such common omissions may be that official recommendations are often impractical to implement. For example, the CDC recommends that schools consider participation in a community surveillance program. These school-based surveillance programs report numbers of students with flu-like symptoms, upset stomach, or absence rates to regional centers. Some experts in public health argue that these measures may be overkill.

"School-based syndromic surveillance, although highly popularized in recent years due to primarily bioterrorism related surveillance, has not been proven either very cost-effective, e.g., too many false alarms," said C. Ed Hsu, associate professor of public health informatics at University of Texas School of Public Health at Houston. "The return on investment of these syndromic surveillance systems is largely unknown."

Hsu argues that while the intent of the study is timely and relevant and the information is much needed, it may be difficult to draw specific policy recommendations from the study.

Nevertheless, author Rebmann does have a simple strategy suggestion for improving school disaster preparedness: get the school nurses involved.

"School nurses are the health professionals responsible for implementing policies and programs to prevent infection transmission in schools, and thus are those best able to inform school disaster planning committees on aspects of plan development that will affect infection transmission," she writes. "In addition, the National Association of School Nurses recommends that school nurses be involved in school disaster preparedness activities."