As colleges nationwide welcome back students, they are also preparing for the return of an unwanted guest: H1N1 influenza, popularly called swine flu. The Centers for Disease Control and Prevention considers college students among several high-risk groups for this new strain of flu, and on Thursday the health organization released guidelines for how colleges should help prevent the flu’s spread.
The typically mild virus has been officially classified a global pandemic by the World Health Organization. And already this month, more than 50 students each at the University of Alabama at Tuscaloosa and Louisiana State University at Baton Rouge have reported flu-like symptoms to the universities’ student-health centers. Flu outbreaks were also reported at several colleges’ summer programs.
“College-aged students are particularly vulnerable to this virus, and they are not necessarily seeing a doctor on a regular basis,” said Kathleen Sebelius, U.S. Secretary of Health and Human Services, in a conference call with reporters Thursday. “A lot of them have not had regular vaccination updates. They need to be encouraged to not only take care of themselves, isolating themselves when they are sick, but also to take advantage of the vaccine when it becomes available.”
The health department has been promoting flu prevention to young adults through Facebook, Twitter, and other viral-marketing techniques, Ms. Sebelius said. College-age people are considered a priority group for receiving vaccinations when they become available this fall.
The CDC’s guidelines for colleges say sick students should isolate themselves until 24 hours after their fevers subside, in the absence of fever-reducing medication. The guidelines urge colleges to make it easy for students, and faculty and staff members with flu symptoms to miss class or work. They also ask colleges to consider offering alternative housing for sick students who live with roommates and to consider telling students who have medical complications putting them at high risk for severe cases of the flu to stay home or in their rooms during outbreaks.
Isolation Plans
Duke University, for instance, has left one of its student apartment complexes unfilled so students with high-risk factors like respiratory problems or weak immune systems can live there in the event of a flu outbreak. The university has been especially hard hit by the flu this summer.
Since football training camp began at Duke in early August, nearly half of the players have had sore throats, fevers, coughs, runny noses, and other symptoms of the flu. Many of Duke’s football players experienced symptoms for fewer than 12 hours, and all have now recovered and are back on the field, said Michael Schoenfeld, the university’s vice president for public affairs and government relations.
Duke also had to cancel one of its 60 or so summer programs for middle- and high-school students because of the flu, and another was cut short. Of 8,000 campers who attended programs at Duke in the last three months, about 70 came down with the flu, though it may not have been H1N1. Health officials no longer test people with flu symptoms to see whether they have that particular strain of the virus because it is generally treated the same as seasonal flu.
Some infected students at Duke this summer were sent home. Those whose parents could not drive to pick them up were sent to a residence-hall-turned-infirmary. “We communicated very frequently with the students and their parents,” he said. “The cases were very mild, consistent with seasonal flu, maybe even milder. Nobody was hospitalized.”
Duke’s situation this summer may serve as a warning of what’s to come. As students nationwide return to college, they are packing themselves by the thousands into dormitories that often lack air conditioning, feature communal showers, and breed close encounters.
“It’s clearly not a matter of if,” Mr. Schoenfeld said. “It’s a matter of when—and how much.”
Preparing for the Worst
Since last spring, the new H1N1 virus has infected an estimated more-than-one-million people in the United States. Health experts have stopped keeping an official tally because most people recover without seeking medical treatment.
On Thursday, federal officials said that the CDC would consider asking colleges to suspend classes only if flu outbreaks are more severe among college students this fall than they were in the spring and summer.
“We wanted to have a menu of options,” Ms. Sebelius said, “because what’s appropriate in Southern California may be a lot different from what colleges in Maine are looking at.”
The new guidelines also recommend that colleges publicize hygiene tips and ask students to clean their rooms frequently. Students with the flu who have been isolated should have a friend or caregiver bring them meals, the guidelines say.
In an interview, a CDC spokesman urged that colleges take precautions. “We need to prepare for the worst and hope for the best,” said Tom Skinner. “Colleges need to expect that novel H1N1 is going to be circulated on their campus, and they need to have a plan.”
An H1N1 vaccine should be ready for distribution in October, Mr. Skinner said. Colleges contacted by The Chronicle said that once shots are available, they plan to offer on-campus immunizations.
“We’ve talked with the health department about having them come to campus for immunizations,” said Michael Leonard, medical director for University Health Services at Binghamton University, part of the State University of New York system. Last year, he said, Binghamton had one confirmed case of H1N1. The student was isolated for seven days. Another student with flu symptoms was isolated for two days before medical tests showed that he did not have the new H1N1 virus.
Dr. Leonard said Binghamton updated its pandemic plan this summer because the previous plan was based on the deadly 1918 flu pandemic. “We had thought the next pandemic would have high mortality,” he said. But health officials at the university realized they needed more-flexible procedures that could be applied to less-severe outbreaks that have low mortality rates but could still shut down the university if enough people were infected.
Oakland Community College, in Michigan, recently updated its pandemic plan as well. Commuter colleges like Oakland face fewer challenges when dealing with flu outbreaks because, if an outbreak were bad enough, they could simply tell students to go home.
“What we don’t have is the dorm situation—we don’t have students living in mass,” said Terry McCauley, Oakland’s director of public safety. “The worst-case scenario for us is if we have to close down business.”
He said the college plans to send out several campuswide e-mail messages reminding students to wash their hands frequently, especially after sneezing or coughing. If the campus had to shut down, he added, the college could hold many classes online.
Dr. Michael Edmond, hospital epidemiologist for the Virginia Commonwealth University Health System, said the university hospital is stocking up on masks and gloves. “We’ve significantly increased our supply,” he said. “When you’re trying to plan for something like this, the just-in-time mentality doesn’t work anymore.”
He said hospital officials have been meeting all summer to work through logistical questions that could arise this flu season: Which employees should be vaccinated first? Should workers with medical conditions that make them more susceptible to the flu be prohibited from caring for flu patients? At what point should the hospital stop allowing visitors?
“There are many issues, but not a lot of answers,” Dr. Edmond said. “It’s totally unpredictable.”
