College Campuses Prepare For Swine Flu

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With students back on college campuses, schools are planning for swine flu outbreaks. James Turner, president of the American College Health Association, describes some of the steps educational institutions are taking, from bolstering student health clinics to preparing large-scale vaccination campaigns.


You're listening to SCIENCE FRIDAY from NPR News. I'm Ira Flatow. It is a Labor Day weekend coming up. Hopefully, we'll be driving safely and carefully this weekend, and maybe you're one of these folks you see on the highways, you know, the station wagon, the van is loaded. It's full of clothing and luggage, and where are you headed? You're headed to take your kid back to college, right? You're going to a campus somewhere, but maybe along with the laptop and the luggage there may be some unwelcome guests who are driving along with you, and I'm speaking, for example, of viruses possibly.

The H-1-N-1 swine flu might be a passenger in your vehicle this week, which so far has produced relatively mild symptoms among people infected with it but which can spread very, very easily from person to person.

Surveillance reports released this week by the American College Health Association show over 1,600 reported cases of swine flu at 165 institutions it tracks, and this is just in the first week of reporting. So if your kid's going to college, or you're headed back to college yourself, what is your college doing about this, and what are colleges and universities doing to prepare for the winter season and the flu season?

Joining me now is James Turner. He's the president of the American College Health Association and executive director of the Department of Student Health at the University of Virginia in Charlottesville, Virginia. He joins us by phone from UVA. Welcome to SCIENCE FRIDAY.

Mr. JAMES TURNER (University of Virginia): Thank you, Ira. Thank you for having me, appreciate it.

FLATOW: You're welcome. Are you expecting an onslaught of the flu?

Mr. TURNER: Yes, yes, I am. You know, and I wanted to actually update the data that American College Health provided on Wednesday. We added 33 schools since then, and this is hot off the presses. So you're the first people to hear about this. But we're over 2,000 cases from 189 schools.

FLATOW: This just in, wow.

Mr. TURNER: Yeah, yeah, and so it's definitely on campuses. It's hitting predominately in the Southeast but some in the Northwest as well. Northeast, Midwest, mid-Atlantic has been spared thus far.

FLATOW: The Northeast, the Midwest and mid-Atlantic have been spared?

Mr. TURNER: Well, lower rates, lower rates.

FLATOW: Any reason why you might think that?

Mr. TURNER: You know, I just think the virus has yet to be introduced into those areas and been given an opportunity to spread. I was told that schools in the Southeast tend to start earlier, and we knew that there was a lot of H-1-N-1 in Georgia to begin with this summer. So I think probably a lot of Georgia residents were picking it up in their communities, going on to campuses, and then it just started spreading.

FLATOW: I see. So as director of the Health Student Program at UVA, what are you going to be doing? How are you physically preparing for this?

Mr. TURNER: Well, we've been preparing for pandemic since 2005. In fact, most people in college health have been. Fortunately, this isn't the avian flu. I mean, we were scared the avian flu would be the one to come and it would be killing people rapidly. That's not the case at all. This is, as you said earlier, a mild disease.

You know, it's kind of a three-pronged approached. One is you're preparing for a surge of clinical activity. Our health services are busy anyway, but as you can imagine, if you're on a college campus and there are campuses reporting 50 to 100 new cases every single day, you have to prepare your health service for that clinical surge.

You have to be able to provide phone triage with nurses. Your clinic needs to be able to absorb the additional cases by either increasing staff or increasing hours.

Aside from the clinical activities, education is key. I mean, those of us who work in college health consider ourselves to be educators. Our students tend to be pretty receptive to health information, and so one thing you do is try to get information in the hands of students about how they can prevent themselves from coming down with the infection: cough etiquette, hand hygiene, not sharing drinking glasses, that type of things.

FLATOW: I was in the DMV the other day, and I saw these notices posted all over the building, you know, about don't cough into your hands, things like that. Are those the kinds of things you can put up around campus?

Mr. TURNER: Yes, you know, posters. You put things on Web sites. Yeah, that's exactly what we're doing. and then the third thing is we're trying to figure out how we're going to give H-1-N-1 vaccine and seasonal flu vaccine to thousands of kids. Now, that H-1-N-1 isn't available yet, but I've got 21,000 students here. So we're talking 40,000 to 50,000 shots, and so that's a daunting task, but we're preparing for that as well.

FLATOW: And it's going to be a month after school starts, right, for the availability of the vaccine?

Mr. TURNER: Yeah, maybe even longer, Ira. They're saying 45 million doses by mid-October, but you know, I don't think college students will be recipients in that first group. It's going to be pregnant women, little children, people with chronic medical conditions and health care workers and emergency workers, and I think then as more vaccine rolls out, 10 or 20 million units a week, probably the vaccine will become available to college students sometime in, you know, mid-November, and honestly, we'll be through probably the first major wave of this, and we'll be facing a second wave in the winter, so…

FLATOW: Just in time for everybody to take it home for Thanksgiving.

Mr. TURNER: Thanksgiving, give it to grandma, granddad, yeah, absolutely.

FLATOW: Wow. Do you expect - this is a silly question, having kids this age myself - do you expect these college students to act responsibly about, you know, their hygiene and passing it around?

(Soundbite of laughter)

Mr. TURNER: Of course. You know, I do. I mean, I've been working with college students for 25 years. I have a tremendous amount of faith in them in terms of acting responsibly. We've been able to turn around binge drinking on our campus over the last nine years, and honestly, all we're talking about is washing hands and not sharing Solo cups when they go out partying, and I think they're going to listen. I do, and of course, this is getting so much media attention, I think they are going to listen to us.

FLATOW: I can see the response now: more beer. Because it has alcohol in it, that'll clean the glasses that way.

Mr. TURNER: The beer does not sterilize the glass, Ira.

FLATOW: Well, that's why I'm asking you this question.

Mr. TURNER: No. Take my word for it. It doesn't.

FLATOW: Or scotch or vodka or…

Mr. TURNER: None of those. None of those.

FLATOW: Yeah, I just wanted to make sure we covered that. But you've had, you know, cases of other viruses that have come through before, right? I mean, colleges are little factories where viruses spread. What's different about this?

Mr. TURNER: You know, well, that's a great question. I have never professionally - I've been practicing medicine since the mid-1970s, and I have not ever practiced during a pandemic, and we're used to seeing seasonal flu, but what this feels like, and I hope I'm not overstating it, but it feels more explosive.

With seasonal flu it kind of starts out slow, gradually builds up, lasts for four to six weeks and then kind of peters out. This is feeling, you know, faster, and I think the virus is much more transmissible, and because these young people have no natural immunity to it, we're seeing rapid, rapid transmission.

So it is feeling more explosive, but again just to reassure people, it remains a mild disease.

FLATOW: Let's go to Max in Richmond. Hi, welcome to SCIENCE FRIDAY, Max.

MAX (Caller): Hi, Ira, nice to be on.

FLATOW: Go ahead.

MAX: I just had a quick comment. I go to school in Richmond, and one of my classes is a once-a-week lecture, and so there was a strict attendance policy that was in the syllabus, but my instructor actually ended up canceling it, you know, to encourage us to stay away from class when one of us seemed to get the swine flu.

FLATOW: Is that going at UVA, too?

Mr. TURNER: Well, we actually are encouraging faculty to have very lenient attendance requirements in classes, and first of all excuse students who say they have swine flu and let them stay home, and faculty members are being encouraged to use distant learning techniques, over the Internet or whatever. And so that actually is a pretty good idea, and I would agree with that approach.

FLATOW: Good luck, Max.

MAX: Thank you.

FLATOW: Have a good semester. Let's go to Diane in Golden. I guess, is that Colorado?

DIANE (Caller): Yeah, it's Colorado, just west of Denver.

FLATOW: Nice place.

DIANE: Yeah, thanks, Ira. I had a question. The few people that I know who have had the flu recently have been told to stay home, stay away from the doctor's office. So I'm just wondering where this number of confirmed cases comes in. Who's getting tested? Who's doing the testing? You know, when do they decide to test somebody for H-1-N-1, and when do they just decide, you know, to keep them home and assume they have it? And I'll take my answer off the air.

FLATOW: Good question. Thank you, Diane.

Mr. TURNER: Diane, that's a great question, and you live in a beautiful area of the world. First of all, we have confirmed nationwide that the primary circulating flu virus is H-1-N-1, and so it is not necessary to test everyone who comes in with flu-like symptoms.

In fact, the CDC and health departments are recommending not testing. When a patient presents with typical symptoms of the flu - fever, body aches and sore throat and a cough - and they don't have another reason for that, doctors make the decision that this meets clinical criteria for a flu-like illness, and they make the diagnosis. This is standard practice that's been done for decades.

The way we're counting it in college health, is we're counting it by the students that we see in clinic and the students that we talk to over the phone who we manage over the phone. We can take a history over the phone and pretty much tell what they have. And that's the way we're counting those cases.

FLATOW: Now, when you get a case, does a, you know, a typical college campus have room for all these sick kids? I mean, in the infirmary? What do you tell them to do? Just stay in your room or what?

Mr. TURNER: Well, we tell them to stay in their room. There are no infirmaries. There's very few infirmaries nationwide. They're a dying breed. I would say the vast majority of schools do not have the flexibility of moving ill or even exposed students around, so we basically are instructing them to self-isolate in their dorm room, arrange for people to bring them food, try to find a place for their well roommate to crash. If there is no place, both of them wear masks and wash hands a lot. And that's pretty much what you do.

There are some schools that do have space. I know that Emory - I read Emory has a dormitory they're using. Harvard has an empty floor somewhere. And I think another school in Pittsburgh has got an empty sorority house. But most of the time, you don't have the luxury of moving people around.

FLATOW: Well, let's go to Jean(ph). Hi, Jean in Winston. Hi. Welcome to SCIENCE FRIDAY.

JEAN (Caller): Oh, hi. Yeah. This sounds very complex. I guess, you know, this virus will be mutating all the time, so the vaccines will always be kind of behind and kind of experimental. And I wondered - what about these rumors that we'll be required to be vaccinated or else relocated to some kind of interment camp? And if they did have this, can you have a religious exemption or something?

FLATOW: That must come in with the death panels rumor, somewhere.

(Soundbite of laughter)

FLATOW: Okay. Let me - Doctor, do you want to answer that?

Mr. TURNER: Well, you know, maybe there's a good use for Guantanamo after all.

(Soundbite of laughter)

Mr. TURNER: We'll send everyone down there. There is absolutely no requirement that people take the flu shot. CDC is saying this is totally voluntary program. So, I don't envision this being a requirement. There may be some hospitals or health care facilities that are requiring their employees to take it just so that they don't inadvertently expose patients. But there will be no requirement whatsoever. I'm going to get it, and I'm going to recommend my family get it, and all of our students; because I don't want to get the disease, and I don't want to place people in my family at risk of being exposed to the virus from me.

FLATOW: I would think that it's going to be some confusion with flu shots, because, you know, the other flu, right, the seasonal flu - where they have different set of recommendations. And then, there is the swine flu. And if you go to your local drugstore or a library where they're giving out the, quote, "the flu shot," there's a chance you might be confused about which shot you're getting.

Mr. TURNER: Excellent point.


Mr. TURNER: I think it's up to vaccine providers, and clinicians, and health departments, and the CDC to make it extremely clear who need shots and when. By the way, the seasonal vaccine is now being shipped and is available. And people who would normally get a seasonal flot(ph) - shot, can go to the doctor or the Health Department and get them right now. That would be a good idea.

FLATOW: You're listening to SCIENCE FRIDAY on NPR News.

I'm Ira Flatow talking with James Turner. And that would be one way about knowing which shot you're getting since the other shot is not going to be available sometime October or November. If you get the one now, you're getting the seasonal flu shot.

Mr. TURNER: That's exactly right.

FLATOW: Okay. Let's go to Cliff in St. Louis. Hi, Cliff.

CLIFF (Caller): Hi, there. Well, James makes a great point, earlier, about social responsibility, such a simple document as the Constitution. You have the right to, you know, to pursuit of life, liberty and the pursuit of happiness. And - but you don't have the right to diminish anyone else's pursuit. And if that means staying in and working hard on your homework and doing flashcards, and keeping yourself away from bars and those places where you can lower your resistance, because that's really what we're talking about, and then come back and be, you know, communicator of these things. I think that he's right on with that.

And I'm really amazed that he has thought out all the variations on how to give people different cups and how to diminish it while still acknowledging that college students are experimenting, and they are very social creatures.

FLATOW: All right.

CLIFF: I think that's a great thing that you're doing there, so I applaud you.

FLATOW: Thank you, Cliff. That's why he's there and we're here. 1-800-989-8255. Let's - how are you going to give that 40 or 50,000 shots, Dr. Turner?

Mr. TURNER: Well, you know - yeah.

(Soundbite of laughter)

Mr. TURNER: Well…

FLATOW: And don't say, very carefully, you know?

Mr. TURNER: Yeah. That's a good question. Now, we give - we have a seasonal flu vaccine clinic that we do once a year in early November. We've been doing it for years. We have a company that comes in with 25 or 30 nurses. And we can get 3,500 students in one day. So, we're going to do that 10 or 11 times this year. That's the way we're going to try to do it.

FLATOW: Is it more - is it a series or just one shot there?

Mr. TURNER: Well, at this point in time, they think the H1N1 vaccine will require two dozes, a primer dose and then a booster shot three to four weeks later.

FLATOW: Wow. So, you really have to be vigilant on this one.

Mr. TURNER: Yes, you do.

FLATOW: Let's go to Robert in the University of Arizona. Hi, Robert.

ROBERT (Caller): Hello.

FLATOW: Hi, there. Quickly, please.

ROBERT: Just real quickly. We really haven't heard much from our campus health and I'm the housing director for a local fraternity, and is there anything special that group housing should be doing?

Mr. TURNER: Yeah, Robert. Arizona is reporting six cases per 10,000 students out there, so it's lower than the national average. You know, hand sanitizer, encouraging people to wash hands, not sharing Solo cups - and that's code for not sharing beer cups, you know? Those are the key things right there.

FLATOW: But they - But Robert raises a good point. Maybe all the Greeks in the frat houses can do something by organizing.

Mr. TURNER: Absolutely. That's a great idea. Education is the way to go. CDC has got great information on their Web site that will help you.

FLATOW: Okay, Robert? Well, he's gone. Thanks for calling. 1-800-989-8255.

We got just a short time. So, when do you think the - you gird up your loins and wait for the big outbreak to happen now?

(Soundbite of laughter)

FLATOW: Is it going to be a week, a period, a peak time or is it now? Now, it will happen.

Mr. TURNER: Well, I'm not addressing my loins but…

(Soundbite of laughter)

Mr. TURNER: …we are at 32 cases and we're two weeks into the year. And if it's going to hit us hard, it's going to be in the next one to two weeks, I think. If not, it's just going to kind of dribble along.

FLATOW: Yeah. Okay. So this is the time to be careful, right?

Mr. TURNER: Yup.

FLATOW: Thanks for taking time to be with us.

Mr. TURNER: You're quite welcome, Ira.

FLATOW: We learned a lot. James Turner…

Mr. TURNER: It's a pleasure.

FLATOW: You're welcome. James Turner is president of the American College Health Association and executive director of the Department of Student Health at UVA, University of Virginia in Charlottesville, Virginia.

We're going to take a break and come back and change gears and talk about prostate cancer, some very interesting new research about whether - about how aggressive you should be in treating it. Whether there's something called wait, you know, watchful waiting is possible. Some interesting research, we'll talk about that when we get back.

Stay with us. We'll be back after this break.

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