College preparing pandemic flu plan

Author: Ben Salkowe

Several weeks into the 1918 fall semester, a number of out-of-state students began to develop colds. The colds soon led to fevers and chills, but the symptoms did not initially raise alarm and there was little worry on the campus. Little worry until one of the students, Charles Thompson of Maplewood, N.J., became "severely prostrated" and died suddenly on Sept. 26. A week later a junior, Charles Dana Carlson of Peacham, Vt., died suffering the same symptoms.

By mid-October, local papers were reporting that the global epidemic of influenza, which would affect 25 percent of the U.S. population and kill 20-40 million people worldwide, had reached Middlebury.

Carlson was the first person at the College or in the town to perish from the 1918 Pandemic Flu. The administration responded by quarantining students and prohibiting them from leaving the campus. The quarantine was not unusual, as an English class of forty students had been locked in for three days earlier that spring, when Gertrude Burditt '19 gave them all scarlet fever.

Beyond the two young men, the College escaped the virus with minimal tragedy and student comments in The Campus described an effective health system. One female student complained to her mother, "since morning I have had six doctors."

Now, nearly nine decades after the influenza pandemic, College administrators are bracing themselves for the prospect that it could all happen again. But this time, with a global Middlebury community and a larger student population, the response in planning would abandon the quarantine approach. Instead, students would be given 24 hours to leave campus, dorms would be locked, and the College would shut down indefinitely.


Planning for a pandemic

It is late afternoon on a Friday and six members of the Emergency Planning Committee are gathered around a conference table in Old Chapel discussing the next pandemic. The administrators - including representatives from the academic program, Library and Information Services, College Communications and the President's staff - speak not in terms of "if," but "when."

"We have a pandemic every 30 to 50 years," says Director of the Health Center Dr. Mark Peluso. "This is overdue."

The committee is battling two dangerous misconceptions: that healthy 20-year-olds are less likely to suffer from an influenza outbreak, and that the best place to be with a global epidemic would be isolated Middlebury College.

The irony is that the 1918 pandemic flu most affected 20-40-year-olds with strong immune systems. The disease caused the body's immune system to overreact, leading to acute respiratory distress syndrome - victims literally drowned inside their own bodies as their lungs filled with fluid. Because the disease preyed on the immune system, those with stronger immune systems suffered more aggressive symptoms.

When the last pandemic flu struck, the world was in the midst of World War I and many college-age students suffered the disease in trenches and other military realms.

"These men start with what appears to be an ordinary attack of LaGrippe or Influenza, and when brought to the hospital they very rapidly develop the most vicious type of pneumonia that has ever been seen," said a World War I physician quoted in John Barry's The Great Influenza. "Two hours after admission they have Mahogany spots over the cheek bones, and a few hours later you can begin to see the cyanosis extending from their ears and spreading all over the face, until it is hard to distinguish the colored men from the white."

Now college administrators across the country worry that students packed in dorm rooms and dining halls could be a modern corollary to the young soldiers who suffered the 1918 pandemic in the barracks of World War I.

"Back then it wasn't so much the colleges as the military barracks," says Peluso. "Today we are the military barracks of 1918."

The other counterintuitive is that, however isolated, Middlebury could be one of the worst places to be in the event of a pandemic flu.

"The Middlebury community is an amazingly global community," says Secretary of the College John Emerson. "With all the people that study abroad, all the people that have contact with the summer Bread Loaf programs on four different campuses, our schools abroad and our international students traveling back and forth across the world, we are potentially at risk despite being in rural, isolated Addison County."

Compounding the risks of that global network are intense, regular interactions between members of the community on a regular basis.

"We all live together, we all eat together, we all go to classes together," says Peluso.

"The school population today is significantly greater than it was in 1918, causing greater and closer interactions between people and making it harder to isolate people and to find enough spaces to house any and all who might fall ill," says Susan Miranowski '07, a pre-med student working with Peluso and the Committee.

The 1918 pandemic flu went away as mysteriously and suddenly as it had arrived, leading health officials today to conclude that the best national strategy for responding to a pandemic outbreak would be to slow its spread while scientists attempted to find a vaccine and hoped it died off on its own.

But slowing its spread requires scattering dense populations, like communities of college students, before infection can occur.


Evacuating a campus

"The key concept is social distancing," explains President of the College Ronald D. Liebowitz in an e-mail. "Dorms, large dining halls, and classrooms do not promote this concept, and for this reason, we decided that closure would be the safest course of action."

Whereas the College in 1918 quarantined students and prohibited them from leaving the campus, the College in 2007 would implement an enforced evacuation if it faced a pandemic flu. The campus community would have 24 hours to evacuate, and the Committee suggested dorms would be padlocked to secure valuables and prevent students from returning.

"It's the opposite of what they did in 1918 in the sense that everyone would leave campus," says Miranowski. "But it makes sense under the changed circumstances."

Peluso expects the pandemic would enter the United States through a major port such as Los Angeles or New York, giving the College a limited amount of time to select a course of action, warn the community and implement an evacuation if necessary.

The most recent response protocols drafted for the Committee are based on a staged, six-level plan. At low risk levels where a pandemic flu was still abroad or only apparent in isolated cases within the United States, the College would remain open, limiting travel to affected areas and possibly postponing the arrival of visitors from those areas. As the Director of the Health Center, Peluso would monitor the pandemic situation and, if necessary, advise the campus of a possible closure.

But if the situation became more severe, with clusters of human-to-human transmission in the United States or even cases or pandemic in the immediate area, the College would cancel events and evacuate the campus. And the closure, according to the Committee, would not be a matter of days or even weeks, but more likely months or semesters.

"It's a hard thing to imagine actually happening," says Miranowski. "I've sort of come around to the feeling that this is the best and really only option."

The evacuation would be based on students implementing their own personal preparedness plans. These plans, which students will soon be required to have, include two possible locations they could get to and a strategy for how they would get there. Next week the College will notify students that in order to register for spring classes in November, they will be
expected to enter two evacuation plans into BannerWeb.

"Given the student body, it's probably the only way to get a response from everyone," says Miranowski about blocking course registration for students without plans. "It's a guarantee that everyone will have to be aware and involved."

The two plans students devise must be based on geographically distinct locations in case one is at the center of a pandemic flu or a student is unable to find transportation to a specific area. Parents will receive copies of the plans their student has entered, but the College will not check the validity of any personal preparedness plan.

"It is not a comfortable position for a college to be in," says Peluso, acknowledging that the College would essentially be leaving students on their own. "But we've looked at lots of other ways to do it and this is the best way. Students know what's best for them and they are in the best position to make their own plans."

Ultimately, the committee plans to work with Geography professors to design GIS systems that would allow them to identify major travel patterns and help students find rides. But the technical complications of such a system make it a long-term goal.

For now, the administrators hope they can inspire students to prepare, without raising unnecessary concern.

"It's a thin line to walk," says Emerson. "We don't want to alarm people and be alarmist. On the other hand we want people to be informed and smart and take this seriously."

"We may not have a pandemic for years," says Peluso, "but we'll have a plan and students will have plans."


The reality of the situation

Given the isolated nature of the College, the Committee is aware that telling students to flee the campus sounds counterintuitive. And given the length of time since the last pandemic, the Committee is also aware that the scenario they are planning for seems unlikely.

But they are convinced that a pandemic flu scenario is not so fantastic as it sounds.

"The public health officials told us to pay attention to this and plan for it," says Peluso, referring to a presentation he attended by U.S. Secretary of Health and Human Services Michael Leavitt. "This is an illness that affects young people who live in groups, so we are taking time away from other things to plan for it."

Middlebury was among the first schools to adopt an evacuation-based response plan for a pandemic flu. According to Peluso, schools like Dartmouth that have teaching hospitals, have more medical staff and resources to rely on before an evacuation would be imperative. Other schools with smaller endowments have more concerns to face from the financial implications of a long-term shutdown.

"Initially our strategy could have been viewed as extreme," says Liebowitz, "but now more schools are recognizing that evacuation would be the best course of action."

Coming off of the College's recent closure several weeks ago due to a blizzard, the planning is also addressing identified weaknesses in current emergency response systems.

"I'm not sure that we did that all that well," acknowledges Emerson about how the decision to shutdown the campus was reached on Feb. 14. "We weren't organized initially to do it in a way that was routine. There almost needs to be a recipe for what you do and how you do it, rather than having to sort that out on the fly through e-mail and telephone conversations.

Along with the pandemic flu scenario, the Committee now oversees other response plans for a wide array of emergency scenarios.

"What we're trying to do right now is figure out what questions need to be asked," says Emerson. "We're also planning for an ice storm, or a flood or a catastrophic failure of the communications system. But the one that's getting the most attention and pressure right now is definitely the pandemic flu."