During the 1918 flu pandemic, Harvard officials requested that professors report any suspicious coughers or sneezers. The university also canceled courses with more than 50 students and isolated likely cases in one dormitory. Between the start of classes and the Christmas recess that year, 227 patients with influenza flooded Harvard's 10-bed Stillman Infirmary, and five died within its walls.
With another strain of the H1N1 virus threatening to invade the cozy quarters of college campuses this fall, Harvard and other universities are making emergency plans. But swine flu seems to be much less virulent and deadly than the 1918 Spanish influenza, and university physicians say the big issue this time around will be containing its spread.
The Centers for Disease Control decided this week to include 19- to 24-year-olds (about 24 million additional Americans) in the first-priority group for the H1N1 vaccine, which will most likely become available in mid-October. Many of the worst cases have struck this age group, and college students are especially susceptible since they live, learn, and socialize in congested settings, according to Dr. Jim Turner, the president of the American College Health Association. "Outbreaks always seem to start in the university and bleed out into the community," he says.
Tom Skinner, a CDC spokesman, says the CDC raised the recommended age cutoff for the vaccine from 18 to 24 in order to limit the impact and spread of the virus. But until it becomes available, it's crucial that colleges and universities make their own plans to limit the spread of the virus, he says.
In Massachusetts, one of the biggest burdens for colleges is the Department of Public Health's mandate that patients be isolated for seven days after the onset of illness, according to Dr. David Rosenthal, the director of Harvard's university health services. "So, OK, where are we going to put them?" he says. Rosenthal hopes that the Department of Public Health will do away with the so-called "seven-day rule" before classes start since patients tend to "rapidly recover" within 48 hours.
To contain the virus, Harvard first plans to increase the number of beds in its Stillman Infirmary from 10 to 25. The next stage would involve finding beds in the neighborhood. Rosenthal says the university can accommodate up to 165 patients in buildings around Harvard Square. After that, isolation will get trickier.
Many larger state schools won't even try to separate the sick from the well. With upwards of 20,000 students, UVA doesn't have the space to isolate the infected, says Turner, who is also UVA's director of student health. Instead, students will be sent back to their rooms with masks and instructions on hand-washing.
But at smaller schools like Skidmore, a liberal arts college in Saratoga Springs, N.Y., that enrolls about 2,500 students, isolation still remains an option. If it becomes necessary to separate ill students on campus, Skidmore plans to house them in Wiecking Hall, a three-story dormitory with individual heating and cooling units in each room, so recycled air does not travel through the building. (Although hotels often feature such systems, fresh air is harder to come by on most college campuses.)
While not every college can provide isolated bedrooms with nonrecycled air, university dining services across the country are working on increasing hygiene this fall. Harvard is stocking up on Purell dispensers. Volunteer students at UVA will get meals from the dining halls and deliver them to their sick classmates. In the event that Skidmore has to cancel classes and close dining services, the college will distribute Meals, Ready to Eat (commonly known as MREs). Although Skidmore has not yet purchased MREs, food purveyors have assured the college that there will be plenty of prepackaged beef teriyaki and meatloaf to go around if the need arises.
Still, the ideal solution would be for relatives or friends to come and pick up sick students, university officials say. Skidmore has asked, for example, that students provide two "geographically distinct" places they could go in case of an emergency. And Skidmore also plans to recommend that students "self-quarantine" at home if they exhibit symptoms before returning from summer vacation. Falling behind in coursework shouldn't pose too much of a problem, university officials say. Skidmore and other colleges plan to provide "distance learning"—via online lecture videos and notes—for sick students.
Of course, the vaccination would avert most of these problems, and coming up with a plan to administer the vaccine is now at the top of his to-do list, says UVA's Turner. In the meantime, UVA is "preparing for a surge," Turner says. During a seasonal flu outbreak, the university typically sees about 300 to 400 students. But with the CDC estimating a 40 percent attack rate over the next two years, Turner says as many as 8,000 students—in two or three waves—could inundate the school's infirmary. To accommodate such numbers, health officials have arranged to triage students through a large conference room.
As the start of school approaches, university physicians are watching what's happening in the Southern hemisphere because "that's where the next wave of flu will come in," Rosenthal says. But already Rosenthal says he sees no comparison in terms of virulence between swine flu and its ancestor. "Yes, there are going to be a lot of people who are going to get the H1N1," Rosenthal says. "But I think the severity is not going to be anywhere like the 1918 pandemic."