Task at hand: Flu-readiness

Sam Morris

Carmen Cruz updates Alejandro Rodriguez’s immunizations Friday at the Communities in Schools clinic at Martinez Elementary. The nonprofit organization will help the School District with a plan to vaccinate students against H1N1.

By Emily Richmond

Sunday, Sept. 20, 2009 | 2 a.m.

Sam Morris

Dr. Noah Kohn examines Christopher Hernandez at the Communities in Schools clinic Friday at Martinez Elementary School. Communities in Schools is a nonprofit organization among several such groups that will be assisting the Clark County School District with its plan to vaccinate students this fall against the swine flu virus.

Sam Morris

Medical assistant Carmen Cruz measures Alejandro Rodriguez at the clinic at Martinez Elementary.

In a state with one of the nation’s worst track records for childhood immunizations, the Clark County School District is strategizing how to provide motivation and opportunity for tens of thousands of students to be vaccinated against the H1N1 “swine flu” virus.

Clark County Schools Superintendent Walt Rulffes, who is in his 12th year with the district, said the effort far outpaces any similar preparedness activities during his tenure. The current activities also reflect greater collaboration with the Southern Nevada Health District, he said.

Plans call for voluntary flu vaccinations, with the district’s nearly 310,000 students able to, among other options, take advantage of free and reduced-cost vaccinations expected to be available at many campuses through the School District’s partnerships with public health agencies and nonprofit groups.

Private providers, such as pharmacies and physicians, will also be offering the vaccines.

The first round of vaccines will go to high-risk populations, which includes pregnant women, children older than 6 months and the elderly. School-age children and young adults up to age 24 are also considered priority groups.

Child care providers who work with infants — who are too young to be vaccinated themselves — are also at the top of the list.

As of Friday, 1,179 cases of H1N1 virus have been confirmed by the Nevada State Health Division’s lab, including 366 from Clark County. Each of the 11 reported swine-flu deaths in Nevada have been in Clark County. None was a child.

Nationally through August, more than 1 million people have been infected by the virus and 593 people — including 47 children — have died of the swine flu since it was first identified in the United States in April, according to the federal Centers for Disease Control and Prevention. Most of those children were school age, compared with previous flu seasons, when most children who died were not yet in school.

Among the measures being developed by the School District to confront swine flu are daily reminders for students to wash their hands frequently and cover their faces when they sneeze or cough, and protocols for staff when students show up with flu-like symptoms, including quickly isolating them. School nurses and first aid assistants will also be on the lookout for early signs of illness, said Diana Taylor, director of student health services for the district.

Schools are also confirming emergency contact information, so that students who need to go home don’t wait longer than necessary to be picked up by a family member.

The district provides schools with basic hygiene supplies, including hand sanitizer. Bottles can be found on most teachers’ desks, as well as in the front offices of many campuses.

In addition to educating students and parents about preventive measures, the district is expected to provide locations for wide-scale vaccinations, which will be carried out by the Southern Nevada Health District as well as private-sector nonprofit groups that have volunteered to help.

Even though the flu’s arrival has been anticipated for months, the School District is still fine-tuning how to conduct the vaccination campaign, said Charlene Green, the district’s deputy superintendent of student support services.

Unresolved, for instance, is how parental consent will be obtained. Will schools notify parents by letter about the hours of public clinics where they can get shots? Will parents be asked in letters to check a box if they don’t want their children vaccinated at school — and if parents don’t complete and return the form, will that be considered default permission to vaccinate?

Among the nonprofit organizations pitching in is Communities in Schools, which operates free-standing clinics at Cunningham and Martinez elementary schools and provides support services to dozens of other campuses throughout the Las Vegas Valley.

It has registered with the Nevada State Health Division to be a recognized provider of the swine flu vaccine and has requested 16,000 doses.

Dr. Noah Kohn, the organization’s director of health service, said he expects a significant number of parents to sign consent forms for their children to be vaccinated through the organization’s initiative.

“In my experience most parents want their children vaccinated,” Kohn said. “The barriers have typically been cost and accessibility, and we’re taking care of both.”

When the virus reached Clark County in the spring, there was concern the outbreak would be worse here because of the flow of tourists through town. But in fact, the local rate of infection is consistent with nationwide averages, health district spokeswoman Jennifer Sizemore said.

The swine flu has been declared a pandemic by the World Health Organization, a designation that refers to how widespread the disease is, not the level of risk.

This particular virus is affecting young children differently than previous flu viruses, according to government health authorities.

Children with neurodevelopmental disabilities — such as cerebral palsy and epilepsy — are particularly vulnerable. They have accounted for two-thirds of swine flu deaths, compared with a third of pediatric deaths in previous flu seasons.

Green said her office will closely monitor schools that serve students with severe physical disabilities, including checking for unusually high absentee rates that might suggest “a crisis situation.”

The spread of the flu could be partly fended off by holding classes outdoors — something the district is considering — because a virus can spread quickly in confined quarters, officials say.

But even if the flu is widespread, closing down an entire campus isn’t necessarily a good option.

Dr. Thomas Frieden, director of the Centers for Disease Control and Prevention, has said it doesn’t appear that closing schools significantly reduces the number of flu cases in a community. He has recommended that local and state officials weigh the potential loss of valuable class time for students — and lost wages for parents who lack emergency child care — against the possible benefit of fewer cases of flu.

If schools must be closed, districts should be ready with alternative means of instruction, federal education officials have advised.

But even though the School District has an expansive network of online instructional materials as well as the resources of Vegas PBS, there “aren’t enough minutes in the day to offer meaningful instruction” even if all of the available television channels were put into use, said Tom Axtell, general manager of Vegas PBS.

“It would be like having a substitute teacher drop in who is either a week ahead or a week behind,” Axtell said.

The online opportunities are also limited because about 30 percent of the district’s students don’t have regular access to computers with high-speed Internet connections, Axtell said.

Closing a school has other repercussions, such as how to provide federally subsidized free and reduced-price meal programs to students from low-income households who have come to rely on the breakfasts and lunches.

And it’s not just student absences that could trigger a school closure. The district is also looking at scenarios for mass staff absences that would prevent a campus from being able to safely operate, said Taylor, the district’s health services director. An outbreak among district bus drivers or food service workers, for example, would require significant countermeasures.

“There’s an infrastructure part of the equation we can’t get around,” said Taylor, a registered nurse. “We’re going to take our cues from health agencies and follow their recommendations and guidelines.”

Perhaps the toughest balance for the district will be to convey a sense of urgency to students, staff and parents without creating anxiety. Families will be receiving regular updates in the mail, on Vegas PBS, via the online ParentLink system and through automated telephone messages.