Colorado State University’s Response to the H1N1 Virus

Every year, administration, staff, and students struggle to prepare for a new school year.

However in the fall of 2009, this struggle was amplified by the sudden spread of H1N1 around the world. Recent polls and studies suggesting a great outbreak of the infection in individuals between the ages of 16 and 24 has made universities even more conscious of the gravity of this pandemic and the affect it may have on a school’s ability to function. (1) Also, the close relationships and interactions between large numbers of students, faculty, and staff on college campuses have raised awareness about the high risk of contraction due to poor hygiene practices.

This recent pandemic has gripped many universities in North America and the dangers and threats posed by the virus have led the administrators to seek new ways of dealing with this grave situation. This recent pandemic threatening the lives of more than 25,000 students and hundreds of faculty and staff at Colorado State University, and lack of a definite “formula” as a defeating factor against the H1N1 flu has caused the University’s administration to implement new and original methods and ideas in combating this deadly outbreak. Colorado State

University is implementing methods like a web-based self-reporting database, student education, offering the H1N1 vaccine, and accommodations by faculty and staff to face this issue.

Influenza is a highly variable virus that can be classified as both pandemic and zoonotic.

(Suchman. Lecture. 28 September 2009) Since carriers of the virus range from mammals to birds, there are occasional cases where the Influenza virus is able to jump from animals to humans due to close contact between the infected individual organism and another species. For farmers, such as those in South America, where the H1N1 strain of influenza originated, contact between animals and humans is a frequent occurrence. (Callahan. Lecture. 26 August 2009) In undeveloped countries, farms are commonly within cities; therefore, the spread of the disease from a swine to a human male who was tending the farm was an easy avenue of transmission.

This is reinforced by the airborne route of transmission which Influenza follows. Because the virus is an infection of the respiratory tract, when an organism sneezes or coughs, Influenza exits through respiratory droplets. These droplets can be transmitted over a length of ten to twelve feet. The highly infectious rate of Influenza is due to the ability of the virus to segment its genome into eight different parts and then randomly assort its segments when the compromised host cell is used to assemble the virus’ parts. Due to Influenza’s variable nature, a host may become infected with more than one strain of the virus at once, allowing for even more variability of the composition of its genome. Influenza’s genome codes for two specific types of antigens that sit on the protein coat that protects the virus’ DNA, which are called “H” and “N” respectively. As the immune system responds by presenting the antigens and beginning to make antibodies against it, the specific “H” and “N” combination that is presented to the B cells - which in turn activate specific antibody-producing plasma cells - are matched with a very specific “lock and key” response from the T-helper cells. Antibody-antigen interactions also function in specific "lock and key" mechanisms, making one antibody ineffective at neutralizing a mutated strand of the virus. When Influenza changes its antigens due to antigenic shift, the immune system fails to continue proper neutralization and must begin the primary immune response to the virus all over again. (Suchman. Lecture. 28 September 2009)

In order to understand the importance of immunization as a preventative measure for the spread of the H1N1 virus, it is important to appreciate the history of the virus and its previous response to vaccines. The last known outbreak of H1N1 was documented in 1918, so the immunity that most individuals had to this virus is now very much gone from the population, effectively eliminating the herd immunity that is present against the more common strains of the virus. (Suchman. Lecture. 28 September 2009) Commonly, an Influenza outbreak is first documented in Australia, due to geographical position resulting in Australia being a season ahead of the rest of the continents. Therefore, the spontaneous jump from swine in Mexico to patient zero was unexpected, as no strain of H1N1 was documented in Australia during its flu season. (Callahan. Lecture. 26 August 2009) This unexpected strain had prompted a necessity for a vaccine against this strain of the virus, which has been produced very quickly and has not been tested thoroughly before it was reproduced in mass quantities. However, advances in medical technology have allowed doctors to provide a more effective form of vaccination rather than the typical “dead virus” vaccine that is presented for a majority of other viruses. A live virus that infects the host’s nose to allow for a response is now also available in a nasal spray form.

However, due to the highly infectious nature of Influenza, the H1N1 virus has been regulated to the dead virus form. There is some debate on how the vaccine must be tested. In the 1918 outbreak, H1N1’s mass-produced vaccine had reported cases of temporary paralysis and rarely caused massive paralysis that resulted in the death of recipients. (Suchman. Lecture. 28

September 2009) New technology and strict regulations from the Food and Drug Administration has increased the safety and effectiveness of the H1N1 vaccine in the present. These facts and recent reports from the Center for Disease Control has led the Colorado State University administration to conclude that the vaccine is a safe, useful, and effective preventative method for the spread of the virus and has made it available to students through the Hartshorn Health

Center. (1) However, as a result of the difficulty of acquiring the vaccine due to the small numbers being produced by pharmacological companies and the safety complications with the vaccine, Colorado State has chosen to implement alternative preventative measures. The main concern with the H1N1 is the fact that it is a new strain exposed to individuals, where normal preventative measures for seasonal flu, such as flu shots, are witnessed to be ineffective. The Colorado State administration is aware of a possible campus-wide outbreak, and is implementing preventative measures by first alerting faculty and staff. The efforts of the

University can be recognized by the use of residence assistants and front desk managers in

Residence Halls to distribute information on the possible campus wide pandemic. “H1N1: AKA

Influenza-A/Swine Flu” is a poster provided and created by Colorado State Housing and Dining to be displayed in all Residence Halls. The picture on the poster shows a man sneezing without covering his mouth, demonstrating the number of particles and their large trajectory. (Figure 1)

The two main points of the poster are prevention of obtaining the virus and caring if an individual becomes ill. The prevention section gives nine tips for sanitation and contact, while the care system lists the symptoms, four steps to recovery, and how to prevent the spread of the virus. Preventative measures that are listed on the poster are sanitary aspects, such as covering a sneeze with a tissue instead of the sick individual’s hand, washing hands often with soap or using hand sanitizer if available, and getting vaccinated when it becomes available to the college population. The poster then lists the protocol for when an individual becomes exposed to the virus. The Residence Halls provide a ‘flu-safe kit’ with hand sanitizer, a mask, cough drops, and a thermometer that is made available to residents at the building’s front desk. A sick individual can also fill out a ‘sick tray’ form, which allows a roommate or friend to pick up food from the dining centers for the individual. An online self-reporting system on RamWeb also lists the protocol for the ill, and is listed on the poster. The last point is that there is a voluntary self- isolation, and that the person should not return to class until 24 hours after the individual’s fever has subsided. (2) Along with the poster is a pamphlet titled “Pandemic Flu: Get Ready” provided by Ready Colorado and distributed by Colorado State Housing and Dining. The pamphlet provides information such as making a ‘ready kit,’ ways to stay healthy, and how a pandemic will affect daily life. The difference between the seasonal flu and a pandemic flu such as H1N1 is provided in a table in the brochure; the main concern with A-H1N1 is that this virus is a new virus being exposed to individuals and seasonal flu shots do not protect from this flu.

The brochure also includes a definition of novel H1N1, its originality, and its symptoms. (3)

Recent studies suggesting social distancing as an effective method of limiting the spread of viruses has caused the Colorado State University’s administration to implement a voluntary self-reporting website. (Ann Gill, Dean. Email. 09/09/2009 ) The university believes that the website will allow students and staff to remain at home and isolate themselves from other individuals as they begin to show symptoms of the flu. The website acts as a database that allows students to input data individually into the database and uses that information to provide useful reports to the staff and administration. The website assists the administration to make and modify their policies by reporting the number of infected individuals on a daily basis and keeps the data current as new students register themselves as sick or as they begin to get well enough to attend classes. The fact that the website is able to keep track of a student’s health condition and requires the student to report back to classes within ten days of reporting symptoms allows for the website to keep its information very current, making it a reliable source for statistics. (Rick Miranda,

Provost. Email. 09/11/2009) Other staff members, like professors and department heads, have also been able to use this device to implement new policies in classrooms, regarding attendance and material needed to be covered. (Bruce Ronda, Department Head. Email.09/14/2009) In email correspondence with the staff, the University recognizes “that the magnitude of possible student cases will surpass the Health Network’s ability to see students simply for the purpose of documenting medical absences” and, therefore, sees this online self-reporting device as an efficient way of monitoring the outbreak. (Rick Miranda, Provost. Email. 09/11/2009) The

University encourages the use of this device to reduce the workload at the Hartshorn Health

Center by allowing less time spent on confirming cases of the outbreak and freeing the health professionals to tend to more serious cases or refocusing the attention of the healthcare staff on preventative measures, like immunizations. Although the effectiveness of this self-reporting device has been debated by professors, school officials, and students, the administration insists upon its success as an effective preventative measure for the spread of H1N1 flu on the Fort

Collins campus. The University’s claim about the website’s effectiveness is somewhat supported by Hartshorn Health Center’s observation that laboratory testing to confirm cases of the H1N1 flu is not very accurate and most “clinicians are basing their diagnoses on clinical symptoms”, therefore, making it easier to confirm cases by having students report their symptoms online. (1)

The Public Safety Team at Colorado State University has made a tremendous effort to help infected students by teaming up with administration and heads of departments to help professors revise their class policies to accommodate these individuals during and after their battle with the H1N1 flu. The Administration has expressed that absences are to be “treated as the equivalent of a University sanctioned activity” as long as the student reports their symptoms on the self-reporting website ahead of time. (Bruce Ronda, Department Head. Email.

09/14/2009) The online self-reporting results in an automatic ten day excused absence, which can be extended if the student continues to have high fever or other symptoms of the flu. Emails and memos sent by the administration, the Public Safety team, and different departments at

Colorado State University have encouraged faculty members to change their policies on absenteeism in their class to allow sick students to catch up with the rest of the class when they recuperate from the H1N1 flu. (Rick Miranda, Provost. Email. 09/11/2009) The administration has also been very proud of their ability to use the self-reporting website to produce statistical data about the rate and numbers of outbreaks in a specific class, enabling a professor to redesign the course structure if a large percentage of the class becomes ill. The administration has also encouraged teachers to provide electronic versions of their notes and lectures, not only to allow infected students to keep up with the class materials, but also in case the teachers become ill themselves. The Administration recognizes a wide outbreak within the faculty as a huge threat to the school’s ability to function. This concern can be seen in recent emails sent by administration and communication within departments, which have aimed at educating teachers about ways they can avoid getting the virus and how to evade an interruption in the course by preparing their lectures ahead of time and identifying “another faculty member who could substitute for the instructor in case of illness and absence.” (Bruce Ronda, Department Head. Email.09/14/2009)

The University’s constant evaluation of the outbreak on campus has resulted in the recognition of the possibility of the virus interfering with school functioning and they have modified policies and procedures to “promote opportunities for faculty and students to complete the semester.”

(CSU Public Safety Team. Email. 09/21/2009)

In facing an issue that has no true solution, Colorado State University’s administration has recognized communication to be the key factor in combating the problem at hand. The

University recognizes that no single method is adequate to stop a wider spread of the H1N1 virus on the Fort Collins campus, and has, therefore, chosen to battle the outbreak by circling the issue from different directions. The University’s main goals seem to be education and communication surrounding the issue. The tight communication between the administration, students, faculty and staff, through emails, informative pamphlets and posters, and other mass audience media, has allowed the University to educate individuals on campus about the virus, how to avoid it, and how to deal with becoming infected with it. The University has also taken advantage of specific organizations and departments within its structure, like Hartshorn Health Center and Residence

Halls, to provide services and information to students and faculty. Due to the fact that Residence

Halls provide a high risk of spread because of the close quarters for individuals residing on campus, they have been a high priority for education on the subject of flu and prevention. The

Colorado State University Health Networks not only offer education on the subject of the H1N1 flu, but they also offer the University a new vector of attack in the battle against the virus by offering vaccines to students and staff as a preventative measure. The overall concern of the

University’s Administration for the wellness of the individuals on campus can be clearly detected in their tremendous efforts to combat H1N1. Annotated Bibliography:

(1) Health.Colostate.edu [Internet]. Fort Collins, CO: Colorado State University Health Network; c2009 [cited 30 September 2009] available from: http://health.colostate.edu/Index.cfm

(2) H1N1: AKA Influenza-A/Swine Flu [poster]. Fort Collins (CO): Colorado State University

Housing and Dining; 2009.

(3) Pandemic Flu: Get Ready [pamphlet]. Denver (CO): Ready Colorado; 2009.

Tiffany M. Corley, Jaycee V. Gaspar, Azin Kheirandish

Colorado State Universtiy, Fort Collins, Colorado, USA (T. Corley, J. Gaspar, A. Kheirandish)

These authors contributed equally to this piece. Figure 1. Image showing the resulting particles from an uncovered sneeze. The number of particles and the trajectory in this image shows how easily the virus can spread and in contrast how easily the spread can be prevented. This poster is referenced in the document.