[House Hearing, 111 Congress]
[From the U.S. Government Publishing Office]
ENSURING PREPAREDNESS AGAINST THE
FLU VIRUS AT SCHOOL AND WORK
=======================================================================
HEARING
before the
COMMITTEE ON
EDUCATION AND LABOR
U.S. House of Representatives
ONE HUNDRED ELEVENTH CONGRESS
FIRST SESSION
__________
HEARING HELD IN WASHINGTON, DC, MAY 7, 2009
__________
Serial No. 111-19
__________
Printed for the use of the Committee on Education and Labor
Available on the Internet:
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COMMITTEE ON EDUCATION AND LABOR
GEORGE MILLER, California, Chairman
Dale E. Kildee, Michigan, Vice Howard P. ``Buck'' McKeon,
Chairman California,
Donald M. Payne, New Jersey Senior Republican Member
Robert E. Andrews, New Jersey Thomas E. Petri, Wisconsin
Robert C. ``Bobby'' Scott, Virginia Peter Hoekstra, Michigan
Lynn C. Woolsey, California Michael N. Castle, Delaware
Ruben Hinojosa, Texas Mark E. Souder, Indiana
Carolyn McCarthy, New York Vernon J. Ehlers, Michigan
John F. Tierney, Massachusetts Judy Biggert, Illinois
Dennis J. Kucinich, Ohio Todd Russell Platts, Pennsylvania
David Wu, Oregon Joe Wilson, South Carolina
Rush D. Holt, New Jersey John Kline, Minnesota
Susan A. Davis, California Cathy McMorris Rodgers, Washington
Raul M. Grijalva, Arizona Tom Price, Georgia
Timothy H. Bishop, New York Rob Bishop, Utah
Joe Sestak, Pennsylvania Brett Guthrie, Kentucky
David Loebsack, Iowa Bill Cassidy, Louisiana
Mazie Hirono, Hawaii Tom McClintock, California
Jason Altmire, Pennsylvania Duncan Hunter, California
Phil Hare, Illinois David P. Roe, Tennessee
Yvette D. Clarke, New York Glenn Thompson, Pennsylvania
Joe Courtney, Connecticut
Carol Shea-Porter, New Hampshire
Marcia L. Fudge, Ohio
Jared Polis, Colorado
Paul Tonko, New York
Pedro R. Pierluisi, Puerto Rico
Gregorio Kilili Camacho Sablan,
Northern Mariana Islands
Dina Titus, Nevada
[Vacant]
Mark Zuckerman, Staff Director
Sally Stroup, Republican Staff Director
C O N T E N T S
----------
Page
Hearing held on May 7, 2009...................................... 1
Statement of Members:
McKeon, Hon. Howard P. ``Buck,'' Senior Republican Member,
Committee on Education and Labor........................... 4
Prepared statement of.................................... 5
Miller, Hon. George, Chairman, Committee on Education and
Labor...................................................... 1
Prepared statement of.................................... 3
Statement of the National Partnership for Women &
Families............................................... 57
Statement of Witnesses:
Barab, Jordan, Acting Assistant Secretary for Occupational
Safety and Health, U.S. Department of Labor................ 26
Prepared statement of.................................... 28
Brockhaus, Ann, MPH, senior occupational safety and health
consultant, ORC Worldwide.................................. 34
Prepared statement of.................................... 35
Garcia, Miguel Antonio, R.N., BSN, for the American
Federation of State, County and Municipal Employees........ 31
Prepared statement of.................................... 32
Modzeleski, William, Associate Assistant Deputy Secretary,
Office of Safe and Drug-Free Schools, U.S. Department of
Education.................................................. 13
Prepared statement of.................................... 15
Additional material: ``Pandemic Flu and General Emergency
Management Resources''................................. 18
O'Connell, Jack, California State superintendent of public
instruction................................................ 22
Prepared statement of.................................... 24
Schuchat, Anne, M.D., Acting Deputy Director for Science and
Program, Centers for Disease Control and Prevention........ 7
Prepared statement of.................................... 10
ENSURING PREPAREDNESS AGAINST THE FLU VIRUS AT SCHOOL AND WORK
----------
Thursday, May 7, 2009
U.S. House of Representatives
Committee on Education and Labor
Washington, DC
----------
The committee met, pursuant to call, at 10:01 a.m., in room
2175, Rayburn House Office Building, Hon. George Miller
[chairman of the committee] presiding.
Present: Representatives Miller, Andrews, Woolsey,
Hinojosa, McCarthy, Kucinich, Wu, Davis, Grijalva, Loebsack,
Hare, Clarke, Courtney, Fudge, Tonko, Sablan, Titus, McKeon,
Castle, Platts, Hunter, and Roe.
Staff present: Ali Al Falahi, Staff Assistant; Tylease
Alli, Hearing Clerk; Catherine Brown, Education Policy Advisor;
Jody Calemine, General Counsel; Lynn Dondis, Labor Counsel,
Subcommittee on Workforce Protections; Carlos Fenwick, Policy
Advisor, Subcommittee on Health, Employment, Labor and
Pensions; Denise Forte, Director of Education Policy; David
Hartzler, Systems Administrator; Jessica Kahanek, Press
Assistant; Sharon Lewis, Senior Disability Policy Advisor;
Ricardo Martinez, Policy Advisor, Subcommittee on Higher
Education, Lifelong Learning and Competitiveness; Stephanie
Moore, General Counsel; Alex Nock, Deputy Staff Director; Joe
Novotny, Chief Clerk; Rachel Racusen, Communications Director;
Meredith Regine, Junior Legislative Associate, Labor; Margaret
Young, Staff Assistant, Education; Mark Zuckerman, Staff
Director; Stephanie Arras, Minority Legislative Assistant;
James Bergeron, Minority Deputy Director of Education and Human
Services Policy; Andrew Blasko, Minority Speech Writer and
Communications Advisor; Cameron Coursen, Minority Assistant
Communications Director; Ed Gilroy, Minority Director of
Workforce Policy; Rob Gregg, Minority Senior Legislative
Assistant; Richard Hoar, Minority Professional Staff Member;
Susan Ross, Minority Director of Education and Human Services
Policy; Ken Serafin, Minority Professional Staff Member; Linda
Stevens, Minority Chief Clerk/Assistant to the General Counsel;
and Loren Sweatt, Minority Professional Staff Member.
Chairman Miller [presiding]. The committee will come to
order. Today's hearing is on ensuring preparedness against flu
virus and school and work, and I want to welcome the witnesses
that will be testifying in a few minutes and all of the members
of the committee.
Just a couple weeks ago, the international health
organizations began warning of the potential of a pandemic
outbreak of H1N1 flu virus. To date, the Center in Disease
Control has confirmed 642 cases of H1N1 in the United States in
over 40 states, and two deaths, including the first adult
death.
Since the alarm was raised, this administration has acted
decisively and responsively to prevent spread of virus and to
prevent undo alarm among the American people. On Tuesday, after
more than 545 school closings that sent more than 341,000
children and 21,000 teachers and staff home, federal officials
recommended that schools with suspected H1N1 flu cases no
longer needed to close. This is good news.
Still, public health officials expect this virus will reach
all 50 states. Experts also warn that the H1N1 or other viruses
may hit harder and stronger by this coming fall. As we look
forward, we have an obligation to examine how this
unpredictable outbreak has tested school, childcare centers,
colleges, and workplaces. In many cases, our morphing public
health needs simply don't align with our education and business
needs.
Today's hearing gives us an opportunity to look at these
challenges while they are fresh and to determine what lessons
we can learn to prepare for future pandemics. This outbreak has
proven that a pandemic can have ripple effects throughout our
entire communities.
Many schools are still closed but preparing to reopen.
Colleges and childcare programs have also closed. Teachers and
faculties have to figure out how to maintain student learning
in the face of closures. There is also no one coordinated
system for reporting cases at schools.
Education agencies are currently tracking information
through country health officials, the CDC, and news reports.
There are no specific reporting requirements for districts. As
a result, agencies may not have the most complete information
about what is happening on the ground.
The ripple effect is evident in workplaces, too. Employers
and workers have questions about how to protect themselves,
their families, their businesses, and their jobs in the event
of a flu outbreak. While the Occupational Safety and Health
Administration has issued guidance and even has some specific
standards relevant to pandemic flu, it does not have a
mandatory comprehensive standard for protecting workers from
airborne transmissible diseases.
As we will hear more about today, this is especially
troubling for workers on the front lines of pandemics. If
nurses, doctors, or first responders and other health care
workers get sick, they can't treat flu victims or anyone else
in the community. If they believe their workplace is unsafe,
they may stay home to protect their own health.
Sufficient worker protections must be in place to ensure
that our health care system has the capacity to deal with
widespread viral outbreaks. We also want to know what measures
businesses are and should be taking to prepare for pandemic
outbreaks, including how to deal with sick employees.
Current federal leave policies only cover some workers.
Paid leave isn't required to ensure sick workers stay home, and
a situation where a working parent has childcare problems due
to school closures aren't covered.
Finally, we also need to examine what preventative actions
employers and employees should be taking, like providing
training on flu prevention, what businesses could do to keep
operating if a pandemic hits. Especially in this economy, it is
critical to ensure that students can keep learning, businesses
can keep providing services to our community.
I would again like to thank all of our witnesses for taking
the time out of your vital work in these areas to join us, and
I look forward to hearing from your testimony. I would like now
to recognize the senior Republican of the committee, my
colleague from California, Congressman McKeon.
[The statement of Mr. Miller follows:]
Prepared Statement of Hon. George Miller, Chairman, Committee on
Education and Labor
Good morning. Welcome to today's hearing on ``Ensuring preparedness
against the flu virus at school and work.''
Just a couple weeks ago, international health organizations began
warning of the potential of a pandemic outbreak of the H1N1 flu virus.
To date, the Center for Disease Control has confirmed 642 cases of
H1N1 in the United States in over 40 states, and two deaths, including
the first adult death.
Under President Obama's steady leadership, our government is acting
decisively, responsibly and aggressively to control the virus and
prevent undue alarm.
On Tuesday, after more than 545 school closings that affected over
341,000 children and almost 21,000 teachers and staff, officials
announced that schools no longer need to close due to confirmed cases
of swine flu.
That is good news.
However, officials still expect the virus to reach all 50 states
within days, and experts predict that H1N1 or another flu pandemic may
hit harder and stronger by fall.
In addition to its public health and safety risks, this pandemic
has also highlighted how transmissible diseases can affect a school, a
workplace, and families--including both their physical and financial
health.
As we look forward, we have an obligation to examine how this
unpredictable outbreak has challenged schools, childcare centers,
colleges and workplaces. In many cases, our morphing public health
needs simply don't align with our education and business needs.
Today's hearing will give us a critical opportunity to look at
these challenges while they're fresh and what lessons we can learn to
prepare for future pandemics.
This outbreak has proven that a pandemic can have a ripple effect
on our communities.
Many schools are still shut but are preparing to re-open. Colleges
and child care programs have also shut down.
These closures don't just affect the students, teachers, and other
staff--but families, coworkers, and surrounding communities.
Parents have to scramble to find last-minute child-care
arrangements for their kids--or take off work.
Teachers and faculty have to figure out how to maintain student
learning in the face of closures.
School districts, childcare facilities and colleges have to
coordinate closely with public health officials to make sound decisions
about suspected or confirmed flu cases.
It's a delicate balancing act between taking necessary safety
precautions without overreacting or igniting panic.
There is also no one coordinated system for reporting cases in
schools. Education agencies are currently tracking information through
county health officials, the CDC and news reports--but there are no
specific reporting requirements for districts.
As a result, agencies may not have the most complete information
about what's happening on the ground. State education and health
agencies have a role to play here.
The ripple effect is evident in workplaces too.
Both employers and workers have questions about how to protect
themselves, their families, their businesses, and their jobs in the
event of a flu outbreak.
While the Occupational Safety and Health Administration has issued
guidance and even has some specific standards relevant to pandemic flu,
OSHA does not have a mandatory standard that comprehensively addresses
the workplace hazards posed by airborne transmissible diseases.
Ensuring that appropriate standards are in place and are being
followed is especially critical in the highest risk workplaces: Health
care facilities.
If nurses, doctors, and other health care workers get sick, they
can't treat flu victims or anyone else.
If they believe their workplace is unsafe, they may stay home out
of their own fear of contracting a virus. Sufficient worker protections
must be in place to ensure that our health care system has the capacity
to deal with widespread viral outbreaks.
But our concern is not limited to the health care workplace.
We want to know what measures businesses in general are and should
be taking to prepare for pandemic outbreaks. For example, one critical
issue that employers face is how to deal with sick employees. In this
economy, workers are less likely to take time off for fear of losing
pay, benefits, or even their job. In the context of a pandemic, having
the right leave policies becomes a matter of public health. It is
becoming increasingly clear that current federal sick leave
requirements aren't designed to address pandemics.
Current federal law covers only some workers. It doesn't require
paid leave to ensure sick workers stay home. And it doesn't cover
situations where a working parent has child care problems due to a
school closure.
We also need to examine what other preventative actions employers
and employees should be taking, like providing training on flu
prevention, and what businesses can do to keep operating if a pandemic
hits.
These challenges are acute, and they won't go away. Experts predict
the likelihood of pandemics will increase. Our federal policies will
need to adapt. On the education front, Secretary Duncan and the CDC
have been in frequent communication with school districts and parents
to provide critical advice.
The CDC is also currently in the process of reviewing its
guidelines to help schools better prepare for and respond to outbreaks.
On the workplace front, under its new leadership, OSHA is looking at
how it can improve its health and safety rules and guidance to address
flu pandemic protocol. We'll learn more about these efforts from our
panel.
Especially in this economy, it's critical to ensure that students
can keep learning and businesses can keep providing services to
communities.
I'd like to thank all of our witnesses for taking time out from the
vital work you're doing to fight this pandemic to join us today.
______
Mr. McKeon. Thank you, Chairman Miller, and good morning.
Over the past few weeks, many parents and employers have
been concerned about, with this threat of H1N1 flu virus, and
rightly so. As most parents know, illnesses such as the flu can
spread through a school almost as fast as an email or text
message. It is one of those facts of life that parents of
school-aged children have had to face for generations.
But the H1N1 flu is different because it can be deadly. And
with its original, exotic, and inaccurate name of swine flu, it
was natural for parents to become worried.
American employers have also been worried. First and
foremost, they are concerned about the health and wellbeing of
their workers. But they are also wondering about how this virus
might affect their ability to run their businesses.
We look at Mexico, where the government ordered a
nationwide shutdown of all nonessential businesses for almost a
week. In Mexico City alone, estimated losses were put at $88
million a day. If something like that happened in the United
States, it would certainly take a toll on working families, and
you do not have to be a financial genius to know it would not
help America's struggling economy.
People also can overreact when they hear about a virus. I
am sure many of us thought about buying facemasks after seeing
others wear them on T.V. I am also sure a few may have got one
already, just in case.
Governments can overreact, too. Earlier this week, U.S.
health officials reversed their recommendation that schools
should close as long as 2 weeks if a student catches the H1N1
virus.
Why did this happen? One of the reasons was that officials
realized that closing schools would do little to prevent the
spread of the disease in the first place. But schools across
the nation have done just that.
In fact, the Washington Post reported yesterday that at
least 726 schools have closed to stop the spread of the flu,
but the Post did not report that there are more than 100,000
elementary and secondary schools in the United States. So that
means less than 1 percent of the schools have closed because of
the flu. This context would have been helpful because it would
have contributed to a better understanding about the threat
from this virus.
That is what I hope our experts can provide today to this
committee and to the American public: a better understanding
about H1N1. Their information, calmly and accurately presented
with context, will be a great help.
We can learn more about this disease, its cause, and most
importantly, the steps that can be taken in both our schools
and places of work to prevent its spread, because at the end of
the day I believe we are all committed to the same goal of
protecting our children and our coworkers. To that end, I
welcome our witnesses today and look forward to hearing from
them and learning more about this virus.
Thank you, Chairman Miller, and I yield back.
[The statement of Mr. McKeon follows:]
Prepared Statement of Hon. Howard P. ``Buck'' McKeon, Senior Republican
Member, Committee on Education and Labor
Thank you, Chairman Miller and good morning.
Over the past few weeks, many parents and employers have been
concerned with the spread of the H1N1 flu virus. And rightly so.
As most parents know, illnesses such as the flu can spread through
a school almost as fast as an e-mail or a text message. It's one of
those facts of life that parents of school-age children have had to
face for generations.
But the H1N1 flu is different because it can be deadly. And, with
its original, exotic (and inaccurate) name of ``swine flu''--it was
natural for parents to become worried.
American employers have also been worried.
First and foremost, they are concerned about the health and well-
being of their workers. But they are also wondering about how this
virus might affect their ability to run their businesses.
They look at Mexico, where the government ordered a nationwide
shutdown of all non-essential businesses for almost a week. In Mexico
City alone, estimated losses were put at $88 million a day.
If something like that happened in the United States, it would
certainly take a toll on working families. And, you do not have to be a
financial genius to know it would not help America's struggling
economy.
People also can overreact when they hear about a virus. I'm sure
many of us thought about buying face masks after seeing others wear
them on TV. I'm also sure a few may have bought one already just in
case.
Governments can overreact, too. Earlier this week, U.S. health
officials reversed their recommendation that schools should close for
as long as two weeks if a student catches the H1N1 virus.
Why did this happen? One of the reasons was that officials realized
that closing schools would do little to prevent the spread of the
disease in the first place.
But schools across the nation have done just that. In fact, the
Washington Post reported yesterday that at least 726 schools have
closed to stop the spread of the flu.
But the Post did NOT report that there are more than 100,000
elementary and secondary schools in the United States.
So that means less than 1 percent of schools have closed because of
the flu.
This context would have been helpful because it would have
contributed to a better understanding about the threat from this virus.
That's what I hope our experts can provide today to this committee
and the American public: a better understanding about H1N1.
Their information, calmly and accurately presented with context,
will be a great help. We can learn more about this disease, its cause
and, most importantly, the steps that can be taken in both our schools
and places of work to prevent its spread.
Because at the end of the day, I believe we are all committed to
the same goal of protecting our children and our co-workers.
To that end, I welcome our witnesses today. I look forward to
hearing from them and learning more about this virus.
Thank you, Chairman Miller. I yield back.
______
Chairman Miller. Thank you.
I would like to briefly introduce our witnesses. First we
will hear from Dr. Anne Schuchat, who currently serves as the
interim deputy director for science and public health programs
at the Center for Disease Control and Prevention.
Before this assignment, Dr. Schuchat was the director of
the CDC's National Center on Immunization and Respiratory
Diseases, and has spend more than 20 years at the CDC working
on immunization, respiratory and other infectious diseases. Dr.
Schuchat graduated with the highest honors from Swarthmore
College and honors from the Dartmouth Medical School.
Mr. Bill Modzeleski is the associate assistant deputy
secretary in the Office of Safe and Drug-Free Schools at the
Department of Education. In Mr. Modzeleski's prior role as the
associate deputy undersecretary of the Office of Safe and Drug-
Free Schools, Mr. Modzeleski was involved in the design and
development of drug and alcohol prevention programs, violence
prevention programs and activities, especially as they affect
schools and in the school health-related issues. Mr. Modzeleski
has a B.A. and a degree from political science form the
University of Bridgeport, and an MPA from the C.W. Post
College.
Mr. Jack O'Connell is the superintendent of public
instruction at the California Department of Education. Mr.
O'Connell previously served in the California state senate,
representing the 18th district from 1994 to 2002, and Mr.
O'Connell received a B.A. in history from the California State
University at Fullerton and earned a secondary teaching
credential from California State University at Long Beach.
Mr. Jordan Barab is the acting assistant secretary of the
Occupational Health and Safety Administration. He served most
recently as a senior policy advisor for the Education and Labor
Committee. Mr. Barab is the special assistant to the assistant
director for labor at the Occupational Safety and Health
Administration from 1998 to 2001, and directed the safety and
health programs for the American Federation of State and County
Municipal Employees from 1982 to 1998. He graduated at
Claremont McKenna College in California and received a master's
degree in international relations for Johns Hopkins University.
Mr. Miguel Antonio Garcia is currently a registered nurse
at Kaiser Permanente Los Angeles Medical Center Emergency
Department and serves as a labor union contract specialist and
workplace safety labor co-chair. Mr. Garcia received a B.S. in
nursing from Franciscan University.
Ms. Ann Brockhaus is the occupational safety and health
consultant at ORC Worldwide, where since 1990 she has provided
assistance to clients on a wide range of occupational health
issues. Ms. Brockhaus holds a BSN from Georgetown University
and a master's degree in public health from Johns Hopkins
University Bloomberg School of Public Health.
Welcome to the committee. Thank you for taking your time to
share your experience and your expertise with the members of
this committee. As I mentioned to you a little bit earlier, we
are here to learn from your experiences over this past month,
and the lessons that you think you have learned, and where you
think, perhaps, there is a misalignment in the system in terms
of best informing our population and protecting them. So we
look forward to your testimony.
When you begin to testify, a green light will go on in
front of you and you will have 5 minutes for your formal
testimony. At 4 minutes an orange light will go on and you want
to think about wrapping your testimony up, and then there will
be a red light. But we want you to complete your thoughts in a
manner that you think is most important to us.
Dr. Schuchat, we will begin with you. Welcome.
STATEMENT OF DR. ANNE SCHUCHAT, DEPUTY DIRECTOR FOR SCIENCE AND
PUBLIC HEALTH PROGRAMS (INTERIM), CENTERS FOR DISEASE CONTROL
AND PREVENTION
Dr. Schuchat. Thank you. Good morning, Chairman Miller,
Ranking Member McKeon, and distinguished members of the
committee. I am Dr. Anne Schuchat, acting deputy director for
science and program at the Centers for Disease Control and
Prevention, and really appreciate the opportunity to talk to
the committee this morning. I will be updating you about what
we know, what CDC is doing, and some of the steps that are in
place, and really appreciate the chance to testify with the
distinguished colleagues.
First, I just want to say that my heart and the hearts of
CDC really go out to the people in the communities that have
been affected here in the United States, in Mexico, and around
the world, both directly from the virus and then indirectly
from some of the interventions and the impacts they have had on
families and communities. We know that our nation's 7.6 million
workplaces and over 126,000 schools and other childhood
settings have been facing the challenges of this outbreak.
We share the concern of people across the country, and we
are responding aggressively at the federal, state, local,
tribal, and territorial levels to understand the complexities
of this outbreak and to implement effective control measures.
Our aggressive actions are possible in many respects because of
investments and support of the Congress in U.S. pandemic
preparedness, which has provided us with many of the tools we
are using to detect, track, and control the impact of this
outbreak at CDC and at state and local health departments
across the country.
Influenza viruses are very unpredictable. It is hard to
anticipate the course that this outbreak will have with any
certainty, either this spring or in the fall at the usual
return of the influenza season. We do expect to see an increase
in the number of cases, the number of states affected, and we
also expect to see additional deaths and hospitalizations.
We are carefully monitoring the severity of illness caused
by this virus. While preliminary evidence is encouraging, we
understand that this, too, could change. Amid this uncertainty,
our goals are to be clear in communicating what we do know,
acknowledge the uncertainties, be clear about communicating
what we are doing and what individuals can do, themselves, to
protect the families in their communities.
Influenza arises from a variety of sources, and in this
case we have determined there is a new, or novel, influenza A
H1N1 virus that is circulating around the globe that contains
genetic sources from four different virus sources. We have been
able, within just 2 weeks, to identify this novel virus,
understand its complete genetic characteristics, and compare
the genetic composition of specimens from U.S. patients to
others from around the globe to watch for mutations that may
change the properties of the virus and how it behaves in
people.
We have also very quickly deployed--or, developed and then
deployed--test kits for use in the widening network of
laboratories that are responding to this outbreak. These steps,
along with the capacity that is in place as a result of
effective planning over the last few years, have allowed for
the rapid diagnostics and epidemiology that contribute to a
clearer understanding of transmission and severity of the
illness caused by the virus. These scientific accomplishments
have provided the basis for an evolving set of responses that
greatly enhance our nation's ability to address this threat.
CDC has determined that the virus is contagious; it is
spreading from human to human. It appears to spread with
similar characteristics to seasonal influenza virus, through
coughing and sneezing, through human-to-human contact.
Sometimes people may become infected by touching something that
has the flu viruses on it and then touching their mouth or
nose. There is no evidence at all that this virus can be
acquired from contact with pigs or from eating pork or pork
products.
Aggressive actions are being taken here in the U.S., as
well as around the world. We are working very closely with
state and local public health officials around the country on
the investigation and on implementation of interventions, such
as infection control measures. We are providing both technical
support on the epidemiology as well as laboratory support for
confirming cases.
We are also working with international partners on the
outbreak, including a collaborative effort in Mexico, really
the epicenter of the problem, to better understand the outbreak
and enhance surveillance and lab capacity there. And we are
working closely with Secretary Napolitano and our other federal
partners to ensure our efforts are coordinated and effective.
CDC has issued numerous health advisories for individuals,
health care practitioners, schools, and communities, and these
continue to evolve as our understanding of the situation
changes. In fact, a key message from CDC is that there is a
role for everyone to play in the outbreak.
At the individual level it is important for people to
understand how to prevent respiratory infections. Frequent hand
washing is a good idea; if you are sick, stay home; if you are
sick, don't get on an airplane or public transport; keep your
kids home from school if they are sick. Taking personal
responsibility can help reduce the spread of this virus as well
as other respiratory infections.
But the path of this outbreak is unclear. As I said,
influenza is unpredictable, and we need to be prepared for the
potential return of this virus in the fall, perhaps in a more
severe format. It is important for public health officials to
continue--that they continue to think about what might be
needed if the outbreak deepens in the communities where you
work. It is also important for businesses, schools, and local
governments to anticipate those types of changes.
Schools and childhood settings, including Head Start and
childcare programs, play a critical role in protecting the
health of their students, staff, and the community from
contagious diseases, including this novel H1N1 influenza. About
one out of five Americans spend considerable time in one of the
more than 90,000 school buildings on any given school day.
Millions of adults work in school and childhood settings, and
many millions more are parents or guardians of school-aged
children.
While CDC has made scientific recommendations about how
schools can deal with this virus, the authority for decisions
regarding school dismissal resides at the state and local
level. We at CDC applaud the collaborative efforts of school
superintendents, Head Start and childcare directors, county
executives, mayors, governors, et cetera, who are on the front
lines of this epidemic.
The emergency preparedness work that communities had done
before this outbreak has been essential in the response. That
includes the 600 local education agencies that have been
working with our colleagues in the Department of Education
through their Readiness and Emergency Management for Schools
Program. Without that sort of considerable advanced planning
and ongoing exercising, we would have been much less prepared
for this outbreak and the ongoing reponse.
Chairman Miller. Dr. Schuchat, I am going to ask if you can
start to wrap up.
Dr. Schuchat. Sure.
Chairman Miller. Thank you.
Dr. Schuchat. Absolutely.
CDC's NIOSH is leading the agency's efforts to minimize
effects on the epidemic and working to disseminate guidelines.
I do want to stress that as we learn more we try to use the
science to inform changes in guidelines and try to work
collaboratively across government and with partners before we
issue new guidelines. We in the government can't solve this
problem on our own, and we do need the cooperation of all the
other sectors.
I just want to conclude by saying, we don't know exactly
where this virus will go, but we have never been as prepared as
we are today, based on the investments of the past few years.
Thank you.
[The statement of Dr. Schuchat follows:]
Prepared Statement of Anne Schuchat, M.D., Acting Deputy Director for
Science and Program, Centers for Disease Control and Prevention
Good morning, Chairman Miller, Ranking Member McKeon, and other
distinguished members of the Committee. I am Dr. Anne Schuchat, Acting
Deputy Director for Science and Public Health Program, Centers for
Disease Control and Prevention.
I thank you for the opportunity to update you on current efforts
CDC is taking to respond to the ongoing novel H1N1 influenza outbreak,
highlighting our efforts regarding schools and workplaces. I am pleased
to be speaking to you today with our colleagues from the US Department
of Education and the Occupational Safety and Health Administration.
Our hearts go out to the people in the United States, in Mexico,
and around the globe who have been directly impacted. We know that our
nation's 7.6 million workplaces and over 126,000 schools and other
childhood settings have been facing the challenges of this outbreak. We
share the concern of people around the country and around the globe;
and are responding aggressively at the federal, state, local, tribal,
and territorial levels to understand the complexities of this outbreak
and to implement control measures. It is important to note that our
nation's current preparedness is a direct result of the investments and
support of the Congress for state and local pandemic preparedness, and
the hard work of state and local officials across the country.
It is important for all of us to understand that flu viruses--and
outbreaks of many infectious diseases--are extremely unpredictable. As
with any public health investigation, our response has evolved as our
investigation proceeds and we learn more about the situation. We have
seen an increase in the number of cases and the number of states
affected, and we can expect more people and states to be affected. We
are carefully monitoring the severity of illness caused by this virus--
and while preliminary evidence is encouraging, we understand that this,
too, could change. Our goal in our daily communication--to the public,
to the Congress, and to the media--is to continue to be clear in what
we do know, explain uncertainty, and clearly communicate what we are
doing to protect the health of Americans. It has also been a clear
priority to communicate the steps that Americans can take to protect
their own health and that of their community. As we continue to learn
more, these communications and our guidance to public health officials,
health care providers, schools, businesses, and the public has changed
and will continue to evolve.
Influenza arises from a variety of sources; for example, swine
influenza (H1N1) is a common respiratory disease of pigs caused by type
A influenza viruses. These and other animal viruses are different from
seasonal human influenza A (H1N1) viruses. From laboratory analysis
already performed at CDC, we have determined that there is a novel H1N1
virus circulating in the U.S. and Mexico that contains genetic pieces
from four different virus sources. This particular genetic combination
of H1N1 influenza virus is new and has not been recognized before in
the United States or anywhere else worldwide. As a result of our
investment in pandemic preparedness, we have been able to move within
two short weeks to identify a novel virus, understand its complete
genetic characteristics, and compare the genetic composition of
specimens from US patients to others around the globe to watch for
mutations. We have also quickly developed and (working with FDA)
deployed test kits for use in a widening network of laboratories. These
steps, along with capacity in place as a result of effective planning,
have allowed for the rapid diagnostic and epidemiologic capabilities
that have contributed to a clearer understanding of the transmission
and severity of illness caused by the virus. These scientific
accomplishments have provided the basis for an evolving set of
responses that greatly enhance our nation's ability to address this
threat.
CDC has determined that this virus is contagious and is spreading
from human to human. It appears to spread with similar characteristics
as seasonal influenza. Flu viruses are thought to spread mainly from
person to person through coughing or sneezing by people with influenza.
Sometimes people may become infected by touching something with flu
viruses on it and then touching their mouth or nose. There is no
evidence to suggest that this virus has been found in swine in the
United States, and there have been no illnesses attributed to handling
or consuming pork. Currently, there is no evidence that one can get
this novel H1N1 influenza from eating pork or pork products. Of course,
it is always important to cook pork to an internal temperature of 160
degrees Fahrenheit in order to ensure safety.
I want to reiterate that as we look for cases, we are seeing more
cases. We fully expect to see not only more cases, but also more cases
of severe illness. We have ramped up our surveillance around the
country to try and get a better understanding of the magnitude of this
outbreak.
Let me provide for you an update in terms of the public health
actions that are underway in the United States and abroad. On the
investigation side, we are working very closely with state, local,
tribal and territorial public health officials around the country.
We're providing both technical support on the epidemiology as well as
laboratory support for confirming cases. We are also working with the
World Health Organization, the Pan American Health Organization, and
the governments of Mexico and Canada on this outbreak. There is a tri-
national team that is working in Mexico to better understand the
outbreak, and answer critical questions such as why cases in Mexico
initially appeared to be more severe than those that were first seen in
the U.S. We are assisting Mexico to establish more laboratory capacity
in-country, a critical step in identifying more cases on which to base
our epidemiological investigation into the spread and severity of this
new virus.
In terms of travel advisories, CDC continues to evaluate incoming
information from the World Health Organization, the Pan American Health
Organization, and other governments to determine the potential impact
of the outbreak on international travel. On Monday, April 27th, CDC
issued a travel health warning for Mexico, and this remains in effect.
With this warning, we recommend that travelers postpone non-essential
travel to Mexico for the time being. CDC is also evaluating information
from other countries and will update travel notices for other affected
countries as necessary. As always, persons with flu or flu-like
symptoms should stay at home and should not attempt to travel.
CDC has and will continue to develop specific recommendations for
what individuals, communities, clinicians, and others professionals can
do. It is important that people understand that there is a role for
everyone to play during an outbreak. At the individual level, it is
important for people to understand how they can prevent respiratory
infections. Very frequent hand-washing is something that we talk about
time and time again and that is an effective way to reduce transmission
of disease. If you are sick, it is very important to stay at home. If
your children are sick, have a fever and flu-like illness, they should
not go to school. And if you are ill, you should not get on an airplane
or any public transport to travel. Taking personal responsibility for
these things will help reduce the spread of this new virus as well as
other respiratory illnesses.
The path of this outbreak may change; and we need to be prepared
for a possible return of this virus in the fall. It is important that
we (in partnership with state and local officials) continue to think
about what might be needed if this outbreak deepens in communities
across the US. We have encouraged communities, businesses, schools, and
local governments to make specific plans to manage this outbreak if
cases appear in their communities, and advised parents to prepare for
what they would do if faced with temporary school and child care center
closures. We also have additional community guidance so that
clinicians, laboratorians, and other public health officials will know
what to do should they see cases in their community. All of these
specific recommendations, as well as other regular updates, are posted
on the CDC web site--www.cdc.gov/H1N1flu.
As places where many people gather across the U.S., schools,
childhood settings including Head Start, family child care and child
care programs, and workplaces are essential for mitigating this
outbreak. Including students and adults who work in schools,
approximately 20% of the US population spends considerable time in one
of the more than 90,000 school buildings on any given school day.
Millions of adults work in school and childhood settings, and many
millions more are parents or guardians of school-aged children. Schools
and childhood settings play a critical role in protecting the health of
their students, staff, and the community from contagious diseases such
as this novel H1N1 influenza. I'd like to recognize the work and
collaboration of our partners at US Department of Education, state and
local education agencies, and other education partners as we have been
learning about this new virus, providing the best science we can in an
uncertain situation, and working hard to keep our nation's children
safe.
While CDC has made scientific recommendations about how schools can
deal with this virus, the responsibility for decisions regarding school
dismissal resides at the state, local, tribal, and territorial level,
and CDC applauds the collaborative efforts of school superintendents,
Head Start and child care Directors, County Executives, mayors,
governors, emergency management officials, and public health officials
who are on the front lines of this epidemic. We are mindful that
science is a critical component in decision-making about how
communities respond--and that there are also many other considerations
that communities must evaluate in making appropriate decisions. The
emergency preparedness work that communities have done before this
outbreak--such as exercising their emergency plans--has been essential
in their response now. This includes the 600 local education agencies
that have been working with our colleagues at the Department of
Education through their Readiness and Emergency Management for Schools
Program. Without considerable advance planning by communities and
ongoing updating and exercising of school emergency plans, we would've
been much less prepared for this outbreak, and we are grateful for all
of the work our Education colleagues have done in this regard.
During public health emergencies like the current novel influenza A
(H1N1) epidemic, protecting workers is a top priority, both as members
of the community, and as workers with special roles in ensuring the
functioning of critical infrastructure. Workers can contract influenza
through general community exposures or workplace-specific transmission.
CDC is working to minimize both pathways.
Some workers--especially healthcare workers and emergency
responders--are at special risk for infection because their jobs, by
definition, bring them into repeated, close contact with individuals
ill with novel H1N1. These workers represent a particularly high
priority for prevention, both because of the potential for added risk
and because it will be particularly problematic if they become
unavailable through illness or reluctant to perform their duties. Other
workers are in critical infrastructure positions--they keep society
functioning by maintaining utilities, public safety, and food and water
supply. Many of these workers may not experience a greater risk of
workplace transmission than other workers, but their functions are
crucial, so keeping them on the job is a priority.
CDC's National Institute for Occupational Safety and Health is
leading the Agency's efforts to minimize effects of the epidemic on
working populations by developing and disseminating guidance regarding
precautions to prevent work-related transmission of the illness.
Guidance is informed by the hierarchy of controls used to reduce
exposure: engineering, administrative and work practices, and personal
protective equipment. Engineering controls include isolation,
ventilation and physical barriers. Administrative and work practice
controls include social distancing, telecommuting, hand hygiene, cough
etiquette, and training. Personal protective equipment or PPE include
gloves, glasses, gowns, and respiratory protection. If exposure should
occur, guidance also addresses the use of antiviral treatment to
prevent or treat disease. Finally, should a vaccine become available,
recommendations for immunization will be developed and disseminated.
Guidance materials are being developed focused on the needs of specific
worker populations and workplace settings; and to provide general
information useful to all businesses. All of these workplace-related
guidance materials are available at http://www.cdc.gov/niosh/topics/
H1N1flu/.
We will continue to provide support to states and communities
throughout this outbreak. In addition to the epidemiologic and
laboratory support that CDC provides, CDC maintains the nation's
Strategic National Stockpile of medications that may be needed for this
or other outbreaks. As part of our pandemic preparedness efforts, the
U.S. Government has purchased extensive supplies of antiviral drugs--
oseltamivir and zanamivir--for the Strategic National Stockpile.
Laboratory testing on the viruses so far indicates that they are
susceptible to oseltamivir and zanamivir. Acting quickly after we
identified this virus and its potential impact on our population, we
have released one-quarter of the states' share of antiviral drugs and
personal protective equipment, to be used pursuant to emergency use
authorizations issued by the FDA Commissioner, to help the states
prepare to respond to the outbreak. As of Sunday, May 3rd--within weeks
of a new virus having been identified--this deployment of the stockpile
was completed for all states and areas.
Whenever we see a novel strain of influenza, we begin our work in
the event that a vaccine needs to be manufactured. Simultaneous efforts
are underway within CDC, FDA, New York Medical College, and St. Jude,
as well as international partners, to develop a vaccine seed strain
specific to this virus--the first step in vaccine manufacturing. This
is something CDC often initiates when we encounter a new influenza
virus that has the potential to cause significant human illness. We
have already isolated and identified the virus and steps are underway
so that should a vaccine be needed, we can work towards that goal very
quickly with interested manufacturers. HHS discussions to consider the
needed pathways to provide rapid production of vaccine after the
appropriate seed strain has been provided to manufacturers are
currently ongoing. As this progresses, HHS operating divisions and
offices including CDC, NIH, FDA, and ASPR/BARDA will work in close
partnership.
In closing, we are simultaneously working hard to understand and
control this outbreak while also keeping the public and the Congress
fully informed about the situation and our response. We are working in
close collaboration with our federal partners, including our sister HHS
agencies and other federal departments, as well as with other
organizations that have unique expertise that helps us provide guidance
for multiple sectors of our economy and society. While events have
progressed with great speed, this will be a marathon, not a sprint.
Even if this outbreak yet proves to be less serious than we might have
initially feared, we can anticipate that we may have a subsequent or
follow-on outbreak several months down the road. Steps we are taking
now are putting us in a strong position to respond.
The Government cannot solve this alone, and as I have noted, all of
us must take constructive steps. Schools, childhood settings, and
workplaces are critical to this effort. If you are sick, stay home. If
children are sick, keep them home from school. Wash your hands. Take
all of those reasonable measures that will help us mitigate how many
people actually get sick in our country.
Finally, it is important to recognize that there have been enormous
efforts in the U.S. and abroad to prepare for this kind of an outbreak
and a pandemic. The Congress has provided strong leadership and support
for these efforts. Our detection of this strain in the United States
came as a result of that investment and our enhanced surveillance and
laboratory capacity are critical to understanding and mitigating this
threat. While we must remain vigilant throughout this and subsequent
outbreaks, it is important to note that at no time in our nation's
history have we been more prepared to face this kind of challenge. As
we face the challenges in the weeks ahead, we look forward to working
closely with the Committee to best address this evolving situation.
______
Chairman Miller. Thank you.
Mr. Modzeleski?
STATEMENT OF BILL MODZELESKI, ASSOCIATE ASSISTANT DEPUTY
SECRETARY, OFFICE OF SAFE AND DRUG-FREE SCHOOLS, U.S.
DEPARTMENT OF EDUCATION
Mr. Modzeleski. Good morning, Mr. Chairman, Congressman
McKeon, and other distinguished members of the committee. I am
Bill Modzeleski, associate assistant deputy secretary at the
Department of Education's Office of Safe and Drug-Free Schools.
I want to thank you for the opportunity to appear before
this committee today to provide you with an overview of the
department's actions during the 2009 H1N1 flu outbreak. This
morning I want to provide an overview of the situation
regarding school closings, summarize some basic principles that
form the foundation of our response efforts, and if time
permits, conclude with some of the actions we have taken
recently to help schools and institutions of higher education
to respond to the current outbreak of the H1N1 flu virus.
Let me start by stating that the situation regarding
schools remains somewhat fluid. That is, we have some schools
opening while others remain closed.
Of the 8 school days we have collected information on
school closings, we saw daily changes. On Monday, April 27th,
22 schools in three states had announced decisions to close for
reasons related to the H2--H1, I should say--H1N1 flu. There
were approximately 15,700 students impacted by those closings.
By Tuesday of this week, the number of closures stood at
726, representing 24 states and the District of Columbia, and
these closures affected approximately 468,000 students. On May
5th, the Centers for Disease Control and Prevention announced
revised guidance on community mitigation that advised that
student with flu symptoms stay home from school, that schools
with confirmed or suspected cases of the flu not close.
While it has been less than 48 hours since this revision
was announced, we have already seen considerable change.
Approximately 140 schools with 100,000 students reopened
yesterday, and more are expected to reopen today. Overall, the
school closures affected a relatively small number of students
and staff, but created a considerable amount of concern.
Although the scientists at CDC are cautiously optimistic
about what they are learning about the virus, we must remain
alert to the possibility that the nature of this current
outbreak could change. We will continue to rely on five key
principles as we work to help schools and institutions of
higher education prepare for and respond to the range of
crises, including a pandemic.
First, our chief concern will continue to be the health and
safety of students, faculty, and staff. Federal education
statutes and regulations should not be an impediment to closing
schools for health reasons. We are ready to consider requests
for waivers related to the flu to the extent of the secretary's
waiver authority.
Next, we recognize that effectively managing crises such as
the H1N1 flu outbreak requires many different agencies and
organizations working together. The Department of Education
can't do it alone. We will continue to collaborate with our
colleagues from the Department of Health and Human Services,
including the Centers for Disease Control, the Department of
Homeland Security, and other federal agencies, to capitalize on
the valuable expertise they possess. Working with them is also
essential in ensuring that we provide a coordinated federal
response.
Next, we need to keep in mind that many of the most
difficult decisions concerning response to the current flu
virus must be made by state and local officials. While state
and localities have a lot to do, a lot has already been done.
States and localities, as well as the federal government,
have already invested a significant amount of effort and
planning for the pandemic flu. Every state has a pan flu plan,
and every plan contains an appendix describing the roles of
schools during an epidemic. We will continue to build on those
planning efforts and support state and local education
officials.
Next, while the current outbreak of the H1N1 flu is the
issue that brings me before the committee today, we believe
that the best approach for schools and institutions of higher
education to take preparing for an outbreak of an infectious
disease or any other crisis situation is to develop an ``all
hazards'' plan that addresses a variety of crises, from
intruders and accidents to school shootings and the flu.
Finally, our decisions about how schools and institutions
of higher education are to deal with a crisis are based upon
the fact that while crisis planning for schools has to consider
the health and welfare of students and staff, the plan also
needs to consider the educational needs of students. Crisis
planning can't exist in a vacuum.
Consistent with these general principles, we have taken
several actions in the past week to support schools and
institutions of higher education. In addition to tracking
information about school closures, we, in coordination with the
Centers for Disease Control and Homeland Security, provided
opportunities for school officials to hear up-to-date
information directly from scientists at CDC and to pose
questions by hosting three conference calls. I am happy to say
about 3,000 conference lines were used during those three
calls.
We also have developed and posted detailed guidance
responding to a number of issues of specific concern to the
schools and institutions of higher education, including school
closures, and have developed a mechanism for school and other
officials to submit questions concerning the flu to the
department, and we are using these questions to help us better
understand the challenges the schools and colleges are facing
to identify issues on which we can develop and post additional
guidance.
I hope that you have found this overview helpful, but I
would be pleased to answer any other questions you may have.
Thank you.
[The statement of Mr. Modzeleski follows:]
Prepared Statement of William Modzeleski, Associate Assistant Deputy
Secretary, Office of Safe and Drug-Free Schools, U.S. Department of
Education
Good morning, Chairman Miller, Representative McKeon, and other
distinguished members of the Committee. I am William Modzeleski,
Associate Assistant Deputy Secretary, Office of Safe and Drug Free
Schools, at the U.S. Department of Education (ED), and on behalf of
Secretary Arne Duncan and the entire department I want to thank you for
the opportunity to provide you with an overview of the Department's
actions regarding the H1N1 flu.
I also want to take this opportunity to thank our colleagues from
the Department of Homeland Security, the Department of Health and Human
Services, and the many other agencies that are participating in the
coordinated Federal response to the H1N1 flu for their ongoing
assistance and support for ED's response efforts.
Although the situation continues to emerge, ED stands ready to act
quickly based on our work in planning for a range of challenges and
situations.
In the current outbreak, there are many key pieces of information
that are emerging on a daily basis. Accordingly, schools face many
challenges, such as whether or not to close, the timing and length of
school closures, and the impact on learning. ED's approach is
predicated on the principle that we want every student, teacher, and
staff person to be safe and healthy and we do not want Federal
education rules or regulations to be an impediment to students' health
and welfare.
In keeping with this key principle of ensuring the health and
safety ofstudents, we have worked with the Centers for Disease Control
and Prevention (CDC) within the Department of Health and Human Services
(HHS) to disseminate guidance on closing schools as part of a
comprehensive community-mitigation strategy. The CDC recommendations
are based on an evolving understanding of the virus, including its
transmissibility and severity. We continue to work closely with the CDC
and to monitor the changing situation.
Authorities for closing schools vary between states and even
sometimes among localities within states. State and local educational
agencies, in coordination with their health counterparts, are
responsible for the interpretation and implementation of CDC's
guidance, including when, and for how long, to close schools. States
and many localities have been planning for an influenza pandemic for
several years now and most are depending on their plans to guide a
range of actions, including communications strategies or enacting
school closure procedures. Responses to the flu outbreak have varied
but range from closing one school to closing all the schools in a
district. On Monday, May 4th, 545 schools were closed, affecting
341,298 students and 20,967 teachers and staff.
We cannot predict what will happen in the future--near or distant--
with regard to how H1N1 will affect schools and institutions of higher
education (IHEs). However, we do know that school closures will be
affected by three key factors:
School districts' decisions about closure will be affected
by what the outbreak looks like locally. If large numbers of students
and staff are ill, we will see more closures. Conversely, if the
illnesses and absences decline, we can anticipate that fewer school
districts will close.
Second, the number of schools that close will be dependent
upon mitigation guidance provided by the CDC. ED has encouraged and
will continue to encourage school districts and IHEs to closely follow
school closing guidance provided by the CDC. If the CDC calls for
longer school closings we can anticipate that schools will close for
longer periods and, hence, more students will be out of school.
Conversely, if the situation changes and the CDC calls for schools to
close for a shorter period of time or calls for fewer individuals to be
excluded from school, we will likely see fewer schools closed.
Finally, closures will be based on the school calendar.
Many institutions of higher education are at or near the end of their
academic calendar. As for K-12 schools, the academic calendar is more
varied with some districts about to close for summer vacation and
others going until the end of June.
As our understanding of the virus evolves, we will look to the CDC
to analyze the data and make more definitive recommendations to
optimally protect the health and safety of our communities.
We will continue to collaborate with the CDC to ensure that any
guidance is quickly disseminated to education partners and
stakeholders, as we have been doing over the last two weeks. We have
convened two calls for education stakeholders; the first call, held on
April 27th, hosted 1700 lines and the second call, held on April 30,
hosted 1300 lines, and we know that there were many more people
listening. We are collecting daily information on closures of schools,
districts, and IHEs, and providing this key information to our Federal
partners to help them assess the impact of this virus. We have also
posted information, including FAQs for school leaders and parents on
our website, participated in stakeholders' outreach efforts, and
created an internet address for the exchange of information with the
field specifically about the flu, [email protected].
While we know that the current outbreak of 2009-H1N1 flu will be
challenging, we believe that we have taken many actions over the past
several years that provide a strong foundation for our current efforts.
In 1995, when we were faced with assisting in the response to the
bombing of the Murrah Federal Office Building in Oklahoma City, it
became clear that we needed to develop capacity and expertise in
emergency management. While the Department of Education is probably not
the first or second organization on a list of Federal agencies with
emergency management responsibilities, elementary and secondary schools
and IHEs are profoundly affected by a broad range of crisis situations,
and face a unique set of challenges in preparing for and responding to
those situations. Over the past several years, we have focused our
emergency management activities on helping schools and colleges and
universities meet those challenges.
Schools and IHEs face the same broad array of potential crisis
situations as their communities--hurricanes, tornadoes, chemical
spills, shootings, terrorist attacks, and outbreaks of infectious
diseases, to name just a handful. As a result, we encourage schools and
IHEs to ground their emergency management efforts in crisis plans that
address all hazards through the four phases of emergency management
planning--prevention-mitigation, preparedness, response, and recovery.
This foundation should enable schools and IHEs to respond in a
comprehensive and appropriate way.
This approach is summarized in ED's publication ``Practical
information Crisis Planning Guidance for Schools and Communities.'' The
document, first released in 2001, was developed in collaboration with
Federal, State, and local partners in school emergency management, and
outlines the four-phase approach. ED recently released a similar guide
for IHEs in January 2009.
ED also provides funds to local school districts to support the
development of emergency management plans for their schools under the
Readiness and Emergency Management for Schools (REMS) program. The
program requires grantees to partner with local first responders,
develop all-hazards plans (including planning for an infectious disease
outbreak), and incorporate the four phases of emergency management into
their planning activities. To date, we've provided grants to more than
600 LEAs across the country, totaling more than $175 million. In FY
2008, in conjunction with our colleagues at the HHS' Substance Abuse
and Mental Health Services Administration, we provided similar awards
to the first cohort of 17 IHE grantees.
ED also provides training and technical assistance to each of the
REMS grantees; a basic course covers the four phases of emergency
management while a more advanced curriculum addresses more specific
emergency management issues that schools may face, including pandemic
flu. In addition to training grantees, ED has provided the basic
training course to another 600 school officials from public and private
schools that are not grant recipients.
Because we wanted to reach out to a broader range of school
officials, we have also developed a technical assistance center that
develops and implements a variety of training and technical assistance
activities for school personnel. Over the past several years, we have
developed and made available more than 40 short publications that
highlight a range of key emergency management issues that schools may
face.
In addition to these and other activities related to emergency
management for schools, ED has participated in a broad range of
activities that specifically relate to an outbreak of pandemic flu, and
that form the underpinning for our response efforts to the 2009-H1N1
flu. We have worked with Federal and non-Federal partners since 2005 on
planning for a potential pandemic. Specifically, we have been working
to articulate questions about, and identify potential barriers to,
implementing and carrying out appropriate community mitigation,
consistent with CDC guidance on the scope and necessity of such
efforts.
We have worked to create tools and guidance for educators to help
State and local entities address their unique planning needs, including
a pre-packaged pandemic tabletop exercise that was pilot-tested during
the summer of 2007 and disseminated to our Readiness and Emergency
Management for Schools grantees. In response to a request for more in-
depth information on pandemic planning, we have developed and refined
an ``advanced training'' on pandemic, as well as one on planning for
infectious diseases in schools in general, which provides practical,
hands-on information about planning for these types of situations that
schools can use during a typical school year. We have presented
information about pandemic planning, including considerations related
to continuity of education, to a wide range of education audiences,
including our grantees, representatives from private and independent
schools, State and local education officials, and education-related
associations. Additionally, we have identified examples of pandemic
planning that others may use to inform their own planning efforts and
have posted these examples on our website and on the REMS Technical
Assistance Center's website.
ED was actively involved in the creation of a planning guide for
States as part of the comprehensive State pandemic planning effort in
2007-2008. This education planning guide covers a range of
considerations for State education leaders, including the provision of
continuity of education, utilization of educational facilities, paying
staff, and communicating with local educational agencies, staff, and
families. During the planning process, we provided technical assistance
to States through a webcast and a video teleconference. Last summer,
States were asked to submit their full pandemic plans to the Federal
government. In turn, various government agencies reviewed the sections
relevant to their entities and rated those sections. Representatives
from various offices at ED, in collaboration with experts on school
closures from CDC, reviewed the States' education-sector plans.
In closing, let me say that we recognize that we have a lot more
work ahead of us. We are cognizant of the fact that even if the
influenza outbreak quickly subsides, it may return at a later time. We
are also cognizant of the fact that the 2009-H1N1 flu is but one crisis
or emergency that schools have to be prepared to deal with. We have a
very large system of schools and colleges in the U.S. and it is an
unusual day when emergencies and crises don't happen. To prepare for
these events, be they another outbreak of the flu, a hurricane, a
school shooting, a student suicide, or an intruder, we need to ensure
that every school and every IHE has an Emergency Management Plan--also
know as a crisis plan--in place. That plan should address all types of
situations and conditions--``all hazards;'' address all four phases of
crisis planning: Prevention/mitigation, Planning, Response, and
Recovery; be practiced on a regular basis; include an incident command
component; and involve the entire community it its development.
Over the remainder of the fiscal year we intend to take several
actions that we believe will help schools and IHEs be better prepared
to deal with crises and emergencies, including the flu. These actions
include:
Making approximately 100 REMS awards to school districts
and 20 to IHEs. These awards, totaling an estimated $31 million will
enable the grantees to develop or improve their Emergency Management
Plans. Those districts and IHEs that have not addressed issues related
to a pandemic will be able to do so.
Outreach activities and technical assistance efforts that
focus on ``lessons learned'' in the response to the H1N1 flu outbreak.
Hosting training for new REMS grantees on emergency management issues.
This will include a focus on preparing for, responding to, and
recovering from an infectious disease outbreak.
Sponsoring a National Conference in August 2009 for
approximately 1,500 educators. The conference will feature a plenary
session and several workshops on the 2009-H1N1 flu.
If we are to be successful in ensuring that are schools and student
are safe and healthy, schools will need to make ``preparedness'' a
priority, and we believe that we can provide valuable assistance to
schools and IHEs as they work to develop and expand their emergency
management capacity.
I have included some additional material for the record that
provides more details about the resources that we are making available
to schools and IHEs.
I look forward to responding to any questions that you may have.
______
[Additional material submitted by Mr. Modzeleski follows:]
[Pandemic Flu and General Emergency Management Resources, U.S.
Department of Education, Office of Safe and Drug-Free Schools]
EMERGENCY MANAGEMENT RESOURCES
Web Resources
U.S. Department of Education (ED)'s Emergency Planning Web site
This Web site offers a ``one stop shop'' for emergency management
information for local educational agencies (LEAs) and institutions of
higher education (IHEs) available from the U.S. Department of
Education.
Available at: www.ed.gov/emergencyplan
Readiness and Emergency Management for Schools (REMS) Technical
Assistance (TA) Center
Established in October 2004, the REMS TA Center offers a variety of
resources including a list of current grantees, emergency management
related publications, links to relevant emergency management
organizations, and an opportunity to submit individual questions for
technical assistance support.
The TA Center's Web site is http://rems.ed.gov
National Clearinghouse for Education Facilities (NCEF) Web site
The NCEF, funded by ED, provides information on planning,
designing, funding, building, improving, and maintaining safe, healthy,
high performance schools. The Web site includes links to campus safety
assessment and campus security resources for colleges and universities.
Accessible at www.edfacilities.org
Safeguarding America's Colleges--Web cast
Aired in October 2008, this Web cast provided an opportunity to
talk about OSDFS' Emergency Management for Higher Education grant; talk
about rights under the Family Educational Rights and Privacy Act;
highlight higher education institutions that are leading the effort to
enhance campus safety; and, provided user-friendly tips on ensuring the
safety, health and security of students.
The archived Web cast is accessible at:
http://www.connectlive.com/events/ednews/20081021.html.
Emergency Planning for Students with Disabilities and Special Needs
Taking place in May 2009, this Webinar focused on emergency
management planning for students with disabilities and special needs.
In particular, it highlighted actions to take before, during, and after
an emergency occurs. It also featured a case study of the Upper Darby
School District.
The archived webinar materials are available at:
http://rems.ed.gov/index.cfm?event=webinars--archives.
Web casts on Emergency Management for Schools Training
Four Web casts and accompanying materials look at the four phases
of emergency management: prevention-mitigation, preparedness, response,
and recovery. The Web casts were filmed at Emergency Management for
Schools training meetings provided for school staff and administrators
in March 2007.
Powerpoints and Web casts available at:
http://www.connectlive.com/events/depteduphilly0207/
School Safety Web cast
In November 2006, the U.S. Department of Education presented a one-
hour Web cast to provide parents, educators, school administrators and
local safety personnel with an opportunity to review key considerations
related to school emergency management planning.
The archived Web cast is accessible
www.ConnectLive.com/events/edschoolsafety. Software to view the Web
cast is available free at that site.
Training and Technical Assistance
Basic Emergency Management for Schools Training
The ``Emergency Management for Schools'' training provides an
opportunity for school personnel to receive critical training in
emergency management. The training focuses on emergency plan
development within the framework of the four phases of emergency
management.
Power points from the last training in 2008 are available
online at:
http://rems.ed.gov/index.cfm?event=trainingsArchived#EMST--SF--CA--08
Development is currently underway for online interactive
modules for this training.
Advanced Emergency Management for Schools Training
Starting in 2008, OSDFS began to create, in collaboration with
school safety experts in the field, a series of ``advanced training''
power points for school-based emergency management. Each PowerPoint is
designed to last for 1.5--2 hours of training and provides focused
attention on a specific area such as: tabletops and drills, pandemic
planning, continuity of operations, special needs, etc.
The current versions of the power points are available at:
http://rems.ed.gov/index.cfm?event=trainingsArchived#FY07FGM--CH--IL--
08.
Publications
Practical Information on Crisis Planning: A Guide for
Schools and Communities
First published in 2003, the U.S. Department of Education developed
``Practical Information on Crisis Planning: A Guide for Schools and
Communities'' to identify some of the key principles in developing
emergency management plans. This document is based on the four phases
of emergency management and is the premier document for emergency
planning for schools.
The entire Guide can be downloaded at:
http://www.ed.gov/admins/lead/safety/emergencyplan/crisisplanning.pdf
Action Guide for Emergency Management at Institutions of
Higher Education
Released in January 2009, the Action Guide provides a series of
suggestions and tips for institutions of higher education interested in
improving their emergency management planning efforts. Created in
collaboration with external experts, the Action Guide is based on the
four phases, all-hazards approach to emergency management.
The entire Action Guide can be downloaded at:
http://www.ed.gov/admins/lead/safety/emergencyplan/remsactionguide.pdf
Guide to School Vulnerability Assessments: Key Principles
for Safe Schools
This publication, released in 2008, is a companion guide to the
Practical Information on Crisis Planning Guide. It offers general
information on establishing vulnerability assessment teams and
selecting vulnerability assessment tools.
The guide can be downloaded at:
http://rems.ed.gov/views/documents/VA--Report--2008.pdf
Threat Assessment in Schools
The U.S. Department of Education and the U.S. Secret Service
established the Safe School Initiative, a study of 37 school shootings
and other school-based attacks that took place between 1974 and 1999.
Through this initiative, the two agencies produced guidance and tools
for schools putting forth a process for identifying, assessing and
managing students who may pose a threat of targeted violence. These
guides are intended for collaborative use by school personnel, law
enforcement officials and others with protective responsibilities in
our nation's schools. Most recently, the initiative has produced an
interactive CD-ROM presenting two hypothetical school scenarios to be
used for further developing the assessments team's skills.
Final Report and Findings: Implications for Prevention of
School Attacks in the United States.
Accessible at:
http://www.ed.gov/admins/lead/safety/preventingattacksreport.doc
Threat Assessment in Schools: A Guide to Managing
Threatening Situations and to Creating Safe School Climate
Accessible at:
http://www.ed.gov/admins/lead/safety/threatassessmentguide.pdf
A Safe School and Threat Assessment Experience: Scenarios
Exploring the
Findings of the Safe School Initiative
Accessible through EDPubs at www.edpubs.org/
Bomb Threat Response: An Interactive Planning Tool for
Schools
OSDFS and The Bureau of Alcohol, Tobacco, Firearms and Explosives
(ATF) collaborated to develop a tool (CD) for schools and law
enforcement. The CD offers a comprehensive guide on how to best respond
to bomb threats in schools. The planning tool offers guidance for
schools administrators and law enforcement to develop policies specific
to the school district and its unique needs. The ``Bomb Threat
Response'' also presents guidelines for how to communicate during the
response phase.
Accessible at http://www.threatplan.org/
Emergency Preparedness Publications produced by the REMS TA Center:
REMS Express Newsletters
Newsletters provide comprehensive information on key
issues in school emergency management.
Available online at: http://rems.ed.gov/
index.cfm?event=express
Lessons Learned
The Lessons Learned series offers brief summaries of
actual school emergencies and the resulting lessons learned by schools.
Available online at: http://rems.ed.gov/
index.cfm?event=lessons
Helpful Hints
Helpful Hints offer a ``snapshot'' overview of school
emergency preparedness topics.
Available online at: http://rems.ed.gov/
index.cfm?event=hints
NIMS Implementation Activities for Schools and Higher
Education Institutions
The National Incident Management System (NIMS) was established
March 1, 2004, following the Homeland Security Presidential Directive-5
(HSPD-5). All local educational agencies (LEAs) and institutions of
higher education (IHEs) who receive federal preparedness funds are
required to support the implementation of NIMS.
The complete guidance is available at:
http://rems.ed.gov/views/documents/NIMS--
ComprehensiveGuidanceActivities.pdf
PANDEMIC PREPAREDNESS RESOURCES
Guidance for Educators for Prolonged School Closures
The U.S. Department of Education analyzed and reviewed our current
authorities and possible flexibilities under No Child Left Behind and
other relevant legislation. These flexibilities are summarized in this
guidance, which could allow a great deal of flexibility for state and
local educational agencies if necessary.
The guidance can be found at:
http://www.ed.gov/admins/lead/safety/emergencyplan/pandemic/guidance/
pan-flu-guidance.pdf.
Pandemic Flu: A Planning Guide for Educators
The U.S. Department of Education published this brochure to provide
a brief summary of pandemic-related concerns, as well as minimum
elements and considerations for planning for the possibility of
prolonged school closures.
This brochure can be found at:
http://www.ed.gov/admins/lead/safety/emergencyplan/pandemic/planning-
guide/index.html
Examples of Plans and Planning Efforts
The U. S. Department of Education gathered information on state and
local pandemic planning efforts to help others begin or refine their
pandemic influenza plans. After examining plans and information from
school districts across the country, a panel of experts in the field of
emergency management identified examples of strong planning efforts or
useful resources.
These samples can be found at:
http://www.ed.gov/admins/lead/safety/emergencyplan/pandemic/
sampleplans/index.html
REMS Advanced Training on Pandemic
In August 2008, OSDFS piloted our new training, ``Business Not as
Usual: Preparing for Pandemic Influenza.'' Pandemic planning is a
requirement of all REMS and EMHE grantees and this PowerPoint provides
an advanced look at the history and background of infectious diseases,
as well as a focused four-phased approach schools can use to deal with
a potential pandemic outbreak.
The current version of this PowerPoint is available in PDF
format at:
http://rems.ed.gov/views/documents/Training--CHIL07--
PrepPandemicInfluenza.pdf
Pandemic Influenza Tabletop Exercise
In August 2007, OSDFS piloted a tabletop exercise at our National
Conference. This tabletop exercise reviewed the rules, objectives, and
scheduling requirements for a pandemic influenza tabletop exercise. The
materials include participant manuals, facilitator's manuals, and a
PowerPoint and the session provides background information on pandemic
influenza as well as scenario briefings.
The materials associated with this exercise are available
at:
http://rems.ed.gov/index.cfm?event=PandemicPreparedns4Schools.
Pandemic Flu.gov
The U.S. Department of Health and Human Services manages a Web site
focused on bringing up-to-date government pandemic information to
individuals, families, schools, businesses and communities across the
nation. Presented on the Web site is a School District (K-12) Pandemic
Influenza Planning Checklist.
Accessible at http://www.pandemicflu.gov
Federal Guidance to Assist States
During 2007-2008, the Federal government collaborated to create a
comprehensive planning guidance for states. The Department of Education
created guidance for the education sector on school closure and student
dismissal for childcare, K-12 schools, and Institutions of Higher
Education. The guidance included considerations for continuity of
education, communications, and alternative use of school facilities.
This guidance can be found in Appendix B.4.
The guidance can be accessed at:
http://www.pandemicflu.gov/news/guidance031108.pdf.
Webcast Series on Pandemic Influenza: State Pandemic
Planning
On April 30, 2008, the U.S. Departments of Education, Labor, and
Agriculture appeared on a webcast to provide guidance to states on
planning efforts. Specifically, the U.S. Department of Labor focused on
the potential impacts of a pandemic on the workforce and the U.S.
Department of Agriculture discussed approaches to providing food to
children who use the school meals program.
The webcast can be viewed at:
http://www.pandemicflu.gov/news/panflu--webinar3.html.
Assessment of State's Operational Plans to Combat Pandemic
Influenza
The U.S. Government reviewed and assessed state's plans, submitted
during the summer of 2008. The results of this assessment process are
posted online, organized by focus area.
Accessible at:
http://www.pandemicflu.gov/plan/states/state--assessment.html.
Additional Web Resources Distributed to ED Grantees in April 2009 to
Assist Schools and IHEs in Understanding, Planning for, and
Responding to, H1N1
Centers for Disease Control and Prevention
This site includes the clearinghouse for all H1N1 information.
http://www.cdc.gov/swineflu/index.htm
Interim CDC Guidance for Nonpharmaceutical Community
Mitigation in Response to Human Infections with Swine Influenza (H1N1)
Virus:
http://www.cdc.gov/swineflu/mitigation.htm
Update on School (K-12) Dismissal and Childcare
Facilities: Interim CDC Guidance in Response to Human Infections with
the 2009 Influenza A H1N1 Virus, available at:
http://www.cdc.gov/h1n1flu/K12--dismissal.htm
H1N1 Flu (Swine Flu) Infections Alert for Institutions of
Higher Education:
http://www.cdc.gov/h1n1flu/college-alert.htm
World Health Organization (WHO)
This world body provides updates on H1N1.
http://www.who.int/csr/don/en/
Readiness and Emergency Management for Schools (REMS)
Technical Assistant Center
Pandemic Preparedness:
http://rems.ed.gov/index.cfm?event=PandemicPreparedns4Schools
IAEM-USA
This organization is tracking closures of Higher Education
Campuses:
http://maps.google.com/maps/ms?ie=UTF8&hl=en&msa=0&ll=39.571822,-
95.625&spn=36.948082,67.851563&z=4&msid=109878326824967605990.000468a80b
7ca216e4d3a
EDUCATIONAL RESOURCES
Joint Guidance on the Application of the Family Educational Rights and
Privacy Act (FERPA) and the Health Insurance Portability and
Accountability Act of 1996 (HIPAA) to Student Health Records
In response to the ``Report to the President on Issues Raised by
the Virginia Tech Tragedy,'' ED and Health and Human Services issued
new guidance that addresses the interplay between FERPA and the HIPAA
Privacy Rule at elementary and secondary levels, as well as at the
postsecondary level. It also addresses certain disclosures that are
allowed without consent or authorization under both laws, especially
those related to health and safety emergency situations.
Accessible at:
http://www.ed.gov/policy/gen/guid/fpco/doc/ferpa-hippa-guidance.pdf.
Higher Education Center for Alcohol and Other Drug Abuse
and Violence Prevention
The Center's mission is to assist ED in serving IHEs in developing
and implementing policies and programs that will foster students'
academic and social development and promote campus and community safety
by preventing the harmful effects of alcohol and other drug use and
violence among college students. The Center is a primary provider of
services in alcohol and other drug abuse and violence prevention in
higher education founded upon state-of-the-art knowledge and research-
based strategies.
Accessible at http://www.higheredcenter.org/
OSDFS National Conference
OSDFS will be hosting its National Conference August 3-5, 2009, at
the Gaylord National Resort and Convention Center. The Conference will
address issues related to emergency management; health, mental health,
and physical education; broad-based issues related to alcohol, drug and
violence prevention; civic and character education; scientifically-
based programs; and many other areas concerning drug and violence
prevention.
______
Chairman Miller. Thank you very much.
Jack, welcome to the committee.
STATEMENT OF JACK O'CONNELL, SUPERINTENDENT OF PUBLIC
INSTRUCTION, CALIFORNIA DEPARTMENT OF EDUCATION
Mr. O'Connell. Thank you very much, Mr. Chairman. Thank
you, Mr. Chairman, and Congressman McKeon, and all the members
of the committee. A pleasure to be here to address the recent
outbreaks of the H1N1 flu in California, specifically the
impacts that it has had on our public education system.
I am pleased that the Centers for Disease Control has
recently determined that the automatic school-wide dismissal of
all of the students at a particular school need not occur with
even a one confirmed or highly suspicious case of this virus.
Clearly, in California local health officials have the ultimate
jurisdiction to close our school and to dismiss all of our
students.
I am pleased at this new guidance, as more and more
information becomes available and better known will allow more
of our students to remain in school, on task, preparing for
their successful future. I also appreciate greatly the initial
concern for our schoolchildren and our entire staff at
Education that led to the recommendations of dismissing all of
our students from any campus that had a confirmed or even a
suspected case of this virus.
CDC still wants, as you have heard earlier, all of our
steps to be taken. Those steps--and try to repeat them all the
time--to wash hands frequently, duration of at least 20 seconds
with soap and water; if you are going to cough or sneeze, the
students have taught me, Mr. Chairman, do the Dracula sneeze
into your arm, slowly into the crux of your elbow; and
obviously, as has already been stated, if you are sick, stay
home, including from school.
I am continuing to encourage our schools, our school
districts, to stay in close contact with local public health
officials. We need to do an even better job of monitoring, as
the chairman pointed out, the number of cases that we have, the
number of illnesses, and we need to do a better job of tracking
absences that also are directly attributable to the flu.
If I might briefly, Mr. Chairman, I would like to walk
through the steps that we have taken during the last couple of
weeks at the California Department of Education with our school
community and our health community since the outbreak of the
H1N1 virus. We did stay in very close contact with both state
and local departments of health in California, with our
schools, our school districts, including our charter schools.
Within hours of the first alert of the H1N1 virus, my
department issued a release to every school, every school
district, about the precautionary steps that students need to
take in order to make sure that they remain safe.
We have numerous information available--posters, sample
letters--easily downloadable to schools on how to prevent and
how to secure, through precautionary steps, for our students
and our staff to remain safe. And again, this is the wash your
hands posters, and how to sneeze, and if you are sick stay
home.
We have also received some reports from some schools in
California, Mr. Chairman, that soap was not available in some
restrooms for our students and our staff. Clearly, that is
unacceptable. We need to have soap or an alcohol-based hand
sanitizer available at all times to our schools, to our
students and our staff.
We also developed, at the Department of Education, a
special link on our Web site to keep school districts informed
of those cases that we knew about, what schools were, in fact,
dismissed, and also all press releases that were issued by
either the educational community or the public health community
in this area. And then just last Friday, we conducted a
statewide conference call where we asked and invited each of
our over 1,000 school districts to have the appropriate person
online to talk and to ask questions to Dr. Bonnie Sorensen, who
is a deputy director for the California Department of Public
Health.
Every school district and almost every county was invited--
every county was invited. Dr. Sorensen had an opportunity to
brief school district officials on the latest guidance for
potential dismissal of all students at their school as it
related to the H1N1 virus. Numerous questions were asked;
schools wanted to know the most recent information and also
trends.
As of Tuesday, just 2 days ago, in California, 37 public
schools had been ordered shut by local public health officials.
To make Congressman McKeon's point, that is 37 out of over
9,000 schools in the state of California.
I believe our schools are much more relieved by the most
recent guidelines by CDC and also California Public Health. We
all understand that this clearly is an evolving process.
Guidelines would need to change and update for more and more
information. I have always stressed the importance of the
school community to work closely with county public health,
because they ultimately have final say on dismissal of
students.
I also wanted to share with you a major topic of concern
for school districts. How would these school closures or the
increase in absences when parents choose to keep their students
home fearing a potential impact, affect our state standardized
tests? This is the testing window in California today for our
standardized testing as well as the California High School Exit
Exam.
We in California are trying to address this on a case-by-
case basis. We are trying to make the accommodations necessary
for the schools and school districts, and we are working with
our contractors and our vendors. We have also communicated with
the federal Department of Education regarding this issue on how
school closures would be impacted, for example, on
participation rates, to make sure that we meet both our
academic performance index and adequate yearly progress rates,
and also reporting schedules.
Some participation rates may, in fact, be affected by
parents who just simply keep their kids home out of fear. The
response from the federal department has been very, very
helpful. They understand, they are very empathetic, and they
have committed to work with us, and we are most appreciative of
that.
And then lastly, I wanted to make an issue also to--
briefly, if I may--we need to have better communication between
the field and our state offices in my department. I believe we
do need to establish a system, really protocols, so that we
know how many schools, how many students have actually been
affected. We want to develop easy reporting procedures so that
we can make better decisions based upon how many students we
are actually talking about.
And finally, Mr. Chairman, I believe that this issue also
highlighted, in my opinion, again, a real need for school
nurses, school health professionals, at the school site. In
California, as I mentioned, over 9,000 schools, 6.3 million
students, over 330,000 teachers, but yet we have only 2,844
school nurses. That ratio is 2,227 students to one school
nurse. That is one of the largest ratios in the country.
Given the recent budget reductions in many local school
districts, many schools have been left without sufficient
health care professional personnel. I think perhaps more school
nurses could have helped us with early detection and even
prevention.
Again, thank you for the opportunity to be here. I greatly
appreciate both the Obama administration and this Congress for
helping us improve our educational delivery system throughout
California and, indeed, the entire nation.
Thank you, Mr. Chairman.
[The statement of Mr. O'Connell follows:]
Prepared Statement of Jack O'Connell, California State Superintendent
of Public Instruction
Thank you Chairman Miller and members for the opportunity to
address the recent outbreaks of the H1N1 flu in California, but more
specifically in our schools.
I would like to start by saying that although there are currently
103 confirmed cases of H1N1 flu in California, I am pleased that the
Centers for Disease Control has determined that the level of severity
of the H1N1 flu does not warrant automatic school-wide student
dismissal even in instances of a confirmed case of the virus. While we
recognize that local health officials may always determine if it is
necessary to close a campus due to a public health threat, this new
guidance will allow our schools to resume their normal operations and
keep healthy students in class and learning.
I also appreciate the initial concern for our school children and
staff that lead to the recommendation of dismissing students from any
campus that had a confirmed or suspected case of the infection.
It is important to note that the CDC still recommends that we
stringently adhere to the procedures we can all use to keep ourselves
and our schools healthy: Students and staff who are sick should stay
home. Everyone should cover their coughs and sneezes, and frequently
wash their hands with soap and water or use hand sanitizer.
I also continue to encourage schools and districts to stay in close
contact with public health officials for any new information about this
flu virus and any potential future changes in student dismissal policy.
I would now like to walk you through the steps the California
Department of Education has taken to address the flu outbreak.
Since the initial flu outbreaks was reported, my department and I
have stayed in close and regular contact with officials from the
California Department of Public Health and our local education agencies
(LEA's), including districts, county offices of education, and charter
schools.
Within hours of the first alert from the California Department of
Public Health about the H1N1 virus, my department advised the education
community about the threat and reminded them about flu prevention
information resources that my Department has made available. We also
strongly encouraged schools to teach students and teachers to take the
following measures to guard against the spread of H1N1:
encourage students and staff to stay home if they are
sick;
urge individuals to cover their coughs and sneezes with a
tissue or by covering with their arms; and
advise students and school staff to frequently wash their
hands thoroughly with soap and water, or an alcohol based hand
sanitizer.
We have received reports that some do not have soap for student
use, so I have advised local school leaders that they must make sure
that soap or alcohol based hand sanitizers, are made available for use
by students and school staff.
We have kept schools up to date about the flu outbreak through a
special link on our Web site, as well as through a series of letters,
press releases, and public events. And in order to achieve an even
higher level of communication, last Friday I invited Dr. Bonnie
Sorensen, the Deputy Director of the California Department of Public
Health to join me on a statewide conference call with district and
county office of education leaders. The purpose of the call was to
brief school officials on the latest guidance on student dismissal
policies due to H1N1, emphasize the importance of sharing the health
protection information, and to respond to questions from the field
about the situation.
As you can imagine, our schools have been particularly concerned
about keeping up to date on the latest guidance from the CDC and the
California Department of Public Health in respect to student dismissal
policies. As of Tuesday of this week, 37 public schools had been
ordered by a local health officer to dismiss students, based on the
existing guidance at the time.
Our schools are greatly relieved that this week the Center for
Disease Control and the California Department of Public Health revised
their student dismissal guidance. But, throughout this evolving
situation, I have stressed to our education community that we must stay
in close touch with our public health community and that a public
health officer always has the final say as to whether or not students
should dismiss student from campus.
Another matter that I addressed during this briefing is testing.
We received numerous questions from local districts about how the
flu outbreak and school closures would affect the administration
deadlines of two of our statewide student examination: Standardized
Testing and Reporting or STAR program and the California High School
Exit Exam, also known as CAHSEE.
Given the current circumstances, we are addressing these concerns
on a case by case basis, and my staff has been communicating with our
testing contractors and vendors to talk about any necessary
accommodations needed for affected schools. However, if the school
closures were to resume, or be ordered for an extended period of time
in a future public health emergency this could become a bigger problem.
To remedy any issues that may arise, I am working with the
Schwarzenegger Administration on options to give my office the ability
to extend or modify the testing administration and release dates of
these exams as needed.
In addition, my staff has been in touch with the U.S. Department of
Education regarding the potential need for flexibility on
accountability requirements--like participation rates and reporting
schedules. I am concerned that participation rates have been affected--
not by student dismissal policies, but by the ``worried well''--healthy
students whose parents kept them home out of fear.
Generally speaking, I feel very strongly that the communication
efforts at the state level, between my department and the department of
public health, have been very good.
I also believe that the line of communication that is ongoing
between the California Department of Education and our local education
agencies is very strong, but could be improved. For example, we
discovered that we did not have a system in place to track and report
the individual schools that had been ordered to dismiss students due to
H1N1. My office is working with the County Offices of Education to
developing an easy-to-use reporting process so that the state could be
kept up to date about any school impacted by an order to dismiss
students. While we hope we never need it, this system will save time
and provide valuable information to the public.
Another issue that certainly needs addressing in order to improve
our response to such outbreaks is school nurses.
At last count, there are approximately 2,844 nurses who serve
California's 6.3 million public school students. That translates to a
ratio of 2,227 students to every one school nurse, the largest student-
to-nurse ratio in the country. This in no way, shape or form provides
effective healthcare for the increasing numbers of students with
complex chronic and immediate health needs that require daily care on
our school campuses. If we had more school nurses on our campuses,
perhaps they could have played an even greater role in early detection
and prevention efforts.
I feel there is definitely a role for the federal government to
play in both of these matters not only for California, but for every
state.
I have thus far been encouraged by the Obama Administration's and
Congress' willingness to listen to the concerns facing California's
educational system, and I am grateful for the opportunity to address
this committee.
I look forward to more dialogues like today's. Thank you.
______
Chairman Miller. Thank you.
Jordan?
STATEMENT OF JORDAN BARAB, ACTING ASSISTANT SECRETARY,
OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION
Mr. Barab. Thank you. Chairman Miller, Ranking Member
McKeon, and members of the committee, thank you for this
opportunity to discuss the Occupational Safety and Health
Administration's strategy for the protection of American
workers from this new strain of influenza A 2009 H1N1.
During an influenza pandemic, as we all realized, the
workplace can be a source of transmission, just as in other
settings. Fortunately, because OSHA has previously prepared for
a possible outbreak or pandemic related to the avian influenza
virus, the agency is now fully prepared to address the dangers
of the 2009 H1N1.
The full range of OSHA's training, education, enforcement,
technical assistance, and public outreach programs will be used
to help employers and workers protect themselves at work.
Preparation is critical. Proper planning will allow employers
to better protect their employees and reduce the impact of a
pandemic on society and the economy.
OSHA has developed guidance to help employers determine the
most appropriate work practices and precautions to limit the
impact of the influenza pandemic. Because pandemic-related
health and safety risks are greater in certain workplaces, OSHA
is focusing its direct efforts on educating employers and
employees in the high risk exposure categories.
OSHA uses its occupational risk pyramid for pandemic
influenza, which is projected on the screen, for both its own
determination and for employers to determine those workplaces
that are at higher exposure risk level. The pyramid visually
demonstrates that only a small portion of workers are at the
highest exposure risk level.
In response to the 2009 H1N1 outbreak, OSHA's current
outreach efforts are primarily focused on high risk and very
high risk workers--those who have direct contact with infected
individuals as part of their job responsibilities, such as
health care workers and first responders. OSHA recognizes the
importance of protecting health care workers on whom this
country relies to identify, treat, and care for individuals
with the flu.
Our front line health care workers are the foundation upon
which our health care system is built. If they are not able to
work due to illness, or unwilling to work due to fears for
their health, then individual patients and the country's entire
health care structure will suffer.
To help health care employees and workers prepare for an
influenza pandemic, OSHA has developed a pandemic flu
preparedness and response guidance for health care workers and
employers. This publication provides valuable information and
tools, which health care workers and health care facilities can
use to protect their employees.
If we expect our health care workers to come to work each
day during a pandemic, then their employers have a
responsibility to ensure that they have the best protection,
including engineering controls, administrative controls,
appropriate respirators, and other personal protective
equipment. And I also want to remind you that we can't forget
the custodians, security guards, and administrative employees
and maintenance workers who support these high risk workers.
While generally not at high risk themselves, if we are to
expect them to report to work every day to carry out their
critical functions, they also need to be educated about the
virus, their level of risk, and in situations where they are at
risk, in how they need to protect themselves.
It is our expectation that most of this nation's hospital
and health care institutions, where workers are clearly at
exposure risk, are fully prepared to provide that training,
equipment, and protection, and if they are not now prepared,
that they are working hard to finalize plans to ensure that
they will soon be ready for an outbreak. These plans should
include ordering and stockpiling respirators and other personal
protective equipment, conducting fit testing, medical
evaluation, and training for those required to wear
respirators. OSHA and CDC have distributed extensive
information on how to protect workers.
Employers play a key role in protecting employees' safety
and health, and OSHA will continue to provide them with the
technical assistance they need. But OSHA also stands prepared
to use its existing authority to aggressively enforce safe work
practices to ensure employees receive appropriate protection.
In appropriate circumstances, OSHA will use the General
Duty Clause of the Occupation Health Act, which requires that
employers follow the practices that public health experts agree
are necessary to protect workers' health. OSHA also has
standards addressing housekeeping and personal protective
equipment as well as a respirator standard that requires a
complete respiratory protection program for employees.
It is the employer's responsibility to ensure that we have
the protection and training that workers need--when to wear a
respirator, what kind of respirator, how to get the respirator
fit tested and wear it properly, when to wear gloves, and how
to put on and take off personal protective equipment. OSHA is
also developing additional information for workers and their
employers on the pandemic influenza, including fact sheets and
quick cards that are appropriate for workers to use. Many of
these materials are on our Web site, and also on
pandemicflu.gov.
Mr. Chairman, I characterize the situation for the
workforce just as the president described it for the nation:
cause for deep concern but not panic. I am very confident in
the expertise of OSHA's medical, scientific, compliance
assistance and enforcement personnel. OSHA is prepared to
answer the threat and will protect the workforce.
I will keep this committee informed on OSHA's efforts to
protect working men and women from the pandemic flu exposure.
Thank you very much.
[The statement of Mr. Barab follows:]
Prepared Statement of Jordan Barab, Acting Assistant Secretary for
Occupational Safety and Health, U.S. Department of Labor
Chairman Miller, Ranking Member McKeon, Members of the Committee:
Thank you for this opportunity to discuss the Occupational Safety and
Health Administration's (OSHA's) strategy for the protection of
American workers from the new strain of Influenza A (2009-H1N1) virus.
During an influenza pandemic, transmission can occur in the workplace
just as it takes place in other settings. A pandemic may also disrupt
many work operations and could conceivably cause major losses to our
economy. Fortunately, because of the work OSHA has done in preparing
for a possible outbreak of a pandemic related to the Avian Influenza
(H5N1) virus, the agency is fully prepared to address the dangers of
the 2009-H1N1 virus. The full range of OSHA's training, education,
enforcement, and public outreach programs will be used to help
employers and workers protect themselves at work.
Preparation is critical. Proper planning will allow employers in
the public and private sectors to better protect their employees and
lessen the impact of a pandemic on society and the economy. OSHA has
developed guidance to help employers determine the most appropriate
work practices and precautions to limit the impact of an influenza
pandemic. Because pandemic-related health and safety risks are greater
in certain workplaces, OSHA is focusing its direct efforts on educating
employers and employees in the higher-risk exposure categories. OSHA
uses its ``Occupational Risk Pyramid for Pandemic Influenza'' to
determine those workplaces that are at a higher exposure risk level.
The Pyramid visually demonstrates that only a small portion of workers
are at the highest exposure risk level (see https://www.osha.gov/
Publications/OSHA3327pandemic.pdf).
In response to the 2009-H1N1 outbreak, OSHA's current outreach
efforts are aimed at high-risk and very-high risk workers--those who
have direct contact with infected individuals as part of their job
responsibilities--such as health care workers and first responders.
OSHA recognizes the importance of protecting healthcare workers on whom
this country will rely to identify, treat and care for individuals with
the flu. Our frontline healthcare workers are the foundation upon which
our health care system is built. If they are not able to work due to
illness, or unwilling to work due to fears for their health, individual
patients and the country's entire health care structure will suffer. To
help health care employers and workers prepare for an influenza
pandemic, OSHA has developed ``Pandemic Influenza Preparedness and
Response Guidance for Healthcare Workers and Employers.'' The
publication is available on OSHA's website, and provides valuable
information and tools about healthcare facility responsibilities during
pandemic alert periods.
If we are to expect our healthcare workforce to come to work each
day during a pandemic, then their employers have a responsibility to
ensure they have the best protection, including appropriate respirators
and other personal protective equipment. And let's not forget the
custodians, security guards, administrative employees and maintenance
workers who support those high-risk workers. While generally not at
high exposure risk themselves while performing their normal job duties,
if we are to expect them to come to work each day to carry out critical
functions, they must be educated about the virus, their level of risk,
what situations increase their risk and how to protect themselves.
OSHA is developing guidance to employers, including in the health
care industry, on how to determine the need to stockpile respirators
and facemasks. The proposed guidance is publicly available on OSHA's
website. Once finalized, this guidance will be added as an appendix to
OSHA's existing guidance to employers on how to prepare for a pandemic.
It is our expectation that most of this nation's hospitals and
healthcare institutions, where workers are clearly at exposure risk,
are fully prepared to provide that training, equipment and protection.
And if they are not now prepared, that they are working hard to prepare
and finalize plans to ensure that they are ready for an outbreak in
their area or for a severe pandemic. These plans should include
ordering and stockpiling respirators and other personal protective
equipment, conducting fit testing, medical evaluation and training
workers.
Employers play a key role in protecting employees' safety and
health and OSHA will continue to provide them with technical
assistance, guidance and other information about steps to be taken to
protect their workforces.
OSHA stands prepared to use its existing authority to aggressively
enforce safe work practices to ensure employees receive appropriate
protection. Although OSHA has no specific standard on influenza
exposure, in appropriate circumstances the agency will use the
``General Duty Clause'' of the Occupational Safety and Health Act,
which requires employers to provide employment free from recognized
hazards, to ensure that employers follow the practices that public
health experts agree are necessary to protect workers' health. OSHA and
the Centers for Disease Control and Prevention (CDC) have distributed
extensive information about how to protect workers from influenza
exposure in the workplace.
OSHA also has standards addressing personal protective equipment,
as well as a respirator standard that requires a complete respiratory
protection program including training, medical evaluation and fit
testing when respirators are needed to protect workers' health. It is
the employer's responsibility to ensure these workers have the
protection and training they need: when to wear a respirator, what kind
of respirator, how to get the respirator fit-tested and wear it
properly; when to wear gloves; and how to put on and take off personal
protective equipment.
OSHA has been addressing the issue of an influenza pandemic in the
workplace for a number of years. The agency first issued guidelines on
this hazard in March 2004. The guidelines were updated and expanded in
February 2007 in a document entitled, Guidance on Preparing Workplaces
for an Influenza Pandemic. This publication, issued jointly by DOL and
the Department of Health and Human Services, is an excellent source of
information for employers on how to prepare for a pandemic and to
select appropriate administrative, work practice, and engineering
controls and the personal protective equipment to reduce the impact a
pandemic could have on business operations, employees, customers and
the general public.
In addition, based on our existing guidance and the current virus,
OSHA is developing numerous sources of information for workers and
their employers on pandemic influenza. They include Fact Sheets and
Quick Cards written in both English and Spanish. The agency's website
(www.osha.gov) contains comprehensive information on dealing with a
pandemic, including frequently asked questions for healthcare workers
and copies of OSHA's guidance documents. OSHA plans to post answers on
this site to common incoming questions about 2009-H1N1 from workers and
employers. The agency's webpage not only contains helpful information
but also is linked to the Federal website at www.pandemicflu.gov. That
site has up-to-the-moment information on the status of the 2009-H1N1
outbreak and advises people of measures they can take to minimize the
risk of their own exposure and how best to avoid exposing others.
If the 2009-H1N1 outbreak becomes severe, OSHA will be fully
integrated in public communication efforts. We will distribute news
releases and public service announcements to media outlets, employers,
trade associations, and unions, directing the viewer to OSHA's more
detailed on-line resources.
OSHA's consultation program, with offices located throughout the
nation that provide assistance to small businesses, is also part of the
pandemic flu response. The state consultants are knowledgeable about
the mix of workplaces and industries in their states and can determine
which worksites most need to be informed. Consultants will deliver
advice and information both to individual worksites and government or
business headquarters. OSHA can provide similar assistance to federal
government agencies by having OSHA compliance safety and health
officers fulfill requests for technical assistance.
Particularly since September 11, 2001, the ensuing anthrax attacks
and Hurricane Katrina, as well as throughout the extensive pandemic
planning, OSHA has worked closely with other agencies involved in
emergency response such as the Department of Homeland Security, the
Environmental Protection Agency, the Department of Agriculture, and
HHS, including the National Institute for Occupational Safety and
Health (NIOSH) and the CDC. The Department of Labor has representatives
participating daily in interagency conference calls and working groups
related to pandemic preparedness and updates on and the coordinated
response to the 2009-H1N1 flu. OSHA, working closely with CDC and
NIOSH, has taken the lead role in establishing worker protection
protocols for pandemic flu and providing advice and assistance to other
government agencies.
OSHA recognizes it plays an essential role in protecting critical
emergency responders and workers in such professions as health care,
border security, and transportation--as well as the general workforce.
Based on OSHA efforts since the World Trade Center tragedy, response
organizations have been coming to OSHA for technical assistance.
Through planning and preparedness practice, OSHA has worked closely
with state and local public health agencies to deal with emerging
health hazards. I am confident that the numerous exercises we have
carried out in emergency planning at both the federal and local levels
in the past eight years will pay off in our ability to work together in
combating this threat to the workplace.
Mr. Chairman, in addressing an influenza pandemic that threatens
the workplaces of this nation, we are confronting an unprecedented
hazard. In OSHA's 38-year history, America has never experienced a flu
pandemic. However, I would characterize this situation for the
workforce just as the President has described it for the nation:
``Cause for deep concern, but not panic.'' I am very confident in the
expertise of OSHA's medical, scientific, compliance assistance and
enforcement personnel. OSHA is prepared to address this threat and we
will protect our workforce. I will keep you informed about OSHA efforts
to protect America's working men and women from pandemic flu exposure.
______
Chairman Miller. Thank you.
Mr. Garcia?
STATEMENT OF MIGUEL GARCIA, REGISTERED NURSE AND MEMBER,
AMERICAN FEDERATION OF STATE, COUNTY AND MUNICIPAL EMPLOYEES
Mr. Garcia. Hi. My name is Miguel Garcia. I am a registered
nurse. And Chairman Miller and other members of the committee,
thank you very much for asking me to come and testify.
Because I work in the emergency department at Kaiser
Permanente Los Angeles Medical Center, I am on the front line
of fighting this current outbreak of the 2009 H1N1 influenza. I
am testifying on behalf of UNAC-UHCP, who is a part of AFSCME,
which represents 1.6 million members, including 360,000 health
care workers. In order for nurses to be able to treat and
protect patients, we must be protected first.
My employer, Kaiser, has taken a positive collaborative
approach towards flu preparedness through a strong labor-
management partnership. Kaiser is taking an organization
approach to how we care for members, our patients, and our
staffs.
In many respects, my employer is the example of
preparedness. However, many of the employers have not taken the
necessary steps to prepare and protect health care workers from
a flu pandemic or the current outbreak of the H1N1 flu
infection.
A recent survey conducted by my union and other labor
unions representing health care workers found that more than
one-third of the respondents believe that their workplace is
not ready or only slightly ready to address the health and the
safety needs necessary to protect health care workers during
this influenza crisis. This survey also found that given this
lack of readiness, 43 percent of the respondents believe that
most or some of their coworkers would stay at home.
Importantly, Kaiser does provide me an annual fit test for
the N95. An N95 respirator is different than a surgical mask.
The surgical masks are designed to prevent the person wearing
the mask from contaminating the external environment with fluid
and air droplets when a person coughs, sneezes, or talks.
Surgical masks aren't designed to have a tight seal on your
face. They leak around the mask while you inhale. Surgical
masks do not protect you from breathing viral particles that
are suspended in small droplets.
Respirators, on the other hand, are specifically designed
to protect the person wearing the respirator from inhaling into
their lungs viral particles that are suspended in the air.
Respirators, unlike surgical masks, seal tightly around the
face and prevent leakage of air inside the respirator that
could then be inhaled into the lungs.
Currently, there is no comprehensive federal standard that
requires employers to protect health care workers from airborne
hazards like the H1N1 or tuberculosis. There are OSHA and CDC
guidelines, but to date these guidelines have only been
voluntary.
Patients who have the H1N1 flu are likely to go to the
emergency room. To treat and to care for these patients, health
care workers and first responders must be protected. We need
more than guidelines from OSHA in order to make sure that all
employers provide consistent protections to health care workers
during this flu pandemic. We need to have clear rules for all
health care employers to follow.
We do not know with certainty the path that the 2009 H1N1
influenza virus will take, but we do know that it is a
recognized hazard. OSHA should use existing standards covering
respiratory protection and personal protective equipment and
use its authority to enforce those standards in heath care
settings where workers may be exposed to the flu virus.
OSHA has authority to make its current pandemic influenza
guidance for health care workers and health care employers
mandatory. Taking such a step quickly would send a clear signal
to the public and health care workers that the government is
proactive in protecting the workers who are needed to care for
the sick in our communities. Protecting these workers will
preserve our surge capacity to treat the infected.
In addition, we need OSHA to move quickly--to move as
quickly as possible to develop and issue a mandatory
comprehensive standard to protect health care workers from
airborne infectious diseases similar to the existing
comprehensive standard on bloodborne diseases.
Thank you for listening, and I invite your questions.
[The statement of Mr. Garcia follows:]
Prepared Statement of Miguel Antonio Garcia, R.N., BSN, for the
American Federation of State, County and Municipal Employees
My name is Miguel Garcia and I am a registered nurse. I want to
thank Chairman Miller and members of the Committee for inviting me to
testify today. Because I work in the Emergency Department at the Kaiser
Permanente Los Angeles Medical Center, I am on the frontline of
fighting the current outbreak of 2009 H1N1 influenza, which has been
called ``swine flu''. I am testifying on behalf of my union, the
American Federation of State, County and Municipal Employees, which
represents 1.6 million members, including 360,000 health care workers.
In order for nurses to be able to treat and protect our patients,
we must be protected first.
My employer, Kaiser, has taken a positive, collaborative approach
towards flu preparedness through a strong labor-management partnership.
Kaiser is taking an organizational and systemic approach to how we care
for our members and workers. For example, at the national level, Kaiser
has engaged its union partners to closely monitor the evolving flu
situation and its impact on patient and worker needs, rapidly adapt
guidance from the Centers for Disease Control and Prevention (CDC),
monitor respiratory protection programs and implement an aggressive
program of worker and member hand washing--which is vital to reducing
flu infection and progression. Stocks of supplies necessary to protect
workers from exposure to this airborne virus are being inventoried
daily at all levels and their use is closely checked and tracked. It is
my understanding that my union, in partnership with Kaiser, is
establishing a rapid communication system to keep workers up-to-date on
current events.
In addition to these vigilant and positive efforts to prepare our
staff to deliver high quality and safe care, my medical center has
advanced technological and engineering features that make us better
prepared. My medical center has several negative pressure isolation
rooms which are designed to reduce the spread of airborne diseases.
Kaiser has also implemented a respiratory protection program for
health care workers with potential exposure to airborne infectious
agents. As part of that program, my employer provides me with an annual
fit-test for an N95 respirator.
An N95 respirator is different than a surgical mask. Surgical masks
are designed to prevent the wearer from contaminating the external
environment around them with fluids and droplets that the wearer
releases when coughing, sneezing or talking. Surgical masks have
specific levels of protection from penetration of blood and body
fluids--not from airborne particles. Surgical masks are not designed to
provide a tight seal on the wearer's face and they leak air around the
seal whenever the wearer inhales. Surgical masks do not protect the
wearer from breathing in virus particles that are suspended in small
droplets in the air.
Respirators, on the other hand, are specifically designed to
protect the wearer from inhaling into their lungs the virus particles
that are suspended in the air. Respirators, unlike surgical masks, seal
tightly on the wearer's face to prevent leakage of air inside the
respirator that could then be inhaled by the wearer into their lungs.
In many respects my employer is the exemplar in preparedness.
However, many health care employers have not taken the necessary steps
to prepare and protect health care workers from a flu pandemic or the
current outbreak of the H1N1 flu infection.
A recent survey conducted by my union and other labor unions
representing health care workers found that more than one-third of
respondents believe their workplace is either not ready or only
slightly ready to address the health and safety needs necessary to
protect health care workers during an influenza pandemic. The survey
also found that, given this lack of readiness, 43 percent of
respondents believe that most or some of their fellow workers will stay
home.
Currently there is no comprehensive federal standard to require
employers to protect health care workers from an airborne virus like
H1N1 or tuberculosis. There are OSHA and CDC guidelines, but to date
these guidelines have only been voluntary.
Patients who have the H1N1 virus are likely to visit their local
hospital's emergency room. To treat and care for these patients, health
care workers and first responders need to be protected. Without clear
mandatory rules, even the best employer may experience gaps in
protecting its workers.
In order to make sure that all employers provide consistent
protections to health care workers during a flu pandemic, we need more
than guidelines from OSHA. We need to have clear rules of the road for
all health care employers to follow. Now is the time to ensure
preparedness and protections by establishing clear requirements that
are put in place immediately.
We do not know with certainty the path the 2009 H1N1 virus will
take, but we know it is a recognized hazard. OSHA should use its
existing standards covering respiratory protection and personal
protective equipment and use its authority to enforce those standards
in health care settings where workers may be exposed to this flu virus.
OSHA has authority to make its current ``Pandemic Influenza
Guidance for Healthcare Workers and Healthcare Employers'' mandatory
for health care facilities under its general duty clause. Taking such a
step quickly would send a clear signal to the public and health care
workers that the government is proactive in protecting the workers who
are needed to care for the sick in our communities. Protecting these
workers will preserve our surge capacity to treat the infected.
In addition, we need OSHA to move as quickly as possible to develop
and issue a mandatory comprehensive standard to protect health care
workers from airborne infectious diseases, similar to the existing
comprehensive standard on bloodborne diseases.
Thank you for listening. I welcome your questions.
______
Chairman Miller. Thank you.
Ms. Brockhaus?
STATEMENT OF ANN BROCKHAUS, OCCUPATIONAL SAFETY AND HEALTH
CONSULTANT, ORC WORLDWIDE
Ms. Brockhaus. Good morning. On behalf of ORC Worldwide I
would like to thank the committee for this opportunity to
discuss some of the steps businesses are taking to ensure that
workers are protected from the H1N1 virus.
Over the past few days there appears to be a growing
consensus among the experts that this new virus is, at least
for now, a less serious threat than originally feared 13 days
ago, although, as has been mentioned, this is no time for
complacency. But the story could have been very different, and
there are a number of important lessons that can be learned
from our observations of the actions taken by businesses as the
situation rapidly evolved.
The first lesson we would like to highlight is that
advanced planning counts. ORC Worldwide conducted
teleconferences on April 28th and May 5th for our networks
membership of several hundred multinational companies from
diverse industry sectors to share critical information on
strategies for responding to the H1N1 outbreak.
Additionally, on May 1st, ORC sent a survey questionnaire
to the health, safety, and human resources function of more
than 600 ORC client companies regarding aspects of their
company's preparedness and response activities. We have learned
useful information from these teleconferences and from the 89
companies that have responded to our survey.
First, an overwhelming majority of those responding to the
survey have a business continuity plan, or pandemic
preparedness plan, in place to respond to global outbreaks of
flu or a full-blown flu pandemic. Over 60 percent of the
companies responding implemented changes to business travel
practices as a result of the outbreak.
Communication to employees in the form of health briefings
and dissemination of contact numbers for medical advice is
reported by the majority of respondents. Almost half of those
responding had instituted policies requiring that employees
returning from areas with confirmed cases of H1N1 stay at home
for a period of time before returning to work.
We learned that existing plans were often geared to worst
case scenarios, and plans had to be adjusted as new information
about the severity and scope of the H1N1 outbreak became
available. Additionally, communication and coordination across
functions has been a challenge in some companies. Preparedness
planning must include regular communication across critical
functions, such as health and safety, human resources,
security, legal, and others, and must be established well
before a crisis occurs.
Companies tell us that planning initiated in response to
the threats of SARS and avian flu, and refined over time, has
proven to be practical and useful in the situation we find
ourselves in today. Effective plans contain feedback loops
allowing for evaluation of their effectiveness and midcourse
corrections. Plans must be scalable, flexible, and adaptable to
rapidly changing conditions.
Lesson two is that timely and consistent government
information and guidance is critical to effective response.
Clear and timely government information at the federal, state,
and local level has proven to be critical to company efforts to
respond effectively to this outbreak. Frequently updated
information and guidance from the CDC has been invaluable.
Preparedness planning activities related to avian flu and
bioterrorism by state and county and local health departments
in California provide the particularly compelling example of
how public-private partnerships and outreach to the business
community have helped inform the business response to the
current public health emergency. OSHA's outreach to the
business community this week was also very welcome.
Particularly heartening is the commitment by OSHA, NIOSH, and
the CDC explicitly expressed, and other agencies, to coordinate
their response activities and eliminate any inconsistencies in
messages.
On the ground coordination is necessary in many more
jurisdictions. This is a two-way street, in our opinion, and
both business and government entities at all levels need to
look for new ways to effectively connect and collaborate on
public health preparedness issues.
Efforts to use novel ways to deliver critical public health
information to a vast and diverse audience must continue. CDC's
use of Twitter is a great example of this.
And lesson three: Making pandemic flu planning part of an
overall safety and health management system optimizes
protection of workers and helps to ensure business continuity.
A basic foundation for effective worker protection is the
establishment of a comprehensive system for managing safety and
health performance, focusing on elimination of injuries and
illnesses through a continuous process of identifying,
assessing, and reducing risks.
Companies with such systems in place and with the active
engagement of senior leadership are in the best position to
effectively engage in preparedness planning, keep plans up to
date, and take decisive action in response to public health
emergencies such as the current H1N1 outbreak.
ORC looks forward to working with the committee as it
continues to evaluate the key components of effective programs
and policies to ensure worker protection, and I would be happy
to answer any questions that the committee might like to pose.
[The statement of Ms. Brockhaus follows:]
Prepared Statement of Ann Brockhaus, MPH, Senior Occupational Safety
and Health Consultant, ORC Worldwide
The Washington, DC office of ORC Worldwide has provided specialized
occupational safety and health services to businesses for more than 35
years. On behalf of ORC Worldwide, I would like to thank the Committee
for this opportunity to discuss some of the steps businesses are taking
to ensure that workers are protected from emerging infectious diseases,
such as H1N1.
Over the past few days, there appears to be a growing consensus
among the experts that the novel Influenza A (H1N1) virus is proving to
be, at least for now, a less serious threat than originally feared 13
days ago. But the story could have been very different and there are a
number of important lessons that can be learned from our observations
of the actions taken by businesses as the situation rapidly evolved.
Lesson #1: Advance Planning Counts!
ORC Worldwide conducted two teleconferences for our Networks
membership of several hundred multinational companies from diverse
industry sectors to share critical information on strategies for
responding to the H1N1 outbreak. On April 28, over 300 individuals
participated in the call. On May 5, more than 120 participated. In
addition, on May 1, ORC fielded a survey to the health, safety and
human resources functions of more than 600 ORC client companies,
regarding aspects of their company's preparedness and response
activities. Based on information from the 89 companies that have
responded so far, it has been apparent that businesses have been
diligent and thorough in their consideration of the appropriate
response. We are also pleased to see responses that are thoughtful,
measured and without over-reaction. We believe we are seeing the
benefit of responsible planning, much of which was initiated in
response to the threats of SARS and avian flu, but most importantly,
planning that has been maintained and proven to be practical and useful
in the situation we find ourselves in today.
While our survey is still in progress, we would like to provide
some preliminary information about what we can conclude from responses
received to date:
An overwhelming majority of the responders have a business
continuity plan or pandemic preparedness plan in place to respond to
global outbreaks of flu or a full-blown flu pandemic.
Over 60% of the companies responding implemented changes
to business travel practices as a result of the outbreak. These changes
primarily involved banning all non-essential travel to affected areas,
requiring higher-level approval for travel to various locations, and
specific restrictions related to travel to Mexico. Another 12-14%
already had restrictions in place due to current economic conditions. A
minority of respondents have taken no action at all, with most of these
continuing to closely the situation closely.
Communication in the form of health briefings and contact
numbers for medical advice when traveling is reported by the majority
of respondents.
Almost half of those responding had at one point
instituted policies requiring that employees returning from areas with
confirmed cases of H1N1 to stay at home for a period of time before
returning to work.
I realize this is a small snapshot of information, but until the
survey is complete, it is difficult to provide much more detail. We
will provide the Committee with the full survey report when it is
finalized.
Recommendations:
Although we believe that large businesses are taking
significant steps to prepare for a flu pandemic, it is likely that
small and medium-sized businesses will need additional messages about
the need for planning and assistance tools that are clear and easy to
use.
Our members report that existing plans were geared to
``worst case scenarios'' and that plans had to be adjusted as new
information about the severity and scope of the H1N1 outbreak became
available. Plans must be scalable, flexible, and adaptable to rapidly
changing conditions.
Our members report that internal communication and
coordination has often been a challenge. Companies need to ensure that
preparedness plans provide for effective communication among critical
functions such as health and safety, human resources, security, legal
and others.
Lesson #2: Timely and Consistent Government Information and Guidance is
Critical to Effective Response!
The timeliness of the government messaging about the outbreak--at
the federal, state and local level--has proven to be critical to
company efforts to respond effectively to the outbreak. The frequent,
clear messages from the CDC have been invaluable. In addition,
preparedness planning activities related to avian flu and bioterrorism
by state and county/local health departments in California, provide a
particularly compelling example of how public/private partnerships and
outreach to the business community have helped inform the business
response. Important groundwork has been laid over the past few years
educating businesses about the public health system and government
response plans, and making connections between key contacts. Again, the
experience in California is instructive: there have been a number of
cross-sector pandemic planning events and exercises that have included
business representatives. There have also been efforts at the county
level to encourage business participation in the CDC's Cities Readiness
Initiative, involving the mass dispensing of critical medications from
the Strategic National Stockpile. The H1N1 outbreak has proven the
value of this preparation.
OSHA's outreach to the business community this week was also
welcome. Particularly heartening is the commitment by OSHA, NIOSH, the
CDC and other agencies to coordinate their response activities and
eliminate inconsistencies in messages.
Recommendations:
``On the ground'' coordination is necessary in many more
jurisdictions. This is a two-way street and both business and
government entities at all levels need to look for new ways to
effectively connect and collaborate on public health preparedness
issues.
The on-going effort to use novel ways to deliver critical
public health information to a vast and diverse audience must continue.
CDC's use of Twitter is a great example of this.
Efforts to ensure consistency of content and timing of
public health messages must continue.
Lesson #3: Making Pandemic Flu Planning Part of an Overall Safety and
Health Management System Optimizes Protection of Workers and
Helps to Ensure Business Continuity!
It is well-established that a basic foundation for effective worker
protection is the establishment of a comprehensive safety and health
management system which focuses on elimination of injuries and
illnesses through a continuous process of identifying, assessing and
reducing risks. Companies with such systems in place and with the
active engagement of senior leadership, have been able to sustain the
effort necessary to mobilize action in response to public health
emergencies such as the current H1N1 outbreak.
ORC looks forward to working with the Committee as it continues to
evaluate the key components of effective programs and policies to
ensure workplace preparedness for public health emergencies such as the
H1N1 outbreak.
______
Chairman Miller. If I might, if you would just take 30
seconds to explain ORC.
Ms. Brockhaus. ORC Worldwide is a human resources and
health and safety consulting firm. For more than 35 years, our
Washington, D.C. office has focused on occupational safety and
health consulting. And I am with the ORC D.C. office.
Chairman Miller. So this is one of the service provided by
ORC to its clients, to its members?
Ms. Brockhaus. ORC advises its clients on best practices in
worker protection, and also helps our clients share information
with each other so that in diverse industry sectors there can
be a sharing of information about what works best in terms of
worker protection.
Chairman Miller. Okay. Thank you. Thank you.
Well, thank you all very much for your testimony, and I
think your testimony helped put a lot of this into context. I
think when we look at it in the communities that we represent
you see a lot of conflicts.
Do you send the kids home, or you don't send the kids home.
If you send the kids home is there anybody home to take care of
them? If workers leave can the business keep running? Or do you
want sick people at work? I mean, this isn't a clear-cut
decision on anybody's part, because there is these conflicts
about how you handle it.
Do you want workers to come in if they are sick or do you
want them to stay home? Do I want to go in if I am not sick, if
other people are sick? I need information about my
environments, I guess, is what I am saying, and people are sort
of pushed in the position of thinking, ``What is the safer
environment for me or my children, my employees, what have you?
What do I know about staying home, being in a community, being
at work, being at school that is helpful to me?''
Jack, you mentioned you thought there was some gap in--or
you needed better communications between the state and the
districts. Is that what you were suggesting?
Mr. O'Connell. It is, Mr. Chairman. And I think so that we
can share the information that we have. And I would also say
the media has a role to play, and in my opinion, an obligation
and a responsibility to let people know, for example, the
severity of this particular strain. And that is why in my
comments earlier, in terms of, ``We are pleased with this most
recent decision,'' that sends a signal that this strain has not
been considered as serious as that in central Mexico that has
led to so many illnesses and so many regrettable deaths, yes.
Chairman Miller. I see.
Jordan, on your pyramid you talked about those who were at
the top, and high risk and very high risk workers, and how do
you and when do you put those workers into that category when
you go through an episode like this? At the beginning, you have
an influenza, you don't know a lot about it. Do you immediately
decide so-called first responders in hospitals, doctors'
offices, public health clinics, that they are immediately put
into this category, in terms of being watched and providing
information, or as it becomes--does that happen later when you
know more about the influenza? How is that coordinated?
Mr. Barab. First of all, we take our lead, in terms of the
seriousness of the virus and the nature of the virus, from the
CDC. We are very involved in a number of different committees
and daily--more than daily--phone calls, and we keep very close
track to how the virus is progressing.
But in general, our advice to the high risk and the very
high risk workers are pretty consistent: If you are in contact
with a person who is infected--confirmed to be infected or
suspected to be infected--you should take all the precautions
that we recommend. And again, the engineering controls, the
administrative controls, but also the respirators and the
respirator----
Chairman Miller. Is that a phased in consideration as you
start to get more information? I mean, would you make a
decision that health care workers in the point of contact
should start protecting themselves, or should their, you know--
which could be washing your hands, but it could also be making
a decision that you better be wearing a respirator. How is that
information transmitted?
Dr. Schuchat. Based on what we know about seasonal
influenza and about respiratory viruses, health care workers
were considered a high risk group, in terms of very close
contact with people who were actively ill.
Chairman Miller. That is a general understanding----
Dr. Schuchat. For this particular infectious disease that
would be. The other thing to say is that in any epidemiologic
investigation, a very early question is, who is at higher risk?
Which are the groups that are seeing the illness
disproportionately?
So one of the reasons CDC has people either working with
state and local health departments in a number of affected
areas, and people on the ground in Mexico, is to rapidly learn
as much as we can about what is going on. Conflicting reports
from different places, but trying to recognize quickly who will
be at risk. This outbreak that we are seeing here, younger
people have been more at risk than in seasonal influenza, so
that was an early focus.
Chairman Miller. And I assume that is not confined just to
health care workers. Teachers could find themselves in that
category if you found evidence that justified that--people in a
place of employment, certain types of employment, perhaps,
could find themselves at high risk?
Dr. Schuchat. Absolutely.
Chairman Miller. Okay.
Dr. Schuchat. We will be looking at the epidemiologic
information and trying to adapt rapidly to it.
Chairman Miller. You mentioned, Ms. Brockhaus, that a
significant number of your clients have business continuity
plans, and that is done for all different kinds of eruptions,
or interruptions----
Ms. Brockhaus. Absolutely. And we are talking about large
companies, mostly multinational companies that have learned
over time that in order to ensure that in the event of a
natural disaster, or all of the things that you can imagine
that could interfere with a company being able to do its
business, that they have plans in place that anticipate ahead
of time what might happen and what the company will do in
response. And for many companies, pandemic preparedness is now
a component of an overall business continuity plan that would
be in place to respond to all sorts of potential interruptions
of business.
Chairman Miller. Thank you.
Mr. McKeon?
Mr. McKeon. Thank you, Mr. Chairman.
Doctor, you mentioned seasonal flu. So we have seasonal
flus every year. Do you know how many deaths we have annually
from seasonal flu?
Dr. Schuchat. Right. Seasonal influenza kills an estimated
36,000 Americans each year; there are 200,000 hospitalizations
and millions and millions of infections.
What is different about this particular outbreak is we have
a completely new influenza virus that we don't expect there is
large population protection against. With seasonal influenza, a
good proportion of the population is naturally protected by
years of experience with these viruses, and many more are
protected through the vaccination efforts we make, with more
than 100 million people getting vaccinated each year. So with a
new influenza virus, a big fear is that if it has a certain
amount of severity, you have the whole population at risk, and
you could get much greater--even a greater burden than that
36,000 deaths a year.
Mr. McKeon. So that was what we were afraid of?
Dr. Schuchat. Well, I think that we had--at the beginning
of this we had a completely new virus, we had reports from
Mexico of severe disease in healthy young adults, and we had
information about things moving quickly. We acted aggressively
and actively to try to take steps to decrease the risk of
illness and death and slow the spread.
The idea of slowing the spread is to stretch things out so
that the heath care system won't get overwhelmed and to buy
time for production of the vaccine, should that be necessary.
So that was the original strategy.
Mr. McKeon. The seasonal flu that kills 36,000 people every
year is the same year after year, and this one is a new one?
Dr. Schuchat. Well, the seasonal influenza viruses shift a
little bit. They are just a little bit different each year and
we make up a new vaccine each year because of that change.
But with a totally new virus you have what is called a
pandemic potential. You can get much more disease.
Mr. McKeon. What does pandemic mean?
Dr. Schuchat. A pandemic of influenza is defined by a
strain that is able to cause severe disease in people, that it
is totally new and you don't expect population protection, and
that it is easily or efficiently transmitted in a sustained
way. The H5N1 bird flu strain that we have been seeing--that
was a totally new strain that there wasn't population immunity
to, caused very severe disease, but it hasn't yet been able to
cause this efficient transmission.
What we saw with this H1N1 strain was a virus that was
apparently being very easily spread, just like seasonal flu is
easily spread, and the uncertainty that we have had, and
continue to some extent to have, is just how severe it will
become, or whether it will mutate and become even more severe
than it is so far. So that is why the World Health Organization
has really been on this high alert, and why the public health
community has been acting so aggressively.
Mr. McKeon. I had an uncle that died as a baby during the
flu of 1918. That was a worldwide pandemic that killed how many
people?
Dr. Schuchat. Here in the U.S. we think it was half a
million people, and up to 50 million worldwide. It was just a
massive, massive problem. And that is really what we often, in
our planning, talk about as the worst case scenario. It is a
big focus of an early response, such as we have been having, to
characterize the severity of the strain and understand what is
going on.
A cautionary note is that with the 1918 pandemic strain, it
caused illness in the first spring of 1918 that was moderate,
but it came back in the fall in a much worse form. And so
either they didn't have antiviral drugs then or couldn't make a
vaccine, and health care wasn't what it is now, but it wasn't
over just in the spring. There was really a second wave that
was more deadly than the first.
Mr. McKeon. One of the concerns that I had when I first
heard about his a couple weeks ago: It was everywhere in the
media, and it was--I was worried that it was scaring people
inordinately, and yet all they said to do was wash your hands,
and unless you really need to go to Mexico, don't go.
I mean, it sounded like in one was it was overkill and in
another way it was, ``Well, you know, it is not that serious,''
and I guess that is a fine line. I think what you were doing
and the other things we heard from the committee were very
important.
I am wondering if the media, as they tend to do, goes a
little overboard and some people were scared, which is maybe
why some schools were closed, some businesses maybe had overly-
concerned. I guess this is a fine line that you have to deal
with on every disease, but when I think about the annual flu
that we just kind of take for granted, I didn't realize that
36,000 people died every year. And we have had two death now--
one person that came into the country already sick.
I wonder where we--you know, how we handle that as regard
to how thoroughly we scare people versus, you know, what
actually finally ends up happening. I know the president asked
for $1.5 billion to address this. Is that for money that you
are already spending, or for schools that have lost money, or,
you know--we haven't even really dealt with this yet in coming
up with that money, but I guess I still have some questions.
But I really appreciate the panel and thank you for your input.
Chairman Miller. If I might take a privilege of the
chairman, I am going to go to Mr. Andrews.
Could you explain positively, because I think Mr. McKeon
has touched on an important point--the idea that schools were
closed and then schools were open was sort of a kiss-off,
``Well, they just don't know what they are doing.'' And could
you just describe the environment and how you arrived at that
decision, both the first and the second decision, how you--the
judgment you have to make? Because I think it is an important
point, that you don't quite know. There is two schools of
thought out there when this is all boiling around in the media.
Dr. Schuchat. Yes. At CDC we have been acting very
aggressively to get information out to local and state
decision-makers and to provide guidance that will inform local
or state decisions. An issue like school dismissals is under
the authority of the local--usually local, sometimes state--
groups.
We issued initial guidance on school dismissal recognizing
that local decisions may differ from the national
recommendations because of there is much better information on
the ground about both the circumstances and where students or
teachers may need to go, and, you know, what would be the
consequences. Our original guidance was issued, we would
probably say, very aggressively about, if you have a case
recognized you should consider dismissing students.
This was because the planning and modeling and the
understanding of the role of school dismissal suggested that it
is very early in a response where that would be effective at
reducing spread by taking students who congregate together in a
school and having them stay home with just the family context
could really reduce the spread. What we found as we went on was
that this virus was spreading in the community already, and
that the disruption of the school environment was not really
being justified by the intervention that we were recommending.
But I would say that the decisions to issue guidance will
vary as information changes. The role of school dismissals was
planned for a very severe new virus.
We didn't have adequate information at the beginning to
rule that out. Right now we feel that what is circulating right
now--it is not nothing, you know, it has severity in some
people but that it wasn't that category five type of pandemic
strain that we had feared. So we took early interventions; we
respected local variability and really supported the locals who
were making tough decisions with information on the ground.
Chairman Miller. Thank you.
Mr. Andrews?
Mr. Andrews. Thank you, Mr. Chairman, and thank you for
having this very timely hearing.
I would like to thank each member of the panel. I know we
are not out of the woods yet by any stretch of the imagination
with this pandemic, but I think that each of you in your own
way has done a very good job responding to this situation in
informing the public and protecting the public. And again, I
know we are not out of the woods, but I think you are off to a
really promising start and we appreciate that. We do.
Dr. Schuchat--did I pronounce your name correctly?
Schuchat? Schuchat--I am sorry.
Dr. Schuchat, on page eight of your testimony you talk
about the two drugs that appear to be successful. I will not
attempt to pronounce them. Since I have already botched your
name I won't try.
You say that acting quickly after you identify the virus
and its potential impact on the population, you have released
one quarter of the state's share of antiviral drugs and
equipment to be used pursuant to help the states prepare to
respond to the outbreak, and that the deployment of the
stockpiles was completed by Sunday. To whom are these drugs
distributed? How do drugs administer people who need help?
Dr. Schuchat. The Strategic National Stockpile antiviral
drugs were targeted primarily for use in treatment--44 million
regiments----
Mr. Andrews. What I am asking is, where does the treatment
take place?
Dr. Schuchat. Right. So they are distributed from us to the
state health departments----
Mr. Andrews. Right.
Dr. Schuchat [continuing]. Or the project areas, and each
state has submitted a plan of how they intend to distribute the
antivirals. Some states would be going through regular
pharmacies; some states would be using the public health
settings.
Mr. Andrews. Right.
Dr. Schuchat. We really, in the pandemic planning efforts,
required each state to think this through with----
Mr. Andrews. Do they also use physicians' offices?
Dr. Schuchat. Yes. Some of them do it that way. So it is
really flexible in terms of what will work with their
population----
Mr. Andrews. One of the facts that really struck me about
Mr. O'Connell's testimony--an amazing statistic: For every one
school nurse in California you have 2,227 students. Wow.
So if this program were in some way to be set up through
the schools, it is certainly not going to succeed given that
kind of ratio. What other kinds of public health--put it to you
this way: If you had to get these drugs to a lot of people in a
hurry, how do states typically do that?
Dr. Schuchat. Again, this is left to the states. They have
talked about their points of distribution--where will they do
it? What type of workforce will they pull in to help with this?
That is really part of the whole preparedness planning that
has been going on around the state and local areas,
understanding which sectors can be brought out to help with
different stages. You know, from our role at CDC, you know, an
early decision is, do you deploy these assets--you know, at
what point do you send them out, because they become the
state's or big city's assets once we deliver them----
Mr. Andrews. Do the drafters of these plans have to pay
special attention for people who do not have health insurance
and therefore do not have primary care?
Dr. Schuchat. Yes. There is a whole area of our pandemic
planning around vulnerable populations, and that is a very
important aspect of what the state and local would be deciding.
The issue is, these are,you know, become state resources to
distribute--not for reimbursement, just, you know, they give
them out--that really focused on the treatment part.
The states also have--no, most of the states all sort of
purchase the same drugs for stockpiling for these types of
reserves, and what we understand is, we have distributed the
material, some of the states actually are using them already,
some of them are holding them to see how things go, because
those drugs are commercially available----
Mr. Andrews. It is a little self-evident, but it occurs to
me that if you don't have health insurance, even if your state
gets its fair share of these drugs, you have pretty hard time
accessing them, right? The school nurse, for legal and
administrative reasons, probably is not going to administer
them. You said the pharmacy--well of course, the pharmacy is
not going to give them out for free, right? Are these
prescription medications?
Dr. Schuchat. The antiviral drugs that we are providing
from the Strategic National Stockpile are not to be charged
for; the government has purchased those--either the state or
federal government----
Mr. Andrews. Do you need a prescription to have one
administered, though?
Dr. Schuchat. We used an emergency use authorization that
the FDA signed off on in this context to be able to just
distribute it without individual prescriptions, so for the
context of an emergency, no. For routine purposes, absolutely
yes, and we think they should be taken under a doctor's advice.
Mr. Andrews. I raise this issue because the chairman and a
good chunk of the staff here is spending an inordinate amount
of time on the health care reform issue, thank goodness, and
this strikes me as yet one more compelling example of why we
need every person in the country to have health care coverage.
Anecdotally, it appears--and I see my time is up--that the
better your primary care is, the lesser effect this virus is
having on people, and more primary care seems to be the answer.
Thank you, Mr. Chairman.
Chairman Miller. Mr. Roe?
Dr. Roe. Thank you, Mr. Chairman, for holding this meeting.
I want to also fuss at the House of Representatives. We have
done a terrible job--not fuss since I have been here--about no
place for people who come in to alcohol their hands off. We
should do that in every hallway. It should have been done
months ago.
So let us have this committee do something positive, and at
least we shake hands with people from all over the country, so
I am just sharing a frustration, Mr. Chairman. If we can get
that fixed we will have done something positive for the House
of Representatives.
I think back when I was child about the polio epidemic and
how that was managed and handled--a tremendous health care
success, and to sort of defend--as a physician--to sort of
defend the health care folks and the school director. What we
planned--and as a surgeon, when I would go to the operating
room, I planned on a train wreck and hoped I went on a train
ride. They didn't know what the biological significance of this
virus was when it came out, so we had to plan for the worst
case scenario and hope for the best case scenario, in terms
of--you know, we overplanned.
And I am sure you recall, Dr. Schuchat, the 1976--maybe
not; I do--swine flu epidemic. It turned out the vaccine was
worse than the disease was. We didn't know that at the time,
and hindsight is always 20/20.
You know, I think from a school director's standpoint, when
it snows in Tennessee where I live, eight flakes, the school
director calls school off and gets ostracized and so forth, but
had you rather do that or have a bus wreck up in the mountains
and hurt some children, or potentially kill them? So you have a
tough decision, and you are the ones that have to make that
call. And I think the call was done appropriately here.
Yes, it turned out this disease was not, or doesn't appear
to be yet, as severe as we thought it was, but I think those
preparations were extremely important. And to Mr. Andrews'
comments, I called our EMA director. I went back in 2001 or
2002 and got my smallpox, because we didn't know at the time,
and we have an EMA plan, and I called some EMA directors in our
area and say, ``Are you guys set to go? Is everyone ready?''
``Yes, we are ready, and we have a plan in our area to
treat these epidemics.'' And I think that from 2000 and so,
Homeland Security and CDC and so forth have made huge gains in
being able to handle a problem as big as a pandemic, which,
fortunately, this didn't turn out to be.
So planning is very important. And I will share with you a
brief story that occurred, and I won't mention which airlines.
But this was when the smallpox scare in the early 2000s came
along, a guy flew in from the Orient on an airline into
Memphis, and they thought that he potentially had--could have
smallpox. So what do the folks do? The keep him on the plane
and send everybody else out. They sent, you know, 150 vectors
out, and I immediately awarded them the Forrest Gump award,
``Stupid is as stupid does.''
So education has helped us, and planning, in the last few
years, tremendously. And that is why, Ms. Brockhaus, I have
really appreciated your comments on planning, because it does
allow us a way to handle these epidemics and pandemics. Could
you comment on that from an employer's standpoint, how they did
just your planning efforts?
Ms. Brockhaus. How--I am sorry, sir----
Dr. Roe. Your planning efforts that you have done in
businesses and so forth, and I know the schools have done that,
also.
Ms. Brockhaus. Well, first of all, I want to say in
recognition of your frustration, Mr. Roe, one of my colleagues,
Judy Freyman, in our office in Sacramento, calls this a
teaching moment, when you were talking about, ``Let us do
something here in the House of Representatives.'' So really,
that is, I guess, the silver lining. Whenever there is an
unhappy situation like a novel virus, like the H1N1, where, as
Dr. Schuchat mentioned earlier, you know, lots of people
suffered in many ways because of this outbreak, even though we
are happy that it doesn't seem quite as severe as we though it
would be.
I just want to say that--to reiterate my point that
planning in companies has to be--include reaching out to the
local and state health departments. And we have said that over
and over again and have showcased the response in California
because it seems so effective to us, and we have been directly
involved with the California state and local--variety of local
health departments, many of them in California, and showcased
those experiences to all of our member companies.
These are large companies. You can imagine many of them
have locations in all 50 states, so it is quite a hurdle for
them to really reach out to the local health departments.
California has really met companies halfway and more than
halfway by initiating those outreach activities.
Dr. Roe. One brief comment about nursing. Again, Mr.
Andrews brought up--half of registered nurses in America can
and will retire in the next 10 years, so it is not just in the
school system. It is systemic, and we really need to train
these health care professionals, and as Mr. Garcia certainly
knows that very well.
Thank you, Mr. Chairman.
Chairman Miller. Thank you.
Mr. Hinojosa?
Mr. Hinojosa. Thank you, Mr. Chairman. I thank you for
calling this very timely congressional hearing on this issue
that impacts the whole country and many, many other nations.
But it especially impacts my congressional district because I
had a hospital in Harlingen, Texas, deep south Texas, that
received a child that came from Mexico with a family that flew
in through the valley and were looking for a second, third
opinions. And that child then was moved on to Houston because
of the complications, and that child died--one of the first
ones--and Texas was charged for that one, that first death.
But just recently, a couple of days ago, we had a second
person die in my area. She was living in Harlingen, a teacher,
who had given birth to a child just a few days before her
death, and she was working in my school district of my
hometown, Mercedes Independent School District. And so I say
that it has hit us hard, and I have talked to those
superintendents, I have spoken to some of the school board
members, and they have all struggled with the decisions that
they had to--that they made in closing down the schools, as
they did several weeks ago.
My question to you, Dr. Schuchat, is where is our country
on collecting information on health workers at health care
facilities that have seen confirmed cases of H1N1, and how many
health care workers have gotten sick?
Dr. Schuchat. First, I just want to say how sorry I am
about what your community has gone through. I know that
families affected and the students in that environment have
been through quite a lot.
CDC is actively working with state and local health
officials to understand the situation in health care workers.
It is a very important population. We have detected a number
cases--I think yesterday it was 26 health care workers with the
confirmed H1N1 virus, and we are actively investigating these
to understand where they may have gotten the infection.
Of course, wherever you work you could also have gotten the
infection at home or in the community, or even while traveling.
But we are also trying to understand the circumstances in the
health care environment, whether they cared for anyone who had
such an illness.
The CDC has also been issuing guidance particular to health
care workers to understand, you know, how can they protect
themselves while we are still in this situation of uncertainty?
We don't have the results of the investigation of the health
care worker exposures or illness, but it is an active priority
right now in a number of areas, and it will be perspective, you
know, enrolling additional ones as well as the ones we have
already found.
Mr. Hinojosa. My other question is, what are the additional
steps that CDC is taking to prepare schools like ours, and
childcare facilities, for a potential pandemic?
Dr. Schuchat. You know, with the switch from school
dismissal guidance to recommending that schools reopen, you
know, based on local decisions as well, we have really built up
a stronger partnership with the Department of Education to try
to identify ways that the school environment itself could be an
opportunity for teaching, for education about how to avoid
these types of respiratory infections, as well as a place to
emphasize recognition of children or teachers who are ill and
encouraging them to leave and stay home until they are better.
So we are continuing to try to make sure that the right
messages get out, and that we are taking steps to make sure we
can keep kids in school where they can learn, and keep children
who are not well home, where they will be able to recover
before they return to the environment.
Mr. Hinojosa. Thank you. I yield back, Mr. Chairman.
Chairman Miller. Mr. Courtney?
Mr. Courtney. Thank you. Thank you, Mr. Chairman, and thank
you for holding this hearing.
There is not question, as the witnesses have said, that
local and state officials in the area of school closings make
the final call, but your direction, I think, is really what
they look to. In Connecticut, in my hometown, we--schools
closed Thursday and Friday. My 14-year-old daughter says,
``Thank you,'' I guess, but it was clearly driven by the
initial guidelines.
And, you know, one of the other ripple effects, in terms of
how school officials reacted--maybe overreacted--was that
schools were then subjected to these pretty dramatic scrub-
downs. Local media was in there doing, you know, coverage, and
certainly we want clean schools, but I guess the question is,
is that really something that makes sense from a scientific
perspective?
Dr. Schuchat. You know, the environmental cleaning is
important for some viruses that can live on surfaces for a
certain period of time, with attention to the high frequency
areas--you know, railings on staircases, or doorknobs, elevator
buttons, those types of things that lots of people touch. You
know, I do think that--we have issued some guidance in working
with environmental health experts at CDC as well as the
virologists to try to focus the energy into the most effective
steps.
So I think that, you know, the media will cover something
that is quite visible, but we do include in our guidance
cleanup of the high frequency--the environmental surfaces that
are touched a lot by lots of different people.
Mr. Courtney. I could care less about the media. The real
questions is just that the local school budgets, as Mr.
O'Connell knows, are stretched thin. This is all overtime that
was generated as a result of this effort, and certainly being
helpful to school superintendents, in terms of trying to not go
overboard, would be helpful in terms of the right response.
Dr. Schuchat. Yes. Thank you. I think one big issue for us
is to try to focus the energy in the most effective efforts and
away from the ones that aren't really worth the trouble. Thank
you.
Mr. Courtney. Mr. Modzeleski, I mean, communicating with
parents in these situations where, you know, dismissal has
suddenly been issued and then rescinded--again, I just, just
using my hometown, I mean, they shut down Thursday and Friday.
SAT testing was Saturday morning, and parents were lost in
terms of whether or not they should drop their kids off to come
in for tests.
I mean, what is the department recommending? Is it, you
know, phone trees, e-mail, I mean, how do you--and how much do
you tell them?
Mr. Modzeleski. That is a good question. What we recommend
is to communicate often, communicate with accurate information,
communicate in different modalities. This is not only--many
schools have phone trees, but phone trees, text messages,
placing it up on the Web, I mean, a lot of the information that
we have received from schools and schools put out is now Web-
based. I mean, this is a good way of doing it.
Text messaging is also another way. You know, we have been
working with schools for the--since 2003 on what we call all
hazards planning, making sure schools dealing with a whole wide
variety of hazards. And one of the things there that we have
seen is that schools have built into their communication plans
is getting messages out to school--getting messages out to
parents quickly in a lot of different ways and making sure that
information is accurate. So those are the three things that we
would recommend to all schools.
Mr. Courtney. I would encourage you to kind of keep
pounding that message, in terms of the department's
communications to the localities, because, you know, it was
clear--again, this happened so fast, and I am not trying to,
you know, Monday morning quarterback, but, you know, it was
pretty uneven--let us put it that way--in terms of how well
that was implemented.
But I think the other point that we have seen is that it is
important to make sure that the information that is put out is
accurate information.
Mr. Modzeleski. Right.
Mr. Courtney. It has to be accurate information. You know,
if that delays the message a little bit I think it is better to
delay the message and get it right, rather than to push it out
and then have to rescind it, because that just confuses
parents.
And one other question for Dr. Schuchat about the--you
know, what happens to the flu virus when, you know, spring
turns into summer, and then when it sort of bounces back in the
fall. I mean, does it go into remission? Does it disappear?
Does it migrate? I mean, why should we still really be
concerned if the summer is coming?
Dr. Schuchat. You know, we will be looking very intensively
in the southern hemisphere our summer, which is their winter,
because they, you know, whether they see a regular seasonal
influenza or whether they see this strain that we have been
having emerge as a dominant problem, so both in terms of
support and assistance to affected countries, but also the
scientific investigation that will help us anticipate our fall
experience. We don't know.
Some of the pandemics of the past have sort of simmered in
the summer. But we are hopeful that this season--the normal
season--will be on our side, because, you know, cases are
continuing to increase right now.
People sort of think we are out of the woods, but every day
we are getting a couple hundred more cases, and some of it is
the backlog in the lab testing, but new cases. So we are
hopeful that as we enter the summer, you know, or primarily as
we enter June, that we might be seeing a dampening here, but we
really need to be prepared for this same strain to be around or
even have evolved a little bit to be in worse shape by then.
Mr. Courtney. So if southern hemisphere countries aren't
experiencing much this summer, is that a signal that we are
not, you know, in a 1918 situation of a strong bounceback?
Dr. Schuchat. That will be a good sign, but with influenza,
you hate to say it, but it is very unpredictable. We have a lot
of this virus here in the United States right now. Almost every
state has it. And in the southern hemisphere they haven't
actually detected cases, really, yet. They are looking. There
is a couple suspect ones, but their flu season is just
beginning, and we really need to work intensively in
partnership----
Chairman Miller. Gentleman's time is expired. We have a
vote on. What I would like to do--I know members have
questions; we are going to go to Ms. Titus next--but if we
could limit it to 3 minutes, so you ask your most--your first
question first, and we will see if we can get the members
before we leave. It is Ms. Titus, Loebsack, Woolsey, McCarthy,
Fudge, Hare----
Titus?
Ms. Titus. Thank you, Mr. Chairman.
Secretary mentioned that every state has a preparedness
plan, and I guess that they submit it to you, and there is an
appendix about schools. Well, I have a copy of Nevada's plan
here. There are 13 agencies that contributed to the plan; none
of those agencies is at all related to education.
The Appendix A has 38 acronyms. Not a one of those is
related to education. I have only found the word ``school''
twice in 76 pages--one is on page 40, where it says, ``For
additional information on schools and health care settings go
to the CDC Web site.'' And the other mention of school is on
page 58, and there it says, ``Other strategies for slowing the
spread could include temporarily closing of schools, arenas, et
cetera.''
I wonder if all the state plans are this bad, and if they
are this lacking in coordination with schools, and if we don't
need to do some review of what the state plans are.
I appreciate the fact that there is more coordination now
as a result of the new flu, but we had a potential pandemic
several years ago, when all of this was supposed to have been
put in place, and none of the demographics or factors of this
new flu are very different from those, so why is that missing?
Why have we not done that before?
Mr. Modzeleski. Well, it is a very good question, and there
are two things going down on parallel tracks here. On the one
hand, I want to repeat, is that we have been working with
schools districts, primarily at the school district level, on
developing and having schools developing what we call all
hazards crisis plans.
In 2006, because of the outbreak of the epidemic--or the
potential outbreak of the epidemic in 2006, is we required that
every school district receiving a grant through the Department
of Education under our Readiness Emergency Management for
Schools--and we have provided funds to over 600 school
districts in this country on that--we required them to have a
pan flu plan at the local level. So if you go out to the local
level, especially for those districts that have received
funding from the Department of Education on the preparedness
grants, is that they have developed pan flu plans.
What you are talking about is a requirement which is not a
Department of Education requirement. It is a requirement which
came down from Health and Human Services as part of a
legislative requirement. And the appendix--I believe it is
Appendix B4--is supposed to list education requirements, both K
through 12 education as well as higher education, which is
another appendix.
We have reviewed all of those plans. Actually, we review
those plans; we provide comments back to the states, and states
were supposed to take the comments based upon our review and
then revise those plans. We have not seen revised plans as of
yet.
Mr. Loebsack. Thank you, Mr. Chairman. Thanks for having
this important hearing.
And thanks to the witnesses. I will be very brief.
Dr. Schuchat, I think you were at our bipartisan caucus. I
brought up the, you know, question of using the word ``swine,''
and I want to thank you again for not using that word, and all
of you for not using that word. I am from Iowa, and the pork
industry is very important in Iowa, as it is in many states
around the country.
But I am pleased to read your testimony. And you did
mention this in your oral testimony, but you state that there
is no evidence to suggest this virus has been found in swine in
the United States, and there have been no illnesses attributed
to handling or consume pork. Currently there is no evidence
that one can get this novel H1N1 influenza from eating pork or
pork products, and you mentioned that we should always cook
pork products to 160 degrees Fahrenheit just in case.
Can you be--I know this is--you may not be able to answer
this question for everyone, but can you be less equivocal and
state that one may not get this influenza from pork products?
Because, you know, this language--I understand why you use this
language, ``no evidence currently right now that anyone has
gotten the, you know, the influenza from pork,'' but can we go
further than that and state that there is no way, if you will,
that anyone can get this influenza from pork products?
Dr. Schuchat. People don't need to be worried about eating
pork, in terms of this particular virus. Influenza viruses can
affect swine. Swine can become ill from influenza viruses. But
everything we know about what is going on right now suggests
you don't need to worry about pork, in terms of eating that or
handling it.
Mr. Loebsack. Thank you for going that far. I appreciate
that.
How are you getting the word out, then, about this, and how
it is the case that, really, that it is not possible to get
this from pork? How is the CDC getting the word out?
Dr. Schuchat. You know, we have placed communication as our
highest priority, really, in this response, because information
and misinformation are important in how the public reacts and
the unintended consequences. In terms of the pork issue, we
have been working with both USDA and the pork board and other
business concerns to understand what we can do to clarify the
issue. You know, here in the U.S. this is an issue and in other
countries it is an issue as well. We are really trying to be
sensitive to both the cultural and economic impacts of our
words.
Mr. Loebsack. Right. Thank you. I think it is very--and for
the record I want to say that it is very unfortunate that China
and a number of other countries have banned pork in ports from
Iowa and other parts of the United States. It is very
unfortunate.
Mr. Modzeleski, have you or have any of you seen any--Mr.
O'Connell, in particular--have you seen any cafeterias--school
cafeterias--banning pork products as a result of this?
Mr. Modzeleski. We are not aware of any, sir.
Mr. Loebsack. Okay, good.
Thank you.
Ms. Woolsey. Thank you, Mr. Chairman. Certainly our number
one concern is the health of every American, everybody around
the world, when it comes to a pandemic.
Today we are talking about children and workers, and
certainly one of the sure ways to stop an epidemic or a
pandemic is for a sick child not to go to school and a sick
employee to stay home from work. So, we need to provide a
series of programs to protect the worker from loss of pay and
from loss of any punitive retribution if they do stay home.
So my question is--to you, Ms. Brockhaus--is, does ORC
support a paid sick leave and/or paid family leave--family and
medical leave--plan, or any other plans that bridge work and
family?
And then, Mr. Garcia, I would like you to think, while she
is answering me, whether your employer has provided any of
these plans or these benefits to their employees.
Ms. Brockhaus. Ms. Woolsey, ORC's experience is really only
with very large companies, and our experience with those
companies--and we have some survey results we can share with
you--is that more than 98 percent of the companies that we have
surveyed are very large companies who have----
Ms. Woolsey. Do they have paid family leave, so a parent
can stay home with a sick child or the worker can stay home
when they are sick?
Ms. Brockhaus. Yes. They call the leave policies by
different names, in many cases, and in many cases there is an
amount of leave that is given that the worker has flexibility
in terms of how to use. I am really not confident to address
the issue of companies that don't provide that leave----
Ms. Woolsey. Okay. Thank you.
Mr. Garcia?
Mr. Garcia. I thank you very much, and we do have, as part
of our--what Kaiser has, part of our benefits, is sick leave
pay, so that someone can stay home, as well as FAMLA and CFRA,
that if there was a need to stay home with a family member,
then we can. And one of the things that you pointed on that I
think is very important is actually recognizing that how do
stop the transmission of it?
And right now, even when our emergency rooms--this is where
I work, and working with workplace safety as a labor co-chair--
you know, emergency rooms are very busy just with our normal
cardiac and stroke. And as we continue to double--and even
though we are at the beginning of this understanding of the
flu, we are seeing a doubling of people being infected,
confirmed, as well as actually probable cases. So being very
familiar with the germ theory is that this is how we stop the
germ from actually--or, the virus from actually being
contracted and transmitted, is by actually taking care of the
worker, whether it be staying home, whether it be having
standards that are put in place.
Ms. Woolsey. And with my little--I have a tiny minute left,
maybe--then you are using OSHA's standards to protect--prevent
this from happening in the first place?
Mr. Garcia. We do have policies in place that we are
implementing, and as we prepare we are communicating when they
start.
Chairman Miller. Ms. Clarke?
Ms. Clarke. Thank you very much, Mr. Chairman. In addition
to being a member of this committee I am also chair of the
Subcommittee on Emerging Threats, Cyber Security, and Science
and Technology for the House Committee on Homeland Security. It
is in this capacity that I am responsible for conducting
oversight to ensure that the Department of Homeland Security is
performing its mission of coordinating federal departments and
agencies that are charged with responding to pandemic flu and
doing what is necessary to address and mitigate the spread of
H1N1 flu.
I also happen to be the only member on this committee from
New York City, but needless to say, I have a very special
interest in being--in this topic being discussed today. And I
would like to thank you, Mr. Chairman, and all of you who are
contributing to this hearing today on this very important
issue. I want to also take a moment to commend Mayor Michael
Bloomberg, our deputy mayor, Linda Gibbs, and our health
commissioner, Tom Frieden, for their response, work, vigilance,
and keeping New Yorkers informed and safe.
My first question is to Mr. Bill Modzeleski, and Jack
O'Connell, and to you, Dr. Schuchat. I have a significant
immigrant population in my home district in Brooklyn, New York.
For many immigrants, English is their second language, and
quick and effective communications with immigrant parents is a
key component to preventing and mitigating this threat of the
H1N1 flu and for future outbreaks.
I would like to know what, if any, outreach our educational
systems and the CDC have done to get this information into
immigrant communities.
Mr. Modzeleski. That is a great question. First of all, let
me say, we have worked very closely with officials--key
officials--in New York City, both in the city as well as with
the Archdiocese school district when you had a recent outbreak
in the high school. There are a lot of populations that we are
dealing with here.
One of the interesting things is that we held, as I
mentioned in my testimony, three outreach phone calls, where we
had well over 3,000 lines come in from people asking questions.
And one of the questions that kept on coming up over and over
again was about immigrant populations, not only those down by
the border, but it other communities. And so what we have been
trying to do is outreach, push information out from the
Department of Education not only to school districts, but to a
lot of community groups and organizations that represent those
particular interests.
Also, trying to ensure--and why we can't do it for every
publication or every journal--is to try to make sure that the
key pieces that we have are translated into key languages,
especially Spanish. And we are not the only ones doing this.
I mean, part of what our philosophy has been is that we
move forward in working in the community. I have to do it with
Dr. Schuchat. I have to do it with DHS. And I should say is, if
you are looking at DHS, they have done a phenomenal job, I
think, in coordinating overall efforts with all of the domestic
agencies, including the Department of Education.
Ms. Clarke. Thank you very much, Mr. Chairman.
Chairman Miller. Mrs. Davis?
Mrs. Davis. Thank you. Thank you, Mr. Chairman.
Good to see you, superintendent. I just have a very
practical question, partly from the stories of bathrooms not
being equipped with soap or sanitizers. Is there some reason
why we shouldn't have sanitizer dispensers in classrooms? Would
that be overreach? Is that necessary?
Would that be a good idea generally, in terms of educating
students to use them? I know whenever I go anywhere people are
always dousing me with, you know, sanitizer, and so just
wondering if we shouldn't sort of look into that being usual
fare for our classrooms.
Mr. O'Connell. Congresswoman, nice to see you again. I
think that is a very good idea. It comes down to a issue of,
you know, funding and priority for our schools, and the
strapped budgets that we have, the inadequate number of school
nurses--and I believe that this issue has really called that
issue, you know, front and center--and a point earlier, the
shortage of nurses that we have not just for schools but also
for our general population is going to be a real challenge for
us.
And that is why the posters, you know, on Congresswoman
Clarke's issue--we have posters in California, as you know,
multiple languages, very diverse student population. Forty-
eight percent of our students are Latino; 40 percent of our
kids go home from school, speak a language other than English;
39 percent of our kids came to school today to learn the
English language, and so that--and one out of four students K
through 12 came to school to learn the English language.
So we do have to make sure that we, you know, multiple
languages, and that we try to meet those basic health care, you
know, good hygienic policies----
Mrs. Davis. Right. Absolutely. But it is partly habit-
forming, and it just occurs to me sitting here, and I wanted to
wait and say hello. Thank you very much.
Mr. O'Connell. Thank you.
Chairman Miller. Thank you very much. If I could have a
couple of questions here. This question of what do--the
interplay between employers and schools is rather significant,
obviously, and so for the moment we have kind of dodged a very
serious situation, and yet people may have to make decisions to
go home to take care of a very ill child or family member, or
they can't get the child to school, and, you know, we have a
system sort of built up--there is various sanctions.
If you don't show up for work, the theory is you are not
doing your job. You could be fired. If you don't show up for
school you can't take the test, you can't go ahead, you lose
your ADA.
There is all of these things that are built into the system
that assume regular order every day, and yet we see--and I
think the CDC has suggested and science has suggested--that we
can expect a continuation of this trend toward something like a
pandemic--it may be dangerous, it may not be dangerous, but it
is going to be upsetting to the economy, to the school
environment, to society. And I just wondered, now that we have
had a bit of experience in terms of a very large-scale, you
know, in my--in the county I represent we had five school
closures, and you know, it kind of shook everybody up. I know
that people were wondering if they should go.
But are we starting to look at how we make these decisions
and whether sanctions--you know, the traditional sanctions that
are sort of institutionally in place or culturally in place--
whether they help us in dealing with the pandemic or they are a
hindrance to is? And it is tough. You are an employer; you have
got product you have got to move; you have got guidelines, you
have got contracts, you have got commitments, and the other
people on the other side of this country may not be
experiencing any of this. What are we thinking about this in a
larger sense?
Start with the--because I know you have to go, and I know
you all want to go. So I am not going to keep you very long,
but Dr. Schuchat?
Dr. Schuchat. You know, I think what you--the issue you
raise is incredibly important. In our pandemic planning we had
identified certain policy issues that would need to be surfaced
that, you know, hadn't really been settled as we were thinking
of the science or the public health impacts.
We did, actually, public engagement around the question of
what we call community mitigation--these issues like closing
schools or making people telework, or, you know, really
shutting down, social distancing, cancelling big gatherings,
and some of the comments from the public citizens involved were
about these matters, you know, will I be able to--you know,
what is my employer going to do? Can I get forgiveness on my
mortgage payments if I have got to, you know, not work for X
amount of time because of these new policies?
I think these are really important issues, and I would say
we probably have a chance to learn from the experience that we
have gone----
Chairman Miller. It is how people make decisions, but I
don't know that they--that we have a set of clear signals about
your interests versus your traditional societal interests that
come into conflict.
Yes?
Mr. Barab. Yes. This is not specifically an OSHA issue, but
it is certainly a Department of Labor issue. When we are
dealing here, we--part of a public health strategy is to get
people to stay home if they are sick or if family members are
sick. Obviously, if people don't have sick leave or don't have
other income support they are not going to be able to do that.
They are not going to do it. And that is a problem for the
public health.
We have, at the Department of Labor, identified a number
of, really, holes in the social safety net that deal with
income support, job retention, FMLA issues that don't
necessarily apply to this situation, and it is an issue of
great concern for us, and we are in deep discussions within the
Department of Labor and with the White House on how to deal
with this should we come across a really serious pandemic.
Chairman Miller. Jack, you have teachers that--what do they
do?
Mr. O'Connell. We do, and the example I was thinking of,
Mr. Chairman, is there is a large hospital in Santa Barbara,
and of course, we are all thinking of them for the fire there
right now, but in Santa Barbara the secret to that hospital's
success is that they were able to provide childcare. You know,
a predominant number of their employees are women, many single
women, many with kids.
And the childcare that they provide, they also have a
segment for if the student--if their child is sick. And it is
the only one that I am aware of, if your kid is sick we still
want you as a nurse, as a doctor, as a LPN, to come to work,
and we are still going to take care of your child. And I say
that not from the health care perspective, but as the employer
community--the hospital is a, you know, for profit institution,
and think that has really helped them with their----
Chairman Miller. With the traditional childcare centers it
is almost the opposite. You want the kids to stay home, I
assume.
Mr. O'Connell. And this is the exception, yes. Right.
Chairman Miller. Yes. Let me ask----
Mr. Garcia, you----
Mr. Garcia. Chairman Miller, I want to just mention, as far
as our labor-management partnership, the things that are
working with Kaiser Permanente that I am finding: I am hired by
them as a contract specialist to actually allow the health care
worker to have a say in--we have something called the unit-
based teams that, monthly we do meet, and every department is
responsible, and our contract is over next year, and our
reiterated, but we are supposed to, each department, to
actually have a unit-based team that there is a equal say
between labor and management.
But I feel like one of the factors is, does the actual
health care worker feel protected by the employer? And for one
of the things that I feel like is working in our community, in
our hospital, is that of a unit-based team and a partnered
laborship-managment, and I am actually there to actually make
sure that that culture is understood, whether it be from the
management or from the labor, to say, ``Are we abusing this or
are we not allowing the culture that you could stay home if you
need to?''
If something is unfair, I go there and I represent them,
and so I feel like that is one of the things that is working,
is a labor-management partnership.
Chairman Miller. Let me ask you this question: I had a
chance, sort of in the middle of all this, to visit a large
medical center on an emergency basis. And so I was there for a
couple hours, and of course, I am always amazed at how fluid
the medical staff moves through in and out of patients with all
different set of circumstances. But, you know, people weren't
wearing masks; they weren't wearing respirators, they were just
taking care of the patient population.
How do those institutions make the determinations that you
ought to move to a level where you should be wearing a mask or
respirator or this? What is the guidelines that are there?
Mr. Barab. We showed you the risk pyramid there. We really
expect employers initially to do their own risk assessment.
They need to decide who is at risk in their environment, and in
this case, again, who as direct contact with infected or
suspected to be infected individuals.
Now, this shouldn't be anything new for hospitals. As you
know, there are a variety of hazards that exist every day in
hospitals, pandemic or no pandemic.
Hospitals, we expect, should have some kind of health and
safety program there, so they are making these determinations
constantly about either infectious disease hazards or chemical
hazards that workers face. So we expect them to apply those
same principals to the pandemic flu situation.
Chairman Miller. I mean, I am watching--sitting in the
waiting room, I am watching the person that is doing the
initial intake. She is talking to families. Somebody in the
family is sick, but the whole family wants information, but
they are gathering around her and they are talking to her and
they are trying to determine--in some cases a member of the
family is interpreting for them.
This intake worker--I don't know if she is considered
medical staff, or where she fits into that process, but she
looked to me like a front line individual. So how would the--
you are saying that is handled based on the institutional
decisions.
Mr. Barab. Partially. I mean, when you get down from the
high, very high risk, or high risk to what we might consider
medium risk people, which may be workers who come across a lot
of people every day--and those could be the intake people, they
could be supermarket checkers, for example--you are dealing
with a whole lot of people. Now, the precautions they need to
take will be determined by how severe the virus is expected to
be or is, and how pervasive it is, and those, again, we get our
cues from CDC.
In this case it wasn't very serious, and it wasn't, you
know, as pervasive, and therefore we weren't dealing with the
precautions at some of the middle level, middle risk--but that
could change.
Chairman Miller. If you are a grocery store, you probably
don't want your checkers wearing a mask.
Mr. Barab. No. Exactly.
Chairman Miller. All right. But, so what is the step point
for that decision? Do they have to be directed by CDC, that if
you come in contact with large numbers of people where the
influenza is geographically, you could say, it is here because
of the level of infection? Who makes that decision? Because
there is a lot of public relations reasons why, you know----
Dr. Schuchat. You know, we have looked at the scientific
information about what is going on, what type of transmission
routes there are. Here we are mainly thinking of what we call
respiratory or droplet precautions that are needed in that
health care environment, and nothing really needed at the
supermarket.
But infectious diseases are different, and the
circumstances will vary. And I just want to make the point that
there is certain protection that the workers in the health care
environment can take every year against the seasonal influenza
strains that are also spread sometimes in health care settings,
and unfortunately, even with that 36,000 deaths a year that we
have and a lot of vaccine that is very effective, only about 43
percent of health care workers take advantage of the seasonal
flu vaccine each year.
So in terms of those teachable moments, there is a lot that
health care workers and hospitals could be doing to protect
workers day-in and day-out in the annual flu.
Chairman Miller. In your continuity plans, what do workers
do if 10, 15 percent of the workforce has kids home sick? They
have influenza, but you don't know at that point whether it is
very serious or not; they have been told the school has been
closed. What do employers----
Ms. Brockhaus. Well, I wanted to make the point that one of
the things that we found companies doing is developing
questionnaires so that they could screen employees. Companies
who were definitely with--definitely want sick workers to stay
home. But it was tough. This is seasonal--seasonal allergy
time. You know, is your runny nose from H1N1 or is it from
allergies?
So companies developed questionnaires, told sick workers to
stay home but call in and have somebody run through a
questionnaire. And the companies were very dependent on the
description of the virus and its symptoms from the CDC. So
questionnaires were developed based on the specific
characteristics of this virus, trying to figure out who are the
right people to keep at home. And so I just want to do another
hats off to the CDC for providing that information.
And the companies were so interested in these
questionnaires that more than 20 companies shared their
questionnaires with us to make them available to other
companies so that they could learn from those questionnaires,
and we are going to post those on our center of excellence Web
site, which is on our public Web site.
Chairman Miller. Well, thank you very much for your time
and your testimony, and the expertise that you brought to this
hearing this morning. There still remain some pretty serious
questions in these large institutional responses, especially if
this is something, unfortunately, that we can continue to look
forward to with strains that we don't know a lot about in the
beginning and we don't have white lines, exactly, what people
should or should not do.
It is a real test for--certainly for schools, I think. It
is a very real test on how they cope with that, because again,
you have deadlines and systems of financing.
But thank you so much. Without objection, members will have
14 days to submit additional materials and questions, and the
hearing will stand adjourned.
[Additional submission of Mr. Miller follows:]
Statement of the National Partnership for Women & Families
The National Partnership for Women & Families commends Chairman
George Miller and Ranking Member Howard ``Buck'' McKeon for holding a
hearing on the timely issue of the flu virus and how schools and
workplaces can prepare. The National Partnership is a non-profit, non-
partisan advocacy group dedicated to promoting fairness in the
workplace, access to quality health care, and policies that help
workers in the United States meet the dual demands of work and family.
Workers Need Paid Sick Days
In recent weeks, much attention has focused on the H1N1 virus
(``swine flu'') and the best ways to contain it. The advice from the
Centers for Disease Control & Prevention (CDC) and Administration
officials is sound: `If you have a fever and you're sick or your
children are sick, don't go to work and don't go to school.' That's
good advice but, unfortunately, nearly half of private sector workers
in the United States (43 percent) don't have a single job-protected
paid sick day.\1\ The same is true for close to four in five low wage
workers--the majority of whom are women.\2\ Nearly 100 million workers
don't have a paid sick day they can use to care for a sick child. For
them, staying home means losing pay and, perhaps, losing their job. In
this economy, that's a terrible choice to have to make.
The problem is particularly acute for working women--the very
people who have primary responsibility for family caregiving. In fact,
almost half of working mothers report that they must miss work when a
child is sick. Of these mothers, 49 percent do not get paid when they
miss work to care for a sick child.\3\ Women also are
disproportionately affected by the lack of a standard of paid sick days
because they are more likely than men to work part-time (or cobble
together full-time hours by working more than one part-time position).
Only 16 percent of part-time workers have paid sick days, compared to
60 percent of full-time workers.\4\
Our failure to guarantee a minimum standard of paid sick days is a
significant public health concern. Many of the workers who interact
with the public every day are among the least likely to have paid sick
days. Only 22 percent of food and public accommodation workers have any
paid sick days, for example. Workers in child care centers, retail
clerks, and nursing homes also disproportionately lack paid sick
days.\5\ If a lack of paid sick days means that they must work when
they are ill, their coworkers and the general public are at risk of
contagion.
Workers with caregiving responsibilities are among those who
urgently need access to paid sick days. As our population ages, more
workers are providing care for elderly parents. Caregiving takes a
financial toll on working people, especially when they have to take
unpaid time off to provide care. More than 34 million caregivers
provide assistance at the weekly equivalent of a part-time job (more
than 21 hours per week), and the estimated economic value of this
support is roughly equal to $350 billion\6\--a huge contribution to the
health and well-being of their families. Caregivers contribute more
than time; 98 percent reported spending on average $5,531 a year, or
one-tenth of their salary, for out-of-pocket expenses.\7\ Yet, many
lose wages each time they must do something as simple as taking a
relative to the doctor.
No state requires private employers to provide paid sick days. San
Francisco, the District of Columbia and Milwaukee have passed
ordinances requiring that private employers provide paid sick days.
More than a dozen cities and states are working to pass paid sick days
laws to ensure that this basic labor standard becomes a right for all
workers. But illness knows no geographic boundaries, and access to paid
sick days should not be dependent on where you work. Paid sick days is
a basic labor standard like the minimum wage--and as with the minimum
wage, there should be a federal minimum standard of paid sick days that
protects all employees, with states free to go above the federal
standard to address the particular needs of their residents.
The Healthy Families Act would allow workers to accrue up to seven
paid sick days a year that they could use to recover from illness or
care for a sick family member. It's simple, it's smart, and it's a
basic workplace standard. We urgently need it to become law.
Businesses Benefit from Paid Sick Days Policies
Research confirms what working families and responsible employers
already know: when businesses take care of their workers, they are
better able to retain them, and when workers have the security of paid
time off, their commitment, productivity and morale increases, and
employers reap the benefits of lower turnover and training costs.
Furthermore, studies show that the costs of losing an employee
(advertising for, interviewing and training a replacement) is often far
greater than the cost of providing short-term leave to retain existing
employees. The average cost of turnover is 25 percent of an employee's
total annual compensation.\8\
As mentioned previously, paid sick days policies also help reduce
the spread of illness in workplaces, schools and child care facilities.
In this economy, businesses cannot afford ``presenteeism,'' when sick
workers come to work rather than stay at home. ``Presenteeism'' costs
our national economy $180 billion annually in lost productivity. For
employers, this costs an average of $255 per employee per year and
exceeds the cost of absenteeism and medical and disability benefits.\9\
In addition, paid sick days policies help level the playing field and
make it easier for small businesses to compete for the best workers.
The Nation Needs Policies that Allow Workers to Meet their Job and
Family Responsibilities
The economic crisis our country is currently facing has been
devastating for working families. More than 11.6 million workers have
lost their jobs, and millions more are underemployed. In February 2009,
the unemployment rate was 8.1 percent--the highest level since December
1983. The unemployment rate for African Americans was 13.4 percent, the
rate for Hispanics was 10.9 percent, and the rate for whites was 7.3
percent in January 2009. For many families that once relied on two
incomes, this crisis has meant managing on one income or no income at
all. As a result, families are not only losing their economic
stability, but their homes: one in nine mortgages is delinquent or in
foreclosure.10
Especially at this time, when so many workers are suffering
terribly, we must put in place a minimum labor standard so that taking
time off for illness doesn't lead to financial disaster for families.
Workers have always gotten sick and always needed to care for children,
family members and older relatives--and they have always managed to be
productive, responsible employees. But without a basic labor standard
of paid sick days, families' economic security can be at grave risk
when illness strikes. In this economic climate, when jobs are so
scarce, we need a basic workplace standard of paid sick days to prevent
workers from being forced to choose between their health or the health
of their family, and their paycheck or even their job.
Our nation has a proud history of passing laws that help workers in
times of economic crisis. Social Security and Unemployment Insurance
became law in 1935; the Fair Labor Standards Act and the National Labor
Relations Act became law in 1938, all in response to the crisis the
nation faced during the Great Depression. Working people should not
have to risk their financial health when they do what all of us agree
is the right thing--take a few days to recover from illness, or care
for a family member who needs them. Now is the time to protect our
communities and put family values to work by adopting policies that
guarantee a basic workplace standard of paid sick days.
endnotes
\1\ Vicky Lovell, Institute for Women's Policy Research, Women and
Paid Sick Days: Crucial for Family Well-Being, 2007.
\2\ Economic Policy Institute, Minimum Wage Issue Guide, 2007,
www.epi.org/content.cfm/issueguides--minwage.
\3\ Kaiser Family Foundation, ``Women, Work and Family Health: A
Balancing Act,'' Issue Brief, April 2003.
\4\ Vicky Lovell, Institute for Women's Policy Research, No Time to
be Sick, 2004.
\5\ Vicky Lovell, Institute of Women's Policy Research, Valuing
Good Health: An Estimate of Costs and Savings for the Healthy Families
Act, 2005.
\6\ Gibson, Mary Jo and Houser, Ari, ``Valuing the Invaluable: A
New Look at the Economic Value of Family Caregiving.'' AARP, June 2007.
\7\ Jane Gross, ``Study Finds Higher Costs for Caregivers of
Elderly,'' New York Times, 11/19/07.
\8\ Employment Policy Foundation 2002. ``Employee Turnover--A
Critical Human Resource Benchmark.'' HR Benchmarks (December 3): 1-5
(www.epf.org, accessed January 3, 2005).
\9\ Ron Goetzal, et al, Health Absence, Disability, and
Presenteeism Cost Estimates of Certain Physical and Mental Health
Conditions Affecting U.S. Employers, Journal of Occupational and
Environmental Medicine, April 2004. 10 Center for American Progress,
www.americanprogress.org/issues/2009/03/econ--snapshot--0309.html,
March 2009.
______
[Whereupon, at 11:52 a.m., the committee was adjourned.]