H1N1 on campus: Club Swine

The front page of this morning's New York Times has an article about quarantine dorms for students with swine flu on college campuses. I have been receiving calls from our University Health Service and will spend several more hours this week working with university administrators on additional planning for swine flu. A number of questions keep circulating in my mind: How much of this planning activity is driven by continuous media reports? Would this have happened 10 years ago? Could our time be used more wisely? How much planning can be done for a disease that is so unpredictable?

So to ensure that my reality testing is intact, I again reviewed the latest CDC surveillance data. In a nutshell, here are how things stand:

• Since mid-April there have been 9,079 hospitalizations and 593 deaths (in a typical flu season there are on average 226,000 hospitalizations and 36,000 deaths)
• During this influenza season there have been 111 flu-related deaths in children, over half of which were due to seasonal strains (in a typical season there are on average 92 deaths in this group)
• Only 1 of 10 national regions currently has an elevated incidence of outpatients with influenza-like illness (ILI)
• For the most recent week reported (ending August 29), the proportion of deaths attributable to pneumonia and ILI were below baseline levels
• 97% of subtyped viruses in the most recent reported week were H1N1

Now back to the situation on college campuses. If you consider that students are likely infectious one day before onset of symptoms, that some symptomatic individuals will ignore recommendations and continue with their normal daily activities, and that social distancing is essentially abnormal behavior in college, does it make sense to attempt to control transmission of swine flu by setting up quarantine dorms? Could it be that doing so may prolong the outbreak on any given campus? Since in the vast majority of students the acuity of disease is about the same as a bad cold, does any of this make sense? If we knew that a vaccine would be available tomorrow, then quarantining students might be a reasonable idea, but since the vaccine is weeks away at best, it's likely that any college community with disease activity today will already have high levels of H1N1 antibody by the time the vaccine arrives.

When the H1N1 epidemic is over it would be interesting to know the opportunity cost for hospital infection control programs. Since these programs run with fixed resources, which in most hospitals are likely inadequate at baseline, diversion from our normal work to plan, and plan, and plan some more for H1N1, is likely to result in more healthcare associated infections.