Keep calm and carry on

22nd May 2009 at 01:00
The outbreak of swine flu has caused chaos for some schools, but many have coped with worse. So how can you avoid mass panic?

Pandemic. The mere mention of the word can spread panic even faster than disease. At the time of going to press, about 4,300 cases of swine flu had been confirmed in 23 countries around the world. Here in the UK there had been 71 reported cases of swine flu and several schools had been closed, at least temporarily. Ofqual, the exams regulator, was preparing contingency plans lest the outbreaks affect this year's summer exams.

But despite the constant media glare and rising concern, this is not the first time schools have been on the frontline of a health scare. Long before swine flu arrived in the UK, schools have had to be vigilant about viral outbreaks that force them to close.

Last year, for example, there were 1,370 confirmed cases of measles in England and Wales (including one death), compared to 56 a decade ago. The increase has been put down to children not getting their measles, mumps and rubella vaccination.

At Sydenham School in Lewisham, south-east London, 38 of its pupils contracted measles over a six-week period last year. The attendance and welfare officer tracked, monitored and supported every case, before the school fed parents clear advice and information from the local education authority (LEA).

"I had to think carefully about who needed to know what," says Barbara Williams, headteacher. "Above all, schools have to stay calm. I thought hard about what I should do and how I could make the information clear without causing mass hysteria. It's important to resist any sort of knee- jerk reaction."

Welsh schools faced a similar dilemma in 2005 when 44 schools across four local authorities were forced to shut following a deadly outbreak of E. coli. It was the second largest eruption of cases to be recorded in the UK, affecting 158 people and killing one five-year-old boy.

And last January, more than 100,000 people a week were struck down by norovirus, or winter vomiting disease. It was the biggest outbreak in five years, the Health Protection Agency (HPA) said, leading to a chronic shortage of pupils and staff in a number of schools.

These sorts of infections can rip through schools at an astonishing rate, says Alex Baker from the HPA. Young pupils are unlikely to use tissues when they sneeze or cough, and are more likely to share drinks or food with each other.

"Children mix differently from adults, which means that infections can spread before you even spot the symptoms," Ms Baker says. "You often only know when there's a major outbreak once the horse has bolted."

So where does that leave schools that are struggling to contain something as contagious - and potentially lethal - as swine flu?

"We're as ready as we can be, but this is uncharted territory in many respects," admits Jonathan McShane from Southwark Primary Care Trust. The borough was among the first to implement its health and safety procedures after a private school, Alleyn's in Dulwich, reported several pupils with swine flu.

"Our procedures went very smoothly and the school was promptly closed," he says. "But we don't want to tempt fate or become complacent. We've never faced anything quite like this before."

Most schools and local authorities will have planned for this type of eventuality. The Government has known for some time that a global outbreak of influenza was overdue and published pandemic guidelines for schools and local authorities in 2006.

But emergency plans can only take a school so far, says Jane English, principal of Paignton Community and Sports College in Devon, the first school forced to close due to swine flu. "After the first read (of the emergency plan), I decided to place it on one side and engage with common sense," she told The TES.

Ounsdale High School in Wolverhampton took a similar stance. It decided to adapt and alter its emergency policy when one of its Year 7 pupils returned from Mexico with flu-like symptoms. "We'd never dealt with something of this scale before," says Christine Brown, headteacher. "The policy was a good guide, but we had to react to the unique events that were unfolding."

Despite the unprecedented nature of swine flu, and the need for quick, decisive action in the midst of media attention, she insists that a calm, controlled response is possible. Ounsdale immediately contacted Staffordshire LEA for specialist advice when the girl, who eventually tested negative, came to their attention.

Within hours of the alarm being raised, Staffordshire LEA helped the school word and issue 1,200 letters for parents, outlining what had happened and what action was being taken. It also prompted guidance and reassurance from the HPA.

"We felt very well supported, but there was a worry about the wider implications for the school and the community," Ms Brown says. "Although some individuals were concerned, I think they had faith that the school would do what was necessary. People only panic if they don't know what's going on."

Ounsdale tried to keep parents, pupils and staff up to date with accurate information, including contingency plans should the school have to close. "There was always a bit of a time lag because we wanted to pass everything by the LEA, but other than that we were totally open," says Ms Brown. "I think that really helped to alleviate fears."

At Sydenham, Ms Williams delegated roles and gave teachers strategies to deal with any measles-related scare stories. "A priority was to brief staff with accurate information. They also needed advice about what to say to pupils so that there was a consistent message."

Although measles is highly contagious and can spread rapidly, Sydenham was advised not to close by the local health authority. Most of the cases were confined to a cluster of Year 9 and 10 tutor groups, but the rest of the school carried on as normally as possible.

Pregnant teachers were sent home, as were the affected pupils, who ceased to be infectious after seven to 10 days. They were too unwell to do any schoolwork initially, but as they started to recover, they could access most of the curriculum via the internet at home.

The LEA procedures stood up well, says Ms Williams. Primary care trust meetings kept all the different agencies informed, while the health authority helped the school devise letters and advice for parents.

"It was awful at the time, but the moral, pragmatic and systematic support we received from the LEA and the health authority was superb," says Ms Williams. "We had a good recovery policy in place and the rest I learnt as we went along."

None of the affected Sydenham pupils suffered long-term consequences, and the school took the opportunity to encourage parents to get their children vaccinated at the school.

Many schools can avoid epidemics like this by doing more preventative work, says Dr Mary Ramsay, a consultant in public health for the HPA. Encouraging parents to vaccinate their children is the most obvious solution.

If cases do arise, it is crucial they are reported to the local health protection unit as soon as possible, Dr Ramsay adds. "It will be able to spot clusters and advise schools about who should be off. It will also be able to provide passive protection for vulnerable pupils, such as those with leukaemia or with immune system problems, who will be susceptible to measles throughout their life."

One of the most alarming outbreaks to have to handle is meningitis. There are 2,500 meningitis cases in the UK every year, mostly involving the under fives and 14-24 age range. It is relatively rare, but when it does strike, it can be deadly: approximately 300 people a year die of it in the UK, according to Meningitis UK. It also strikes fast - one couple lost their young child within four hours of the first symptoms.

A 17-year-old pupil at King Edward VI Grammar School in Chelmsford was unwell with flu-like symptoms for a few days before he died of meningitis at home in 2007.

"It was very much out of the blue," says Robin Newman, deputy headteacher and head of sixth form. "Rumours were going round that the boy had died, which quickly became quite frenzied."

The school called his parents and then, once armed with the facts, held an impromptu whole-school assembly. It continued to keep pupils updated once it had received advice from Essex health authority, which also offered additional counselling support. Only "kissing contacts" - in this case, the boy's immediate family - needed to take antibiotics.

"You never quite know how you'll respond until you're actually going through it," says Mr Newman. "For us, it was crucial to work closely with the boy's family and pre-empt any parental anxiety. Year 12 were so sensitive and caring with each other - our job was just to facilitate that."

The school went on to raise money for Meningitis UK, which in return sent a representative to the school to raise awareness and minimise concerns. "Schools are constantly having to find a balance between keeping calm and keeping vigilant," says Kate Rowland, head of development at Meningitis UK.

Sudbourne Primary School in Brixton, south London, is acutely aware of maintaining that balance. It is a feeder primary school for Alleyn's, and a lot of Alleyn siblings attend, raising the stakes of a swine flu infection. But it receives three to four daily updates from Lambeth LEA and constantly passes that information on to parents.

"Understandably there's some concern, so it's important we keep parents up to date on developments," says Claire Majumdar, deputy head. "We've always had a plan of action in place, but now it's become a priority."

The school has put information about swine flu in its newsletter and its website, reassuring parents that it is monitoring the situation and sending them to the NHS website.

Sudbourne has always encouraged staff to practise good hygiene to lower teacher sickness rates. But the imminent pandemic gave it the impetus to install hand gel (which cleans hands without water) throughout, and remind staff to wash their hands frequently.

The school is used to dealing with a smattering of measles or chickenpox cases and is cautiously confident that it will react calmly and effectively should swine flu ever become an issue. If one pupil gets nits, for example, a leaflet is immediately sent home telling parents to check their children.

It will respond equally quickly to any potential swine flu cases, says Ms Majumdar. "We have a very good nurse team from Lambeth who come in and talk to parents if anything crops up," she says.

"They come in regularly to check for allergies or to monitor the height and weight of our looked-after children. We're as prepared as we can be."

Should more schools close, many have the technological set-up to teach some things remotely. They can set up tasks via the school's intranet (as recommended at Ultimately, an entire television channel could be dedicated to educational programmes, similar to Teachers TV. In an idea mooted by the Government in November last year, TV programmes could provide resources for homebound pupils, plus teaching guidelines for parents.

This may not reassure those affected who are about to sit their exams, but it's good to know that education, in some form, can continue unhindered.

Pandemics timeline

  • 1347-50: The Black Death (or bubonic plague) killed an estimated 20 to 30 million Europeans in six years, a third of the total population. It resurfaced most notably in 1665 - the year of The Great Plague - killing 100,000 people in London alone.
  • 1816-1826: The first of seven cholera pandemics broke out, starting in Bengal and claiming millions of lives worldwide.
  • 1918-19: Spanish flu. The most lethal flu on record killed between 20 to 100 million (two to five times the number killed in the First World War). Scientists recently concluded that it was a strain of bird flu.
  • 1968-69: Hong Kong flu (or the Influenza A virus) killed approximately one million people worldwide.
  • 1997: Bird flu, or avian influenza. It led to the death or slaughter of millions of poultry, mostly in Asia. About 250 humans have died of bird flu across 12 countries to date.
    • Official guidance

      All schools should remain open and operate as normal. In the meantime:

      • Encourage good hygiene.
      • Make sure there are plenty of tissues, hot water and soap.
      • Keep staff informed about how they should respond to pupil queries.
      • Check cleaning arrangementscontracts and whether special provision could be provided during a pandemic.
      • Encourage parents to call NHS Direct if their children show any symptoms (0845 4647).
      • Compile a list of key contacts, including your LEA liaison officer.
      • Check and update parent contact details.
      • Consider the allocation of responsibilities and duties in the event of a pandemic.
      • Establish or update remote or e-learning avenues. Source:


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