Planning helped but it was improvisation using cell phones and sticky notes that enabled school nurse Mary Pappas to cope when the U.S. swine flu epidemic started in her tiny office in April.
St. Francis Preparatory High School was an early epicenter of what has become the first pandemic of the 21st century, the new H1N1 influenza virus, and the New York City Health Department documented at least 69 cases at the private academy.
But on that first morning in April, Pappas knew there were many more.
"I had many, many, many children come in my office ... with fevers, coughs and such looks of despair because they had left their homes that morning feeling well," Pappas told a meeting organized by the U.S. Health and Human Services Department at the National Institutes of Health near Washington.
"They were genuinely scared," Pappas said. "(I knew) that if I remained calm, even though I was dying inside, they remained calm."
Pappas spoke at a session of educators at the "summit" of state and local health officials. HHS Secretary Kathleen Sebelius told them earlier in the day to get ready fast for a possibly worsening pandemic of H1N1 flu.
Schools are always a breeding ground for infections but this virus has hit school-aged children especially hard. In part because of this, Sebelius said a federally funded vaccination campaign against swine flu, if one is ordered, may make use of schools.
700 Schools Closed
At the height of the epidemic in the United States, said William Modzeleski of the U.S. Department of Education, more than 700 schools closed, affecting 468,000 students and 30,000 teachers. "Cumulatively, there were over 2 million student school days that were missed," he said.
And this can happen fast, as Pappas discovered.
Her first challenge — taking all those temperatures. Influenza is marked by a sudden onset of fever, cough, chills and muscle aches. "I ... asked the security guard to help me and I said 'would you please just go down the line and take their temperature' and I gave him a Post-it pack and said 'throw the temperature on their chest,'" Pappas said.
Then she looked at her one telephone line.
"Because I had only one phone line, I sent 102 kids home by having every child pull out their cell phone," she said. Each one called his or her parents.
This could be an issue in some places, said Modzeleski.
"There are are a lot of school districts which prohibit cell phones coming into a school," he told the meeting. "When we begin to do planning, we have to look at these little issues, too."
Pappas, the only nurse for 2,700 students and 250 staff, said schools need to make sure they can cope.
Other school officials said new technologies can help get the word out.
"We opened up a Twitter account," said Belinda Pustka, superintendent of the Schertz-Cibolo Universal City school district near San Antonio, Texas. "The most asked question was what was the status of prom," she laughed. Although schools closed, the high schools were able to hold the popular end-of-the-year dances.