Testimony of Anne Goldman, RN UFT Special Representative and Chris Proctor UFT Industrial Hygenist UFT Health and Safety Department before NYS Assembly Standing Committees on Health, Labor, Education and Higher Education and the NYS Assembly Subcommittee on Workplace Safety

Oct 13, 2009 4:12 PM

Good afternoon, and thank you for this opportunity to testify today on efforts to monitor and prevent the spread of the H1N1 flu virus in health care settings, schools and workplaces. We are Anne Goldman, a registered nurse and special representative for the Federation of Nurses and the United Federation of Teachers (UFT), and Chris Proctor, an industrial hygienist and coordinator of the UFT School Safety and Health Department. Our union represents approximately 200,000 members, including New York City public school educators and several thousand hospital and visiting nurses.   

Since the very beginning of last spring’s flu epidemic, the UFT has worked closely with the New York City Department of Education (DOE) and the Department of Health and Mental Hygiene (DOH) to develop a program to address the concerns of parents, students and staff about the school system’s preparedness to deal with H1N1 and influenza-like illnesses (ILI). Thanks to our joint collaboration, plans and protocols are now in place.

The city school system’s flu preparedness plan includes three key components: provisions for infection control combined with an influenza prevention campaign; monitoring and surveillance of influenza-like illnesses in schools; and a vaccination program. Allow us to briefly outline each of the components.

Infection Control and Influenza Prevention Campaign

First and foremost, the campaign calls for teachers and other school personnel to emphasize prevention and infection control measures such as hand washing, avoiding touching one’s mouth, nose and eyes, and covering coughs and sneezes with handkerchiefs, sleeves or tissues. These important and fundamental steps are going to make the critical difference as the flu attempts to spread.

Other aspects of the campaign include:

• Outreach efforts by the Department of Education to advise parents to keep sick children at home.
• Informational letters in nine different languages were sent to parents the first week of school noting the flu prevention and infection control measures such as hand washing, keeping sick children at home and the need to get children vaccinated.
• Providing influenza prevention information, materials and posters to every school.
• Having the DOE communicate with principals about the subject on a weekly basis through its electronic publication, the Principal’s Weekly.
• Having the DOE/DOH maintain ongoing communication with school nurses and having the DOE conduct outreach to Community Education Councils and parent groups.

 

Monitoring/Surveillance and Daily Posting of Absentee Rates and ILI

            The second component of the three-prong preparation plan for schools involves the careful monitoring of flu cases and the public posting of that information, specifically:

• School nurses are using a citywide data base to report the number of students treated for influenza-like illnesses (ILI) in school each day. ILI is defined as fever with a cough or sore throat.
• If more than five students in a particular school have ILI, parents are to receive a second letter telling them to keep sick children at home, and preventive measures, including hand washing, will be reinforced.
• If four percent of the student body in a particular school is seen by the school nurse on a single day then a doctor or supervising nurse will visit the school to assess the situation, determine whether students’ conditions put them at high risk of influenza complications and take steps to improve the school’s infection control efforts. If the DOH determines that the school has a high concentration of medically vulnerable children then officials may consider closing it.
• The DOE and the DOH will post on a daily basis student absentee rates and ILI on the Web site www.nyc.gov/flu. The city now lists all schools reporting five or more cases of ILI on the previous day and shows the previous day’s absentee rates for every school, and we at the Federation of Nurses/UFT review it daily. Thus far no clusters – that is, five or more cases of ILI – have been reported in any school.

Vaccination Program

            The final component of the three-prong preparation plan is the vaccination program, which is being intensely debated right now. The DOH/DOE is currently conducting outreach to parents to get their children vaccinated for the H1N1 flu, and the vaccine is totally voluntary for those children. The city’s current plan is to offer on-site vaccination to students in all city elementary schools, public and non-public, and to middle school and high school students at one or more central sites in each borough.

Additional Recommendations

            The preparation plan for the H1N1 virus includes critical improvements over the approach taken earlier this year that were the result of a collaborative effort between various government agencies and organizations such as the UFT. We applaud that effort.

However, even with the critical improvements in this year’s school preparedness plan, the UFT believes strongly that more can still be done. We urge the city and state to consider the following recommendations for our public schools:

• A nurse in every school.
• Accommodations for school staff who do not have enough sick days or those staff members at risk for complications from the flu who are advised by physicians to stay home when there is flu in the school.
• Paid sick days in the private sector so parents can stay at home with sick children.
• N95 respirators for nurses and personnel staffing isolation rooms housing students with suspected, probable or confirmed H1N1 or influenza-like illness as per OSHA/PESH compliance directives.
• Making the vaccine available to staff on a voluntary basis only, making sure that it goes first to staff members who are especially vulnerable, namely pregnant women and those with chronic respiratory conditions such as asthma and staff on chemotherapy, which is especially important because the prevalence of breast cancer is high among teachers.

In addition to this plan for schools, we recommend that health care facilities have comprehensive infection control and influenza prevention programs in place that include:

• Isolation of contagious patients.
• Appropriate and adequate supplies of personal protective equipment.
• Use of N-95 or higher respirators when caring for patients with H1N1 influenza.
• A respiratory protection program.
• Monitoring/Surveillance of ILI rates in the health care setting to ensure that ILI is not spreading within the health care facility or the geographic area affected as well as mapping outbreaks of patients who are being seen or treated in their homes.
• A voluntary vaccination program that encourages health care workers to take the vaccine, which should be provided at no cost at a time and location convenient to all workers with demonstrated support from management.
• Sick leave coverage for personnel who become ill as a result of exposure to the vaccine so that they do not have to use their limited sick days at their own cost.

 

The program in place for schools and the additional steps we’ve outlined here for both schools and health care facilities should go far to help prevent the spread of influenza-like illnesses. But there is another important issue that we want to address today.

While we are encouraging our members to take the H1N1 vaccine, we want it to be made available to staff on a voluntary basis only. We want to stress that we adamantly oppose the current adoption of emergency regulation Subpart 66-3 to make the vaccine mandatory for health care facility personnel in hospitals, diagnostic and treatment centers, hospice programs and home care service agencies. Let us take a moment to explain our opposition.

The Federation of Nurses/UFT realizes the seriousness of the situation and we firmly believe that reducing the spread of the H1N1 virus and other virulent strains of influenza is crucial. We also understand that health officials must act quickly and decisively to respond to targeted outbreaks. After all, the health care workers we represent are educated professionals who know the value of vaccinations in combating public health threats.

But it’s also important to recognize that many of the professionals we represent have legitimate medical, religious and personal reasons for objecting to mandatory vaccinations. We strongly believe that they should not be forced to choose between vaccinations and their jobs when they have reasonable issues and legitimate concerns, including doubts about the safety and effectiveness of those vaccines.

While we hope that this H1N1 vaccine will prove to be effective in preventing the spread of the virus, we must note that it is new and has no track record or history of tried and true effectiveness. As you know, medicine is not an exact science and no one can guarantee that the vaccine itself will not make recipients ill. The effectiveness of the vaccine during any given flu season cannot be reliably predicted, and there are different recommendations by government health agencies and medical associations on how to administer the vaccine to different classes of individuals.

On that point, we want you to be aware that some of the health care professionals we represent who have taken the seasonal flu vaccine this fall have had adverse reactions. For example, one of our public health nurses working in the Bronx ended up with breathing complications that led to four days in the hospital. Another nurse missed three weeks of work after experiencing severe respiratory symptoms and extreme joint pain that required treatment with steroids and analgesics.

These were extreme cases, of course, but they provide some context for the resistance that we are now seeing about the H1N1 vaccine. Many of our members affected by the mandate are voicing their concerns as well as their anger about it – you’ve already seen protests in Albany and elsewhere – and we expect that to continue in the weeks ahead as we approach the November 30 deadline for receiving the vaccinations.

Had discussions and hearings been held to air these concerns before the mandate for health care personnel was approved, we probably would not have seen this sort of response.

It’s also important to note that immunizing health care personnel targets only one potential hazard for spreading flu to patients and at-risk members of the greater community. What we would prefer to see implemented is a wide-ranging program that stresses the education component of prevention, increases worker participation and addresses other root causes of the spread of contagious illnesses.

We must also caution those who believe that the vaccine alone will take care of the problem. Relying on the vaccine alone could give a false sense of security and make people less vigilant in taking other preventive steps to control the spread of flu viruses. To that end, we must not forego sensible approaches that address the full range of root causes for the spread of viruses.

We appreciate the efforts that all of you are making to prevent another major outbreak of the H1N1 epidemic in New York. We encourage you to take the next step and assess and address all of the risks, not just those for health care personnel. Immunizing those workers is just one tactic that should be part of a much broader and more comprehensive plan.

Thank you for your consideration, and we wish you all the best in your efforts to address this important public health issue.