investment they would be cutting back on the investment which is so sorely needed and i can ensure all honorable members we will be taking the >> each week, the house of commons is in session, we airlines said wednesday at 7:00 a.m. and then sunday nights at 9:00 p.m. eastern and pacific. and at c-span.org can find a video archive of past prime ministers questions. >> next, a forum on preparations concerning the h1n1 flu virus. and then friends and colleagues on the life and career of judge

sonia sotomayor. then a look at the guantanamo military base. >> genesee simons picture -- tennessee senator lamar alexander discusses climate change in the future of nuclear power, live coverage tomorrow on c-span 3. >> how is c-span funded? >> of taxpayer dollars? >> private donations? >> public support? >> consumer funded, i guess? >> private contributions? >> , his c-span funded, cable companies created c-span as a public service, no government mandate, no government money. >> the government held a summit

last week on swine flu prepared this, also known as h1n1. experts are expecting a resurgence of the virus this fall. we begin with for mark from president barack obama. this is two hours 10 minutes. help leaders are here. we're delighted you could join us. >> first of all, let me tell you that everyone is asking about janet, including president of alfano. -- president of paunapalotano. my remarks will be brief. i think that it is clear that

although we were fortunate not to see a and more serious situation in the spring when we first got news of this outbreak, that the potential for a significant outbreak in the fall is looming. kathleen, janet, arnie duncan, and our entire team have tried to engage in the most rigorous planning exercises to make sure that anything that may occur in the fall, we are prepared for.

i am sure that kathleen and others have laid out what the potential consequences are of a renewed outbreak. we want to make sure that we are not not promoting panicked, but we're promoting vigilance and preparation. the most important for us to do in this process is to make sure that state prepare now for an event -- a plan for this fall these of the possibilities that we may need to be dealing with schools that are safe. and, we have looked at past

cases of this being properly handled and situations like this being improperly handled. one of the most important differences is that where it is well handled, local officials have complete ownership over this issue and they are providing good ideas for the federal government. they are critical links to inform us what is working and what is not i am very grateful that all of you are taking this seriously we may end up avoiding a crisis. i think that if we are all working together in a thoughtful, systematic way, based on the best science possible, that even if this turns out to be a serious

situation, we can mitigate the damage and protect our neighbors and our friends and co-workers. again, my main message to you is to say thank you. you're working with an outstanding team. if there are any issues at all that you think we have not raised, if any t's we have not crossed for any i's we have not dotted, we do not want to find out after the fact that there are things that we could have done better. we want to find out now and make sure that we are planning for it. kathleen, good job as always. i want you to know that in

conversations with world leaders, what is clear is that we are way ahead and, in fact, we may need to provide guidance and direction to other public officials who may not have done such excellent preparation. well, thank you mr. president. travel safely and we will see you back here soon. >> thank you. bye-bye. >> welcome back, we are now going to have to back to back panels that are very important for our preparedness.

the first one has to do with school preparedness. we are very pleased to have william as a moderator. bill has 25 years of experience. he is now a national leader in the design of school safety programs. ams. then we have three wonderful panelists who have a lot to share with us about what school prepared this is like in the trenches. first today, who is the educational specialists for the wisconsin department of public instruction. she has been working on pandemic influenza plants with school teams in her state for quite a while and she has great expertise as a teacher, counselor, administrator and president of verse school board. melinda as superintendent of the university independent school

district in taxes, and she has tremendous experience as a classroom teacher, a building principle and now currently is the superintendent overseeing a fast-growing suburban and san antonio school district with close to 12,000 students, and then last but not least mary pappas, who is nurse that the st. francis preparatory school in new york city. she is had experience as a nurse for 27 years and is the school nurse for six years at st. francis which has a population of about 3,000 students and staff and a place that was very much in the news this past spring. this panel loans coal preparedness will go until 11: 11:15, so please welcome our panelist. [applause] >> good morning. i wanted thank everybody for coming this morning and also thank you to the previous

panelists. that was a tough act to follow, a lot of great questions there. i want to start where secretary duncan sort of laughed often thinking a lot of people and i know it is a little bit redundant but i think there is one lesson we have learned in the recent outbreak of h1n1 is it is all about partnerships. speaking from the education perspective as there is absolutely no way, no way in the world we can be successful if we don't form those partnerships so here is say thank you to the wonderful people, staff, leadership nctc, health and human services department, agriculture labor and the white house. all of the steps of done a phenomenal job. i also want to thank all those of the state local level both in the public health perspective as well asification perspective. this is all about working together in both the view that the state and local level for all 15,000 districts have done a phenomenal job so thank you. there are two groups which we tend to ignore.

i want to say thank you to them. first of all parents and thank you for putting up with us. we are opened, we are closed, were open, it will be for a day, it will be for two days, it will be for three days and one thing i can say to all those parents out there is the promise to do better next time around. we will do better next time around. lastly to a group we often overlooked during theselosings is students. thank you for the students for not knowing whether we are going to come back to school, whether it's going to be safe for knots s.a. but there's a lot of thank you's for all the health and coordination you have given us an over the last since the end of april. this is a panel designed to share a lot of information and ideas and hopefully to address some key issues. more specifically over the course of the next 50 minutes or so we hope to provide you with a brief overview of what, what

transpired in three very diverts areas. as we thought to provide you with some lessons learned, what worked, what didn't work. for is to identify some obstacles to implementing a community mitigation policy which calls for the closing and i may say reopening of schools because we have issues with reopening as much as closing schools. and lastly, to examine the way forward. before turning to our panelist i want to say that finding a way to effectively mitigate the consequences of the flu while ensuring that learning continues is one of the most difficult tasks faced by communities both large and small. during the recent outbreak we found a community mitigation actions had a tremendous impact on schools and students. school started to close in late april and continue to close until the end of the school year

in june. at the height of the break, which we can this make it, over 700 schools were closed. these closures affected 400, approximately 460,000 students and because schools are also at work places approximately 30,000 teachers were also impacted by these closures. we also found that if you took the daily count of students who were not in school because of the flu, you'll find that cumulatively there were over 2 million students days that were missed so this comes together to show us that even closing schools for a short period of time has a tremendous impact on the ability to teach and the ability to learn. we are cognizant that if there is a recurrence of the flu in the fall we may have to take measures to again close schools. we are also fully aware of the difficulties in complexities and hardships of students, faculty parents and employers of closing schools even if it is for a short period of time.

here today to provide insight in their experiences during the break and helpless think through how we may be able to overcome some of the obstacles faced when schools are closed are three experts. they were already introduced but let me say that as susan today is here because one of the issues or i should say one of the things she brings to the table is a phenomenal state plan to deal with the flu. belinda is here from texas, and one of the wonderful things they have done and i hope you have a lot of questions for her about this is the communication strategy they have applied to get information out to parents and community groups about what they are doing. lastly mary pappas, she is here because of her standing in the community, one because it is a non-public school. we often don't talk about non-public schools but she is one of the school nurse's that the leadership of identifying and dealing with the flu outbreak.

i going to start each of the panelists to@@@@@ while being a panel member, i am learning a great deal from the great resources in this room. i would like to briefly a talk about the wisconsin department of instruction role in the pandemic flu prepared us and our response. we were in a position to move forward with this situation because we have a long history of collaboration with our state thealth agency with our health issues.

a formal memo of understanding to collaborate on school health related issues, which dates back to 1993. our agency, the department of public instruction, also head in place crisis procedures for the continuity of our own operations as the department. we have been actively involved in our state pandemic flu cross agencies work group since 2006. we have assisted in the development and the updating of our state pandemic flu plan, which bill referred to, which has been reviewed and highly praised at a federal level. we have played an active role in tabletop exercise simulations of

school closures, and we have used the results of these to prepare our communications, regarding k-12 school closures. with financial support, from our state health agency, we have established and delivered technical assistance programs to our school community teams. we have this year been conducting a daylong workshops for teams who representing schools and communities to come together to prepare pandemic flu plans. win the situation hit in april, we had a great increase the interest in those plans. schools that have the plts down they worked very well. schools that didn't found they really needed to get moving and develop those plans. we have done a number of webcast. we have publications. we have several web sites.

we are updating the web site right now. we have sample crisis plans on the web site for schools to use. we have electronic tool kits. we have training, we have consultation, technical assistance, periodic communications from our state superintendent to all schools, collaboration with their state educational organizations, have and our area educational agencies. all of these situations were in place to help us deal with the h1n1 in april. we have also collaborated with the state public television network to identify educational programming that students and families can access during a school closure. we have also established communications with our private schools through a network that we have established. during the april situation,

starting in april, we were actively involved with their state agency through the incident command center, through briefings, teleconferences, with the field and with the agency. we monitored the outbreak in school closures daily. we used our state plan to assist us with all of the happenings in april and may with the flexibility needed to meet this particular situation. we collaborated with state health organizations and at the local level with local health organizations to communicate regarding school closures and school health services. we maintain regular communications with their k-12 the administrators and our school nurses via e-mail list serves. we also found we needed to develop some new web-based resources to assist our schools as they were dealing with what do we do with field trips?

what do we do with coe curricular activities when their school closures? we needed to provide constant updating, parent notification letters and we also developed a unit of instruction at the elementary, middle and high school levels regarding communicable diseases. we are now and the process of the action just as we are doing here, looking at the briefing with schools that were closed, looking at lessons learned and preparing for the next wave. we are presently responding to the current increased interest in school pandemic planning and preparation and provide technical assistance. >> thank you very much. one thing i should ask you before we go is, there's a lot of great information ham before we leave some were i would like to get the web page where that information can be found so everybody can access all of that

information. belinda. >> i am belinda sub-- pustka at the suburban san antonio school district. weiss serve not only universal city but we also serve converse in portions of those but they did not get their name in the title. i have been a superintendent there for eight years, and it's a great community. it is a growing community. we grow by eight to 12% per year so it is phenomenal growth. weiss serve a very large military population, about 30% of our students are military dependents and steel high-school which was the first school where h1n1 was identified, they serve about probably close to 40% military dependents. this has been an interesting time for us as the district. we have a very good community, a very supportive community and

this is what i found there our experiences. durao this time, the community chose to support in ways not only where the schools were closed, which placed an incredible hardship on parents, the city's cooperated, they closed parks, they limited some of their activities. the churches agreed to close. they were closed for eglise to sundays, which presented a financial hardship on their behalf. but, overall it has been a great community effort. i will tell you that i have met with parents, gatherings as large as this and they are usually angry over either tax increases or rezoning or something like that, but i had an outpouring of support from parents i had never received on any issue during my eight years

within the community. .. so, but i will tell you it was a

very positive experience. however, it was a very hard experience for the community. almost every e-mail i got from a parent said thank you for taking the health of my child into consideration. it was a difficult decision to make, but when it comes to the life of a child, no one wants to do anything that will put them in harm's way. >> thank you very much. quick question, what was the answer to the problem? [laughter] >> both high schools had their prom. >> mary? >> my name is mary pappas, the school nurse from san francis prep high school. i appreciate very much the invitation to be here by the government. i appreciate the invitation to be here by the government and the nursing association.

i am a private school nurse brought about 2700 students and 250 staff. i am the only nurse. i have to assistance. because i'm a private school, i work very closely with the department of health and new york city. for any questions that i have. sorry, is that better? okay. so, thursday in my office began like any other day. i never know what's going to happen and an unusual trend started it very quickly with many fevers and coughs. i alerted my principal and then in turn told him shortly after winep was painfully obvious it was getting worse the health department. i did have the health department's cell phone because i do, like i said, keep very close contact with them, and they alerted the cdc. i had many, many children come

in my office, which is a very small office, with fevers, coughs, and such looks of despair because that morning they left their homes feeling well. usually the children i didn't feel good in the morning but my mom made me come. [laughter] i had many children just looking like pick me, pick me, because they didn't feel that this morning and they were genuinely scared, and i also got that impression from some of the staff. so if i remained column even though i was dying inside they remained calm, and i had disaster plans up the walls do on my bulletin board, but we all know that when these things happen you have to tailor them and change them and i believe it is my nursing experience of all the years i have my organization skills and my instincts from my

medical profession helped me put in to work a plan, emergency plan at the drop of the act and it seemed to work. and the parents, the staff, the department of health, the principal, everyone seemed to be happy with the way it went. it could have been a much worse disaster. i sent home 102 children the first day and 80 the second day, and that doesn't mention all the other children that i've seen for just the regular accidents, bumps, bruises, so it was very stressful. >> let me start and come back this way. this is not a question but if you could provide a bit more information to the audience. mary, you talk about sending 102 students home the first day and 80 the second day, but you also closed the school. so can you talk about the

impact, the community mitigation of closing the school, the impact, how many students, how many families and a little bit about the impact that had on the community? >> well, the first day the way i did it was because i only had one phone line, is a recent 102 kids home by having every child pullout their cell phone. [laughter] because what child doesn't know where their mother is and i also asked the security guard to help me and said can you go down the line, take the temperature and i gave them a posted and said through the temperature on their chest. so after i ascertained every parent was who they were i asked them to pick up the child, explain quickly what happened, give the temperature and low on. because of their cooperation and the parents were very appreciative i was able to send everybody home in a timely and orderly manner.

that was very greatly appreciated by the parents, and the teachers, the staff, the administration because in a school that large, you could have four assistant principals but every single one looks at you. you're in it in an medical emergency and that's your responsibility, you have to keep your cool. you almost have to represent the school to the parents come and it's my nursing and the fact that i was prepared for my experience, and also because you're an advocate i was very helpful to the parents. that was thursday and for day and by monday, we were closed. i got a lot of emails from

parents and the community that were very thankful and they had questions and thought that i handled it well. i got many emails from the nurses around the country who are recognized me and they all understand that they might have 750 kids or they might have to order 75, but i had 2700, which is a very large amount of kids. i think there is more. some students do not have an interest. i really feel for them because people have to be healthy to learn. there is no one like and their 2nd prevent things, assess things, and do the intervention to keep them there. that helps keep the teachers in the classroom teaching because they are not doing the medical things. . . ot doing the medical things. >> thank you very much. i think not only you at the level with the nurses through

the country did a phenomenal job in identifying this as well as helping us work our way through and helping with parents. thank you. linda, how about in your school district? how did things unfold? >> this is what life out. we work very closely with our health department but we are very new to a pandemic. this is the first time for us. we worked with the health department, sometimes with staff infections or something like that, so we have had dealings before. i received a phone call from the health department saying that we have students that had been identified as having h1n1, and we were told that we would need to close. now what i have found in the now what i have found in the state of texas the health code there is the -- there is a method for closing schools that the health department is very familiar with. on a more familiar with the

education department. and so, finding a message for these overlying authorities -- i found out very quickly that the county government has some say in this. i found out there are many different entities that would have a say and whether a school is opened or closed. but what i discovered a few days in 28 is one of the things that would help school districts the most is determining right now what would be the method for closing the school. and something bill mentioned earlier is not only a method for closing the school, but once a school or school district is closed what are the signposts, what would be the protocol for opening the school back up? and i think that would be very helpful. >> thank you very much. sue, how about in wisconsin?

how did things start to unfold there? >> i think there was a great deal of concern in the beginning on the part of parents, and some of that had to do with communication. the communication was coming so fast and so furiously and changing so fast from the national to the state to the local level that it became confusing for parents. they might check one source and get one message and then check another source and get a little different message, and that of course was frustrating. what we have talked about now is the need to communicate to parents and families and to the community that this is probably going to be the case. there is probably going to be rapid communication and changing communication. and we need to be prepared for that. the message isn't going to come down on monday that will

necessarily be the same on friday. so we have to get the word out to the families now so that they can anticipate those kind of things. we also found it was helpful to have at the state level in nursing consultant who could provide invaluable technical assistance to our schools. the schools were interested in the question that one of the governors had this morning at about the state aid and we did get on to the web site in a very prominent place the situation in wisconsin is that the days that schools are closed under a health department order count toward our 180 day requirement, and this was very important with very tight budgets. we needed superintendents and school boards to have that kind of information. if the clothes on their own

without the health department order then they could apply to our state department of education for waiver consideration. these were all some of the issues that we thought were in need of being addressed at the state level. also resources. we needed to provide even more resources than what we had provided to our schools already. and we are making plans now to assure those up even further. and also to stress to our local school districts that they must work with their local health departments. this is a team approach, and we have to have everyone on board before we get into a crisis situation. we are also stressing to our superintendents and school boards they need to be part of the team. we can't simply delegate these tasks to school nurses, because as mary has pointed out, not

every school district has a school nurse, and even if they do, this has to be a team approach, not simply a school nurse shouldering all the burden. >> thank you very much. and mary raises a very interesting point. what i think a lot of us would call a conundrum, which i don't know whether she realizes one of not, but this gets into communication of the individuals and students pullout their cell phone and called home but the was a few educators in the audience know there's a lot of school systems that prohibit self phones from coming into school and this offers i think an opportunity to begin to think that issue through from a different perspective, entirely different perspective if we want to communicate with parents especially in large numbers in your case 2700 we have to look at these little issues because the could have a significant impact when it comes time to mitigate these issues. thank you. again i'm going to start over to

my right. one of the questions we have is we look back at this experience and we know that there are lessons to be learned from this, some good lessons and some not so good lessons. things that work and things that didn't work and if each of you could briefly talk about one thing you think it worked well and one thing which didn't work well and maybe the reason why they either work well or didn't work well. and mary, i'm going to start with you. >> okay, the thing that worked well for me was communication with the parents and the cellphone enabled -- the kids actually helped me with that finding their parents because to use one phone in a school office with that volume it wouldn't have worked so that worked well and the parents were appreciative. the thing that didn't work well as i have a very small office and once autrey ghosh them the kind of just hung around and

more came in. so, one of the things that we looked at, and we called it like a ready room if you will, to have these children who are definitely sick, definitely infectious but they all have the same thing but their parents are coming to move to another area and designate as a ready room and that is what we decided to do in my school that we are going to change. and also just want to stress universal precautions with the kids on every level, which is a fetus that and it's not yours, don't touch it. [laughter] the more teaching we do to the kids the better. [laughter] >> you know, i guess going back to what we did well i think that we did a very good job of

communicating. i think we used as many methods of communication as we had. we are -- we pride ourselves on being a technology rich school district. we invest in technology. however i don't think you have to be a technology rich district to communicate well with parents and the modes they are used to. they are very familiar with the use of technology. i also knew that we had both ap tests and ib test saloom and whenever the students returned as well as the state accountability measures and so, there was still instruction that needed to happen, and so once the schools were closed and the first day students were home i knew the first they would be a holiday and the day after that they would be bored and i started hearing from parents singing please give activities we can have our students do at home and so we had small groups

like two or three teachers meeting developing activities and we posted all of those things on line but i guess on the flip side it was on opening because we use technology in the school district to support the classroom instruction. we also look at online instruction and the value but for the first time i saw a truly what instruction needed to be is seem less so that you can have classroom instruction supported by technology and from those times students aren't in the classroom the need to have -- needs to be coordinated and it needs to be so that students can flow from a regular classroom instruction to online and back again and we are not there yet but if we are looking to the future that is one thing we have to consider so that it's not a separate but it is all the work made.

>> belinda, before i get to you, sue, before you post the district to get support closing the district from the superintendents in the surrounding area from the state? was their support from that? >> initially. [laughter] it's easy at first, but it is more difficult the more days that you are into it. the first day everybody is supportive. the second day is tougher, the third day -- and i think that also looking at it, because the symptoms were mild, people discounted it over a period of time, and so having a coordinated effort all the way through will be the most challenging part of the process. >> thank you. xu? >> i think what worked well for us is having a solid state plan

and using that plan over the past several years to assist school districts are around the state with their planning to provide them with the training and to provide all of the technical assistance they might need, encouraging the collaboration of the state level with various agencies involved and encouraging collaboration at the local level. as far as what didn't work so well we didn't have too much opportunity to get into continuing education because of the short closure time. but i would agree with belinda this is an area that definitely needs work. we have talked about it in all of our trainings. we have encouraged local school districts to get involved in putting together a plan for continuing education but that isn't easy to do.

yes, online works in some cases. i represent a state that has a lot of rural areas students do not because of poverty reasons or geography reasons have access to high-speed internet so we cannot jeopardize the learning of those students during a prolonged closure. we have to look at things other than online learning. we have to look at educational television which does hit every single corner of our state. we have to look at learning packets. yes, that may sound old-fashioned but in some cases that is the way students are going to learn. we have to look at getting the word out to parents and families, how they can be involved in learning of our students. some of our area educational agencies and our state are looking at how they can help

local districts to provide this continuing education during a prolonged closure but this is definitely a challenge that we need to address. >> thank you. one of the questions we were constantly asked as we were going through this epidemic is when do schools closed in this country? i think we were trying to figure out the quicker we could close the quicker we could get ourselves out of litigation and what we discovered as there are some schools that close and may and some clothes in june and some schools never close, they go year are now and then we have the question on the other and what are we going to do when school is open and went to schools open? the fact is as we begin to look at this some open in august, some open in september. and again, some go year round, schools: in the opening, what changes are you going to bring

about in your emergency management plans -- schools are going to be opening. what changes are you going to institute as they open for the new school year? >> one of the things that we are going to be doing is conducting several after action groups now and talk to the superintendent's to gather that information and put that together -- talk to the superintendent's, and we are looking at more training to stress to districts that they need to have a plan. we're looking at enhancing our website, our electronic tool kit, which is very valuable to local districts. we're looking at a state letter similar to the dunkin-sebelius letter that went out to schools. we are looking at helping parents to better prepare for

that -- the duncan =- sebelius letter, looking to anything nutrition needs of our students, who depend on breakfast and lunch programs at our school. end upon breakfast and lunch programs at our school. as i mentioned we need to address the continuing education plans that we at this point have not lost out to the point they should be. and we need to let our parents and families and communities know that this will be an evolving situation, and what we know now is not the same as what we may know in the very future. and things will change very rapidly. and we need to help our communities better prepare for what may occur in the fall. >> i guess this is a bit of a

true confession time for me. we have to have a pandemic plan and the school board had approved the memorandum of understanding with the county group, and i will tell you the county director did a great job of trying to put everything together. but i didn't really pay attention to it that much. it's one of those things i assigned someone else and went about educating students on to all this came about. but the good thing was the was a plan in place. it wasn't necessarily the parts we practiced, but there was a connection that had been established and so that's good. so going forward and i will pay closer attention to what that plan means and i rely very much on the people within the guadalupe county association. it was and valuable as far as

helping us communicate, getting information. it was a good association, very worthwhile. also going forward, and you might ask me how i'm going to address this and i don't have an answer i'm concerned about to student groups in my school. i'm concerned about the teenagers. they are a social group and i can understand why they would be the most at risk. i am also concerned about the campuses where we have the highest number of students offering reduced lunch. i know they don't have access to the same health care other students have. and so going forward watching those groups will be something we have to pay very close attention to. >> one of the things that changed and is going to change is my position in the school i think is much more respected.

[laughter] because of what i did and what i do. the administration almost bowel's to me as they pass me in the hallway, which is very nice. so that's a good change. like i said again, the plans we have had, plans in place, the ready room which is just a moratorium, and teachers, staff and parents know where it is, that is a good change. we always communicate to parents about important things, activities on the web which we will do. we keep in contact with the principle administration with the department of health and cdc. sue anything new they want to change or add or do for september it will be on the web. one of the things we want to do though is maybe reintroduce the phone notification system if a crisis does happen. also now they would like to get

cell phones of parents to register the number so maybe we can send a quick text which seems to be the state of the art thing to do. we have ordered the monitors that are non-invasive, they can just put up to the child's forehead so you don't have to worry about disposable covers. it's good infection control and because of the volume of kids i have that's a big help. and again, just to say like belinda said i have teenagers, it's education, education, education and all kind of talks or seminars, whatever they have they are going to talk about universal precautions like i said before hand washing, sneezing into your sleeve was mentioned before and if it is wet don't touch it. and just hope for a good year. >> thank you. one final question for the panel and we will start with sue and

that is you have an audience here filled with leaders of the federal and state level, persons from health and human services, homeland security, the cdc, agriculture, labor, all of the key agencies involved in mitigating the consequences of h1n1. if he had one thing you want to say to them what would it be? >> communicate, communicate, communicate. we need that communication at the state level so that we can get it out to our constituents out there in the local districts and the local teams. and we need the communication frequently. we needed to be accurate. we needed to be meaningful. and we need communication that we can get out to families and parents of these young people. we also need to support our

schools. we need to have the dollars to be able to provide the education, the nutrition and health services to them. thank you. >> we are in the education business and we are pretty -- we do a good job of educating students. what i need from all of you is an idea of when it is best to close and when it is necessary to close and when it's not. when is it the student's health isn't jeopardized by being in school and telling us what is most critical and we do a good job adapting to what we hear but we need a good strong clear message and it needs to be consistent.

>> my most important point is every school needs a nurse. every child deserves to be safe and healthy and an opportunity to learn. >> thank you, mary. just one of nurse? [laughter] if you're going to ask, ask big. [laughter] you know, as i listen to the panel it's interesting because a lot of things that the three of them at the state, local level have to say or parallel a lot of with the secretaries were saying that the federal level. and if there's any take away -- i wrote down about five takeaways. these are sort of messages that come over and over again. one is planning is essential. the time of the crisis is not the time to call up your health worker, mental health worker.

i think secretary don king talked about our efforts at the department of education and secretary sebelius talked about her efforts, secretary napolitano and this is about planning and we encourage every school in the country if they don't have a plan to get a plan and tested with the plan together to make sure they partner it with folks from homeland security, folks from the public health, folks from the mental health site. this is a community effort, it isn't just a school eckert. number two as i think mary talked about this and belinda talked about this somewhat, and sue talked about this and this is the uniqueness to schools. we come from urban areas, suburban areas, rural areas and there isn't one-size-fits-all and when we began to do the planning we need to take into consideration the uniqueness and the resources available and build a plan are not that. number three is it's all about the old song you've got to have friends, while you've got to have partnerships and this is

about partnerships. this is like facebook and the more friends you have -- this is about how many partnerships can we build. this is about good, strong, effective partnerships. and if there's one thing we preach at education to the staff it's that we've got to reach out to people who we don't even normally deal with and forge those partnerships and alliances because we know as educators we cannot do it ourselves. fourth, it's about communicate, communicate, communicate. one of the things, and i think belinda, you mentioned it, which i found very interesting, is it's not only communicate, communicate, communicate, but also communicate at the local level. your parents are also much interested in what we have to say from washington, they were interested in what you had to say about the district, right? did you find the same thing, mary? >> [inaudible] >> okay. and last week, and i hope that all of us never forget this, is that schools are about teaching

and learning. and that we need to find ways to basically continue that process if we have to close schools. and last, i want to give a pitch for my colleagues at the centers for disease control and prevention and the department of education who are working on a system to help monitor school closings. i think it's absolutely essential and vital as we close schools if we have to close schools in the fall is we have information that -- timely information, accurate information on what is happening in wisconsin and texas and what's happening in new york city and all that so hopefully all of you work with your groups and associations to help us work through and develop an effective monitoring system. let's give the panel a round of applause. they did a phenomenal job. [applause]

all three of the panelists will be here throughout the day. please go up, introduce yourself, ask questions and trust me, they have a lot of questions for you. again, thank you very much. [applause] >> thank you very much. i would like to ask the next panel to come forward. they do you are welcome to stand up and stretch in your seats for about 30 seconds. that's good for public learned from states and localities. and first i'm very pleased to introduce the moderator

dr. steve the director of the influence coordination unit at centers for disease control and prevention. he has many years of experience at the cdc in areas of international health, malaria, immunization program and national center for environmental health. he's joined by three very distinguished panelists. first dr. arnold director of public health for the illinois department of health. he's been in that position since october, 2007 and previously served as medical director for bioterrorism and preparedness for the chicago department of public health. dr. arnold also served the national guard for 24 years and currently is also the state surgeon for the illinois army national guard. dr. marcy late and his assistant commissioner for the new york city department of health and mental hygiene. she has played a leadership role in many new york city public health responses for example west mile five is in 1999 and to the world trade center attacks and anthrax in 2001.

she's frequently lecture on a national and international circuits on preparedness and infectious diseases. and last but not least, we have expected of director of the navajo nation division of health. he has held this position since june, 2003 and he has over 30 years of experience and social services, child welfare and health care including 12 years with the navajo area indian health service. dr. read will start as moderator. >> thank you. it is a great pleasure for me to be here today moderating this session reviewing what we've learned and what we need to plan for in the future. we have got a great plan panel as you heard and what's great about this panelist the spectrum of experience and situations that represents that we have got new york we have got the tribal

perspectives in indian country, rural situations, and then from illinois, both geographically and epidemiological we both between those extremes, but before we return, i want to go back for just a moment -- epidemiologically. this will really be echoing their remarks that have been made up to this point. the first point i want to touch on is the importance of planning and exercising, and this pandemic that we prepared for was not the one that we actually experienced, but the plans that we developed and exercised where critical in the first few months. rcised were critical in the first few months. mosul much for what we actually did or executed but for the process of knowing what questions we needed to address and process for answering those questions.

and so, at this point we have new factors and assumptions, so as you heard already there is a new planning process that needs. what's different about this planning process is that it is an open ended that we have to have new plans in place for what may occur in the coming months and we may see an upsurge in cases. having said all of that we need to maintain the flexibility that we used in the first few cases that we are going to be confronted by new facts. the second thing i want to point out is the importance of partnership in responding and i might even use a different word than partnership. what we have executed is the ability to work as a team and it goes beyond partnership. everybody has their role but we know what they are and we work together. this is especially relevant for our state and local partners

since the national response in a lot of ways is the sum of those state and local responses. and at the federal level, what we need to do is to create an environment where those local decisions and planning process these can be most effective. so, i just want to reiterate in the spirit of teamwork that now is the time to be planning, and this needs to occur at all levels of the partnership. and just as a closing point, i want to reiterate how important communications have been in this whole response and that it will be very important when forward. i think we have done a -- we've recognized the need to tell people what we need to know, what we don't know, what we are doing and again create the environment with the right kind of decisions made at individual and at institutional levels. so we have a lot of work ahead.

this is different from most emergency responses. it this is not bring to the short-term response. we don't know how many months we are going to be responding, but we do know it will be all weigel and we should expect new facts, we will be confronted with new facts and have to make decisions that can't be completely anticipated at this point. but in working together, we can plan working in partnership and we will work to protect public health. so with those introductory remarks let me turn first to dr. arnold to tell about the situation in the illinois. >> okay, first of all don't worry about the slides. i'm gwen to go through those very quickly. my wife also installed a pop-up

blocker so i will be stopping at some point very shortly. [laughter] so, the first slide i naturally going to go to the first slide there are about 19 key resource sectors. as i start this i want to acknowledge the president, secretary sebelius, secretary napolitano, also secretary duncan. very essentials people to have coordinated effort. other messages were incredible. i also want to recognize the doctor from the cdc. he saved my blood pressure and my life many times by his announcements on the tube. also to nih and doctor now assistant secretary with hhs, they have a good person as we have multiple people in the room i want to thank the military for its continued service and that includes the public health service, the cdc did a

phenomenal job in the spring. that really brought this to a good point in time. the association of territorial officials worked with them and actually did an incredible job bringing the right messages and the american public health laboratories. you can name the association of the epidemiologist, there are multiple agencies that came together to make this a success including dhs and all of its branches. one of the things i wanted to point to is this one area for the public health and health care sector back in the early 1900's we had separation between sanitation and public health for some reason. many of the public health sanitation avenues have been separated in the state much of the sanitation infrastructure is independent and operates independently from us. they are private sector entities many of them.

those sanitation services if they were to fail would give the onset of a potential of a secondary epidemic in the middle of a crisis. we must pay attention to the sanitation sector. this is one slide i always liked how and why. how is the science question valid or invalid whereas why is one in theology, philosophy, mental health and legal and it's really fallacies of logic and explanations ideological opinions. those things are two separate questions when we are answering a question of science we still have to keep in mind that a community operates in both sectors and it works with the why question. very few people during katrina asked me why did my house get blown down. they know a geological phenomena came through and asked me why did it happen to me so we must always have a human dimension and compassion that our

associations have for reaching the people. here are models i liked some are wrong summer useful. in god we trust, all other spurring data. that's actually the cry of the monotheists scientist. also fear is that counsel and this is a public state paradigm. the department was many times right in the middle of the hourglass. the point where the sand passes through, and what i heard from above was follow me but lead yourselves from the federal level and from the locals, give resources that we can handle alone and lead ourselves. [laughter] so that left us in a very peculiar situation. so things like the associations actually help us work through that. these are very essentials to get through this old paradigm.

we also worked with that esf a function and esf-6 function of the we are relatively confined into the esf-8, essentials support functions. okay what we did and away the first state to conduct the exercise in may 2006 called flu ex. he is working in l.i. stage right now and funds legislation, passed some on-the-spot legislation that actually allowed us to distribute the stockpile. he took a very serious consideration of all of the exercise is we had done in the past. this year i actually had my entire senior staff, 42 idp h staff go through nims training, 100, 200, 700 come 800 then 300,

400 level. they also -- that was to be worried also the cdc training which they have brochures outside on the table in march actually they put the cap on this so that when in april that can flow came along with the cdc guidance and the other organizations we were able to put people into the public health emergency operations center and an operational mode. rubber on the ground. they fell into position, set up their command structure and were operational from day one. they know exactly where they were. they walked in amazement up to me and said i know where i am and they knew what their functions were. very important to this kind of training in the background. interagency collaboration. the illinois emergency management agency, my counterpart and my state is

director andrew velázquez. it was critical to have his coordination and collaboration. it brought us a very long way. this is different from that old bottleneck i was talking about with the hourglass model. this requires people to knock down the walls and start working together to find solutions to problems. also the illinois national guard was essential. the illinois department of human services and the illinois department of transportation worked together to make sure this worked. the multiple community-based faith based and guarantee based organizations as well as volunteer organizations were essential, those are our emergency response volunteers, nurses and medical personnel. very essential. i also want to come end of the cdc and nih. all of the institutions putting information out because he saved

this country during an economic downturn billions and billions of dollars. that isn't being said yet. but billions and billions of dollars. you stop the crisis from happening by controlling the messaging and making sure people remained calm. i talk about public health many times as being very close to being analogous to a car you drive to work every day and never think about the break. but let the break fail at an intersection and you have morbidity and mortality. so i'm going to go very quickly for the rest of the slides. this one is the guidance focus establishment of the authorities through nims, operational planning objectives, clear-cut strategic goals, definitive implementation strategies, and equivocal responsibility assignment. you are responsible to get this done, your name. measurable performance

objectives and monitoring of agency continuity operations planning. it is essential to keep the balance in the agency. public health monitors water, food, it does many other things, neonatal screening, nursing home care, you name it. a very vast array of services we can not allowed to lapse. other things with g.i. s mapping and population movements, deploying members, migrant farmworker camps, commercial transportation, graduation ceremonies, community spring season events were a problem. faith based celanese, business meetings and inaccurate census data as we have movement around the state without realizing where the populations are without the 2010 census being in debt. okay. pharmaceutical distribution which had five major regions we used, that was the distribution point for this act will

implementation. these were the convoy routes we had through the state. because of the coordination between the army, our unit at the department of public health and several other agencies of transportation, we were able in 16 hours to distribute the 25% of the national stockpile given by the cdc to 102 counties, 95 local health departments and 356 hospitals throughout the state, 16 hours, no injuries. it was because they planned, exercise and knew exactly what they had to do. this is the case count through and i want to show you the time frame, this is may 14th. so this is where the actual cases were occurring. this is top line call.

this was on the 12th. look at all of the hot line calls and these were not even affected. it was all media driven. they were responding to what they were listening to in the media. okay. and these are the cases. we mapped out of the migrant camps because the forms we were worried about the migration and they were also trading as though they were army camps. they were not only a possibility of bringing infection in but susceptible to infection as well and could act for an explosion of local outbreaks. the things we did, as an s deployment 16 hours, three state idp each laboratory locations so we did a confirmatory test in-house with assistance through the cdc, sample search capacity flexibility because of the locations, springfield and

chicago and carbondale are separate geographical@@@@@@@ @ ) we had the hot line. we went to our poison control center, and they were used to handling stress. and calls. they were able to talk to people without having to be worried. they could calm them down, allay the air for years, and they knew how to handle the people, so we actually get the communication lines, spanish, english, and then other languages, as well. multi lingual was important. they were all critical for making sure that we had if not daily meetings to bring all the

departments together, to bring all of the hospitals together on call, and the practitioners, so we were doing it with strategic cause, making sure everyone on the lines from those agencies and everyone was listening to the same message. same message. also the star, 21 radio system we put in a year ago that has allowed us to communicate with all hospitals at the distribution sites. it worked out very, very well. the fifth based organizations we actually had a pandemic flu ambassador programs. we have had that in existence for about two years. it encompasses 7,000 face based institutions in a database with 500 being on the main 80 or broadcast ministers during the pandemic flu outbreak we have been putting information into their missile let's or documents to hand out in the faith based

institutions. the 35 seized were always contain, cover, clean. we made sure they had a simple message and that we kept going for the community. the faith based institutions are trusted organizations with the local health department as well and our communities sectors. we do not have enough private sector interaction and that is what the leadership is about. this is a current situation, 3,002 to 59 cases in illinois. 6,762 cents were tested and 37 of 102 counties, some 37 counties are affected currently. there were 14 deaths mostly in people who had underlining medical conditions but we did see that particular situation with asthma as being one of those that stood out in our groupings. it was also seasonal flu vaccination campaign. it is essential for us to do

this. we are mounting one now. the reason is if you do push the seasonal flu vaccination program what you will do is allow us to stop potentially 36,000 deaths that occur every year as one of the things. second thing is you will decrease the prevalence of seasonal flu because if i had the flu and i am on that educated about this, with the symptoms are i'm going to my doctor, i'm going to my hospital. it could prevent a surge on hospitals, local health departments and private practice if people are immunized against the seasonal flu because once the media were john starts people are going to come in so it's important to do that. it also saves businesses and employees from getting sick from seasonal flee when you also have people out from potentially h1n1 there's also the preparation for a mass vaccination and surges we

continue to monitor these things and the last slide as to follow the cdc outlined according to age now and this is the total number of cases and the number of deaths for each of these categories and you can see it's almost a distribution as we thought with this group the 25 to 49 be more affected. at least preliminary from this data. what we needed, some things we need other than founding with a smile, more wireless access for laptops, workspace templates and emergency operations centers, pre-identify and traditional stuff to support the pheoc and distribution sites and we need staff. my staff was at the image of being burned out. we hav got to get and make sure we have a staff that is sustainable for the long haul.

the national guard made a mention from the bureau one of the major generals and what his statement was is that in the army there is one of these statements that says in the day the bea weare. people who are becoming ill should be put on the cyclist so when they are recovered they can be reinterpreted in areas where you have potential risks for exposure. also better private-sector involvement and much clearer definition of the usage and when it is appropriate to use an mi5 mask orloff mask. even a coif basque can stop you from inoculation and maintain local drop site database and restructure all of the incident action plans for partner integration. so that's all i have to say in won sohn said.

-- one sunset. [applause] >> thank you, dr. arnold. now we will hear from dr. marcy from new york. >> good morning. i don't have any slides which is unusual for me and i am a new yorker so i talk fast. a lot of people have talked about the importance of planning and i am definitely a proponent of emergency response planning ahead of time and ironically we were in the midst of finalizing a revision of the 2006 pandemic plan this spring when the h1n1 outbreak of life in new york city and although overall the planning process for pandemic helped the response this spring there were definitely several assumptions that ended up not being applicable to this particular outbreak. first, we thought we would have morning ahead of time a pandemic was occurring and that it was more likely to be recognized overseas prior to its arrival in new york city and second, we

were preparing for the worse case scenario in 1918 like pandemic and we thought that we would be able to address my older for the worst-case scenario but we hadn't thought through in enough detail how we might need to modify our actions fortunately and new york city we were able to identify the introduction of the swine flu into the city early after its arrival since new york city as you heard in the last session and presented as a highly explosive outbreak at st. francis prep high school in queens which was just two days after the cdc first announced the initial cases in california and only one actively a day before the first confirmation that h1n1 was causing an outbreak of severe respiratory disease in mexico. a challenge though of being one of the first affected sites was that there was no information yet on the viral transmission characteristics or its virulence, as we had to make our initial decisions on how to respond in the absence of the

data that we had hoped would be available and though initially the new york city outbreak was primarily associated with the high school within two weeks we started to see evidence of more widespread community transmission first in the area around the high school and then eventually all areas of the city and as of yesterday we had identified over 900 hospitalized cases and 47 deaths and we estimate the several hundred thousand new yorkers were infected. and though the miracle impact was probably no worse than the seasonal flu as other speakers diluted to is that younger age groups were more severely affected. in new york city about 43% fossilized cases occurred in children, and 96% of deaths occurred in people less than 65 psp one ..

epidemic for pandemic, identify whether the people are at risk for complications for those affected by h1n1 and if there were any different from seasonal flu. second we wanted to try that trajectory of the outbreak in did this by focusing on how their illness using existing electronic surveillance system.

not a good sign. existing electronic, the outbreak -- i should be ok. [laughter] use derrin surveillance system for emergency department and primary care visits which allowed us with minimal staff resources to monitor this geographic spread in the age groups affected and third reading several population based telephone service to provide information on the overall infection rates in the city in order to estimate of hospitalization and a fatality rates and allow us to compare the severity with seasonal flu and lastly we did if you epidemiologic modeling studies with both cdc and academic partners to assess by a transmission characteristics such as incubation and generation time. in response to outbreaks in institutional settings was intense obviously in schools but

also city jail system. in new york city we have system hundred public schools with every million students and rationale for school closure was not to mitigates any widespread, we realize that was possible but to prevent transmission to those at highest risk in that particular affected school community if it was experiencing existing or increased incidence of influenza like illness at the school. our policy was not based on just having one or more confirmed cases. and told a closed 55 schools for five to seven days, none of which experienced a recurrence when reopened. as far as correctional settings our main city jail has over 13,000 inmates on average in a given day and when the initial cases were recognized around the time we started to seek limited transmission we implemented it and aggressive screening, isolation, prophylaxis and restriction policy to contain the outbreak and were very successful. we have 100 confirmed cases,

very little sustained transmission in any housing units and no deaths in the correctional facility. as far as public communication we did numerous press releases and press conferences, in number of black shoes were developed to address a wide range of issues and translated into opera and languages. we tried to share information as soon as it was available using multiple modalities which had detailed at the same logic updates available on-line. we distributed over 21,000 educational posters and brochures and tree -- about 54,000 h1n1 related calls to our public call center. as far as medical provider of education we did a number of health alert through our network to get up-to-date information to our medical partners and developed new york city specific guidance documents to help providers in new york deal with triage patients presenting with nonspecific a fever and respiratory illness as well as

guidance on the use of the antiviral and a proper precautions or infection control and personal protection. we tried to make ourselves available to our medical partners by doing almost daily conference calls especially at the start of the outbreak with our hospitals as well as separate calls with private providers and a committed to health clinics and mental health agencies and our provider access line or call center was opened seven days a week and a little over 5,000 calls. although our response to health care will be addressed in the afternoon session in much more detail by dr. debra. here with me today we like other affected cities experience extremely high patient visits and our emergency department and primary care centers mostly involving children. two briefly touch on some of the challenges and opportunities that we faced from is surveillance perspective the absence of having comparable of surveillance systems for seasonal flu made it difficult to compare are dated to the

regular flimsies and and our findings that data describing are in perspective and especially to quicklyetermine if the outbreak was more severe and more restrictive control measures and unusual for flume justified in paris second it was difficult to compare our findings to the rest of the u.s. since different types and intensity of many states were mosul reporting numbers of mild cases, and we quickly determined that was not feasible, and even if we tried, it would not be representative. we have limited public health lab capacity. in new york, we prioritize testing very early on and hospitalized fatal cases only and did not inundate the lab with the specimens from milder cases. they initially wanted to use the test results for clinical management, but since h1n1 was really