Friday, August 7, 2009

The New CDC H1N1 Guidance for Schools

I often use this space to lament the inadequate or wrongheaded response of one group or another to a crisis. That is, after all, the essence of Monday Morning quarterbacking. However, I like to think of myself as a fair person, and as such I would like to give three hearty cheers to the CDC for the new guidance they issued today for schools regarding H1N1 "swine" flu.

I am in no position whatsoever to comment on whether these new guidelines are what they should be in terms of scientific content. At some point, we have to have some faith in our scientists that what they tell us is true. I suppose it is possible that these guidelines are absolutely horrific from a scientific standpoint and will get us all killed by this new virus. I doubt it.

From a crisis preparation and crisis communication standpoint, however, the guidance issued today is very, very good. And since I take such joy from tearing this sort of thing apart, I'd like to look in a fairly detailed way at what is right about how this was done:
  • Information was shared in multiple ways. There was a press conference and a press release, and within a relatively short time a detailed guidance document, as well as the press release and the video of the press conference was available on the web. Someone reading about the new guidelines and wanting more information can find it relatively easily. And if they wanted even more information, each section of the guidelines links to a more detailed "Technical Report" intended for public health officials.
  • The guidelines consider multiple contingencies. There are guidelines for what we expect to happen, and then guidelines for the possibility that the problem will be worse than we expect. This lends credibility to the message of the initial guidelines and makes people more likely to trust that things are under control, because they know up front that the authorities have considered the possibility that this could be really bad. Nothing makes people feel worse than hearing the equivalent of "here's the plan for right now, and if things change, well, we have no idea."
  • Directives include information about why they are being issued, and also consider what those questioning might ask. For example, the directive on school cleaning reads: "School staff should routinely clean areas that students and staff touch often with the cleaners they typically use. Special cleaning with bleach and other non-detergent-based cleaners is not necessary." This not only tells us what to do, it tells us what we don't need to bother with. Last spring, many schools found themselves being pressured to do more than what the CDC recommended, particularly with regards to cleaning, and had no response. With a single sentence, the CDC now has provided them with something specific they can say -- "the guidelines indicate that special cleaners are not necessary." Extra points would have been awarded if they had explained why, but still, high marks.
  • They give schools issues to think about that include emotional reactions to the situation. There is a very large amount of space devoted to how to make local decisions about schools, and it's all very good. The last section is entitled "acceptability" and it asks schools to consider how they will deal with people's anxiety about the flu and their possible resistance to whatever decisions are being implemented. Three more cheers just for this -- they recognized that implementing a plan isn't just about the science of the flu, it's about the psychology of those affected by the plan.
I'll be re-opening my building in a couple of weeks, and I know I'll start getting flu questions pretty quickly. My usual mantra is, "I have no doubt that when it's time to panic, the CDC will let us know." I truly appreciate them putting out a document that really helps us understand their thinking and to communicate it effectively to our communities.


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Naomi Zikmund-Fisher
is a clinical social worker, former school Principal and a Crisis Consultant for schools and community organizations. You can learn more about her at
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