Camps at the Forefront of H1N1 Response

Existing policies and procedures at ACA-accredited camps helped calm a crisis.

I’m not sure if you heard, but the swine flu’s been everywhere, and summer camps were not immune.  Fortunately, according to Dr. Dora Ann Mills, the Director of the Maine CDC, “summer camps were phenomenal” at preparing for and dealing with it.  At the State H1N1 Flu Summit in August, attended by over 1400 people, Dr. Mills “held up the camp response to the virus as a model for handling the flu in residential facilities where close quarters are shared.”  She noted that “no Maine camp closed, few campers were sent home, and no camper was hospitalized with H1N1.  In contrast, 80 camps nationwide closed due to H1N1 outbreaks.” According to statistics from the state, over 90% of all Maine camps provided prevention education. They used all forms of reasonable treatment for reported, suspected, or detected cases, including antiviral treatment, prophylaxis, and isolation.  

Thanks in some part to the policies that ACA accreditation requires to be in place, a summer camp may have been among the safest places in the country for a child (or staff member) to contract the swine flu.  We asked those who dealt with the disease what they learned from the experience and what they thought might be valuable to pass on to you.  Kris Light, the director of Merrowvista, a camp in New Hampshire, offered a detailed and valuable description of their H1N1 situation and the camp’s response:

First Signs: Influenza-like illness first reared its head on our opening day when staff returning from a day off began to show symptoms.

Action Taken: These staff were pulled immediately and isolated in a housing area that was not being used for any programming.  They were monitored until their temperatures spiked, at which point they were sent to the hospital for testing.  By the next day, we had three confirmed cases of influenza A and B, the results of which were sent off to the state to test for H1N1.  The staff were then sent home for seven days.

Still: At our peak, we were without ten staff members due to illness, all of which were village leaders.  In the following days, we began to see campers arriving to the health center with flu-like symptoms.  Initially, we attempted to monitor these children in isolation for 24 hours after noting a temperature over 99 degrees. 

Observation and Response: Sometimes, the fever would go down and children would return to programming.  Other times, the fever would spike and we would send them home to recover or get tested.  If they tested positive for the flu, they would have to remain out of program for seven days as per state advisement.  If they tested negative (but positive for strep or other illness), they were kept home until they were symptom free for 24 hours.  If they were not able to get tested, it was assumed and treated as if they would test positive, and thus were out for seven days.

Perfect!  Except: Unfortunately, this assessment method proved inadequate for the volume of children who began arriving with symptoms, an issue exacerbated by the relentless series of rainy days.  Ultimately, bed space in our health center required us to begin sending children home at the first sign of a fever. 

So: Parents were advised to get their children tested as soon as possible, and that they were all invited back to camp once they were cleared.  Families were amazingly understanding of our position and grateful for the openness we assured in our management of the concerns. 

In Sum: By the end of our first week, we had around 35 children miss program due to some sort of illness.  About two thirds of that number tested positive for influenza, and the state later confirmed that the influenza was the H1N1 strand.  By the end of our second week, we were no longer seeing any campers reporting to the health center with symptoms, and all but two of the 35 that missed programming had returned to camp to complete their session.  The third and final week of our first session was remarkably quiet and healthy, and we began to prepare for our second wave of campers.

Once More, But With More Prevention: For our second session opening day, we were determined to take a more aggressive, proactive approach at preventing H1N1 from entering the community.  This included taking temperatures of all children arriving while they were still in their vehicles, or at the airport from which they were being picked up.  Children with temperatures above 100 degrees were asked to return home until they were healthy enough to come to camp.  This was communicated to families prior to arrival, and also coincided with a change in the state protocol, stipulating that a mandatory 7-day waiting period was no longer necessary after symptoms were apparent.  Instead, campers were now able to return to camp 24 hours after being asymptomatic regardless of the diagnosis. 

Better Results: I was impressed by the acceptance of our parent community to this new protocol.  Patience and understanding characterized their response, and made opening day run very smoothly.  Fortunately, no campers were turned away, and no campers were sent home for the entire four weeks of second session.  We appeared free of the illness that had decimated roughly twenty percent of our camp population in the first session.

The Effect on the Rest of Camp: Programmatically, we were stretched thin, but did not alter our schedule or activities significantly.  At most, we cut some nights shorter in order to provide more rest time for campers and staff.  The campers that were healthy had a great time at camp despite many of their villages shrinking in size.  I attribute the program success to our staff as a whole.  Specialists not specifically assigned to villages became village leaders; their focus remained on campers the entire time, and a general ‘do what needs to be done to make this work’ attitude prevailed.  They rose against a challenge to become the most camper-focused staff I have ever seen here.  It’s my belief that their resiliency transferred to the campers and made for a camp community aware of what was going on, but uninterested in letting it ruin their time at camp. 

And What of Older Campers?: Our older trip programs were unaffected by flu in either session, something we put a lot of effort into ensuring.  When these villages were in camp between trips, they were kept physically separated from the in-camp programming, eating meals in a different section of the eating lodge and conducting different activities in the evening.

How About Those Tired Nurses?: The group that suffered the most during this ordeal was our health team.  They became overworked and overburdened with trying to maintain efficiency and best care practices while simultaneously caring for sick children, maintaining parent communication, turning over bed space, and conducting normal clinic hours for distributing medications and attending to normal camp health concerns.  It was for this reason that the transition was made to sending children home after reading a fever.

Don’t Take the New Hampshire Department of Health for Granite: We would never have made it through this as successfully as we did without the New Hampshire Department of Health.  In the early days of the situation, a conscious decision was made to bring the state in and keep them closely in the loop on what our action steps were.  This was a decision made with some hesitation – the thought of bringing a government agency in to help manage a problem so specific to site and industry created some fears of overreaction and irrelevant guidelines.  Nothing could have been further from the truth.  In fact, we found that the more detailed, open, and forthcoming we were with the NHDH, the more space they gave us to make our own decisions.  They essentially became an advisory group that we could feel confident bouncing our plans off of and knowing they would give us thoughtful feedback (including when they thought we were being too conservative).  This, in turn, allowed us to inform parents that we were acting with the blessing of the state, a message that may have been the single most effective tool in de-escalating stress and continuing the practice of being able to work with parents, rather than in conflict with them.  I strongly believe that the reason all of these relationships were as effective and free flowing as they were was because of open communication early.  I feel that the state trusted us for coming to them right away, and it set up a working relationship that enabled us all to do what was best for our campers.  I suppose that would be the message from our experience that I would want other camp directors to know.

Other Positives: In a situation that could have generated lots of fear, everyone remained calm and did what had to be done.  All decisions were made with big picture focus in mind, and I believe we would conduct ourselves in a similar manner next time.  We brought outside advisors in early and made choices based on a gathering of information and a realistic assessment of what we were able to manage.  Each day that went by saw us managing the incident better and better, until we were relatively certain that we were clear and out of the woods.

If you think your camp’s story of dealing with H1N1 or another crisis might be instructive for our community of professionals, please email Josh.