Going into the Summer with H1N1:
Information for Camp Professionals
The following information has been provided by Linda Ebner Erceg, R.N., M.S., P.H.N.

5/27/09

As the summer camp season arrives, H1N1 influenza continues to pass from person-to-person. Camp professionals are attempting to articulate a balanced response to this ever-changing disease profile, a response that acknowledges the risk profile of H1N1 with the benefits of camp for millions of children and the staff who work with them. Some of us must now make decisions for our camp season and/or refine those that have already been made. This information is provided to help that balancing process.

While reading, keep in mind that each camp is unique and so are the people who attend.  Day camps send campers and staff home each evening; their potential for exposure to H1N1 exists with the start of each new camp day. Because resident campers and staff stay at camp, the potential for H1N1 to move through camp's captive audience and overwhelm Health Center capabilities exists. For those who may get H1N1 influenza, some will have a typical flu experience while others, particularly those with compromised health, may have a much more significant illness. 

The strategies that are discussed generally fall into one of four categories:  topics that camp administrators must consider, points of information for parents, training aspects for camp staff, and potential adaptations to the camp's health services. Carefully consider the information. Assess it from the perspective of your camp, paying particular attention to:

• The clients you serve; some may be more sensitive to this topic than others.
• The health status of your clients; for example, people coping with respiratory challenges or those who are immune-compromised have a greater H1N1 risk profile  than generally healthy people.
• Your camp's ability to respond to flu-like illnesses that emerge while people are at camp.
• Your refund policy for cancellations due to health concerns.
•  Recommendations from your State's Department of Health.  These vary from State to State.
• A reliable knowledge base regarding H1N1 influenza.  As more is learned, refine strategies to remain as effective as possible.
• Your business continuance plans and/or insurance parameters.
• Your ability to train staff to help manage this challenge.
• Culture-bound responses from international campers and staff.  Talk with these staff and camper families; help them negotiate the differences between cultures.

With things like these in mind, here are some of the questions camp professionals have been asking:

Will parents be concerned about people at camp from geographic areas that have been impacted by H1N1?
Some may be. As H1N1 continues to spread throughout the world, there may be a participant (camper or staff member) who comes from a geographic area that has the influenza virus. Just because someone comes from an impacted area is no assurance that they are/are not ill.

Some parents may be very uncomfortable with the fact that camp cannot provide a guarantee of protection from H1N1 influenza exposure. While we can minimize the potential of exposure, there is currently no strategy that will eliminate it. In addition, some parents have children who may be more susceptible to potential H1N1 health impacts. Ask these parents to talk with their child's physician and jointly make a decision about camp that is in the best interests of that child.

What can a camp do to minimize the potential that H1N1 will come to camp?
First, ask that ill people remain at home and not come to camp. It's much better to consider a delayed start for a camper or staff member – or a different session – than risk introducing a communicable illness like H1N1 to the camp community. 

This being said, remember that a person is contagious for H1N1 for about 24 hours prior to experiencing H1N1 symptoms. So asking ill people to stay home will be somewhat protective but not a guarantee of protection.

Consider giving your parents and staff a guideline to help them make their decision. The following questionnaire is suggested. It may be particularly helpful for Day Camp parents. The questionnaire is based on information from CDC, WHO, and several State Departments of Health as of 26 May 2009:

Also consider improving your Opening Day screening process.  For example, specifically ask each person, "Have you had flu-like symptoms (fever with cough and/or sore throat) during the past week? Has anyone in your family?" If asking this question, determine what you'll do and who will do it should someone responds with "Yes." 

This section would be incomplete without mention of strategies to keep campers and staff healthy. This is not the summer for run-down campers and staff. This is the summer for keeping people as resilient as possible:

• Resiliency starts with being well rested, nourished and hydrated.  Keep an eagle eye on these baselines. Involve staff with keeping an eye on campers; involve staff supervisors with monitoring staff.
• Review your camp's hand-washing options, especially in relation to mealtimes. Consider using hand sanitizer pumps to improve options.
• Show all staff the video clip from www.CoughSafe.com. Make it imperative that people adequately cover coughs and sneezes; start scoring and keep it up all summer long!
• Coach staff to both recognize people who are not acting in a healthful way (e.g., coughing, sneezing into a group) and appropriately redirect behavior.
• Monitor for and intervene with the over-ambitious folks (those who run themselves ragged).
• Note the places where people are in closest contact with one another (e.g., the dining room, in tents, bunk beds) and adapt the areas to maximize space.
• When in doubt, go for an arm's length of distance between people.

Kids come down with flu-like symptoms all the time at camp. How do we know if it's H1N1?  If there something different about caring for them?
There are a few things to think about when responding to this question. First, some States still test every flu-like illness for H1N1.  Other States don't; they may only test those who get significantly ill (are hospitalized). Know what your State Department of Health recommends; consider telling that to your camp families. Talk with your local Department of Health's contact person specifically about camp. Educate them as to what you're capable of handling and doing while determining what action the State is requiring.

As for your Health Center staff, current recommendation is to care for ill people based on their presenting symptoms. Talk with your supervising physician; is there need to adapt the camp's medical protocols to cover the H1N1 contingency? 

Provide your Health Center staff with the same questionnaire that was recommended for parents (above). If a person presents with flu-like symptoms and falls within the parameters of the questionnaire, direct your Health Center staff to admit the person to a fairly isolated environment until H1N1 influenza can be ruled out. Remind your staff to alert the camp director ASAP should someone be admitted who meets the parameters; you want to stay on top of what's happening.
 
Note: this may be the summer when people with flu-like symptoms won't be visited by their cabin group but would get cabin-made Get Well cards instead.

Also consider your communication with parents. Will parents of campers with flu-like symptoms be notified? How soon? Should campers or staff with H1N1 go home? Since some people may have health concerns that have not been disclosed on their health history form, will you inform your camp families and staff if H1N1 is definitively diagnosed? How might you do that?

What if the worst happens and a lot of people get flu-like symptoms?
The key to this is preparedness. Figure out – now – what needs to be done and how the camp will respond:

• Know the parameters used by the Department of Health.  At what point would they want to be informed? What will they do when told?
• Consider the capacity of the Health Center and what you might do should that capacity be exceeded. Think about bringing in extra help or reassigning counselors to help. Consider how people will be fed and the ability to handle their waste (vomit, diarrhea, etc).  Think about the parameters you'd use to determine "we may have a problem" before the situation is so overwhelming that camp may have to close.
• Consider what supplies will be needed and how those can be quickly obtained. Include N95-rated face masks for direct care-givers.

What should I tell parents and staff ahead of time?
There isn't a pat answer to this question. Each camp will have to consider the various aspects presented by the H1N1 influenza challenge and take action appropriate to your situation.

Many parents and staff simply want assurance that you are aware of the problem and have plans in place, plans that assure them of their child's care should the unforeseen happen. A smaller group will want greater detail. And, yes, some may be difficult to please. There's no way we can guarantee that camp will be an "H1N1 free zone" but we can assure people that attention to safety and health remains a top priority for our camp community.

In closing, I'm reminded of a classic disease control mantra: "For a communicable disease to occur, there must be a susceptible human in an appropriate environment who is exposed to a viable pathogen in adequate amounts. Interrupt one or more of those factors to break the chain of communicability." That is the impact of utilizing strategies such as those described in this article.  We may not be 100% effective, but we can maximize the potential that this summer's camp spirit will be experienced by most.

Return to H1N1 Influenza Hot Topics page.