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49–372 PDF 2009

ENSURING PREPAREDNESS AGAINST THE 

FLU VIRUS AT SCHOOL AND WORK 

HEARING 

BEFORE THE

COMMITTEE ON 

EDUCATION AND LABOR 

U.S. HOUSE OF REPRESENTATIVES

ONE HUNDRED ELEVENTH CONGRESS 

FIRST SESSION 

HEARING HELD IN WASHINGTON, DC, MAY 7, 2009 

Serial No. 111–19 

Printed for the use of the Committee on Education and Labor 

( 

Available on the Internet: 

http://www.gpoaccess.gov/congress/house/education/index.html 
(II) 

COMMITTEE ON EDUCATION AND LABOR 

GEORGE MILLER, California, Chairman 

Dale E. Kildee, Michigan, Vice Chairman 

Donald M. Payne, New Jersey 

Robert E. Andrews, New Jersey 

Robert C. ‘‘Bobby’’ Scott, Virginia 

Lynn C. Woolsey, California 

Rube ́n Hinojosa, Texas 

Carolyn McCarthy, New York 

John F. Tierney, Massachusetts 

Dennis J. Kucinich, Ohio 

David Wu, Oregon 

Rush D. Holt, New Jersey 

Susan A. Davis, California 

Rau ́l M. Grijalva, Arizona 

Timothy H. Bishop, New York 

Joe Sestak, Pennsylvania 

David Loebsack, Iowa 

Mazie Hirono, Hawaii 

Jason Altmire, Pennsylvania 

Phil Hare, Illinois 

Yvette D. Clarke, New York 

Joe Courtney, Connecticut 

Carol Shea-Porter, New Hampshire 

Marcia L. Fudge, Ohio 

Jared Polis, Colorado 

Paul Tonko, New York 

Pedro R. Pierluisi, Puerto Rico 

Gregorio Kilili Camacho Sablan, 

Northern Mariana Islands 

Dina Titus, Nevada 

[Vacant] 

Howard P. ‘‘Buck’’ McKeon, California, 

Senior Republican Member 

Thomas E. Petri, Wisconsin 

Peter Hoekstra, Michigan 

Michael N. Castle, Delaware 

Mark E. Souder, Indiana 

Vernon J. Ehlers, Michigan 

Judy Biggert, Illinois 

Todd Russell Platts, Pennsylvania 

Joe Wilson, South Carolina 

John Kline, Minnesota 

Cathy McMorris Rodgers, Washington 

Tom Price, Georgia 

Rob Bishop, Utah 

Brett Guthrie, Kentucky 

Bill Cassidy, Louisiana 

Tom McClintock, California 

Duncan Hunter, California 

David P. Roe, Tennessee 

Glenn Thompson, Pennsylvania 

Mark Zuckerman, Staff Director 

Sally Stroup, Republican Staff Director 
(III) 

C O N T E N T S 

Page 

Hearing held on May 7, 2009 ................................................................................. 1 

Statement of Members: 

McKeon, Hon. Howard P. ‘‘Buck,’’ Senior Republican Member, Committee 

on Education and Labor ............................................................................... 4 

Prepared statement of ............................................................................... 5 

Miller, Hon. George, Chairman, Committee on Education and Labor ......... 1 

Prepared statement of ............................................................................... 3 

Statement of the National Partnership for Women & Families ............ 57 

Statement of Witnesses: 

Barab, Jordan, Acting Assistant Secretary for Occupational Safety and 

Health, U.S. Department of Labor .............................................................. 26 

Prepared statement of ............................................................................... 28 

Brockhaus, Ann, MPH, senior occupational safety and health consultant, 

ORC Worldwide ............................................................................................. 34 

Prepared statement of ............................................................................... 35 

Garcia, Miguel Antonio, R.N., BSN, for the American Federation of State, 

County and Municipal Employees ............................................................... 31 

Prepared statement of ............................................................................... 32 

Modzeleski, William, Associate Assistant Deputy Secretary, Office of Safe 

and Drug-Free Schools, U.S. Department of Education ............................ 13 

Prepared statement of ............................................................................... 15 

Additional material: ‘‘Pandemic Flu and General Emergency Management Resources’’ ..................................................................................... 18 

O’Connell, Jack, California State superintendent of public instruction ...... 22 

Prepared statement of ............................................................................... 24 

Schuchat, Anne, M.D., Acting Deputy Director for Science and Program, 

Centers for Disease Control and Prevention .............................................. 7 

Prepared statement of ............................................................................... 10 

(1) 

ENSURING PREPAREDNESS AGAINST THE 

FLU VIRUS AT SCHOOL AND WORK 

Thursday, May 7, 2009 

U.S. House of Representatives 

Committee on Education and Labor 

Washington, DC 

The committee met, pursuant to call, at 10:01 a.m., in room 

2175, Rayburn House Office Building, Hon. George Miller [chairman of the committee] presiding. 

Present: Representatives Miller, Andrews, Woolsey, Hinojosa, 

McCarthy, Kucinich, Wu, Davis, Grijalva, Loebsack, Hare, Clarke, 

Courtney, Fudge, Tonko, Sablan, Titus, McKeon, Castle, Platts, 

Hunter, and Roe. 

Staff present: Ali Al Falahi, Staff Assistant; Tylease Alli, Hearing Clerk; Catherine Brown, Education Policy Advisor; Jody 

Calemine, General Counsel; Lynn Dondis, Labor Counsel, Subcommittee on Workforce Protections; Carlos Fenwick, Policy Advisor, Subcommittee on Health, Employment, Labor and Pensions; 

Denise Forte, Director of Education Policy; David Hartzler, Systems Administrator; Jessica Kahanek, Press Assistant; Sharon 

Lewis, Senior Disability Policy Advisor; Ricardo Martinez, Policy 

Advisor, Subcommittee on Higher Education, Lifelong Learning 

and Competitiveness; Stephanie Moore, General Counsel; Alex 

Nock, Deputy Staff Director; Joe Novotny, Chief Clerk; Rachel 

Racusen, Communications Director; Meredith Regine, Junior Legislative Associate, Labor; Margaret Young, Staff Assistant, Education; Mark Zuckerman, Staff Director; Stephanie Arras, Minority 

Legislative Assistant; James Bergeron, Minority Deputy Director of 

Education and Human Services Policy; Andrew Blasko, Minority 

Speech Writer and Communications Advisor; Cameron Coursen, 

Minority Assistant Communications Director; Ed Gilroy, Minority 

Director of Workforce Policy; Rob Gregg, Minority Senior Legislative Assistant; Richard Hoar, Minority Professional Staff Member; 

Susan Ross, Minority Director of Education and Human Services 

Policy; Ken Serafin, Minority Professional Staff Member; Linda 

Stevens, Minority Chief Clerk/Assistant to the General Counsel; 

and Loren Sweatt, Minority Professional Staff Member. 

Chairman MILLER [presiding]. The committee will come to order. 

Today’s hearing is on ensuring preparedness against flu virus and 

school and work, and I want to welcome the witnesses that will be 

testifying in a few minutes and all of the members of the committee. 
2 

Just a couple weeks ago, the international health organizations 

began warning of the potential of a pandemic outbreak of H1N1 flu 

virus. To date, the Center in Disease Control has confirmed 642 

cases of H1N1 in the United States in over 40 states, and two 

deaths, including the first adult death. 

Since the alarm was raised, this administration has acted decisively and responsively to prevent spread of virus and to prevent 

undo alarm among the American people. On Tuesday, after more 

than 545 school closings that sent more than 341,000 children and 

21,000 teachers and staff home, federal officials recommended that 

schools with suspected H1N1 flu cases no longer needed to close. 

This is good news. 

Still, public health officials expect this virus will reach all 50 

states. Experts also warn that the H1N1 or other viruses may hit 

harder and stronger by this coming fall. As we look forward, we 

have an obligation to examine how this unpredictable outbreak has 

tested school, childcare centers, colleges, and workplaces. In many 

cases, our morphing public health needs simply don’t align with 

our education and business needs. 

Today’s hearing gives us an opportunity to look at these challenges while they are fresh and to determine what lessons we can 

learn to prepare for future pandemics. This outbreak has proven 

that a pandemic can have ripple effects throughout our entire communities. 

Many schools are still closed but preparing to reopen. Colleges 

and childcare programs have also closed. Teachers and faculties 

have to figure out how to maintain student learning in the face of 

closures. There is also no one coordinated system for reporting 

cases at schools. 

Education agencies are currently tracking information through 

country health officials, the CDC, and news reports. There are no 

specific reporting requirements for districts. As a result, agencies 

may not have the most complete information about what is happening on the ground. 

The ripple effect is evident in workplaces, too. Employers and 

workers have questions about how to protect themselves, their families, their businesses, and their jobs in the event of a flu outbreak. 

While the Occupational Safety and Health Administration has 

issued guidance and even has some specific standards relevant to 

pandemic flu, it does not have a mandatory comprehensive standard for protecting workers from airborne transmissible diseases. 

As we will hear more about today, this is especially troubling for 

workers on the front lines of pandemics. If nurses, doctors, or first 

responders and other health care workers get sick, they can’t treat 

flu victims or anyone else in the community. If they believe their 

workplace is unsafe, they may stay home to protect their own 

health. 

Sufficient worker protections must be in place to ensure that our 

health care system has the capacity to deal with widespread viral 

outbreaks. We also want to know what measures businesses are 

and should be taking to prepare for pandemic outbreaks, including 

how to deal with sick employees. 

Current federal leave policies only cover some workers. Paid 

leave isn’t required to ensure sick workers stay home, and a situa-
3 

tion where a working parent has childcare problems due to school 

closures aren’t covered. 

Finally, we also need to examine what preventative actions employers and employees should be taking, like providing training on 

flu prevention, what businesses could do to keep operating if a pandemic hits. Especially in this economy, it is critical to ensure that 

students can keep learning, businesses can keep providing services 

to our community. 

I would again like to thank all of our witnesses for taking the 

time out of your vital work in these areas to join us, and I look forward to hearing from your testimony. I would like now to recognize 

the senior Republican of the committee, my colleague from California, Congressman McKeon. 

[The statement of Mr. Miller follows:] 

Prepared Statement of Hon. George Miller, Chairman, Committee on 

Education and Labor 

Good morning. Welcome to today’s hearing on ‘‘Ensuring preparedness against the 

flu virus at school and work.’’ 

Just a couple weeks ago, international health organizations began warning of the 

potential of a pandemic outbreak of the H1N1 flu virus. 

To date, the Center for Disease Control has confirmed 642 cases of H1N1 in the 

United States in over 40 states, and two deaths, including the first adult death. 

Under President Obama’s steady leadership, our government is acting decisively, 

responsibly and aggressively to control the virus and prevent undue alarm. 

On Tuesday, after more than 545 school closings that affected over 341,000 children and almost 21,000 teachers and staff, officials announced that schools no 

longer need to close due to confirmed cases of swine flu. 

That is good news. 

However, officials still expect the virus to reach all 50 states within days, and experts predict that H1N1 or another flu pandemic may hit harder and stronger by 

fall. 

In addition to its public health and safety risks, this pandemic has also highlighted how transmissible diseases can affect a school, a workplace, and families— 

including both their physical and financial health. 

As we look forward, we have an obligation to examine how this unpredictable outbreak has challenged schools, childcare centers, colleges and workplaces. In many 

cases, our morphing public health needs simply don’t align with our education and 

business needs. 

Today’s hearing will give us a critical opportunity to look at these challenges 

while they’re fresh and what lessons we can learn to prepare for future pandemics. 

This outbreak has proven that a pandemic can have a ripple effect on our communities. 

Many schools are still shut but are preparing to re-open. Colleges and child care 

programs have also shut down. 

These closures don’t just affect the students, teachers, and other staff—but families, coworkers, and surrounding communities. 

Parents have to scramble to find last-minute child-care arrangements for their 

kids—or take off work. 

Teachers and faculty have to figure out how to maintain student learning in the 

face of closures. 

School districts, childcare facilities and colleges have to coordinate closely with 

public health officials to make sound decisions about suspected or confirmed flu 

cases. 

It’s a delicate balancing act between taking necessary safety precautions without 

overreacting or igniting panic. 

There is also no one coordinated system for reporting cases in schools. Education 

agencies are currently tracking information through county health officials, the CDC 

and news reports—but there are no specific reporting requirements for districts. 

As a result, agencies may not have the most complete information about what’s 

happening on the ground. State education and health agencies have a role to play 

here. 

The ripple effect is evident in workplaces too. 
4 

Both employers and workers have questions about how to protect themselves, 

their families, their businesses, and their jobs in the event of a flu outbreak. 

While the Occupational Safety and Health Administration has issued guidance 

and even has some specific standards relevant to pandemic flu, OSHA does not have 

a mandatory standard that comprehensively addresses the workplace hazards posed 

by airborne transmissible diseases. 

Ensuring that appropriate standards are in place and are being followed is especially critical in the highest risk workplaces: Health care facilities. 

If nurses, doctors, and other health care workers get sick, they can’t treat flu victims or anyone else. 

If they believe their workplace is unsafe, they may stay home out of their own 

fear of contracting a virus. Sufficient worker protections must be in place to ensure 

that our health care system has the capacity to deal with widespread viral outbreaks. 

But our concern is not limited to the health care workplace. 

We want to know what measures businesses in general are and should be taking 

to prepare for pandemic outbreaks. For example, one critical issue that employers 

face is how to deal with sick employees. In this economy, workers are less likely 

to take time off for fear of losing pay, benefits, or even their job. In the context of 

a pandemic, having the right leave policies becomes a matter of public health. It 

is becoming increasingly clear that current federal sick leave requirements aren’t 

designed to address pandemics. 

Current federal law covers only some workers. It doesn’t require paid leave to ensure sick workers stay home. And it doesn’t cover situations where a working parent 

has child care problems due to a school closure. 

We also need to examine what other preventative actions employers and employees should be taking, like providing training on flu prevention, and what businesses 

can do to keep operating if a pandemic hits. 

These challenges are acute, and they won’t go away. Experts predict the likelihood 

of pandemics will increase. Our federal policies will need to adapt. On the education 

front, Secretary Duncan and the CDC have been in frequent communication with 

school districts and parents to provide critical advice. 

The CDC is also currently in the process of reviewing its guidelines to help 

schools better prepare for and respond to outbreaks. On the workplace front, under 

its new leadership, OSHA is looking at how it can improve its health and safety 

rules and guidance to address flu pandemic protocol. We’ll learn more about these 

efforts from our panel. 

Especially in this economy, it’s critical to ensure that students can keep learning 

and businesses can keep providing services to communities. 

I’d like to thank all of our witnesses for taking time out from the vital work you’re 

doing to fight this pandemic to join us today. 

Mr. MCKEON. Thank you, Chairman Miller, and good morning. 

Over the past few weeks, many parents and employers have been 

concerned about, with this threat of H1N1 flu virus, and rightly so. 

As most parents know, illnesses such as the flu can spread through 

a school almost as fast as an email or text message. It is one of 

those facts of life that parents of school-aged children have had to 

face for generations. 

But the H1N1 flu is different because it can be deadly. And with 

its original, exotic, and inaccurate name of swine flu, it was natural for parents to become worried. 

American employers have also been worried. First and foremost, 

they are concerned about the health and wellbeing of their workers. But they are also wondering about how this virus might affect 

their ability to run their businesses. 

We look at Mexico, where the government ordered a nationwide 

shutdown of all nonessential businesses for almost a week. In Mexico City alone, estimated losses were put at $88 million a day. If 

something like that happened in the United States, it would certainly take a toll on working families, and you do not have to be 
5 

a financial genius to know it would not help America’s struggling 

economy. 

People also can overreact when they hear about a virus. I am 

sure many of us thought about buying facemasks after seeing others wear them on T.V. I am also sure a few may have got one already, just in case. 

Governments can overreact, too. Earlier this week, U.S. health 

officials reversed their recommendation that schools should close as 

long as 2 weeks if a student catches the H1N1 virus. 

Why did this happen? One of the reasons was that officials realized that closing schools would do little to prevent the spread of the 

disease in the first place. But schools across the nation have done 

just that. 

In fact, the Washington Post reported yesterday that at least 726 

schools have closed to stop the spread of the flu, but the Post did 

not report that there are more than 100,000 elementary and secondary schools in the United States. So that means less than 1 percent of the schools have closed because of the flu. This context 

would have been helpful because it would have contributed to a 

better understanding about the threat from this virus. 

That is what I hope our experts can provide today to this committee and to the American public: a better understanding about 

H1N1. Their information, calmly and accurately presented with 

context, will be a great help. 

We can learn more about this disease, its cause, and most importantly, the steps that can be taken in both our schools and places 

of work to prevent its spread, because at the end of the day I believe we are all committed to the same goal of protecting our children and our coworkers. To that end, I welcome our witnesses 

today and look forward to hearing from them and learning more 

about this virus. 

Thank you, Chairman Miller, and I yield back. 

[The statement of Mr. McKeon follows:] 

Prepared Statement of Hon. Howard P. ‘‘Buck’’ McKeon, Senior Republican 

Member, Committee on Education and Labor 

Thank you, Chairman Miller and good morning. 

Over the past few weeks, many parents and employers have been concerned with 

the spread of the H1N1 flu virus. And rightly so. 

As most parents know, illnesses such as the flu can spread through a school almost as fast as an e-mail or a text message. It’s one of those facts of life that parents of school-age children have had to face for generations. 

But the H1N1 flu is different because it can be deadly. And, with its original, exotic (and inaccurate) name of ‘‘swine flu’’—it was natural for parents to become worried. 

American employers have also been worried. 

First and foremost, they are concerned about the health and well-being of their 

workers. But they are also wondering about how this virus might affect their ability 

to run their businesses. 

They look at Mexico, where the government ordered a nationwide shutdown of all 

non-essential businesses for almost a week. In Mexico City alone, estimated losses 

were put at $88 million a day. 

If something like that happened in the United States, it would certainly take a 

toll on working families. And, you do not have to be a financial genius to know it 

would not help America’s struggling economy. 

People also can overreact when they hear about a virus. I’m sure many of us 

thought about buying face masks after seeing others wear them on TV. I’m also sure 

a few may have bought one already just in case. 
6 

Governments can overreact, too. Earlier this week, U.S. health officials reversed 

their recommendation that schools should close for as long as two weeks if a student 

catches the H1N1 virus. 

Why did this happen? One of the reasons was that officials realized that closing 

schools would do little to prevent the spread of the disease in the first place. 

But schools across the nation have done just that. In fact, the Washington Post 

reported yesterday that at least 726 schools have closed to stop the spread of the 

flu. 

But the Post did NOT report that there are more than 100,000 elementary and 

secondary schools in the United States. 

So that means less than 1 percent of schools have closed because of the flu. 

This context would have been helpful because it would have contributed to a better understanding about the threat from this virus. 

That’s what I hope our experts can provide today to this committee and the American public: a better understanding about H1N1. 

Their information, calmly and accurately presented with context, will be a great 

help. We can learn more about this disease, its cause and, most importantly, the 

steps that can be taken in both our schools and places of work to prevent its spread. 

Because at the end of the day, I believe we are all committed to the same goal 

of protecting our children and our co-workers. 

To that end, I welcome our witnesses today. I look forward to hearing from them 

and learning more about this virus. 

Thank you, Chairman Miller. I yield back. 

Chairman MILLER. Thank you. 

I would like to briefly introduce our witnesses. First we will hear 

from Dr. Anne Schuchat, who currently serves as the interim deputy director for science and public health programs at the Center 

for Disease Control and Prevention. 

Before this assignment, Dr. Schuchat was the director of the 

CDC’s National Center on Immunization and Respiratory Diseases, 

and has spend more than 20 years at the CDC working on immunization, respiratory and other infectious diseases. Dr. Schuchat 

graduated with the highest honors from Swarthmore College and 

honors from the Dartmouth Medical School. 

Mr. Bill Modzeleski is the associate assistant deputy secretary in 

the Office of Safe and Drug-Free Schools at the Department of 

Education. In Mr. Modzeleski’s prior role as the associate deputy 

undersecretary of the Office of Safe and Drug-Free Schools, Mr. 

Modzeleski was involved in the design and development of drug 

and alcohol prevention programs, violence prevention programs 

and activities, especially as they affect schools and in the school 

health-related issues. Mr. Modzeleski has a B.A. and a degree from 

political science form the University of Bridgeport, and an MPA 

from the C.W. Post College. 

Mr. Jack O’Connell is the superintendent of public instruction at 

the California Department of Education. Mr. O’Connell previously 

served in the California state senate, representing the 18th district 

from 1994 to 2002, and Mr. O’Connell received a B.A. in history 

from the California State University at Fullerton and earned a secondary teaching credential from California State University at 

Long Beach. 

Mr. Jordan Barab is the acting assistant secretary of the Occupational Health and Safety Administration. He served most recently 

as a senior policy advisor for the Education and Labor Committee. 

Mr. Barab is the special assistant to the assistant director for labor 

at the Occupational Safety and Health Administration from 1998 

to 2001, and directed the safety and health programs for the Amer-
7 

ican Federation of State and County Municipal Employees from 

1982 to 1998. He graduated at Claremont McKenna College in 

California and received a master’s degree in international relations 

for Johns Hopkins University. 

Mr. Miguel Antonio Garcia is currently a registered nurse at Kaiser Permanente Los Angeles Medical Center Emergency Department and serves as a labor union contract specialist and workplace 

safety labor co-chair. Mr. Garcia received a B.S. in nursing from 

Franciscan University. 

Ms. Ann Brockhaus is the occupational safety and health consultant at ORC Worldwide, where since 1990 she has provided assistance to clients on a wide range of occupational health issues. Ms. 

Brockhaus holds a BSN from Georgetown University and a master’s degree in public health from Johns Hopkins University 

Bloomberg School of Public Health. 

Welcome to the committee. Thank you for taking your time to 

share your experience and your expertise with the members of this 

committee. As I mentioned to you a little bit earlier, we are here 

to learn from your experiences over this past month, and the lessons that you think you have learned, and where you think, perhaps, there is a misalignment in the system in terms of best informing our population and protecting them. So we look forward to 

your testimony. 

When you begin to testify, a green light will go on in front of you 

and you will have 5 minutes for your formal testimony. At 4 minutes an orange light will go on and you want to think about wrapping your testimony up, and then there will be a red light. But we 

want you to complete your thoughts in a manner that you think 

is most important to us. 

Dr. Schuchat, we will begin with you. Welcome. 

STATEMENT OF DR. ANNE SCHUCHAT, DEPUTY DIRECTOR 

FOR SCIENCE AND PUBLIC HEALTH PROGRAMS (INTERIM), 

CENTERS FOR DISEASE CONTROL AND PREVENTION 

Dr. SCHUCHAT. Thank you. Good morning, Chairman Miller, 

Ranking Member McKeon, and distinguished members of the committee. I am Dr. Anne Schuchat, acting deputy director for science 

and program at the Centers for Disease Control and Prevention, 

and really appreciate the opportunity to talk to the committee this 

morning. I will be updating you about what we know, what CDC 

is doing, and some of the steps that are in place, and really appreciate the chance to testify with the distinguished colleagues. 

First, I just want to say that my heart and the hearts of CDC 

really go out to the people in the communities that have been affected here in the United States, in Mexico, and around the world, 

both directly from the virus and then indirectly from some of the 

interventions and the impacts they have had on families and communities. We know that our nation’s 7.6 million workplaces and 

over 126,000 schools and other childhood settings have been facing 

the challenges of this outbreak. 

We share the concern of people across the country, and we are 

responding aggressively at the federal, state, local, tribal, and territorial levels to understand the complexities of this outbreak and to 

implement effective control measures. Our aggressive actions are 
8 

possible in many respects because of investments and support of 

the Congress in U.S. pandemic preparedness, which has provided 

us with many of the tools we are using to detect, track, and control 

the impact of this outbreak at CDC and at state and local health 

departments across the country. 

Influenza viruses are very unpredictable. It is hard to anticipate 

the course that this outbreak will have with any certainty, either 

this spring or in the fall at the usual return of the influenza season. We do expect to see an increase in the number of cases, the 

number of states affected, and we also expect to see additional 

deaths and hospitalizations. 

We are carefully monitoring the severity of illness caused by this 

virus. While preliminary evidence is encouraging, we understand 

that this, too, could change. Amid this uncertainty, our goals are 

to be clear in communicating what we do know, acknowledge the 

uncertainties, be clear about communicating what we are doing 

and what individuals can do, themselves, to protect the families in 

their communities. 

Influenza arises from a variety of sources, and in this case we 

have determined there is a new, or novel, influenza A H1N1 virus 

that is circulating around the globe that contains genetic sources 

from four different virus sources. We have been able, within just 

2 weeks, to identify this novel virus, understand its complete genetic characteristics, and compare the genetic composition of specimens from U.S. patients to others from around the globe to watch 

for mutations that may change the properties of the virus and how 

it behaves in people. 

We have also very quickly deployed—or, developed and then deployed—test kits for use in the widening network of laboratories 

that are responding to this outbreak. These steps, along with the 

capacity that is in place as a result of effective planning over the 

last few years, have allowed for the rapid diagnostics and epidemiology that contribute to a clearer understanding of transmission 

and severity of the illness caused by the virus. These scientific accomplishments have provided the basis for an evolving set of responses that greatly enhance our nation’s ability to address this 

threat. 

CDC has determined that the virus is contagious; it is spreading 

from human to human. It appears to spread with similar characteristics to seasonal influenza virus, through coughing and sneezing, 

through human-to-human contact. Sometimes people may become 

infected by touching something that has the flu viruses on it and 

then touching their mouth or nose. There is no evidence at all that 

this virus can be acquired from contact with pigs or from eating 

pork or pork products. 

Aggressive actions are being taken here in the U.S., as well as 

around the world. We are working very closely with state and local 

public health officials around the country on the investigation and 

on implementation of interventions, such as infection control measures. We are providing both technical support on the epidemiology 

as well as laboratory support for confirming cases. 

We are also working with international partners on the outbreak, 

including a collaborative effort in Mexico, really the epicenter of 

the problem, to better understand the outbreak and enhance sur-
9 

veillance and lab capacity there. And we are working closely with 

Secretary Napolitano and our other federal partners to ensure our 

efforts are coordinated and effective. 

CDC has issued numerous health advisories for individuals, 

health care practitioners, schools, and communities, and these continue to evolve as our understanding of the situation changes. In 

fact, a key message from CDC is that there is a role for everyone 

to play in the outbreak. 

At the individual level it is important for people to understand 

how to prevent respiratory infections. Frequent hand washing is a 

good idea; if you are sick, stay home; if you are sick, don’t get on 

an airplane or public transport; keep your kids home from school 

if they are sick. Taking personal responsibility can help reduce the 

spread of this virus as well as other respiratory infections. 

But the path of this outbreak is unclear. As I said, influenza is 

unpredictable, and we need to be prepared for the potential return 

of this virus in the fall, perhaps in a more severe format. It is important for public health officials to continue—that they continue 

to think about what might be needed if the outbreak deepens in 

the communities where you work. It is also important for businesses, schools, and local governments to anticipate those types of 

changes. 

Schools and childhood settings, including Head Start and 

childcare programs, play a critical role in protecting the health of 

their students, staff, and the community from contagious diseases, 

including this novel H1N1 influenza. About one out of five Americans spend considerable time in one of the more than 90,000 school 

buildings on any given school day. Millions of adults work in school 

and childhood settings, and many millions more are parents or 

guardians of school-aged children. 

While CDC has made scientific recommendations about how 

schools can deal with this virus, the authority for decisions regarding school dismissal resides at the state and local level. We at CDC 

applaud the collaborative efforts of school superintendents, Head 

Start and childcare directors, county executives, mayors, governors, 

et cetera, who are on the front lines of this epidemic. 

The emergency preparedness work that communities had done 

before this outbreak has been essential in the response. That includes the 600 local education agencies that have been working 

with our colleagues in the Department of Education through their 

Readiness and Emergency Management for Schools Program. Without that sort of considerable advanced planning and ongoing exercising, we would have been much less prepared for this outbreak 

and the ongoing reponse. 

Chairman MILLER. Dr. Schuchat, I am going to ask if you can 

start to wrap up. 

Dr. SCHUCHAT. Sure. 

Chairman MILLER. Thank you. 

Dr. SCHUCHAT. Absolutely. 

CDC’s NIOSH is leading the agency’s efforts to minimize effects 

on the epidemic and working to disseminate guidelines. I do want 

to stress that as we learn more we try to use the science to inform 

changes in guidelines and try to work collaboratively across government and with partners before we issue new guidelines. We in the 
10 

government can’t solve this problem on our own, and we do need 

the cooperation of all the other sectors. 

I just want to conclude by saying, we don’t know exactly where 

this virus will go, but we have never been as prepared as we are 

today, based on the investments of the past few years. Thank you. 

[The statement of Dr. Schuchat follows:] 

Prepared Statement of Anne Schuchat, M.D., Acting Deputy Director for 

Science and Program, Centers for Disease Control and Prevention 

Good morning, Chairman Miller, Ranking Member McKeon, and other distinguished members of the Committee. I am Dr. Anne Schuchat, Acting Deputy Director for Science and Public Health Program, Centers for Disease Control and Prevention. 

I thank you for the opportunity to update you on current efforts CDC is taking 

to respond to the ongoing novel H1N1 influenza outbreak, highlighting our efforts 

regarding schools and workplaces. I am pleased to be speaking to you today with 

our colleagues from the US Department of Education and the Occupational Safety 

and Health Administration. 

Our hearts go out to the people in the United States, in Mexico, and around the 

globe who have been directly impacted. We know that our nation’s 7.6 million workplaces and over 126,000 schools and other childhood settings have been facing the 

challenges of this outbreak. We share the concern of people around the country and 

around the globe; and are responding aggressively at the federal, state, local, tribal, 

and territorial levels to understand the complexities of this outbreak and to implement control measures. It is important to note that our nation’s current preparedness is a direct result of the investments and support of the Congress for state and 

local pandemic preparedness, and the hard work of state and local officials across 

the country. 

It is important for all of us to understand that flu viruses—and outbreaks of 

many infectious diseases—are extremely unpredictable. As with any public health 

investigation, our response has evolved as our investigation proceeds and we learn 

more about the situation. We have seen an increase in the number of cases and the 

number of states affected, and we can expect more people and states to be affected. 

We are carefully monitoring the severity of illness caused by this virus—and while 

preliminary evidence is encouraging, we understand that this, too, could change. 

Our goal in our daily communication—to the public, to the Congress, and to the 

media—is to continue to be clear in what we do know, explain uncertainty, and 

clearly communicate what we are doing to protect the health of Americans. It has 

also been a clear priority to communicate the steps that Americans can take to protect their own health and that of their community. As we continue to learn more, 

these communications and our guidance to public health officials, health care providers, schools, businesses, and the public has changed and will continue to evolve. 

Influenza arises from a variety of sources; for example, swine influenza (H1N1) 

is a common respiratory disease of pigs caused by type A influenza viruses. These 

and other animal viruses are different from seasonal human influenza A (H1N1) viruses. From laboratory analysis already performed at CDC, we have determined 

that there is a novel H1N1 virus circulating in the U.S. and Mexico that contains 

genetic pieces from four different virus sources. This particular genetic combination 

of H1N1 influenza virus is new and has not been recognized before in the United 

States or anywhere else worldwide. As a result of our investment in pandemic preparedness, we have been able to move within two short weeks to identify a novel 

virus, understand its complete genetic characteristics, and compare the genetic composition of specimens from US patients to others around the globe to watch for 

mutations. We have also quickly developed and (working with FDA) deployed test 

kits for use in a widening network of laboratories. These steps, along with capacity 

in place as a result of effective planning, have allowed for the rapid diagnostic and 

epidemiologic capabilities that have contributed to a clearer understanding of the 

transmission and severity of illness caused by the virus. These scientific accomplishments have provided the basis for an evolving set of responses that greatly enhance 

our nation’s ability to address this threat. 

CDC has determined that this virus is contagious and is spreading from human 

to human. It appears to spread with similar characteristics as seasonal influenza. 

Flu viruses are thought to spread mainly from person to person through coughing 

or sneezing by people with influenza. Sometimes people may become infected by 

touching something with flu viruses on it and then touching their mouth or nose. 

There is no evidence to suggest that this virus has been found in swine in the 
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United States, and there have been no illnesses attributed to handling or consuming 

pork. Currently, there is no evidence that one can get this novel H1N1 influenza 

from eating pork or pork products. Of course, it is always important to cook pork 

to an internal temperature of 160 degrees Fahrenheit in order to ensure safety. 

I want to reiterate that as we look for cases, we are seeing more cases. We fully 

expect to see not only more cases, but also more cases of severe illness. We have 

ramped up our surveillance around the country to try and get a better understanding of the magnitude of this outbreak. 

Let me provide for you an update in terms of the public health actions that are 

underway in the United States and abroad. On the investigation side, we are working very closely with state, local, tribal and territorial public health officials around 

the country. We’re providing both technical support on the epidemiology as well as 

laboratory support for confirming cases. We are also working with the World Health 

Organization, the Pan American Health Organization, and the governments of Mexico and Canada on this outbreak. There is a tri-national team that is working in 

Mexico to better understand the outbreak, and answer critical questions such as 

why cases in Mexico initially appeared to be more severe than those that were first 

seen in the U.S. We are assisting Mexico to establish more laboratory capacity incountry, a critical step in identifying more cases on which to base our epidemiological investigation into the spread and severity of this new virus. 

In terms of travel advisories, CDC continues to evaluate incoming information 

from the World Health Organization, the Pan American Health Organization, and 

other governments to determine the potential impact of the outbreak on international travel. On Monday, April 27th, CDC issued a travel health warning for 

Mexico, and this remains in effect. With this warning, we recommend that travelers 

postpone non-essential travel to Mexico for the time being. CDC is also evaluating 

information from other countries and will update travel notices for other affected 

countries as necessary. As always, persons with flu or flu-like symptoms should stay 

at home and should not attempt to travel. 

CDC has and will continue to develop specific recommendations for what individuals, communities, clinicians, and others professionals can do. It is important that 

people understand that there is a role for everyone to play during an outbreak. At 

the individual level, it is important for people to understand how they can prevent 

respiratory infections. Very frequent hand-washing is something that we talk about 

time and time again and that is an effective way to reduce transmission of disease. 

If you are sick, it is very important to stay at home. If your children are sick, have 

a fever and flu-like illness, they should not go to school. And if you are ill, you 

should not get on an airplane or any public transport to travel. Taking personal responsibility for these things will help reduce the spread of this new virus as well 

as other respiratory illnesses. 

The path of this outbreak may change; and we need to be prepared for a possible 

return of this virus in the fall. It is important that we (in partnership with state 

and local officials) continue to think about what might be needed if this outbreak 

deepens in communities across the US. We have encouraged communities, businesses, schools, and local governments to make specific plans to manage this outbreak if cases appear in their communities, and advised parents to prepare for what 

they would do if faced with temporary school and child care center closures. We also 

have additional community guidance so that clinicians, laboratorians, and other 

public health officials will know what to do should they see cases in their community. All of these specific recommendations, as well as other regular updates, are 

posted on the CDC web site—www.cdc.gov/H1N1flu. 

As places where many people gather across the U.S., schools, childhood settings 

including Head Start, family child care and child care programs, and workplaces are 

essential for mitigating this outbreak. Including students and adults who work in 

schools, approximately 20% of the US population spends considerable time in one 

of the more than 90,000 school buildings on any given school day. Millions of adults 

work in school and childhood settings, and many millions more are parents or 

guardians of school-aged children. Schools and childhood settings play a critical role 

in protecting the health of their students, staff, and the community from contagious 

diseases such as this novel H1N1 influenza. I’d like to recognize the work and collaboration of our partners at US Department of Education, state and local education 

agencies, and other education partners as we have been learning about this new 

virus, providing the best science we can in an uncertain situation, and working hard 

to keep our nation’s children safe. 

While CDC has made scientific recommendations about how schools can deal with 

this virus, the responsibility for decisions regarding school dismissal resides at the 

state, local, tribal, and territorial level, and CDC applauds the collaborative efforts 

of school superintendents, Head Start and child care Directors, County Executives, 
12 

mayors, governors, emergency management officials, and public health officials who 

are on the front lines of this epidemic. We are mindful that science is a critical component in decision-making about how communities respond—and that there are also 

many other considerations that communities must evaluate in making appropriate 

decisions. The emergency preparedness work that communities have done before 

this outbreak—such as exercising their emergency plans—has been essential in 

their response now. This includes the 600 local education agencies that have been 

working with our colleagues at the Department of Education through their Readiness and Emergency Management for Schools Program. Without considerable advance planning by communities and ongoing updating and exercising of school emergency plans, we would’ve been much less prepared for this outbreak, and we are 

grateful for all of the work our Education colleagues have done in this regard. 

During public health emergencies like the current novel influenza A (H1N1) epidemic, protecting workers is a top priority, both as members of the community, and 

as workers with special roles in ensuring the functioning of critical infrastructure. 

Workers can contract influenza through general community exposures or workplacespecific transmission. CDC is working to minimize both pathways. 

Some workers—especially healthcare workers and emergency responders—are at 

special risk for infection because their jobs, by definition, bring them into repeated, 

close contact with individuals ill with novel H1N1. These workers represent a particularly high priority for prevention, both because of the potential for added risk 

and because it will be particularly problematic if they become unavailable through 

illness or reluctant to perform their duties. Other workers are in critical infrastructure positions—they keep society functioning by maintaining utilities, public safety, 

and food and water supply. Many of these workers may not experience a greater 

risk of workplace transmission than other workers, but their functions are crucial, 

so keeping them on the job is a priority. 

CDC’s National Institute for Occupational Safety and Health is leading the Agency’s efforts to minimize effects of the epidemic on working populations by developing 

and disseminating guidance regarding precautions to prevent work-related transmission of the illness. Guidance is informed by the hierarchy of controls used to reduce exposure: engineering, administrative and work practices, and personal protective equipment. Engineering controls include isolation, ventilation and physical barriers. Administrative and work practice controls include social distancing, telecommuting, hand hygiene, cough etiquette, and training. Personal protective equipment 

or PPE include gloves, glasses, gowns, and respiratory protection. If exposure should 

occur, guidance also addresses the use of antiviral treatment to prevent or treat disease. Finally, should a vaccine become available, recommendations for immunization 

will be developed and disseminated. Guidance materials are being developed focused 

on the needs of specific worker populations and workplace settings; and to provide 

general information useful to all businesses. All of these workplace-related guidance 

materials are available at http://www.cdc.gov/niosh/topics/H1N1flu/. 

We will continue to provide support to states and communities throughout this 

outbreak. In addition to the epidemiologic and laboratory support that CDC provides, CDC maintains the nation’s Strategic National Stockpile of medications that 

may be needed for this or other outbreaks. As part of our pandemic preparedness 

efforts, the U.S. Government has purchased extensive supplies of antiviral drugs— 

oseltamivir and zanamivir—for the Strategic National Stockpile. Laboratory testing 

on the viruses so far indicates that they are susceptible to oseltamivir and 

zanamivir. Acting quickly after we identified this virus and its potential impact on 

our population, we have released one-quarter of the states’ share of antiviral drugs 

and personal protective equipment, to be used pursuant to emergency use authorizations issued by the FDA Commissioner, to help the states prepare to respond to the 

outbreak. As of Sunday, May 3rd—within weeks of a new virus having been identified—this deployment of the stockpile was completed for all states and areas. 

Whenever we see a novel strain of influenza, we begin our work in the event that 

a vaccine needs to be manufactured. Simultaneous efforts are underway within 

CDC, FDA, New York Medical College, and St. Jude, as well as international partners, to develop a vaccine seed strain specific to this virus—the first step in vaccine 

manufacturing. This is something CDC often initiates when we encounter a new influenza virus that has the potential to cause significant human illness. We have already isolated and identified the virus and steps are underway so that should a vaccine be needed, we can work towards that goal very quickly with interested manufacturers. HHS discussions to consider the needed pathways to provide rapid production of vaccine after the appropriate seed strain has been provided to manufacturers are currently ongoing. As this progresses, HHS operating divisions and offices 

including CDC, NIH, FDA, and ASPR/BARDA will work in close partnership. 
13 

In closing, we are simultaneously working hard to understand and control this 

outbreak while also keeping the public and the Congress fully informed about the 

situation and our response. We are working in close collaboration with our federal 

partners, including our sister HHS agencies and other federal departments, as well 

as with other organizations that have unique expertise that helps us provide guidance for multiple sectors of our economy and society. While events have progressed 

with great speed, this will be a marathon, not a sprint. Even if this outbreak yet 

proves to be less serious than we might have initially feared, we can anticipate that 

we may have a subsequent or follow-on outbreak several months down the road. 

Steps we are taking now are putting us in a strong position to respond. 

The Government cannot solve this alone, and as I have noted, all of us must take 

constructive steps. Schools, childhood settings, and workplaces are critical to this effort. If you are sick, stay home. If children are sick, keep them home from school. 

Wash your hands. Take all of those reasonable measures that will help us mitigate 

how many people actually get sick in our country. 

Finally, it is important to recognize that there have been enormous efforts in the 

U.S. and abroad to prepare for this kind of an outbreak and a pandemic. The Congress has provided strong leadership and support for these efforts. Our detection of 

this strain in the United States came as a result of that investment and our enhanced surveillance and laboratory capacity are critical to understanding and mitigating this threat. While we must remain vigilant throughout this and subsequent 

outbreaks, it is important to note that at no time in our nation’s history have we 

been more prepared to face this kind of challenge. As we face the challenges in the 

weeks ahead, we look forward to working closely with the Committee to best address this evolving situation. 

Chairman MILLER. Thank you. 

Mr. Modzeleski? 

STATEMENT OF BILL MODZELESKI, ASSOCIATE ASSISTANT 

DEPUTY SECRETARY, OFFICE OF SAFE AND DRUG–FREE 

SCHOOLS, U.S. DEPARTMENT OF EDUCATION 

Mr. MODZELESKI. Good morning, Mr. Chairman, Congressman 

McKeon, and other distinguished members of the committee. I am 

Bill Modzeleski, associate assistant deputy secretary at the Department of Education’s Office of Safe and Drug-Free Schools. 

I want to thank you for the opportunity to appear before this 

committee today to provide you with an overview of the department’s actions during the 2009 H1N1 flu outbreak. This morning 

I want to provide an overview of the situation regarding school 

closings, summarize some basic principles that form the foundation 

of our response efforts, and if time permits, conclude with some of 

the actions we have taken recently to help schools and institutions 

of higher education to respond to the current outbreak of the H1N1 

flu virus. 

Let me start by stating that the situation regarding schools remains somewhat fluid. That is, we have some schools opening 

while others remain closed. 

Of the 8 school days we have collected information on school closings, we saw daily changes. On Monday, April 27th, 22 schools in 

three states had announced decisions to close for reasons related to 

the H2—H1, I should say—H1N1 flu. There were approximately 

15,700 students impacted by those closings. 

By Tuesday of this week, the number of closures stood at 726, 

representing 24 states and the District of Columbia, and these closures affected approximately 468,000 students. On May 5th, the 

Centers for Disease Control and Prevention announced revised 

guidance on community mitigation that advised that student with 
14 

flu symptoms stay home from school, that schools with confirmed 

or suspected cases of the flu not close. 

While it has been less than 48 hours since this revision was announced, we have already seen considerable change. Approximately 

140 schools with 100,000 students reopened yesterday, and more 

are expected to reopen today. Overall, the school closures affected 

a relatively small number of students and staff, but created a considerable amount of concern. 

Although the scientists at CDC are cautiously optimistic about 

what they are learning about the virus, we must remain alert to 

the possibility that the nature of this current outbreak could 

change. We will continue to rely on five key principles as we work 

to help schools and institutions of higher education prepare for and 

respond to the range of crises, including a pandemic. 

First, our chief concern will continue to be the health and safety 

of students, faculty, and staff. Federal education statutes and regulations should not be an impediment to closing schools for health 

reasons. We are ready to consider requests for waivers related to 

the flu to the extent of the secretary’s waiver authority. 

Next, we recognize that effectively managing crises such as the 

H1N1 flu outbreak requires many different agencies and organizations working together. The Department of Education can’t do it 

alone. We will continue to collaborate with our colleagues from the 

Department of Health and Human Services, including the Centers 

for Disease Control, the Department of Homeland Security, and 

other federal agencies, to capitalize on the valuable expertise they 

possess. Working with them is also essential in ensuring that we 

provide a coordinated federal response. 

Next, we need to keep in mind that many of the most difficult 

decisions concerning response to the current flu virus must be 

made by state and local officials. While state and localities have a 

lot to do, a lot has already been done. 

States and localities, as well as the federal government, have already invested a significant amount of effort and planning for the 

pandemic flu. Every state has a pan flu plan, and every plan contains an appendix describing the roles of schools during an epidemic. We will continue to build on those planning efforts and support state and local education officials. 

Next, while the current outbreak of the H1N1 flu is the issue 

that brings me before the committee today, we believe that the best 

approach for schools and institutions of higher education to take 

preparing for an outbreak of an infectious disease or any other crisis situation is to develop an ‘‘all hazards’’ plan that addresses a 

variety of crises, from intruders and accidents to school shootings 

and the flu. 

Finally, our decisions about how schools and institutions of higher education are to deal with a crisis are based upon the fact that 

while crisis planning for schools has to consider the health and 

welfare of students and staff, the plan also needs to consider the 

educational needs of students. Crisis planning can’t exist in a vacuum. 

Consistent with these general principles, we have taken several 

actions in the past week to support schools and institutions of higher education. In addition to tracking information about school clo-
15 

sures, we, in coordination with the Centers for Disease Control and 

Homeland Security, provided opportunities for school officials to 

hear up-to-date information directly from scientists at CDC and to 

pose questions by hosting three conference calls. I am happy to say 

about 3,000 conference lines were used during those three calls. 

We also have developed and posted detailed guidance responding 

to a number of issues of specific concern to the schools and institutions of higher education, including school closures, and have developed a mechanism for school and other officials to submit questions 

concerning the flu to the department, and we are using these questions to help us better understand the challenges the schools and 

colleges are facing to identify issues on which we can develop and 

post additional guidance. 

I hope that you have found this overview helpful, but I would be 

pleased to answer any other questions you may have. Thank you. 

[The statement of Mr. Modzeleski follows:] 

Prepared Statement of William Modzeleski, Associate Assistant Deputy Secretary, Office of Safe and Drug-Free Schools, U.S. Department of Education 

Good morning, Chairman Miller, Representative McKeon, and other distinguished 

members of the Committee. I am William Modzeleski, Associate Assistant Deputy 

Secretary, Office of Safe and Drug Free Schools, at the U.S. Department of Education (ED), and on behalf of Secretary Arne Duncan and the entire department I 

want to thank you for the opportunity to provide you with an overview of the Department’s actions regarding the H1N1 flu. 

I also want to take this opportunity to thank our colleagues from the Department 

of Homeland Security, the Department of Health and Human Services, and the 

many other agencies that are participating in the coordinated Federal response to 

the H1N1 flu for their ongoing assistance and support for ED’s response efforts. 

Although the situation continues to emerge, ED stands ready to act quickly based 

on our work in planning for a range of challenges and situations. 

In the current outbreak, there are many key pieces of information that are emerging on a daily basis. Accordingly, schools face many challenges, such as whether or 

not to close, the timing and length of school closures, and the impact on learning. 

ED’s approach is predicated on the principle that we want every student, teacher, 

and staff person to be safe and healthy and we do not want Federal education rules 

or regulations to be an impediment to students’ health and welfare. 

In keeping with this key principle of ensuring the health and safety ofstudents, 

we have worked with the Centers for Disease Control and Prevention (CDC) within 

the Department of Health and Human Services (HHS) to disseminate guidance on 

closing schools as part of a comprehensive community-mitigation strategy. The CDC 

recommendations are based on an evolving understanding of the virus, including its 

transmissibility and severity. We continue to work closely with the CDC and to 

monitor the changing situation. 

Authorities for closing schools vary between states and even sometimes among localities within states. State and local educational agencies, in coordination with 

their health counterparts, are responsible for the interpretation and implementation 

of CDC’s guidance, including when, and for how long, to close schools. States and 

many localities have been planning for an influenza pandemic for several years now 

and most are depending on their plans to guide a range of actions, including communications strategies or enacting school closure procedures. Responses to the flu 

outbreak have varied but range from closing one school to closing all the schools 

in a district. On Monday, May 4th, 545 schools were closed, affecting 341,298 students and 20,967 teachers and staff. 

We cannot predict what will happen in the future—near or distant—with regard 

to how H1N1 will affect schools and institutions of higher education (IHEs). However, we do know that school closures will be affected by three key factors: 

• School districts’ decisions about closure will be affected by what the outbreak 

looks like locally. If large numbers of students and staff are ill, we will see more 

closures. Conversely, if the illnesses and absences decline, we can anticipate that 

fewer school districts will close. 
16 

• Second, the number of schools that close will be dependent upon mitigation 

guidance provided by the CDC. ED has encouraged and will continue to encourage 

school districts and IHEs to closely follow school closing guidance provided by the 

CDC. If the CDC calls for longer school closings we can anticipate that schools will 

close for longer periods and, hence, more students will be out of school. Conversely, 

if the situation changes and the CDC calls for schools to close for a shorter period 

of time or calls for fewer individuals to be excluded from school, we will likely see 

fewer schools closed. • Finally, closures will be based on the school calendar. Many institutions of higher education are at or near the end of their academic calendar. As for K-12 schools, 

the academic calendar is more varied with some districts about to close for summer 

vacation and others going until the end of June. 

As our understanding of the virus evolves, we will look to the CDC to analyze 

the data and make more definitive recommendations to optimally protect the health 

and safety of our communities. 

We will continue to collaborate with the CDC to ensure that any guidance is 

quickly disseminated to education partners and stakeholders, as we have been doing 

over the last two weeks. We have convened two calls for education stakeholders; the 

first call, held on April 27th, hosted 1700 lines and the second call, held on April 

30, hosted 1300 lines, and we know that there were many more people listening. 

We are collecting daily information on closures of schools, districts, and IHEs, and 

providing this key information to our Federal partners to help them assess the impact of this virus. We have also posted information, including FAQs for school leaders and parents on our website, participated in stakeholders’ outreach efforts, and 

created an internet address for the exchange of information with the field specifically about the flu, flu@ed.gov. 

While we know that the current outbreak of 2009-H1N1 flu will be challenging, 

we believe that we have taken many actions over the past several years that provide 

a strong foundation for our current efforts. In 1995, when we were faced with assisting in the response to the bombing of the Murrah Federal Office Building in Oklahoma City, it became clear that we needed to develop capacity and expertise in 

emergency management. While the Department of Education is probably not the 

first or second organization on a list of Federal agencies with emergency management responsibilities, elementary and secondary schools and IHEs are profoundly 

affected by a broad range of crisis situations, and face a unique set of challenges 

in preparing for and responding to those situations. Over the past several years, we 

have focused our emergency management activities on helping schools and colleges 

and universities meet those challenges. 

Schools and IHEs face the same broad array of potential crisis situations as their 

communities—hurricanes, tornadoes, chemical spills, shootings, terrorist attacks, 

and outbreaks of infectious diseases, to name just a handful. As a result, we encourage schools and IHEs to ground their emergency management efforts in crisis plans 

that address all hazards through the four phases of emergency management planning—prevention-mitigation, preparedness, response, and recovery. This foundation 

should enable schools and IHEs to respond in a comprehensive and appropriate 

way. 

This approach is summarized in ED’s publication ‘‘Practical information Crisis 

Planning Guidance for Schools and Communities.’’ The document, first released in 

2001, was developed in collaboration with Federal, State, and local partners in 

school emergency management, and outlines the four-phase approach. ED recently 

released a similar guide for IHEs in January 2009. 

ED also provides funds to local school districts to support the development of 

emergency management plans for their schools under the Readiness and Emergency 

Management for Schools (REMS) program. The program requires grantees to partner with local first responders, develop all-hazards plans (including planning for an 

infectious disease outbreak), and incorporate the four phases of emergency management into their planning activities. To date, we’ve provided grants to more than 600 

LEAs across the country, totaling more than $175 million. In FY 2008, in conjunction with our colleagues at the HHS’ Substance Abuse and Mental Health Services 

Administration, we provided similar awards to the first cohort of 17 IHE grantees. 

ED also provides training and technical assistance to each of the REMS grantees; 

a basic course covers the four phases of emergency management while a more advanced curriculum addresses more specific emergency management issues that 

schools may face, including pandemic flu. In addition to training grantees, ED has 

provided the basic training course to another 600 school officials from public and 

private schools that are not grant recipients. 

Because we wanted to reach out to a broader range of school officials, we have 

also developed a technical assistance center that develops and implements a variety 
17 

of training and technical assistance activities for school personnel. Over the past 

several years, we have developed and made available more than 40 short publications that highlight a range of key emergency management issues that schools may 

face. 

In addition to these and other activities related to emergency management for 

schools, ED has participated in a broad range of activities that specifically relate 

to an outbreak of pandemic flu, and that form the underpinning for our response 

efforts to the 2009-H1N1 flu. We have worked with Federal and non-Federal partners since 2005 on planning for a potential pandemic. Specifically, we have been 

working to articulate questions about, and identify potential barriers to, implementing and carrying out appropriate community mitigation, consistent with CDC 

guidance on the scope and necessity of such efforts. 

We have worked to create tools and guidance for educators to help State and local 

entities address their unique planning needs, including a pre-packaged pandemic tabletop exercise that was pilot-tested during the summer of 2007 and disseminated 

to our Readiness and Emergency Management for Schools grantees. In response to 

a request for more in-depth information on pandemic planning, we have developed 

and refined an ‘‘advanced training’’ on pandemic, as well as one on planning for infectious diseases in schools in general, which provides practical, hands-on information about planning for these types of situations that schools can use during a typical school year. We have presented information about pandemic planning, including 

considerations related to continuity of education, to a wide range of education audiences, including our grantees, representatives from private and independent schools, 

State and local education officials, and education-related associations. Additionally, 

we have identified examples of pandemic planning that others may use to inform 

their own planning efforts and have posted these examples on our website and on 

the REMS Technical Assistance Center’s website. 

ED was actively involved in the creation of a planning guide for States as part 

of the comprehensive State pandemic planning effort in 2007-2008. This education 

planning guide covers a range of considerations for State education leaders, including the provision of continuity of education, utilization of educational facilities, paying staff, and communicating with local educational agencies, staff, and families. 

During the planning process, we provided technical assistance to States through a 

webcast and a video teleconference. Last summer, States were asked to submit their 

full pandemic plans to the Federal government. In turn, various government agencies reviewed the sections relevant to their entities and rated those sections. Representatives from various offices at ED, in collaboration with experts on school closures from CDC, reviewed the States’ education-sector plans. 

In closing, let me say that we recognize that we have a lot more work ahead of 

us. We are cognizant of the fact that even if the influenza outbreak quickly subsides, it may return at a later time. We are also cognizant of the fact that the 2009- 

H1N1 flu is but one crisis or emergency that schools have to be prepared to deal 

with. We have a very large system of schools and colleges in the U.S. and it is an 

unusual day when emergencies and crises don’t happen. To prepare for these events, 

be they another outbreak of the flu, a hurricane, a school shooting, a student suicide, or an intruder, we need to ensure that every school and every IHE has an 

Emergency Management Plan—also know as a crisis plan—in place. That plan 

should address all types of situations and conditions—‘‘all hazards;’’ address all four 

phases of crisis planning: Prevention/mitigation, Planning, Response, and Recovery; 

be practiced on a regular basis; include an incident command component; and involve the entire community it its development. 

Over the remainder of the fiscal year we intend to take several actions that we 

believe will help schools and IHEs be better prepared to deal with crises and emergencies, including the flu. These actions include: 

• Making approximately 100 REMS awards to school districts and 20 to IHEs. 

These awards, totaling an estimated $31 million will enable the grantees to develop 

or improve their Emergency Management Plans. Those districts and IHEs that have 

not addressed issues related to a pandemic will be able to do so. 

• Outreach activities and technical assistance efforts that focus on ‘‘lessons 

learned’’ in the response to the H1N1 flu outbreak. Hosting training for new REMS 

grantees on emergency management issues. This will include a focus on preparing 

for, responding to, and recovering from an infectious disease outbreak. 

• Sponsoring a National Conference in August 2009 for approximately 1,500 educators. The conference will feature a plenary session and several workshops on the 

2009-H1N1 flu. 

If we are to be successful in ensuring that are schools and student are safe and 

healthy, schools will need to make ‘‘preparedness’’ a priority, and we believe that 
18 

we can provide valuable assistance to schools and IHEs as they work to develop and 

expand their emergency management capacity. 

I have included some additional material for the record that provides more details 

about the resources that we are making available to schools and IHEs. 

I look forward to responding to any questions that you may have. 

[Additional material submitted by Mr. Modzeleski follows:] 

[Pandemic Flu and General Emergency Management Resources, U.S. Department of Education, Office of Safe 

and Drug-Free Schools] 

EMERGENCY MANAGEMENT RESOURCES 

Web Resources 

U.S. Department of Education (ED)’s Emergency Planning Web site 

This Web site offers a ‘‘one stop shop’’ for emergency management information for 

local educational agencies (LEAs) and institutions of higher education (IHEs) available from the U.S. Department of Education. 

• Available at: www.ed.gov/emergencyplan 

Readiness and Emergency Management for Schools (REMS) Technical Assistance 

(TA) Center 

Established in October 2004, the REMS TA Center offers a variety of resources 

including a list of current grantees, emergency management related publications, 

links to relevant emergency management organizations, and an opportunity to submit individual questions for technical assistance support. 

• The TA Center’s Web site is http://rems.ed.gov 

National Clearinghouse for Education Facilities (NCEF) Web site 

The NCEF, funded by ED, provides information on planning, designing, funding, 

building, improving, and maintaining safe, healthy, high performance schools. The 

Web site includes links to campus safety assessment and campus security resources 

for colleges and universities. 

• Accessible at www.edfacilities.org 

Safeguarding America’s Colleges—Web cast 

Aired in October 2008, this Web cast provided an opportunity to talk about 

OSDFS’ Emergency Management for Higher Education grant; talk about rights 

under the Family Educational Rights and Privacy Act; highlight higher education 

institutions that are leading the effort to enhance campus safety; and, provided 

user-friendly tips on ensuring the safety, health and security of students. 

• The archived Web cast is accessible at: 

http://www.connectlive.com/events/ednews/20081021.html. 

Emergency Planning for Students with Disabilities and Special Needs 

Taking place in May 2009, this Webinar focused on emergency management planning for students with disabilities and special needs. In particular, it highlighted 

actions to take before, during, and after an emergency occurs. It also featured a case 

study of the Upper Darby School District. 

• The archived webinar materials are available at: 

http://rems.ed.gov/index.cfm?event=webinars—archives. 

Web casts on Emergency Management for Schools Training 

Four Web casts and accompanying materials look at the four phases of emergency 

management: prevention-mitigation, preparedness, response, and recovery. The Web 

casts were filmed at Emergency Management for Schools training meetings provided 

for school staff and administrators in March 2007. 

• Powerpoints and Web casts available at: 

http://www.connectlive.com/events/depteduphilly0207/ 

School Safety Web cast 

In November 2006, the U.S. Department of Education presented a one-hour Web 

cast to provide parents, educators, school administrators and local safety personnel 

with an opportunity to review key considerations related to school emergency management planning. 

• The archived Web cast is accessible 

www.ConnectLive.com/events/edschoolsafety. Software to view the Web cast is 

available free at that site. 
19 

Training and Technical Assistance 

Basic Emergency Management for Schools Training 

The ‘‘Emergency Management for Schools’’ training provides an opportunity for 

school personnel to receive critical training in emergency management. The training 

focuses on emergency plan development within the framework of the four phases of 

emergency management. • Power points from the last training in 2008 are available online at: 

http://rems.ed.gov/index.cfm?event=trainingsArchived#EMST—SF—CA—08 • Development is currently underway for online interactive modules for this 

training. 

Advanced Emergency Management for Schools Training 

Starting in 2008, OSDFS began to create, in collaboration with school safety experts in the field, a series of ‘‘advanced training’’ power points for school-based 

emergency management. Each PowerPoint is designed to last for 1.5—2 hours of 

training and provides focused attention on a specific area such as: tabletops and 

drills, pandemic planning, continuity of operations, special needs, etc. • The current versions of the power points are available at: http://rems.ed.gov/ 

index.cfm?event=trainingsArchived#FY07FGM—CH—IL—08. 

Publications 

Practical Information on Crisis Planning: A Guide for Schools and Communities 

First published in 2003, the U.S. Department of Education developed ‘‘Practical 

Information on Crisis Planning: A Guide for Schools and Communities’’ to identify 

some of the key principles in developing emergency management plans. This document is based on the four phases of emergency management and is the premier document for emergency planning for schools. • The entire Guide can be downloaded at: 

http://www.ed.gov/admins/lead/safety/emergencyplan/crisisplanning.pdf 

Action Guide for Emergency Management at Institutions of Higher Education 

Released in January 2009, the Action Guide provides a series of suggestions and 

tips for institutions of higher education interested in improving their emergency 

management planning efforts. Created in collaboration with external experts, the 

Action Guide is based on the four phases, all-hazards approach to emergency management. • The entire Action Guide can be downloaded at: 

http://www.ed.gov/admins/lead/safety/emergencyplan/remsactionguide.pdf 

Guide to School Vulnerability Assessments: Key Principles for Safe Schools 

This publication, released in 2008, is a companion guide to the Practical Information on Crisis Planning Guide. It offers general information on establishing vulnerability assessment teams and selecting vulnerability assessment tools. • The guide can be downloaded at: 

http://rems.ed.gov/views/documents/VA—Report—2008.pdf 

Threat Assessment in Schools 

The U.S. Department of Education and the U.S. Secret Service established the 

Safe School Initiative, a study of 37 school shootings and other school-based attacks 

that took place between 1974 and 1999. Through this initiative, the two agencies 

produced guidance and tools for schools putting forth a process for identifying, assessing and managing students who may pose a threat of targeted violence. These 

guides are intended for collaborative use by school personnel, law enforcement officials and others with protective responsibilities in our nation’s schools. Most recently, the initiative has produced an interactive CD-ROM presenting two hypothetical school scenarios to be used for further developing the assessments team’s 

skills. 

• Final Report and Findings: Implications for Prevention of School Attacks in the 

United States. 

• Accessible at: 

http://www.ed.gov/admins/lead/safety/preventingattacksreport.doc 

• Threat Assessment in Schools: A Guide to Managing Threatening Situations 

and to Creating Safe School Climate 

• Accessible at: 

http://www.ed.gov/admins/lead/safety/threatassessmentguide.pdf 

• A Safe School and Threat Assessment Experience: Scenarios Exploring the 

Findings of the Safe School Initiative 
20 

• Accessible through EDPubs at www.edpubs.org/ 

Bomb Threat Response: An Interactive Planning Tool for Schools 

OSDFS and The Bureau of Alcohol, Tobacco, Firearms and Explosives (ATF) collaborated to develop a tool (CD) for schools and law enforcement. The CD offers a 

comprehensive guide on how to best respond to bomb threats in schools. The planning tool offers guidance for schools administrators and law enforcement to develop 

policies specific to the school district and its unique needs. The ‘‘Bomb Threat Response’’ also presents guidelines for how to communicate during the response phase. 

• Accessible at http://www.threatplan.org/ 

Emergency Preparedness Publications produced by the REMS TA Center: 

• REMS Express Newsletters 

• Newsletters provide comprehensive information on key issues in school emergency management. 

• Available online at: http://rems.ed.gov/index.cfm?event=express 

• Lessons Learned 

• The Lessons Learned series offers brief summaries of actual school emergencies 

and the resulting lessons learned by schools. 

• Available online at: http://rems.ed.gov/index.cfm?event=lessons 

• Helpful Hints 

• Helpful Hints offer a ‘‘snapshot’’ overview of school emergency preparedness 

topics. 

• Available online at: http://rems.ed.gov/index.cfm?event=hints 

NIMS Implementation Activities for Schools and Higher Education Institutions 

The National Incident Management System (NIMS) was established March 1, 

2004, following the Homeland Security Presidential Directive-5 (HSPD-5). All local 

educational agencies (LEAs) and institutions of higher education (IHEs) who receive 

federal preparedness funds are required to support the implementation of NIMS. 

• The complete guidance is available at: 

http://rems.ed.gov/views/documents/NIMS—ComprehensiveGuidanceActivities.pdf 

PANDEMIC PREPAREDNESS RESOURCES 

Guidance for Educators for Prolonged School Closures 

The U.S. Department of Education analyzed and reviewed our current authorities 

and possible flexibilities under No Child Left Behind and other relevant legislation. 

These flexibilities are summarized in this guidance, which could allow a great deal 

of flexibility for state and local educational agencies if necessary. 

• The guidance can be found at: 

http://www.ed.gov/admins/lead/safety/emergencyplan/pandemic/guidance/panflu-guidance.pdf. 

Pandemic Flu: A Planning Guide for Educators 

The U.S. Department of Education published this brochure to provide a brief summary of pandemic-related concerns, as well as minimum elements and considerations for planning for the possibility of prolonged school closures. 

• This brochure can be found at: 

http://www.ed.gov/admins/lead/safety/emergencyplan/pandemic/planning-guide/ 

index.html 

Examples of Plans and Planning Efforts 

The U. S. Department of Education gathered information on state and local pandemic planning efforts to help others begin or refine their pandemic influenza plans. 

After examining plans and information from school districts across the country, a 

panel of experts in the field of emergency management identified examples of strong 

planning efforts or useful resources. 

• These samples can be found at: 

http://www.ed.gov/admins/lead/safety/emergencyplan/pandemic/sampleplans/ 

index.html 

REMS Advanced Training on Pandemic 

In August 2008, OSDFS piloted our new training, ‘‘Business Not as Usual: Preparing for Pandemic Influenza.’’ Pandemic planning is a requirement of all REMS 

and EMHE grantees and this PowerPoint provides an advanced look at the history 

and background of infectious diseases, as well as a focused four-phased approach 

schools can use to deal with a potential pandemic outbreak. 

• The current version of this PowerPoint is available in PDF format at: 
21 

http://rems.ed.gov/views/documents/Training—CHIL07— 

PrepPandemicInfluenza.pdf 

Pandemic Influenza Tabletop Exercise 

In August 2007, OSDFS piloted a tabletop exercise at our National Conference. 

This tabletop exercise reviewed the rules, objectives, and scheduling requirements 

for a pandemic influenza tabletop exercise. The materials include participant manuals, facilitator’s manuals, and a PowerPoint and the session provides background information on pandemic influenza as well as scenario briefings. 

• The materials associated with this exercise are available at: 

http://rems.ed.gov/index.cfm?event=PandemicPreparedns4Schools. 

Pandemic Flu.gov 

The U.S. Department of Health and Human Services manages a Web site focused 

on bringing up-to-date government pandemic information to individuals, families, 

schools, businesses and communities across the nation. Presented on the Web site 

is a School District (K-12) Pandemic Influenza Planning Checklist. 

• Accessible at http://www.pandemicflu.gov 

Federal Guidance to Assist States 

During 2007-2008, the Federal government collaborated to create a comprehensive 

planning guidance for states. The Department of Education created guidance for the 

education sector on school closure and student dismissal for childcare, K-12 schools, 

and Institutions of Higher Education. The guidance included considerations for continuity of education, communications, and alternative use of school facilities. This 

guidance can be found in Appendix B.4. 

• The guidance can be accessed at: 

http://www.pandemicflu.gov/news/guidance031108.pdf. 

Webcast Series on Pandemic Influenza: State Pandemic Planning 

On April 30, 2008, the U.S. Departments of Education, Labor, and Agriculture appeared on a webcast to provide guidance to states on planning efforts. Specifically, 

the U.S. Department of Labor focused on the potential impacts of a pandemic on 

the workforce and the U.S. Department of Agriculture discussed approaches to providing food to children who use the school meals program. 

• The webcast can be viewed at: 

http://www.pandemicflu.gov/news/panflu—webinar3.html. 

Assessment of State’s Operational Plans to Combat Pandemic Influenza 

The U.S. Government reviewed and assessed state’s plans, submitted during the 

summer of 2008. The results of this assessment process are posted online, organized 

by focus area. 

• Accessible at: 

http://www.pandemicflu.gov/plan/states/state—assessment.html. 

Additional Web Resources Distributed to ED Grantees in April 2009 to Assist Schools 

and IHEs in Understanding, Planning for, and Responding to, H1N1 

Centers for Disease Control and Prevention 

This site includes the clearinghouse for all H1N1 information. 

• http://www.cdc.gov/swineflu/index.htm 

• Interim CDC Guidance for Nonpharmaceutical Community Mitigation in Response to Human Infections with Swine Influenza (H1N1) Virus: 

http://www.cdc.gov/swineflu/mitigation.htm 

• Update on School (K-12) Dismissal and Childcare Facilities: Interim CDC Guidance in Response to Human Infections with the 2009 Influenza A H1N1 Virus, 

available at: 

http://www.cdc.gov/h1n1flu/K12—dismissal.htm 

• H1N1 Flu (Swine Flu) Infections Alert for Institutions of Higher Education: 

http://www.cdc.gov/h1n1flu/college-alert.htm 

World Health Organization (WHO) 

This world body provides updates on H1N1. 

• http://www.who.int/csr/don/en/ 

Readiness and Emergency Management for Schools (REMS) Technical Assistant Center 

• Pandemic Preparedness: 

http://rems.ed.gov/index.cfm?event=PandemicPreparedns4Schools 
22 

IAEM–USA 

This organization is tracking closures of Higher Education Campuses: 

http://maps.google.com/maps/ms?ie=UTF8&hl=en&msa=0&ll=39.571822,- 

95.625&spn=36.948082,67.851563&z=4&msid=109878326824967605990.000468a80b7ca216e4d3a 

EDUCATIONAL RESOURCES 

Joint Guidance on the Application of the Family Educational Rights and Privacy Act (FERPA) and the Health 

Insurance Portability and Accountability Act of 1996 (HIPAA) to Student Health Records 

In response to the ‘‘Report to the President on Issues Raised by the Virginia Tech 

Tragedy,’’ ED and Health and Human Services issued new guidance that addresses 

the interplay between FERPA and the HIPAA Privacy Rule at elementary and secondary levels, as well as at the postsecondary level. It also addresses certain disclosures that are allowed without consent or authorization under both laws, especially 

those related to health and safety emergency situations. 

• Accessible at: 

http://www.ed.gov/policy/gen/guid/fpco/doc/ferpa-hippa-guidance.pdf. 

Higher Education Center for Alcohol and Other Drug Abuse and Violence Prevention 

The Center’s mission is to assist ED in serving IHEs in developing and implementing policies and programs that will foster students’ academic and social development and promote campus and community safety by preventing the harmful effects of alcohol and other drug use and violence among college students. The Center 

is a primary provider of services in alcohol and other drug abuse and violence prevention in higher education founded upon state-of-the-art knowledge and researchbased strategies. 

• Accessible at http://www.higheredcenter.org/ 

OSDFS National Conference 

OSDFS will be hosting its National Conference August 3-5, 2009, at the Gaylord 

National Resort and Convention Center. The Conference will address issues related 

to emergency management; health, mental health, and physical education; broadbased issues related to alcohol, drug and violence prevention; civic and character 

education; scientifically-based programs; and many other areas concerning drug and 

violence prevention. 

Chairman MILLER. Thank you very much. 

Jack, welcome to the committee. 

STATEMENT OF JACK O’CONNELL, SUPERINTENDENT OF PUBLIC INSTRUCTION, CALIFORNIA DEPARTMENT OF EDUCATION 

Mr. O’CONNELL. Thank you very much, Mr. Chairman. Thank 

you, Mr. Chairman, and Congressman McKeon, and all the members of the committee. A pleasure to be here to address the recent 

outbreaks of the H1N1 flu in California, specifically the impacts 

that it has had on our public education system. 

I am pleased that the Centers for Disease Control has recently 

determined that the automatic school-wide dismissal of all of the 

students at a particular school need not occur with even a one confirmed or highly suspicious case of this virus. Clearly, in California 

local health officials have the ultimate jurisdiction to close our 

school and to dismiss all of our students. 

I am pleased at this new guidance, as more and more information becomes available and better known will allow more of our 

students to remain in school, on task, preparing for their successful 

future. I also appreciate greatly the initial concern for our schoolchildren and our entire staff at Education that led to the recommendations of dismissing all of our students from any campus 

that had a confirmed or even a suspected case of this virus. 
23 

CDC still wants, as you have heard earlier, all of our steps to be 

taken. Those steps—and try to repeat them all the time—to wash 

hands frequently, duration of at least 20 seconds with soap and 

water; if you are going to cough or sneeze, the students have 

taught me, Mr. Chairman, do the Dracula sneeze into your arm, 

slowly into the crux of your elbow; and obviously, as has already 

been stated, if you are sick, stay home, including from school. 

I am continuing to encourage our schools, our school districts, to 

stay in close contact with local public health officials. We need to 

do an even better job of monitoring, as the chairman pointed out, 

the number of cases that we have, the number of illnesses, and we 

need to do a better job of tracking absences that also are directly 

attributable to the flu. 

If I might briefly, Mr. Chairman, I would like to walk through 

the steps that we have taken during the last couple of weeks at the 

California Department of Education with our school community 

and our health community since the outbreak of the H1N1 virus. 

We did stay in very close contact with both state and local departments of health in California, with our schools, our school districts, 

including our charter schools. Within hours of the first alert of the 

H1N1 virus, my department issued a release to every school, every 

school district, about the precautionary steps that students need to 

take in order to make sure that they remain safe. 

We have numerous information available—posters, sample letters—easily downloadable to schools on how to prevent and how to 

secure, through precautionary steps, for our students and our staff 

to remain safe. And again, this is the wash your hands posters, and 

how to sneeze, and if you are sick stay home. 

We have also received some reports from some schools in California, Mr. Chairman, that soap was not available in some restrooms for our students and our staff. Clearly, that is unacceptable. 

We need to have soap or an alcohol-based hand sanitizer available 

at all times to our schools, to our students and our staff. 

We also developed, at the Department of Education, a special 

link on our Web site to keep school districts informed of those cases 

that we knew about, what schools were, in fact, dismissed, and also 

all press releases that were issued by either the educational community or the public health community in this area. And then just 

last Friday, we conducted a statewide conference call where we 

asked and invited each of our over 1,000 school districts to have 

the appropriate person online to talk and to ask questions to Dr. 

Bonnie Sorensen, who is a deputy director for the California Department of Public Health. 

Every school district and almost every county was invited—every 

county was invited. Dr. Sorensen had an opportunity to brief school 

district officials on the latest guidance for potential dismissal of all 

students at their school as it related to the H1N1 virus. Numerous 

questions were asked; schools wanted to know the most recent information and also trends. 

As of Tuesday, just 2 days ago, in California, 37 public schools 

had been ordered shut by local public health officials. To make 

Congressman McKeon’s point, that is 37 out of over 9,000 schools 

in the state of California. 
24 

I believe our schools are much more relieved by the most recent 

guidelines by CDC and also California Public Health. We all understand that this clearly is an evolving process. Guidelines would 

need to change and update for more and more information. I have 

always stressed the importance of the school community to work 

closely with county public health, because they ultimately have 

final say on dismissal of students. 

I also wanted to share with you a major topic of concern for 

school districts. How would these school closures or the increase in 

absences when parents choose to keep their students home fearing 

a potential impact, affect our state standardized tests? This is the 

testing window in California today for our standardized testing as 

well as the California High School Exit Exam. 

We in California are trying to address this on a case-by-case 

basis. We are trying to make the accommodations necessary for the 

schools and school districts, and we are working with our contractors and our vendors. We have also communicated with the federal 

Department of Education regarding this issue on how school closures would be impacted, for example, on participation rates, to 

make sure that we meet both our academic performance index and 

adequate yearly progress rates, and also reporting schedules. 

Some participation rates may, in fact, be affected by parents who 

just simply keep their kids home out of fear. The response from the 

federal department has been very, very helpful. They understand, 

they are very empathetic, and they have committed to work with 

us, and we are most appreciative of that. 

And then lastly, I wanted to make an issue also to—briefly, if I 

may—we need to have better communication between the field and 

our state offices in my department. I believe we do need to establish a system, really protocols, so that we know how many schools, 

how many students have actually been affected. We want to develop easy reporting procedures so that we can make better decisions based upon how many students we are actually talking about. 

And finally, Mr. Chairman, I believe that this issue also highlighted, in my opinion, again, a real need for school nurses, school 

health professionals, at the school site. In California, as I mentioned, over 9,000 schools, 6.3 million students, over 330,000 teachers, but yet we have only 2,844 school nurses. That ratio is 2,227 

students to one school nurse. That is one of the largest ratios in 

the country. 

Given the recent budget reductions in many local school districts, 

many schools have been left without sufficient health care professional personnel. I think perhaps more school nurses could have 

helped us with early detection and even prevention. 

Again, thank you for the opportunity to be here. I greatly appreciate both the Obama administration and this Congress for helping 

us improve our educational delivery system throughout California 

and, indeed, the entire nation. 

Thank you, Mr. Chairman. 

[The statement of Mr. O’Connell follows:] 

Prepared Statement of Jack O’Connell, California State Superintendent of 

Public Instruction 

Thank you Chairman Miller and members for the opportunity to address the recent outbreaks of the H1N1 flu in California, but more specifically in our schools. 
25 

I would like to start by saying that although there are currently 103 confirmed 

cases of H1N1 flu in California, I am pleased that the Centers for Disease Control 

has determined that the level of severity of the H1N1 flu does not warrant automatic school-wide student dismissal even in instances of a confirmed case of the 

virus. While we recognize that local health officials may always determine if it is 

necessary to close a campus due to a public health threat, this new guidance will 

allow our schools to resume their normal operations and keep healthy students in 

class and learning. 

I also appreciate the initial concern for our school children and staff that lead to 

the recommendation of dismissing students from any campus that had a confirmed 

or suspected case of the infection. 

It is important to note that the CDC still recommends that we stringently adhere 

to the procedures we can all use to keep ourselves and our schools healthy: Students 

and staff who are sick should stay home. Everyone should cover their coughs and 

sneezes, and frequently wash their hands with soap and water or use hand sanitizer. 

I also continue to encourage schools and districts to stay in close contact with public health officials for any new information about this flu virus and any potential 

future changes in student dismissal policy. 

I would now like to walk you through the steps the California Department of Education has taken to address the flu outbreak. 

Since the initial flu outbreaks was reported, my department and I have stayed 

in close and regular contact with officials from the California Department of Public 

Health and our local education agencies (LEA’s), including districts, county offices 

of education, and charter schools. 

Within hours of the first alert from the California Department of Public Health 

about the H1N1 virus, my department advised the education community about the 

threat and reminded them about flu prevention information resources that my Department has made available. We also strongly encouraged schools to teach students 

and teachers to take the following measures to guard against the spread of H1N1: • encourage students and staff to stay home if they are sick; • urge individuals to cover their coughs and sneezes with a tissue or by covering 

with their arms; and • advise students and school staff to frequently wash their hands thoroughly with 

soap and water, or an alcohol based hand sanitizer. 

We have received reports that some do not have soap for student use, so I have 

advised local school leaders that they must make sure that soap or alcohol based 

hand sanitizers, are made available for use by students and school staff. 

We have kept schools up to date about the flu outbreak through a special link 

on our Web site, as well as through a series of letters, press releases, and public 

events. And in order to achieve an even higher level of communication, last Friday 

I invited Dr. Bonnie Sorensen, the Deputy Director of the California Department of 

Public Health to join me on a statewide conference call with district and county office of education leaders. The purpose of the call was to brief school officials on the 

latest guidance on student dismissal policies due to H1N1, emphasize the importance of sharing the health protection information, and to respond to questions from 

the field about the situation. 

As you can imagine, our schools have been particularly concerned about keeping 

up to date on the latest guidance from the CDC and the California Department of 

Public Health in respect to student dismissal policies. As of Tuesday of this week, 

37 public schools had been ordered by a local health officer to dismiss students, 

based on the existing guidance at the time. 

Our schools are greatly relieved that this week the Center for Disease Control and 

the California Department of Public Health revised their student dismissal guidance. But, throughout this evolving situation, I have stressed to our education community that we must stay in close touch with our public health community and that 

a public health officer always has the final say as to whether or not students should 

dismiss student from campus. 

Another matter that I addressed during this briefing is testing. 

We received numerous questions from local districts about how the flu outbreak 

and school closures would affect the administration deadlines of two of our statewide student examination: Standardized Testing and Reporting or STAR program 

and the California High School Exit Exam, also known as CAHSEE. 

Given the current circumstances, we are addressing these concerns on a case by 

case basis, and my staff has been communicating with our testing contractors and 

vendors to talk about any necessary accommodations needed for affected schools. 

However, if the school closures were to resume, or be ordered for an extended period 

of time in a future public health emergency this could become a bigger problem. To 
26 

remedy any issues that may arise, I am working with the Schwarzenegger Administration on options to give my office the ability to extend or modify the testing administration and release dates of these exams as needed. 

In addition, my staff has been in touch with the U.S. Department of Education 

regarding the potential need for flexibility on accountability requirements—like participation rates and reporting schedules. I am concerned that participation rates 

have been affected—not by student dismissal policies, but by the ‘‘worried well’’— 

healthy students whose parents kept them home out of fear. 

Generally speaking, I feel very strongly that the communication efforts at the 

state level, between my department and the department of public health, have been 

very good. 

I also believe that the line of communication that is ongoing between the California Department of Education and our local education agencies is very strong, but 

could be improved. For example, we discovered that we did not have a system in 

place to track and report the individual schools that had been ordered to dismiss 

students due to H1N1. My office is working with the County Offices of Education 

to developing an easy-to-use reporting process so that the state could be kept up 

to date about any school impacted by an order to dismiss students. While we hope 

we never need it, this system will save time and provide valuable information to 

the public. 

Another issue that certainly needs addressing in order to improve our response 

to such outbreaks is school nurses. 

At last count, there are approximately 2,844 nurses who serve California’s 6.3 million public school students. That translates to a ratio of 2,227 students to every one 

school nurse, the largest student-to-nurse ratio in the country. This in no way, 

shape or form provides effective healthcare for the increasing numbers of students 

with complex chronic and immediate health needs that require daily care on our 

school campuses. If we had more school nurses on our campuses, perhaps they could 

have played an even greater role in early detection and prevention efforts. 

I feel there is definitely a role for the federal government to play in both of these 

matters not only for California, but for every state. 

I have thus far been encouraged by the Obama Administration’s and Congress’ 

willingness to listen to the concerns facing California’s educational system, and I am 

grateful for the opportunity to address this committee. 

I look forward to more dialogues like today’s. Thank you. 

Chairman MILLER. Thank you. 

Jordan? 

STATEMENT OF JORDAN BARAB, ACTING ASSISTANT SECRETARY, OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION 

Mr. BARAB. Thank you. Chairman Miller, Ranking Member 

McKeon, and members of the committee, thank you for this opportunity to discuss the Occupational Safety and Health Administration’s strategy for the protection of American workers from this 

new strain of influenza A 2009 H1N1. 

During an influenza pandemic, as we all realized, the workplace 

can be a source of transmission, just as in other settings. Fortunately, because OSHA has previously prepared for a possible outbreak or pandemic related to the avian influenza virus, the agency 

is now fully prepared to address the dangers of the 2009 H1N1. 

The full range of OSHA’s training, education, enforcement, technical assistance, and public outreach programs will be used to help 

employers and workers protect themselves at work. Preparation is 

critical. Proper planning will allow employers to better protect their 

employees and reduce the impact of a pandemic on society and the 

economy. 

OSHA has developed guidance to help employers determine the 

most appropriate work practices and precautions to limit the impact of the influenza pandemic. Because pandemic-related health 
27 

and safety risks are greater in certain workplaces, OSHA is focusing its direct efforts on educating employers and employees in the 

high risk exposure categories. 

OSHA uses its occupational risk pyramid for pandemic influenza, 

which is projected on the screen, for both its own determination 

and for employers to determine those workplaces that are at higher 

exposure risk level. The pyramid visually demonstrates that only 

a small portion of workers are at the highest exposure risk level. 

In response to the 2009 H1N1 outbreak, OSHA’s current outreach efforts are primarily focused on high risk and very high risk 

workers—those who have direct contact with infected individuals 

as part of their job responsibilities, such as health care workers 

and first responders. OSHA recognizes the importance of protecting 

health care workers on whom this country relies to identify, treat, 

and care for individuals with the flu. 

Our front line health care workers are the foundation upon 

which our health care system is built. If they are not able to work 

due to illness, or unwilling to work due to fears for their health, 

then individual patients and the country’s entire health care structure will suffer. 

To help health care employees and workers prepare for an influenza pandemic, OSHA has developed a pandemic flu preparedness 

and response guidance for health care workers and employers. This 

publication provides valuable information and tools, which health 

care workers and health care facilities can use to protect their employees. 

If we expect our health care workers to come to work each day 

during a pandemic, then their employers have a responsibility to 

ensure that they have the best protection, including engineering 

controls, administrative controls, appropriate respirators, and other 

personal protective equipment. And I also want to remind you that 

we can’t forget the custodians, security guards, and administrative 

employees and maintenance workers who support these high risk 

workers. While generally not at high risk themselves, if we are to 

expect them to report to work every day to carry out their critical 

functions, they also need to be educated about the virus, their level 

of risk, and in situations where they are at risk, in how they need 

to protect themselves. 

It is our expectation that most of this nation’s hospital and 

health care institutions, where workers are clearly at exposure 

risk, are fully prepared to provide that training, equipment, and 

protection, and if they are not now prepared, that they are working 

hard to finalize plans to ensure that they will soon be ready for an 

outbreak. These plans should include ordering and stockpiling respirators and other personal protective equipment, conducting fit 

testing, medical evaluation, and training for those required to wear 

respirators. OSHA and CDC have distributed extensive information 

on how to protect workers. 

Employers play a key role in protecting employees’ safety and 

health, and OSHA will continue to provide them with the technical 

assistance they need. But OSHA also stands prepared to use its existing authority to aggressively enforce safe work practices to ensure employees receive appropriate protection. 
28 

In appropriate circumstances, OSHA will use the General Duty 

Clause of the Occupation Health Act, which requires that employers follow the practices that public health experts agree are necessary to protect workers’ health. OSHA also has standards addressing housekeeping and personal protective equipment as well 

as a respirator standard that requires a complete respiratory protection program for employees. 

It is the employer’s responsibility to ensure that we have the protection and training that workers need—when to wear a respirator, 

what kind of respirator, how to get the respirator fit tested and 

wear it properly, when to wear gloves, and how to put on and take 

off personal protective equipment. OSHA is also developing additional information for workers and their employers on the pandemic influenza, including fact sheets and quick cards that are appropriate for workers to use. Many of these materials are on our 

Web site, and also on pandemicflu.gov. 

Mr. Chairman, I characterize the situation for the workforce just 

as the president described it for the nation: cause for deep concern 

but not panic. I am very confident in the expertise of OSHA’s medical, scientific, compliance assistance and enforcement personnel. 

OSHA is prepared to answer the threat and will protect the workforce. 

I will keep this committee informed on OSHA’s efforts to protect 

working men and women from the pandemic flu exposure. Thank 

you very much. 

[The statement of Mr. Barab follows:] 

Prepared Statement of Jordan Barab, Acting Assistant Secretary for 

Occupational Safety and Health, U.S. Department of Labor 

Chairman Miller, Ranking Member McKeon, Members of the Committee: Thank 

you for this opportunity to discuss the Occupational Safety and Health Administration’s (OSHA’s) strategy for the protection of American workers from the new strain 

of Influenza A (2009-H1N1) virus. During an influenza pandemic, transmission can 

occur in the workplace just as it takes place in other settings. A pandemic may also 

disrupt many work operations and could conceivably cause major losses to our economy. Fortunately, because of the work OSHA has done in preparing for a possible 

outbreak of a pandemic related to the Avian Influenza (H5N1) virus, the agency is 

fully prepared to address the dangers of the 2009-H1N1 virus. The full range of 

OSHA’s training, education, enforcement, and public outreach programs will be used 

to help employers and workers protect themselves at work. 

Preparation is critical. Proper planning will allow employers in the public and private sectors to better protect their employees and lessen the impact of a pandemic 

on society and the economy. OSHA has developed guidance to help employers determine the most appropriate work practices and precautions to limit the impact of an 

influenza pandemic. Because pandemic-related health and safety risks are greater 

in certain workplaces, OSHA is focusing its direct efforts on educating employers 

and employees in the higher-risk exposure categories. OSHA uses its ‘‘Occupational 

Risk Pyramid for Pandemic Influenza’’ to determine those workplaces that are at 

a higher exposure risk level. The Pyramid visually demonstrates that only a small 

portion of workers are at the highest exposure risk level (see https:// 

www.osha.gov/Publications/OSHA3327pandemic.pdf). 
29 

In response to the 2009-H1N1 outbreak, OSHA’s current outreach efforts are 

aimed at high-risk and very-high risk workers—those who have direct contact with 

infected individuals as part of their job responsibilities—such as health care workers 

and first responders. OSHA recognizes the importance of protecting healthcare 

workers on whom this country will rely to identify, treat and care for individuals 

with the flu. Our frontline healthcare workers are the foundation upon which our 

health care system is built. If they are not able to work due to illness, or unwilling 

to work due to fears for their health, individual patients and the country’s entire 

health care structure will suffer. To help health care employers and workers prepare 

for an influenza pandemic, OSHA has developed ‘‘Pandemic Influenza Preparedness 

and Response Guidance for Healthcare Workers and Employers.’’ The publication is 

available on OSHA’s website, and provides valuable information and tools about 

healthcare facility responsibilities during pandemic alert periods. 

If we are to expect our healthcare workforce to come to work each day during a 

pandemic, then their employers have a responsibility to ensure they have the best 

protection, including appropriate respirators and other personal protective equipment. And let’s not forget the custodians, security guards, administrative employees 

and maintenance workers who support those high-risk workers. While generally not 

at high exposure risk themselves while performing their normal job duties, if we are 

to expect them to come to work each day to carry out critical functions, they must 

be educated about the virus, their level of risk, what situations increase their risk 

and how to protect themselves. 

OSHA is developing guidance to employers, including in the health care industry, 

on how to determine the need to stockpile respirators and facemasks. The proposed 

guidance is publicly available on OSHA’s website. Once finalized, this guidance will 

be added as an appendix to OSHA’s existing guidance to employers on how to prepare for a pandemic. It is our expectation that most of this nation’s hospitals and 

healthcare institutions, where workers are clearly at exposure risk, are fully prepared to provide that training, equipment and protection. And if they are not now 

prepared, that they are working hard to prepare and finalize plans to ensure that 

they are ready for an outbreak in their area or for a severe pandemic. These plans 

should include ordering and stockpiling respirators and other personal protective 

equipment, conducting fit testing, medical evaluation and training workers. 
30 

Employers play a key role in protecting employees’ safety and health and OSHA 

will continue to provide them with technical assistance, guidance and other information about steps to be taken to protect their workforces. 

OSHA stands prepared to use its existing authority to aggressively enforce safe 

work practices to ensure employees receive appropriate protection. Although OSHA 

has no specific standard on influenza exposure, in appropriate circumstances the 

agency will use the ‘‘General Duty Clause’’ of the Occupational Safety and Health 

Act, which requires employers to provide employment free from recognized hazards, 

to ensure that employers follow the practices that public health experts agree are 

necessary to protect workers’ health. OSHA and the Centers for Disease Control and 

Prevention (CDC) have distributed extensive information about how to protect workers from influenza exposure in the workplace. 

OSHA also has standards addressing personal protective equipment, as well as 

a respirator standard that requires a complete respiratory protection program including training, medical evaluation and fit testing when respirators are needed to 

protect workers’ health. It is the employer’s responsibility to ensure these workers 

have the protection and training they need: when to wear a respirator, what kind 

of respirator, how to get the respirator fit-tested and wear it properly; when to wear 

gloves; and how to put on and take off personal protective equipment. 

OSHA has been addressing the issue of an influenza pandemic in the workplace 

for a number of years. The agency first issued guidelines on this hazard in March 

2004. The guidelines were updated and expanded in February 2007 in a document 

entitled, Guidance on Preparing Workplaces for an Influenza Pandemic. This publication, issued jointly by DOL and the Department of Health and Human Services, 

is an excellent source of information for employers on how to prepare for a pandemic 

and to select appropriate administrative, work practice, and engineering controls 

and the personal protective equipment to reduce the impact a pandemic could have 

on business operations, employees, customers and the general public. 

In addition, based on our existing guidance and the current virus, OSHA is developing numerous sources of information for workers and their employers on pandemic influenza. They include Fact Sheets and Quick Cards written in both English 

and Spanish. The agency’s website (www.osha.gov) contains comprehensive information on dealing with a pandemic, including frequently asked questions for 

healthcare workers and copies of OSHA’s guidance documents. OSHA plans to post 

answers on this site to common incoming questions about 2009-H1N1 from workers 

and employers. The agency’s webpage not only contains helpful information but also 

is linked to the Federal website at www.pandemicflu.gov. That site has up-to-themoment information on the status of the 2009-H1N1 outbreak and advises people 

of measures they can take to minimize the risk of their own exposure and how best 

to avoid exposing others. 

If the 2009-H1N1 outbreak becomes severe, OSHA will be fully integrated in public communication efforts. We will distribute news releases and public service announcements to media outlets, employers, trade associations, and unions, directing 

the viewer to OSHA’s more detailed on-line resources. 

OSHA’s consultation program, with offices located throughout the nation that provide assistance to small businesses, is also part of the pandemic flu response. The 

state consultants are knowledgeable about the mix of workplaces and industries in 

their states and can determine which worksites most need to be informed. Consultants will deliver advice and information both to individual worksites and government or business headquarters. OSHA can provide similar assistance to federal government agencies by having OSHA compliance safety and health officers fulfill requests for technical assistance. 

Particularly since September 11, 2001, the ensuing anthrax attacks and Hurricane Katrina, as well as throughout the extensive pandemic planning, OSHA has 

worked closely with other agencies involved in emergency response such as the Department of Homeland Security, the Environmental Protection Agency, the Department of Agriculture, and HHS, including the National Institute for Occupational 

Safety and Health (NIOSH) and the CDC. The Department of Labor has representatives participating daily in interagency conference calls and working groups related 

to pandemic preparedness and updates on and the coordinated response to the 2009- 

H1N1 flu. OSHA, working closely with CDC and NIOSH, has taken the lead role 

in establishing worker protection protocols for pandemic flu and providing advice 

and assistance to other government agencies. 

OSHA recognizes it plays an essential role in protecting critical emergency responders and workers in such professions as health care, border security, and transportation—as well as the general workforce. Based on OSHA efforts since the World 

Trade Center tragedy, response organizations have been coming to OSHA for technical assistance. Through planning and preparedness practice, OSHA has worked 
31 

closely with state and local public health agencies to deal with emerging health hazards. I am confident that the numerous exercises we have carried out in emergency 

planning at both the federal and local levels in the past eight years will pay off in 

our ability to work together in combating this threat to the workplace. 

Mr. Chairman, in addressing an influenza pandemic that threatens the workplaces of this nation, we are confronting an unprecedented hazard. In OSHA’s 38- 

year history, America has never experienced a flu pandemic. However, I would characterize this situation for the workforce just as the President has described it for 

the nation: ‘‘Cause for deep concern, but not panic.’’ I am very confident in the expertise of OSHA’s medical, scientific, compliance assistance and enforcement personnel. OSHA is prepared to address this threat and we will protect our workforce. 

I will keep you informed about OSHA efforts to protect America’s working men and 

women from pandemic flu exposure. 

Chairman MILLER. Thank you. 

Mr. Garcia? 

STATEMENT OF MIGUEL GARCIA, REGISTERED NURSE AND 

MEMBER, AMERICAN FEDERATION OF STATE, COUNTY AND 

MUNICIPAL EMPLOYEES 

Mr. GARCIA. Hi. My name is Miguel Garcia. I am a registered 

nurse. And Chairman Miller and other members of the committee, 

thank you very much for asking me to come and testify. 

Because I work in the emergency department at Kaiser 

Permanente Los Angeles Medical Center, I am on the front line of 

fighting this current outbreak of the 2009 H1N1 influenza. I am 

testifying on behalf of UNAC-UHCP, who is a part of AFSCME, 

which represents 1.6 million members, including 360,000 health 

care workers. In order for nurses to be able to treat and protect patients, we must be protected first. 

My employer, Kaiser, has taken a positive collaborative approach 

towards flu preparedness through a strong labor-management partnership. Kaiser is taking an organization approach to how we care 

for members, our patients, and our staffs. 

In many respects, my employer is the example of preparedness. 

However, many of the employers have not taken the necessary 

steps to prepare and protect health care workers from a flu pandemic or the current outbreak of the H1N1 flu infection. 

A recent survey conducted by my union and other labor unions 

representing health care workers found that more than one-third 

of the respondents believe that their workplace is not ready or only 

slightly ready to address the health and the safety needs necessary 

to protect health care workers during this influenza crisis. This 

survey also found that given this lack of readiness, 43 percent of 

the respondents believe that most or some of their coworkers would 

stay at home. 

Importantly, Kaiser does provide me an annual fit test for the 

N95. An N95 respirator is different than a surgical mask. The surgical masks are designed to prevent the person wearing the mask 

from contaminating the external environment with fluid and air 

droplets when a person coughs, sneezes, or talks. 

Surgical masks aren’t designed to have a tight seal on your face. 

They leak around the mask while you inhale. Surgical masks do 

not protect you from breathing viral particles that are suspended 

in small droplets. 
32 

Respirators, on the other hand, are specifically designed to protect the person wearing the respirator from inhaling into their 

lungs viral particles that are suspended in the air. Respirators, unlike surgical masks, seal tightly around the face and prevent leakage of air inside the respirator that could then be inhaled into the 

lungs. 

Currently, there is no comprehensive federal standard that requires employers to protect health care workers from airborne hazards like the H1N1 or tuberculosis. There are OSHA and CDC 

guidelines, but to date these guidelines have only been voluntary. 

Patients who have the H1N1 flu are likely to go to the emergency room. To treat and to care for these patients, health care 

workers and first responders must be protected. We need more 

than guidelines from OSHA in order to make sure that all employers provide consistent protections to health care workers during 

this flu pandemic. We need to have clear rules for all health care 

employers to follow. 

We do not know with certainty the path that the 2009 H1N1 influenza virus will take, but we do know that it is a recognized hazard. OSHA should use existing standards covering respiratory protection and personal protective equipment and use its authority to 

enforce those standards in heath care settings where workers may 

be exposed to the flu virus. 

OSHA has authority to make its current pandemic influenza 

guidance for health care workers and health care employers mandatory. Taking such a step quickly would send a clear signal to the 

public and health care workers that the government is proactive in 

protecting the workers who are needed to care for the sick in our 

communities. Protecting these workers will preserve our surge capacity to treat the infected. 

In addition, we need OSHA to move quickly—to move as quickly 

as possible to develop and issue a mandatory comprehensive standard to protect health care workers from airborne infectious diseases 

similar to the existing comprehensive standard on bloodborne diseases. 

Thank you for listening, and I invite your questions. 

[The statement of Mr. Garcia follows:] 

Prepared Statement of Miguel Antonio Garcia, R.N., BSN, for the American 

Federation of State, County and Municipal Employees 

My name is Miguel Garcia and I am a registered nurse. I want to thank Chairman Miller and members of the Committee for inviting me to testify today. Because 

I work in the Emergency Department at the Kaiser Permanente Los Angeles Medical Center, I am on the frontline of fighting the current outbreak of 2009 H1N1 

influenza, which has been called ‘‘swine flu’’. I am testifying on behalf of my union, 

the American Federation of State, County and Municipal Employees, which represents 1.6 million members, including 360,000 health care workers. 

In order for nurses to be able to treat and protect our patients, we must be protected first. 

My employer, Kaiser, has taken a positive, collaborative approach towards flu preparedness through a strong labor-management partnership. Kaiser is taking an organizational and systemic approach to how we care for our members and workers. 

For example, at the national level, Kaiser has engaged its union partners to closely 

monitor the evolving flu situation and its impact on patient and worker needs, rapidly adapt guidance from the Centers for Disease Control and Prevention (CDC), 

monitor respiratory protection programs and implement an aggressive program of 

worker and member hand washing—which is vital to reducing flu infection and progression. Stocks of supplies necessary to protect workers from exposure to this air-
33 

borne virus are being inventoried daily at all levels and their use is closely checked 

and tracked. It is my understanding that my union, in partnership with Kaiser, is 

establishing a rapid communication system to keep workers up-to-date on current 

events. 

In addition to these vigilant and positive efforts to prepare our staff to deliver 

high quality and safe care, my medical center has advanced technological and engineering features that make us better prepared. My medical center has several negative pressure isolation rooms which are designed to reduce the spread of airborne 

diseases. 

Kaiser has also implemented a respiratory protection program for health care 

workers with potential exposure to airborne infectious agents. As part of that program, my employer provides me with an annual fit-test for an N95 respirator. 

An N95 respirator is different than a surgical mask. Surgical masks are designed 

to prevent the wearer from contaminating the external environment around them 

with fluids and droplets that the wearer releases when coughing, sneezing or talking. Surgical masks have specific levels of protection from penetration of blood and 

body fluids—not from airborne particles. Surgical masks are not designed to provide 

a tight seal on the wearer’s face and they leak air around the seal whenever the 

wearer inhales. Surgical masks do not protect the wearer from breathing in virus 

particles that are suspended in small droplets in the air. 

Respirators, on the other hand, are specifically designed to protect the wearer 

from inhaling into their lungs the virus particles that are suspended in the air. Respirators, unlike surgical masks, seal tightly on the wearer’s face to prevent leakage 

of air inside the respirator that could then be inhaled by the wearer into their lungs. 

In many respects my employer is the exemplar in preparedness. However, many 

health care employers have not taken the necessary steps to prepare and protect 

health care workers from a flu pandemic or the current outbreak of the H1N1 flu 

infection. 

A recent survey conducted by my union and other labor unions representing 

health care workers found that more than one-third of respondents believe their 

workplace is either not ready or only slightly ready to address the health and safety 

needs necessary to protect health care workers during an influenza pandemic. The 

survey also found that, given this lack of readiness, 43 percent of respondents believe that most or some of their fellow workers will stay home. 

Currently there is no comprehensive federal standard to require employers to protect health care workers from an airborne virus like H1N1 or tuberculosis. There 

are OSHA and CDC guidelines, but to date these guidelines have only been voluntary. 

Patients who have the H1N1 virus are likely to visit their local hospital’s emergency room. To treat and care for these patients, health care workers and first responders need to be protected. Without clear mandatory rules, even the best employer may experience gaps in protecting its workers. 

In order to make sure that all employers provide consistent protections to health 

care workers during a flu pandemic, we need more than guidelines from OSHA. We 

need to have clear rules of the road for all health care employers to follow. Now 

is the time to ensure preparedness and protections by establishing clear requirements that are put in place immediately. 

We do not know with certainty the path the 2009 H1N1 virus will take, but we 

know it is a recognized hazard. OSHA should use its existing standards covering 

respiratory protection and personal protective equipment and use its authority to 

enforce those standards in health care settings where workers may be exposed to 

this flu virus. 

OSHA has authority to make its current ‘‘Pandemic Influenza Guidance for 

Healthcare Workers and Healthcare Employers’’ mandatory for health care facilities 

under its general duty clause. Taking such a step quickly would send a clear signal 

to the public and health care workers that the government is proactive in protecting 

the workers who are needed to care for the sick in our communities. Protecting 

these workers will preserve our surge capacity to treat the infected. 

In addition, we need OSHA to move as quickly as possible to develop and issue 

a mandatory comprehensive standard to protect health care workers from airborne 

infectious diseases, similar to the existing comprehensive standard on bloodborne 

diseases. 

Thank you for listening. I welcome your questions. 

Chairman MILLER. Thank you. 

Ms. Brockhaus? 
34 

STATEMENT OF ANN BROCKHAUS, OCCUPATIONAL SAFETY 

AND HEALTH CONSULTANT, ORC WORLDWIDE 

Ms. BROCKHAUS. Good morning. On behalf of ORC Worldwide I 

would like to thank the committee for this opportunity to discuss 

some of the steps businesses are taking to ensure that workers are 

protected from the H1N1 virus. 

Over the past few days there appears to be a growing consensus 

among the experts that this new virus is, at least for now, a less 

serious threat than originally feared 13 days ago, although, as has 

been mentioned, this is no time for complacency. But the story 

could have been very different, and there are a number of important lessons that can be learned from our observations of the actions taken by businesses as the situation rapidly evolved. 

The first lesson we would like to highlight is that advanced planning counts. ORC Worldwide conducted teleconferences on April 

28th and May 5th for our networks membership of several hundred 

multinational companies from diverse industry sectors to share 

critical information on strategies for responding to the H1N1 outbreak. 

Additionally, on May 1st, ORC sent a survey questionnaire to the 

health, safety, and human resources function of more than 600 

ORC client companies regarding aspects of their company’s preparedness and response activities. We have learned useful information from these teleconferences and from the 89 companies that 

have responded to our survey. 

First, an overwhelming majority of those responding to the survey have a business continuity plan, or pandemic preparedness 

plan, in place to respond to global outbreaks of flu or a full-blown 

flu pandemic. Over 60 percent of the companies responding implemented changes to business travel practices as a result of the outbreak. 

Communication to employees in the form of health briefings and 

dissemination of contact numbers for medical advice is reported by 

the majority of respondents. Almost half of those responding had 

instituted policies requiring that employees returning from areas 

with confirmed cases of H1N1 stay at home for a period of time before returning to work. 

We learned that existing plans were often geared to worst case 

scenarios, and plans had to be adjusted as new information about 

the severity and scope of the H1N1 outbreak became available. Additionally, communication and coordination across functions has 

been a challenge in some companies. Preparedness planning must 

include regular communication across critical functions, such as 

health and safety, human resources, security, legal, and others, 

and must be established well before a crisis occurs. 

Companies tell us that planning initiated in response to the 

threats of SARS and avian flu, and refined over time, has proven 

to be practical and useful in the situation we find ourselves in 

today. Effective plans contain feedback loops allowing for evaluation of their effectiveness and midcourse corrections. Plans must be 

scalable, flexible, and adaptable to rapidly changing conditions. 

Lesson two is that timely and consistent government information 

and guidance is critical to effective response. Clear and timely government information at the federal, state, and local level has prov-
35 

en to be critical to company efforts to respond effectively to this 

outbreak. Frequently updated information and guidance from the 

CDC has been invaluable. 

Preparedness planning activities related to avian flu and bioterrorism by state and county and local health departments in California provide the particularly compelling example of how publicprivate partnerships and outreach to the business community have 

helped inform the business response to the current public health 

emergency. OSHA’s outreach to the business community this week 

was also very welcome. Particularly heartening is the commitment 

by OSHA, NIOSH, and the CDC explicitly expressed, and other 

agencies, to coordinate their response activities and eliminate any 

inconsistencies in messages. 

On the ground coordination is necessary in many more jurisdictions. This is a two-way street, in our opinion, and both business 

and government entities at all levels need to look for new ways to 

effectively connect and collaborate on public health preparedness 

issues. 

Efforts to use novel ways to deliver critical public health information to a vast and diverse audience must continue. CDC’s use 

of Twitter is a great example of this. 

And lesson three: Making pandemic flu planning part of an overall safety and health management system optimizes protection of 

workers and helps to ensure business continuity. A basic foundation for effective worker protection is the establishment of a comprehensive system for managing safety and health performance, focusing on elimination of injuries and illnesses through a continuous 

process of identifying, assessing, and reducing risks. 

Companies with such systems in place and with the active engagement of senior leadership are in the best position to effectively 

engage in preparedness planning, keep plans up to date, and take 

decisive action in response to public health emergencies such as the 

current H1N1 outbreak. 

ORC looks forward to working with the committee as it continues 

to evaluate the key components of effective programs and policies 

to ensure worker protection, and I would be happy to answer any 

questions that the committee might like to pose. 

[The statement of Ms. Brockhaus follows:] 

Prepared Statement of Ann Brockhaus, MPH, Senior Occupational Safety 

and Health Consultant, ORC Worldwide 

The Washington, DC office of ORC Worldwide has provided specialized occupational safety and health services to businesses for more than 35 years. On behalf 

of ORC Worldwide, I would like to thank the Committee for this opportunity to discuss some of the steps businesses are taking to ensure that workers are protected 

from emerging infectious diseases, such as H1N1. 

Over the past few days, there appears to be a growing consensus among the experts that the novel Influenza A (H1N1) virus is proving to be, at least for now, 

a less serious threat than originally feared 13 days ago. But the story could have 

been very different and there are a number of important lessons that can be learned 

from our observations of the actions taken by businesses as the situation rapidly 

evolved. 

Lesson #1: Advance Planning Counts! 

ORC Worldwide conducted two teleconferences for our Networks membership of 

several hundred multinational companies from diverse industry sectors to share 

critical information on strategies for responding to the H1N1 outbreak. On April 28, 

over 300 individuals participated in the call. On May 5, more than 120 participated. 
36 

In addition, on May 1, ORC fielded a survey to the health, safety and human resources functions of more than 600 ORC client companies, regarding aspects of their 

company’s preparedness and response activities. Based on information from the 89 

companies that have responded so far, it has been apparent that businesses have 

been diligent and thorough in their consideration of the appropriate response. We 

are also pleased to see responses that are thoughtful, measured and without overreaction. We believe we are seeing the benefit of responsible planning, much of 

which was initiated in response to the threats of SARS and avian flu, but most importantly, planning that has been maintained and proven to be practical and useful 

in the situation we find ourselves in today. 

While our survey is still in progress, we would like to provide some preliminary 

information about what we can conclude from responses received to date: 

• An overwhelming majority of the responders have a business continuity plan or 

pandemic preparedness plan in place to respond to global outbreaks of flu or a fullblown flu pandemic. 

• Over 60% of the companies responding implemented changes to business travel 

practices as a result of the outbreak. These changes primarily involved banning all 

non-essential travel to affected areas, requiring higher-level approval for travel to 

various locations, and specific restrictions related to travel to Mexico. Another 12- 

14% already had restrictions in place due to current economic conditions. A minority 

of respondents have taken no action at all, with most of these continuing to closely 

the situation closely. 

• Communication in the form of health briefings and contact numbers for medical 

advice when traveling is reported by the majority of respondents. 

• Almost half of those responding had at one point instituted policies requiring 

that employees returning from areas with confirmed cases of H1N1 to stay at home 

for a period of time before returning to work. 

I realize this is a small snapshot of information, but until the survey is complete, 

it is difficult to provide much more detail. We will provide the Committee with the 

full survey report when it is finalized. 

Recommendations: 

• Although we believe that large businesses are taking significant steps to prepare for a flu pandemic, it is likely that small and medium-sized businesses will 

need additional messages about the need for planning and assistance tools that are 

clear and easy to use. 

• Our members report that existing plans were geared to ‘‘worst case scenarios’’ 

and that plans had to be adjusted as new information about the severity and scope 

of the H1N1 outbreak became available. Plans must be scalable, flexible, and adaptable to rapidly changing conditions. 

• Our members report that internal communication and coordination has often 

been a challenge. Companies need to ensure that preparedness plans provide for effective communication among critical functions such as health and safety, human 

resources, security, legal and others. 

Lesson #2: Timely and Consistent Government Information and Guidance is Critical 

to Effective Response! 

The timeliness of the government messaging about the outbreak—at the federal, 

state and local level—has proven to be critical to company efforts to respond effectively to the outbreak. The frequent, clear messages from the CDC have been invaluable. In addition, preparedness planning activities related to avian flu and bioterrorism by state and county/local health departments in California, provide a particularly compelling example of how public/private partnerships and outreach to the 

business community have helped inform the business response. Important groundwork has been laid over the past few years educating businesses about the public 

health system and government response plans, and making connections between key 

contacts. Again, the experience in California is instructive: there have been a number of cross-sector pandemic planning events and exercises that have included business representatives. There have also been efforts at the county level to encourage 

business participation in the CDC’s Cities Readiness Initiative, involving the mass 

dispensing of critical medications from the Strategic National Stockpile. The H1N1 

outbreak has proven the value of this preparation. 

OSHA’s outreach to the business community this week was also welcome. Particularly heartening is the commitment by OSHA, NIOSH, the CDC and other agencies 

to coordinate their response activities and eliminate inconsistencies in messages. 

Recommendations: 

• ‘‘On the ground’’ coordination is necessary in many more jurisdictions. This is 

a two-way street and both business and government entities at all levels need to 
37 

look for new ways to effectively connect and collaborate on public health preparedness issues. 

• The on-going effort to use novel ways to deliver critical public health information to a vast and diverse audience must continue. CDC’s use of Twitter is a great 

example of this. 

• Efforts to ensure consistency of content and timing of public health messages 

must continue. 

Lesson #3: Making Pandemic Flu Planning Part of an Overall Safety and Health 

Management System Optimizes Protection of Workers and Helps to Ensure Business Continuity! 

It is well-established that a basic foundation for effective worker protection is the 

establishment of a comprehensive safety and health management system which focuses on elimination of injuries and illnesses through a continuous process of identifying, assessing and reducing risks. Companies with such systems in place and with 

the active engagement of senior leadership, have been able to sustain the effort necessary to mobilize action in response to public health emergencies such as the current H1N1 outbreak. 

ORC looks forward to working with the Committee as it continues to evaluate the 

key components of effective programs and policies to ensure workplace preparedness 

for public health emergencies such as the H1N1 outbreak. 

Chairman MILLER. If I might, if you would just take 30 seconds 

to explain ORC. 

Ms. BROCKHAUS. ORC Worldwide is a human resources and 

health and safety consulting firm. For more than 35 years, our 

Washington, D.C. office has focused on occupational safety and 

health consulting. And I am with the ORC D.C. office. 

Chairman MILLER. So this is one of the service provided by ORC 

to its clients, to its members? 

Ms. BROCKHAUS. ORC advises its clients on best practices in 

worker protection, and also helps our clients share information 

with each other so that in diverse industry sectors there can be a 

sharing of information about what works best in terms of worker 

protection. 

Chairman MILLER. Okay. Thank you. Thank you. 

Well, thank you all very much for your testimony, and I think 

your testimony helped put a lot of this into context. I think when 

we look at it in the communities that we represent you see a lot 

of conflicts. 

Do you send the kids home, or you don’t send the kids home. If 

you send the kids home is there anybody home to take care of 

them? If workers leave can the business keep running? Or do you 

want sick people at work? I mean, this isn’t a clear-cut decision on 

anybody’s part, because there is these conflicts about how you handle it. 

Do you want workers to come in if they are sick or do you want 

them to stay home? Do I want to go in if I am not sick, if other 

people are sick? I need information about my environments, I 

guess, is what I am saying, and people are sort of pushed in the 

position of thinking, ‘‘What is the safer environment for me or my 

children, my employees, what have you? What do I know about 

staying home, being in a community, being at work, being at school 

that is helpful to me?’’ 

Jack, you mentioned you thought there was some gap in—or you 

needed better communications between the state and the districts. 

Is that what you were suggesting? 
38 

Mr. O’CONNELL. It is, Mr. Chairman. And I think so that we can 

share the information that we have. And I would also say the 

media has a role to play, and in my opinion, an obligation and a 

responsibility to let people know, for example, the severity of this 

particular strain. And that is why in my comments earlier, in 

terms of, ‘‘We are pleased with this most recent decision,’’ that 

sends a signal that this strain has not been considered as serious 

as that in central Mexico that has led to so many illnesses and so 

many regrettable deaths, yes. 

Chairman MILLER. I see. 

Jordan, on your pyramid you talked about those who were at the 

top, and high risk and very high risk workers, and how do you and 

when do you put those workers into that category when you go 

through an episode like this? At the beginning, you have an influenza, you don’t know a lot about it. Do you immediately decide socalled first responders in hospitals, doctors’ offices, public health 

clinics, that they are immediately put into this category, in terms 

of being watched and providing information, or as it becomes—does 

that happen later when you know more about the influenza? How 

is that coordinated? 

Mr. BARAB. First of all, we take our lead, in terms of the seriousness of the virus and the nature of the virus, from the CDC. We 

are very involved in a number of different committees and daily— 

more than daily—phone calls, and we keep very close track to how 

the virus is progressing. 

But in general, our advice to the high risk and the very high risk 

workers are pretty consistent: If you are in contact with a person 

who is infected—confirmed to be infected or suspected to be infected—you should take all the precautions that we recommend. 

And again, the engineering controls, the administrative controls, 

but also the respirators and the respirator—— 

Chairman MILLER. Is that a phased in consideration as you start 

to get more information? I mean, would you make a decision that 

health care workers in the point of contact should start protecting 

themselves, or should their, you know—which could be washing 

your hands, but it could also be making a decision that you better 

be wearing a respirator. How is that information transmitted? 

Dr. SCHUCHAT. Based on what we know about seasonal influenza 

and about respiratory viruses, health care workers were considered 

a high risk group, in terms of very close contact with people who 

were actively ill. 

Chairman MILLER. That is a general understanding—— 

Dr. SCHUCHAT. For this particular infectious disease that would 

be. The other thing to say is that in any epidemiologic investigation, a very early question is, who is at higher risk? Which are the 

groups that are seeing the illness disproportionately? 

So one of the reasons CDC has people either working with state 

and local health departments in a number of affected areas, and 

people on the ground in Mexico, is to rapidly learn as much as we 

can about what is going on. Conflicting reports from different 

places, but trying to recognize quickly who will be at risk. This outbreak that we are seeing here, younger people have been more at 

risk than in seasonal influenza, so that was an early focus. 
39 

Chairman MILLER. And I assume that is not confined just to 

health care workers. Teachers could find themselves in that category if you found evidence that justified that—people in a place 

of employment, certain types of employment, perhaps, could find 

themselves at high risk? 

Dr. SCHUCHAT. Absolutely. 

Chairman MILLER. Okay. 

Dr. SCHUCHAT. We will be looking at the epidemiologic information and trying to adapt rapidly to it. 

Chairman MILLER. You mentioned, Ms. Brockhaus, that a significant number of your clients have business continuity plans, and 

that is done for all different kinds of eruptions, or interruptions—— 

Ms. BROCKHAUS. Absolutely. And we are talking about large companies, mostly multinational companies that have learned over 

time that in order to ensure that in the event of a natural disaster, 

or all of the things that you can imagine that could interfere with 

a company being able to do its business, that they have plans in 

place that anticipate ahead of time what might happen and what 

the company will do in response. And for many companies, pandemic preparedness is now a component of an overall business continuity plan that would be in place to respond to all sorts of potential interruptions of business. 

Chairman MILLER. Thank you. 

Mr. McKeon? 

Mr. MCKEON. Thank you, Mr. Chairman. 

Doctor, you mentioned seasonal flu. So we have seasonal flus 

every year. Do you know how many deaths we have annually from 

seasonal flu? 

Dr. SCHUCHAT. Right. Seasonal influenza kills an estimated 

36,000 Americans each year; there are 200,000 hospitalizations and 

millions and millions of infections. 

What is different about this particular outbreak is we have a 

completely new influenza virus that we don’t expect there is large 

population protection against. With seasonal influenza, a good proportion of the population is naturally protected by years of experience with these viruses, and many more are protected through the 

vaccination efforts we make, with more than 100 million people 

getting vaccinated each year. So with a new influenza virus, a big 

fear is that if it has a certain amount of severity, you have the 

whole population at risk, and you could get much greater—even a 

greater burden than that 36,000 deaths a year. 

Mr. MCKEON. So that was what we were afraid of? 

Dr. SCHUCHAT. Well, I think that we had—at the beginning of 

this we had a completely new virus, we had reports from Mexico 

of severe disease in healthy young adults, and we had information 

about things moving quickly. We acted aggressively and actively to 

try to take steps to decrease the risk of illness and death and slow 

the spread. 

The idea of slowing the spread is to stretch things out so that 

the heath care system won’t get overwhelmed and to buy time for 

production of the vaccine, should that be necessary. So that was 

the original strategy. 
40 

Mr. MCKEON. The seasonal flu that kills 36,000 people every 

year is the same year after year, and this one is a new one? 

Dr. SCHUCHAT. Well, the seasonal influenza viruses shift a little 

bit. They are just a little bit different each year and we make up 

a new vaccine each year because of that change. 

But with a totally new virus you have what is called a pandemic 

potential. You can get much more disease. 

Mr. MCKEON. What does pandemic mean? 

Dr. SCHUCHAT. A pandemic of influenza is defined by a strain 

that is able to cause severe disease in people, that it is totally new 

and you don’t expect population protection, and that it is easily or 

efficiently transmitted in a sustained way. The H5N1 bird flu 

strain that we have been seeing—that was a totally new strain 

that there wasn’t population immunity to, caused very severe disease, but it hasn’t yet been able to cause this efficient transmission. 

What we saw with this H1N1 strain was a virus that was apparently being very easily spread, just like seasonal flu is easily 

spread, and the uncertainty that we have had, and continue to 

some extent to have, is just how severe it will become, or whether 

it will mutate and become even more severe than it is so far. So 

that is why the World Health Organization has really been on this 

high alert, and why the public health community has been acting 

so aggressively. 

Mr. MCKEON. I had an uncle that died as a baby during the flu 

of 1918. That was a worldwide pandemic that killed how many people? 

Dr. SCHUCHAT. Here in the U.S. we think it was half a million 

people, and up to 50 million worldwide. It was just a massive, massive problem. And that is really what we often, in our planning, 

talk about as the worst case scenario. It is a big focus of an early 

response, such as we have been having, to characterize the severity 

of the strain and understand what is going on. 

A cautionary note is that with the 1918 pandemic strain, it 

caused illness in the first spring of 1918 that was moderate, but 

it came back in the fall in a much worse form. And so either they 

didn’t have antiviral drugs then or couldn’t make a vaccine, and 

health care wasn’t what it is now, but it wasn’t over just in the 

spring. There was really a second wave that was more deadly than 

the first. 

Mr. MCKEON. One of the concerns that I had when I first heard 

about his a couple weeks ago: It was everywhere in the media, and 

it was—I was worried that it was scaring people inordinately, and 

yet all they said to do was wash your hands, and unless you really 

need to go to Mexico, don’t go. 

I mean, it sounded like in one was it was overkill and in another 

way it was, ‘‘Well, you know, it is not that serious,’’ and I guess 

that is a fine line. I think what you were doing and the other 

things we heard from the committee were very important. 

I am wondering if the media, as they tend to do, goes a little 

overboard and some people were scared, which is maybe why some 

schools were closed, some businesses maybe had overly-concerned. 

I guess this is a fine line that you have to deal with on every disease, but when I think about the annual flu that we just kind of 
41 

take for granted, I didn’t realize that 36,000 people died every year. 

And we have had two death now—one person that came into the 

country already sick. 

I wonder where we—you know, how we handle that as regard to 

how thoroughly we scare people versus, you know, what actually finally ends up happening. I know the president asked for $1.5 billion to address this. Is that for money that you are already spending, or for schools that have lost money, or, you know—we haven’t 

even really dealt with this yet in coming up with that money, but 

I guess I still have some questions. But I really appreciate the 

panel and thank you for your input. 

Chairman MILLER. If I might take a privilege of the chairman, 

I am going to go to Mr. Andrews. 

Could you explain positively, because I think Mr. McKeon has 

touched on an important point—the idea that schools were closed 

and then schools were open was sort of a kiss-off, ‘‘Well, they just 

don’t know what they are doing.’’ And could you just describe the 

environment and how you arrived at that decision, both the first 

and the second decision, how you—the judgment you have to make? 

Because I think it is an important point, that you don’t quite know. 

There is two schools of thought out there when this is all boiling 

around in the media. 

Dr. SCHUCHAT. Yes. At CDC we have been acting very aggressively to get information out to local and state decision-makers and 

to provide guidance that will inform local or state decisions. An 

issue like school dismissals is under the authority of the local— 

usually local, sometimes state—groups. 

We issued initial guidance on school dismissal recognizing that 

local decisions may differ from the national recommendations because of there is much better information on the ground about both 

the circumstances and where students or teachers may need to go, 

and, you know, what would be the consequences. Our original guidance was issued, we would probably say, very aggressively about, 

if you have a case recognized you should consider dismissing students. 

This was because the planning and modeling and the understanding of the role of school dismissal suggested that it is very 

early in a response where that would be effective at reducing 

spread by taking students who congregate together in a school and 

having them stay home with just the family context could really reduce the spread. What we found as we went on was that this virus 

was spreading in the community already, and that the disruption 

of the school environment was not really being justified by the 

intervention that we were recommending. 

But I would say that the decisions to issue guidance will vary as 

information changes. The role of school dismissals was planned for 

a very severe new virus. 

We didn’t have adequate information at the beginning to rule 

that out. Right now we feel that what is circulating right now—it 

is not nothing, you know, it has severity in some people but that 

it wasn’t that category five type of pandemic strain that we had 

feared. So we took early interventions; we respected local variability and really supported the locals who were making tough decisions with information on the ground. 
42 

Chairman MILLER. Thank you. 

Mr. Andrews? 

Mr. ANDREWS. Thank you, Mr. Chairman, and thank you for having this very timely hearing. 

I would like to thank each member of the panel. I know we are 

not out of the woods yet by any stretch of the imagination with this 

pandemic, but I think that each of you in your own way has done 

a very good job responding to this situation in informing the public 

and protecting the public. And again, I know we are not out of the 

woods, but I think you are off to a really promising start and we 

appreciate that. We do. 

Dr. Schuchat—did I pronounce your name correctly? Schuchat? 

Schuchat—I am sorry. 

Dr. Schuchat, on page eight of your testimony you talk about the 

two drugs that appear to be successful. I will not attempt to pronounce them. Since I have already botched your name I won’t try. 

You say that acting quickly after you identify the virus and its 

potential impact on the population, you have released one quarter 

of the state’s share of antiviral drugs and equipment to be used 

pursuant to help the states prepare to respond to the outbreak, and 

that the deployment of the stockpiles was completed by Sunday. To 

whom are these drugs distributed? How do drugs administer people 

who need help? 

Dr. SCHUCHAT. The Strategic National Stockpile antiviral drugs 

were targeted primarily for use in treatment—44 million regiments—— 

Mr. ANDREWS. What I am asking is, where does the treatment 

take place? 

Dr. SCHUCHAT. Right. So they are distributed from us to the 

state health departments—— 

Mr. ANDREWS. Right. 

Dr. SCHUCHAT [continuing]. Or the project areas, and each state 

has submitted a plan of how they intend to distribute the 

antivirals. Some states would be going through regular pharmacies; 

some states would be using the public health settings. 

Mr. ANDREWS. Right. 

Dr. SCHUCHAT. We really, in the pandemic planning efforts, required each state to think this through with—— 

Mr. ANDREWS. Do they also use physicians’ offices? 

Dr. SCHUCHAT. Yes. Some of them do it that way. So it is really 

flexible in terms of what will work with their population—— 

Mr. ANDREWS. One of the facts that really struck me about Mr. 

O’Connell’s testimony—an amazing statistic: For every one school 

nurse in California you have 2,227 students. Wow. 

So if this program were in some way to be set up through the 

schools, it is certainly not going to succeed given that kind of ratio. 

What other kinds of public health—put it to you this way: If you 

had to get these drugs to a lot of people in a hurry, how do states 

typically do that? 

Dr. SCHUCHAT. Again, this is left to the states. They have talked 

about their points of distribution—where will they do it? What type 

of workforce will they pull in to help with this? 

That is really part of the whole preparedness planning that has 

been going on around the state and local areas, understanding 
43 

which sectors can be brought out to help with different stages. You 

know, from our role at CDC, you know, an early decision is, do you 

deploy these assets—you know, at what point do you send them 

out, because they become the state’s or big city’s assets once we deliver them—— 

Mr. ANDREWS. Do the drafters of these plans have to pay special 

attention for people who do not have health insurance and therefore do not have primary care? 

Dr. SCHUCHAT. Yes. There is a whole area of our pandemic planning around vulnerable populations, and that is a very important 

aspect of what the state and local would be deciding. The issue is, 

these are,you know, become state resources to distribute—not for 

reimbursement, just, you know, they give them out—that really focused on the treatment part. 

The states also have—no, most of the states all sort of purchase 

the same drugs for stockpiling for these types of reserves, and what 

we understand is, we have distributed the material, some of the 

states actually are using them already, some of them are holding 

them to see how things go, because those drugs are commercially 

available—— 

Mr. ANDREWS. It is a little self-evident, but it occurs to me that 

if you don’t have health insurance, even if your state gets its fair 

share of these drugs, you have pretty hard time accessing them, 

right? The school nurse, for legal and administrative reasons, probably is not going to administer them. You said the pharmacy—well 

of course, the pharmacy is not going to give them out for free, 

right? Are these prescription medications? 

Dr. SCHUCHAT. The antiviral drugs that we are providing from 

the Strategic National Stockpile are not to be charged for; the government has purchased those—either the state or federal government—— 

Mr. ANDREWS. Do you need a prescription to have one administered, though? 

Dr. SCHUCHAT. We used an emergency use authorization that the 

FDA signed off on in this context to be able to just distribute it 

without individual prescriptions, so for the context of an emergency, no. For routine purposes, absolutely yes, and we think they 

should be taken under a doctor’s advice. 

Mr. ANDREWS. I raise this issue because the chairman and a good 

chunk of the staff here is spending an inordinate amount of time 

on the health care reform issue, thank goodness, and this strikes 

me as yet one more compelling example of why we need every person in the country to have health care coverage. Anecdotally, it appears—and I see my time is up—that the better your primary care 

is, the lesser effect this virus is having on people, and more primary care seems to be the answer. 

Thank you, Mr. Chairman. 

Chairman MILLER. Mr. Roe? 

Dr. ROE. Thank you, Mr. Chairman, for holding this meeting. I 

want to also fuss at the House of Representatives. We have done 

a terrible job—not fuss since I have been here—about no place for 

people who come in to alcohol their hands off. We should do that 

in every hallway. It should have been done months ago. 
44 

So let us have this committee do something positive, and at least 

we shake hands with people from all over the country, so I am just 

sharing a frustration, Mr. Chairman. If we can get that fixed we 

will have done something positive for the House of Representatives. 

I think back when I was child about the polio epidemic and how 

that was managed and handled—a tremendous health care success, 

and to sort of defend—as a physician—to sort of defend the health 

care folks and the school director. What we planned—and as a surgeon, when I would go to the operating room, I planned on a train 

wreck and hoped I went on a train ride. They didn’t know what the 

biological significance of this virus was when it came out, so we 

had to plan for the worst case scenario and hope for the best case 

scenario, in terms of—you know, we overplanned. 

And I am sure you recall, Dr. Schuchat, the 1976—maybe not; 

I do—swine flu epidemic. It turned out the vaccine was worse than 

the disease was. We didn’t know that at the time, and hindsight 

is always 20/20. 

You know, I think from a school director’s standpoint, when it 

snows in Tennessee where I live, eight flakes, the school director 

calls school off and gets ostracized and so forth, but had you rather 

do that or have a bus wreck up in the mountains and hurt some 

children, or potentially kill them? So you have a tough decision, 

and you are the ones that have to make that call. And I think the 

call was done appropriately here. 

Yes, it turned out this disease was not, or doesn’t appear to be 

yet, as severe as we thought it was, but I think those preparations 

were extremely important. And to Mr. Andrews’ comments, I called 

our EMA director. I went back in 2001 or 2002 and got my smallpox, because we didn’t know at the time, and we have an EMA 

plan, and I called some EMA directors in our area and say, ‘‘Are 

you guys set to go? Is everyone ready?’’ 

‘‘Yes, we are ready, and we have a plan in our area to treat these 

epidemics.’’ And I think that from 2000 and so, Homeland Security 

and CDC and so forth have made huge gains in being able to handle a problem as big as a pandemic, which, fortunately, this didn’t 

turn out to be. 

So planning is very important. And I will share with you a brief 

story that occurred, and I won’t mention which airlines. But this 

was when the smallpox scare in the early 2000s came along, a guy 

flew in from the Orient on an airline into Memphis, and they 

thought that he potentially had—could have smallpox. So what do 

the folks do? The keep him on the plane and send everybody else 

out. They sent, you know, 150 vectors out, and I immediately 

awarded them the Forrest Gump award, ‘‘Stupid is as stupid does.’’ 

So education has helped us, and planning, in the last few years, 

tremendously. And that is why, Ms. Brockhaus, I have really appreciated your comments on planning, because it does allow us a 

way to handle these epidemics and pandemics. Could you comment 

on that from an employer’s standpoint, how they did just your 

planning efforts? 

Ms. BROCKHAUS. How—I am sorry, sir—— 

Dr. ROE. Your planning efforts that you have done in businesses 

and so forth, and I know the schools have done that, also. 
45 

Ms. BROCKHAUS. Well, first of all, I want to say in recognition 

of your frustration, Mr. Roe, one of my colleagues, Judy Freyman, 

in our office in Sacramento, calls this a teaching moment, when 

you were talking about, ‘‘Let us do something here in the House 

of Representatives.’’ So really, that is, I guess, the silver lining. 

Whenever there is an unhappy situation like a novel virus, like the 

H1N1, where, as Dr. Schuchat mentioned earlier, you know, lots of 

people suffered in many ways because of this outbreak, even 

though we are happy that it doesn’t seem quite as severe as we 

though it would be. 

I just want to say that—to reiterate my point that planning in 

companies has to be—include reaching out to the local and state 

health departments. And we have said that over and over again 

and have showcased the response in California because it seems so 

effective to us, and we have been directly involved with the California state and local—variety of local health departments, many 

of them in California, and showcased those experiences to all of our 

member companies. 

These are large companies. You can imagine many of them have 

locations in all 50 states, so it is quite a hurdle for them to really 

reach out to the local health departments. California has really met 

companies halfway and more than halfway by initiating those outreach activities. 

Dr. ROE. One brief comment about nursing. Again, Mr. Andrews 

brought up—half of registered nurses in America can and will retire in the next 10 years, so it is not just in the school system. It 

is systemic, and we really need to train these health care professionals, and as Mr. Garcia certainly knows that very well. 

Thank you, Mr. Chairman. 

Chairman MILLER. Thank you. 

Mr. Hinojosa? 

Mr. HINOJOSA. Thank you, Mr. Chairman. I thank you for calling 

this very timely congressional hearing on this issue that impacts 

the whole country and many, many other nations. But it especially 

impacts my congressional district because I had a hospital in Harlingen, Texas, deep south Texas, that received a child that came 

from Mexico with a family that flew in through the valley and were 

looking for a second, third opinions. And that child then was moved 

on to Houston because of the complications, and that child died— 

one of the first ones—and Texas was charged for that one, that 

first death. 

But just recently, a couple of days ago, we had a second person 

die in my area. She was living in Harlingen, a teacher, who had 

given birth to a child just a few days before her death, and she was 

working in my school district of my hometown, Mercedes Independent School District. And so I say that it has hit us hard, and 

I have talked to those superintendents, I have spoken to some of 

the school board members, and they have all struggled with the decisions that they had to—that they made in closing down the 

schools, as they did several weeks ago. 

My question to you, Dr. Schuchat, is where is our country on collecting information on health workers at health care facilities that 

have seen confirmed cases of H1N1, and how many health care 

workers have gotten sick? 
46 

Dr. SCHUCHAT. First, I just want to say how sorry I am about 

what your community has gone through. I know that families affected and the students in that environment have been through 

quite a lot. 

CDC is actively working with state and local health officials to 

understand the situation in health care workers. It is a very important population. We have detected a number cases—I think yesterday it was 26 health care workers with the confirmed H1N1 virus, 

and we are actively investigating these to understand where they 

may have gotten the infection. 

Of course, wherever you work you could also have gotten the infection at home or in the community, or even while traveling. But 

we are also trying to understand the circumstances in the health 

care environment, whether they cared for anyone who had such an 

illness. 

The CDC has also been issuing guidance particular to health 

care workers to understand, you know, how can they protect themselves while we are still in this situation of uncertainty? We don’t 

have the results of the investigation of the health care worker exposures or illness, but it is an active priority right now in a number 

of areas, and it will be perspective, you know, enrolling additional 

ones as well as the ones we have already found. 

Mr. HINOJOSA. My other question is, what are the additional 

steps that CDC is taking to prepare schools like ours, and childcare 

facilities, for a potential pandemic? 

Dr. SCHUCHAT. You know, with the switch from school dismissal 

guidance to recommending that schools reopen, you know, based on 

local decisions as well, we have really built up a stronger partnership with the Department of Education to try to identify ways that 

the school environment itself could be an opportunity for teaching, 

for education about how to avoid these types of respiratory infections, as well as a place to emphasize recognition of children or 

teachers who are ill and encouraging them to leave and stay home 

until they are better. 

So we are continuing to try to make sure that the right messages 

get out, and that we are taking steps to make sure we can keep 

kids in school where they can learn, and keep children who are not 

well home, where they will be able to recover before they return 

to the environment. 

Mr. HINOJOSA. Thank you. I yield back, Mr. Chairman. 

Chairman MILLER. Mr. Courtney? 

Mr. COURTNEY. Thank you. Thank you, Mr. Chairman, and 

thank you for holding this hearing. 

There is not question, as the witnesses have said, that local and 

state officials in the area of school closings make the final call, but 

your direction, I think, is really what they look to. In Connecticut, 

in my hometown, we—schools closed Thursday and Friday. My 14- 

year-old daughter says, ‘‘Thank you,’’ I guess, but it was clearly 

driven by the initial guidelines. 

And, you know, one of the other ripple effects, in terms of how 

school officials reacted—maybe overreacted—was that schools were 

then subjected to these pretty dramatic scrub-downs. Local media 

was in there doing, you know, coverage, and certainly we want 
47 

clean schools, but I guess the question is, is that really something 

that makes sense from a scientific perspective? 

Dr. SCHUCHAT. You know, the environmental cleaning is important for some viruses that can live on surfaces for a certain period 

of time, with attention to the high frequency areas—you know, railings on staircases, or doorknobs, elevator buttons, those types of 

things that lots of people touch. You know, I do think that—we 

have issued some guidance in working with environmental health 

experts at CDC as well as the virologists to try to focus the energy 

into the most effective steps. 

So I think that, you know, the media will cover something that 

is quite visible, but we do include in our guidance cleanup of the 

high frequency—the environmental surfaces that are touched a lot 

by lots of different people. 

Mr. COURTNEY. I could care less about the media. The real questions is just that the local school budgets, as Mr. O’Connell knows, 

are stretched thin. This is all overtime that was generated as a result of this effort, and certainly being helpful to school superintendents, in terms of trying to not go overboard, would be helpful in 

terms of the right response. 

Dr. SCHUCHAT. Yes. Thank you. I think one big issue for us is 

to try to focus the energy in the most effective efforts and away 

from the ones that aren’t really worth the trouble. Thank you. 

Mr. COURTNEY. Mr. Modzeleski, I mean, communicating with 

parents in these situations where, you know, dismissal has suddenly been issued and then rescinded—again, I just, just using my 

hometown, I mean, they shut down Thursday and Friday. SAT 

testing was Saturday morning, and parents were lost in terms of 

whether or not they should drop their kids off to come in for tests. 

I mean, what is the department recommending? Is it, you know, 

phone trees, e-mail, I mean, how do you—and how much do you tell 

them? 

Mr. MODZELESKI. That is a good question. What we recommend 

is to communicate often, communicate with accurate information, 

communicate in different modalities. This is not only—many 

schools have phone trees, but phone trees, text messages, placing 

it up on the Web, I mean, a lot of the information that we have 

received from schools and schools put out is now Web-based. I 

mean, this is a good way of doing it. 

Text messaging is also another way. You know, we have been 

working with schools for the—since 2003 on what we call all hazards planning, making sure schools dealing with a whole wide variety of hazards. And one of the things there that we have seen is 

that schools have built into their communication plans is getting 

messages out to school—getting messages out to parents quickly in 

a lot of different ways and making sure that information is accurate. So those are the three things that we would recommend to 

all schools. 

Mr. COURTNEY. I would encourage you to kind of keep pounding 

that message, in terms of the department’s communications to the 

localities, because, you know, it was clear—again, this happened so 

fast, and I am not trying to, you know, Monday morning quarterback, but, you know, it was pretty uneven—let us put it that way— 

in terms of how well that was implemented. 
48 

But I think the other point that we have seen is that it is important to make sure that the information that is put out is accurate 

information. 

Mr. MODZELESKI. Right. 

Mr. COURTNEY. It has to be accurate information. You know, if 

that delays the message a little bit I think it is better to delay the 

message and get it right, rather than to push it out and then have 

to rescind it, because that just confuses parents. 

And one other question for Dr. Schuchat about the—you know, 

what happens to the flu virus when, you know, spring turns into 

summer, and then when it sort of bounces back in the fall. I mean, 

does it go into remission? Does it disappear? Does it migrate? I 

mean, why should we still really be concerned if the summer is 

coming? 

Dr. SCHUCHAT. You know, we will be looking very intensively in 

the southern hemisphere our summer, which is their winter, because they, you know, whether they see a regular seasonal influenza or whether they see this strain that we have been having 

emerge as a dominant problem, so both in terms of support and assistance to affected countries, but also the scientific investigation 

that will help us anticipate our fall experience. We don’t know. 

Some of the pandemics of the past have sort of simmered in the 

summer. But we are hopeful that this season—the normal season— 

will be on our side, because, you know, cases are continuing to increase right now. 

People sort of think we are out of the woods, but every day we 

are getting a couple hundred more cases, and some of it is the 

backlog in the lab testing, but new cases. So we are hopeful that 

as we enter the summer, you know, or primarily as we enter June, 

that we might be seeing a dampening here, but we really need to 

be prepared for this same strain to be around or even have evolved 

a little bit to be in worse shape by then. 

Mr. COURTNEY. So if southern hemisphere countries aren’t experiencing much this summer, is that a signal that we are not, you 

know, in a 1918 situation of a strong bounceback? 

Dr. SCHUCHAT. That will be a good sign, but with influenza, you 

hate to say it, but it is very unpredictable. We have a lot of this 

virus here in the United States right now. Almost every state has 

it. And in the southern hemisphere they haven’t actually detected 

cases, really, yet. They are looking. There is a couple suspect ones, 

but their flu season is just beginning, and we really need to work 

intensively in partnership—— 

Chairman MILLER. Gentleman’s time is expired. We have a vote 

on. What I would like to do—I know members have questions; we 

are going to go to Ms. Titus next—but if we could limit it to 3 minutes, so you ask your most—your first question first, and we will 

see if we can get the members before we leave. It is Ms. Titus, 

Loebsack, Woolsey, McCarthy, Fudge, Hare—— 

Titus? 

Ms. TITUS. Thank you, Mr. Chairman. 

Secretary mentioned that every state has a preparedness plan, 

and I guess that they submit it to you, and there is an appendix 

about schools. Well, I have a copy of Nevada’s plan here. There are 
49 

13 agencies that contributed to the plan; none of those agencies is 

at all related to education. 

The Appendix A has 38 acronyms. Not a one of those is related 

to education. I have only found the word ‘‘school’’ twice in 76 

pages—one is on page 40, where it says, ‘‘For additional information on schools and health care settings go to the CDC Web site.’’ 

And the other mention of school is on page 58, and there it says, 

‘‘Other strategies for slowing the spread could include temporarily 

closing of schools, arenas, et cetera.’’ 

I wonder if all the state plans are this bad, and if they are this 

lacking in coordination with schools, and if we don’t need to do 

some review of what the state plans are. 

I appreciate the fact that there is more coordination now as a result of the new flu, but we had a potential pandemic several years 

ago, when all of this was supposed to have been put in place, and 

none of the demographics or factors of this new flu are very different from those, so why is that missing? Why have we not done 

that before? 

Mr. MODZELESKI. Well, it is a very good question, and there are 

two things going down on parallel tracks here. On the one hand, 

I want to repeat, is that we have been working with schools districts, primarily at the school district level, on developing and having schools developing what we call all hazards crisis plans. 

In 2006, because of the outbreak of the epidemic—or the potential outbreak of the epidemic in 2006, is we required that every 

school district receiving a grant through the Department of Education under our Readiness Emergency Management for Schools— 

and we have provided funds to over 600 school districts in this 

country on that—we required them to have a pan flu plan at the 

local level. So if you go out to the local level, especially for those 

districts that have received funding from the Department of Education on the preparedness grants, is that they have developed pan 

flu plans. 

What you are talking about is a requirement which is not a Department of Education requirement. It is a requirement which 

came down from Health and Human Services as part of a legislative requirement. And the appendix—I believe it is Appendix B4— 

is supposed to list education requirements, both K through 12 education as well as higher education, which is another appendix. 

We have reviewed all of those plans. Actually, we review those 

plans; we provide comments back to the states, and states were 

supposed to take the comments based upon our review and then revise those plans. We have not seen revised plans as of yet. 

Mr. LOEBSACK. Thank you, Mr. Chairman. Thanks for having 

this important hearing. 

And thanks to the witnesses. I will be very brief. 

Dr. Schuchat, I think you were at our bipartisan caucus. I 

brought up the, you know, question of using the word ‘‘swine,’’ and 

I want to thank you again for not using that word, and all of you 

for not using that word. I am from Iowa, and the pork industry is 

very important in Iowa, as it is in many states around the country. 

But I am pleased to read your testimony. And you did mention 

this in your oral testimony, but you state that there is no evidence 

to suggest this virus has been found in swine in the United States, 
50 

and there have been no illnesses attributed to handling or consume 

pork. Currently there is no evidence that one can get this novel 

H1N1 influenza from eating pork or pork products, and you mentioned that we should always cook pork products to 160 degrees 

Fahrenheit just in case. 

Can you be—I know this is—you may not be able to answer this 

question for everyone, but can you be less equivocal and state that 

one may not get this influenza from pork products? Because, you 

know, this language—I understand why you use this language, ‘‘no 

evidence currently right now that anyone has gotten the, you know, 

the influenza from pork,’’ but can we go further than that and state 

that there is no way, if you will, that anyone can get this influenza 

from pork products? 

Dr. SCHUCHAT. People don’t need to be worried about eating 

pork, in terms of this particular virus. Influenza viruses can affect 

swine. Swine can become ill from influenza viruses. But everything 

we know about what is going on right now suggests you don’t need 

to worry about pork, in terms of eating that or handling it. 

Mr. LOEBSACK. Thank you for going that far. I appreciate that. 

How are you getting the word out, then, about this, and how it 

is the case that, really, that it is not possible to get this from pork? 

How is the CDC getting the word out? 

Dr. SCHUCHAT. You know, we have placed communication as our 

highest priority, really, in this response, because information and 

misinformation are important in how the public reacts and the unintended consequences. In terms of the pork issue, we have been 

working with both USDA and the pork board and other business 

concerns to understand what we can do to clarify the issue. You 

know, here in the U.S. this is an issue and in other countries it 

is an issue as well. We are really trying to be sensitive to both the 

cultural and economic impacts of our words. 

Mr. LOEBSACK. Right. Thank you. I think it is very—and for the 

record I want to say that it is very unfortunate that China and a 

number of other countries have banned pork in ports from Iowa 

and other parts of the United States. It is very unfortunate. 

Mr. Modzeleski, have you or have any of you seen any—Mr. 

O’Connell, in particular—have you seen any cafeterias—school 

cafeterias—banning pork products as a result of this? 

Mr. MODZELESKI. We are not aware of any, sir. 

Mr. LOEBSACK. Okay, good. 

Thank you. 

Ms. WOOLSEY. Thank you, Mr. Chairman. Certainly our number 

one concern is the health of every American, everybody around the 

world, when it comes to a pandemic. 

Today we are talking about children and workers, and certainly 

one of the sure ways to stop an epidemic or a pandemic is for a 

sick child not to go to school and a sick employee to stay home from 

work. So, we need to provide a series of programs to protect the 

worker from loss of pay and from loss of any punitive retribution 

if they do stay home. 

So my question is—to you, Ms. Brockhaus—is, does ORC support 

a paid sick leave and/or paid family leave—family and medical 

leave—plan, or any other plans that bridge work and family? 
51 

And then, Mr. Garcia, I would like you to think, while she is answering me, whether your employer has provided any of these 

plans or these benefits to their employees. 

Ms. BROCKHAUS. Ms. Woolsey, ORC’s experience is really only 

with very large companies, and our experience with those companies—and we have some survey results we can share with you— 

is that more than 98 percent of the companies that we have surveyed are very large companies who have—— 

Ms. WOOLSEY. Do they have paid family leave, so a parent can 

stay home with a sick child or the worker can stay home when they 

are sick? 

Ms. BROCKHAUS. Yes. They call the leave policies by different 

names, in many cases, and in many cases there is an amount of 

leave that is given that the worker has flexibility in terms of how 

to use. I am really not confident to address the issue of companies 

that don’t provide that leave—— 

Ms. WOOLSEY. Okay. Thank you. 

Mr. Garcia? 

Mr. GARCIA. I thank you very much, and we do have, as part of 

our—what Kaiser has, part of our benefits, is sick leave pay, so 

that someone can stay home, as well as FAMLA and CFRA, that 

if there was a need to stay home with a family member, then we 

can. And one of the things that you pointed on that I think is very 

important is actually recognizing that how do stop the transmission 

of it? 

And right now, even when our emergency rooms—this is where 

I work, and working with workplace safety as a labor co-chair—you 

know, emergency rooms are very busy just with our normal cardiac 

and stroke. And as we continue to double—and even though we are 

at the beginning of this understanding of the flu, we are seeing a 

doubling of people being infected, confirmed, as well as actually 

probable cases. So being very familiar with the germ theory is that 

this is how we stop the germ from actually—or, the virus from actually being contracted and transmitted, is by actually taking care 

of the worker, whether it be staying home, whether it be having 

standards that are put in place. 

Ms. WOOLSEY. And with my little—I have a tiny minute left, 

maybe—then you are using OSHA’s standards to protect—prevent 

this from happening in the first place? 

Mr. GARCIA. We do have policies in place that we are implementing, and as we prepare we are communicating when they 

start. 

Chairman MILLER. Ms. Clarke? 

Ms. CLARKE. Thank you very much, Mr. Chairman. In addition 

to being a member of this committee I am also chair of the Subcommittee on Emerging Threats, Cyber Security, and Science and 

Technology for the House Committee on Homeland Security. It is 

in this capacity that I am responsible for conducting oversight to 

ensure that the Department of Homeland Security is performing its 

mission of coordinating federal departments and agencies that are 

charged with responding to pandemic flu and doing what is necessary to address and mitigate the spread of H1N1 flu. 

I also happen to be the only member on this committee from New 

York City, but needless to say, I have a very special interest in 
52 

being—in this topic being discussed today. And I would like to 

thank you, Mr. Chairman, and all of you who are contributing to 

this hearing today on this very important issue. I want to also take 

a moment to commend Mayor Michael Bloomberg, our deputy 

mayor, Linda Gibbs, and our health commissioner, Tom Frieden, 

for their response, work, vigilance, and keeping New Yorkers informed and safe. 

My first question is to Mr. Bill Modzeleski, and Jack O’Connell, 

and to you, Dr. Schuchat. I have a significant immigrant population in my home district in Brooklyn, New York. For many immigrants, English is their second language, and quick and effective 

communications with immigrant parents is a key component to preventing and mitigating this threat of the H1N1 flu and for future 

outbreaks. 

I would like to know what, if any, outreach our educational systems and the CDC have done to get this information into immigrant communities. 

Mr. MODZELESKI. That is a great question. First of all, let me 

say, we have worked very closely with officials—key officials—in 

New York City, both in the city as well as with the Archdiocese 

school district when you had a recent outbreak in the high school. 

There are a lot of populations that we are dealing with here. 

One of the interesting things is that we held, as I mentioned in 

my testimony, three outreach phone calls, where we had well over 

3,000 lines come in from people asking questions. And one of the 

questions that kept on coming up over and over again was about 

immigrant populations, not only those down by the border, but it 

other communities. And so what we have been trying to do is outreach, push information out from the Department of Education not 

only to school districts, but to a lot of community groups and organizations that represent those particular interests. 

Also, trying to ensure—and why we can’t do it for every publication or every journal—is to try to make sure that the key pieces 

that we have are translated into key languages, especially Spanish. 

And we are not the only ones doing this. 

I mean, part of what our philosophy has been is that we move 

forward in working in the community. I have to do it with Dr. 

Schuchat. I have to do it with DHS. And I should say is, if you are 

looking at DHS, they have done a phenomenal job, I think, in coordinating overall efforts with all of the domestic agencies, including the Department of Education. 

Ms. CLARKE. Thank you very much, Mr. Chairman. 

Chairman MILLER. Mrs. Davis? 

Mrs. DAVIS. Thank you. Thank you, Mr. Chairman. 

Good to see you, superintendent. I just have a very practical 

question, partly from the stories of bathrooms not being equipped 

with soap or sanitizers. Is there some reason why we shouldn’t 

have sanitizer dispensers in classrooms? Would that be overreach? 

Is that necessary? 

Would that be a good idea generally, in terms of educating students to use them? I know whenever I go anywhere people are always dousing me with, you know, sanitizer, and so just wondering 

if we shouldn’t sort of look into that being usual fare for our classrooms. 
53 

Mr. O’CONNELL. Congresswoman, nice to see you again. I think 

that is a very good idea. It comes down to a issue of, you know, 

funding and priority for our schools, and the strapped budgets that 

we have, the inadequate number of school nurses—and I believe 

that this issue has really called that issue, you know, front and 

center—and a point earlier, the shortage of nurses that we have 

not just for schools but also for our general population is going to 

be a real challenge for us. 

And that is why the posters, you know, on Congresswoman 

Clarke’s issue—we have posters in California, as you know, multiple languages, very diverse student population. Forty-eight percent of our students are Latino; 40 percent of our kids go home 

from school, speak a language other than English; 39 percent of our 

kids came to school today to learn the English language, and so 

that—and one out of four students K through 12 came to school to 

learn the English language. 

So we do have to make sure that we, you know, multiple languages, and that we try to meet those basic health care, you know, 

good hygienic policies—— 

Mrs. DAVIS. Right. Absolutely. But it is partly habit-forming, and 

it just occurs to me sitting here, and I wanted to wait and say 

hello. Thank you very much. 

Mr. O’CONNELL. Thank you. 

Chairman MILLER. Thank you very much. If I could have a couple of questions here. This question of what do—the interplay between employers and schools is rather significant, obviously, and so 

for the moment we have kind of dodged a very serious situation, 

and yet people may have to make decisions to go home to take care 

of a very ill child or family member, or they can’t get the child to 

school, and, you know, we have a system sort of built up—there is 

various sanctions. 

If you don’t show up for work, the theory is you are not doing 

your job. You could be fired. If you don’t show up for school you 

can’t take the test, you can’t go ahead, you lose your ADA. 

There is all of these things that are built into the system that 

assume regular order every day, and yet we see—and I think the 

CDC has suggested and science has suggested—that we can expect 

a continuation of this trend toward something like a pandemic—it 

may be dangerous, it may not be dangerous, but it is going to be 

upsetting to the economy, to the school environment, to society. 

And I just wondered, now that we have had a bit of experience in 

terms of a very large-scale, you know, in my—in the county I represent we had five school closures, and you know, it kind of shook 

everybody up. I know that people were wondering if they should go. 

But are we starting to look at how we make these decisions and 

whether sanctions—you know, the traditional sanctions that are 

sort of institutionally in place or culturally in place—whether they 

help us in dealing with the pandemic or they are a hindrance to 

is? And it is tough. You are an employer; you have got product you 

have got to move; you have got guidelines, you have got contracts, 

you have got commitments, and the other people on the other side 

of this country may not be experiencing any of this. What are we 

thinking about this in a larger sense? 
54 

Start with the—because I know you have to go, and I know you 

all want to go. So I am not going to keep you very long, but Dr. 

Schuchat? 

Dr. SCHUCHAT. You know, I think what you—the issue you raise 

is incredibly important. In our pandemic planning we had identified certain policy issues that would need to be surfaced that, you 

know, hadn’t really been settled as we were thinking of the science 

or the public health impacts. 

We did, actually, public engagement around the question of what 

we call community mitigation—these issues like closing schools or 

making people telework, or, you know, really shutting down, social 

distancing, cancelling big gatherings, and some of the comments 

from the public citizens involved were about these matters, you 

know, will I be able to—you know, what is my employer going to 

do? Can I get forgiveness on my mortgage payments if I have got 

to, you know, not work for X amount of time because of these new 

policies? 

I think these are really important issues, and I would say we 

probably have a chance to learn from the experience that we have 

gone—— 

Chairman MILLER. It is how people make decisions, but I don’t 

know that they—that we have a set of clear signals about your interests versus your traditional societal interests that come into conflict. 

Yes? 

Mr. BARAB. Yes. This is not specifically an OSHA issue, but it 

is certainly a Department of Labor issue. When we are dealing 

here, we—part of a public health strategy is to get people to stay 

home if they are sick or if family members are sick. Obviously, if 

people don’t have sick leave or don’t have other income support 

they are not going to be able to do that. They are not going to do 

it. And that is a problem for the public health. 

We have, at the Department of Labor, identified a number of, 

really, holes in the social safety net that deal with income support, 

job retention, FMLA issues that don’t necessarily apply to this situation, and it is an issue of great concern for us, and we are in deep 

discussions within the Department of Labor and with the White 

House on how to deal with this should we come across a really serious pandemic. 

Chairman MILLER. Jack, you have teachers that—what do they 

do? 

Mr. O’CONNELL. We do, and the example I was thinking of, Mr. 

Chairman, is there is a large hospital in Santa Barbara, and of 

course, we are all thinking of them for the fire there right now, but 

in Santa Barbara the secret to that hospital’s success is that they 

were able to provide childcare. You know, a predominant number 

of their employees are women, many single women, many with 

kids. 

And the childcare that they provide, they also have a segment for 

if the student—if their child is sick. And it is the only one that I 

am aware of, if your kid is sick we still want you as a nurse, as 

a doctor, as a LPN, to come to work, and we are still going to take 

care of your child. And I say that not from the health care perspective, but as the employer community—the hospital is a, you know, 
55 

for profit institution, and think that has really helped them with 

their—— 

Chairman MILLER. With the traditional childcare centers it is almost the opposite. You want the kids to stay home, I assume. 

Mr. O’CONNELL. And this is the exception, yes. Right. 

Chairman MILLER. Yes. Let me ask—— 

Mr. Garcia, you—— 

Mr. GARCIA. Chairman Miller, I want to just mention, as far as 

our labor-management partnership, the things that are working 

with Kaiser Permanente that I am finding: I am hired by them as 

a contract specialist to actually allow the health care worker to 

have a say in—we have something called the unit-based teams 

that, monthly we do meet, and every department is responsible, 

and our contract is over next year, and our reiterated, but we are 

supposed to, each department, to actually have a unit-based team 

that there is a equal say between labor and management. 

But I feel like one of the factors is, does the actual health care 

worker feel protected by the employer? And for one of the things 

that I feel like is working in our community, in our hospital, is that 

of a unit-based team and a partnered laborship-managment, and I 

am actually there to actually make sure that that culture is understood, whether it be from the management or from the labor, to 

say, ‘‘Are we abusing this or are we not allowing the culture that 

you could stay home if you need to?’’ 

If something is unfair, I go there and I represent them, and so 

I feel like that is one of the things that is working, is a labor-management partnership. 

Chairman MILLER. Let me ask you this question: I had a chance, 

sort of in the middle of all this, to visit a large medical center on 

an emergency basis. And so I was there for a couple hours, and of 

course, I am always amazed at how fluid the medical staff moves 

through in and out of patients with all different set of circumstances. But, you know, people weren’t wearing masks; they 

weren’t wearing respirators, they were just taking care of the patient population. 

How do those institutions make the determinations that you 

ought to move to a level where you should be wearing a mask or 

respirator or this? What is the guidelines that are there? 

Mr. BARAB. We showed you the risk pyramid there. We really expect employers initially to do their own risk assessment. They need 

to decide who is at risk in their environment, and in this case, 

again, who as direct contact with infected or suspected to be infected individuals. 

Now, this shouldn’t be anything new for hospitals. As you know, 

there are a variety of hazards that exist every day in hospitals, 

pandemic or no pandemic. 

Hospitals, we expect, should have some kind of health and safety 

program there, so they are making these determinations constantly 

about either infectious disease hazards or chemical hazards that 

workers face. So we expect them to apply those same principals to 

the pandemic flu situation. 

Chairman MILLER. I mean, I am watching—sitting in the waiting 

room, I am watching the person that is doing the initial intake. 

She is talking to families. Somebody in the family is sick, but the 
56 

whole family wants information, but they are gathering around her 

and they are talking to her and they are trying to determine—in 

some cases a member of the family is interpreting for them. 

This intake worker—I don’t know if she is considered medical 

staff, or where she fits into that process, but she looked to me like 

a front line individual. So how would the—you are saying that is 

handled based on the institutional decisions. 

Mr. BARAB. Partially. I mean, when you get down from the high, 

very high risk, or high risk to what we might consider medium risk 

people, which may be workers who come across a lot of people 

every day—and those could be the intake people, they could be supermarket checkers, for example—you are dealing with a whole lot 

of people. Now, the precautions they need to take will be determined by how severe the virus is expected to be or is, and how pervasive it is, and those, again, we get our cues from CDC. 

In this case it wasn’t very serious, and it wasn’t, you know, as 

pervasive, and therefore we weren’t dealing with the precautions at 

some of the middle level, middle risk—but that could change. 

Chairman MILLER. If you are a grocery store, you probably don’t 

want your checkers wearing a mask. 

Mr. BARAB. No. Exactly. 

Chairman MILLER. All right. But, so what is the step point for 

that decision? Do they have to be directed by CDC, that if you come 

in contact with large numbers of people where the influenza is geographically, you could say, it is here because of the level of infection? Who makes that decision? Because there is a lot of public relations reasons why, you know—— 

Dr. SCHUCHAT. You know, we have looked at the scientific information about what is going on, what type of transmission routes 

there are. Here we are mainly thinking of what we call respiratory 

or droplet precautions that are needed in that health care environment, and nothing really needed at the supermarket. 

But infectious diseases are different, and the circumstances will 

vary. And I just want to make the point that there is certain protection that the workers in the health care environment can take 

every year against the seasonal influenza strains that are also 

spread sometimes in health care settings, and unfortunately, even 

with that 36,000 deaths a year that we have and a lot of vaccine 

that is very effective, only about 43 percent of health care workers 

take advantage of the seasonal flu vaccine each year. 

So in terms of those teachable moments, there is a lot that 

health care workers and hospitals could be doing to protect workers 

day-in and day-out in the annual flu. 

Chairman MILLER. In your continuity plans, what do workers do 

if 10, 15 percent of the workforce has kids home sick? They have 

influenza, but you don’t know at that point whether it is very serious or not; they have been told the school has been closed. What 

do employers—— 

Ms. BROCKHAUS. Well, I wanted to make the point that one of 

the things that we found companies doing is developing questionnaires so that they could screen employees. Companies who were 

definitely with—definitely want sick workers to stay home. But it 

was tough. This is seasonal—seasonal allergy time. You know, is 

your runny nose from H1N1 or is it from allergies? 
57 

So companies developed questionnaires, told sick workers to stay 

home but call in and have somebody run through a questionnaire. 

And the companies were very dependent on the description of the 

virus and its symptoms from the CDC. So questionnaires were developed based on the specific characteristics of this virus, trying to 

figure out who are the right people to keep at home. And so I just 

want to do another hats off to the CDC for providing that information. 

And the companies were so interested in these questionnaires 

that more than 20 companies shared their questionnaires with us 

to make them available to other companies so that they could learn 

from those questionnaires, and we are going to post those on our 

center of excellence Web site, which is on our public Web site. 

Chairman MILLER. Well, thank you very much for your time and 

your testimony, and the expertise that you brought to this hearing 

this morning. There still remain some pretty serious questions in 

these large institutional responses, especially if this is something, 

unfortunately, that we can continue to look forward to with strains 

that we don’t know a lot about in the beginning and we don’t have 

white lines, exactly, what people should or should not do. 

It is a real test for—certainly for schools, I think. It is a very real 

test on how they cope with that, because again, you have deadlines 

and systems of financing. 

But thank you so much. Without objection, members will have 14 

days to submit additional materials and questions, and the hearing 

will stand adjourned. 

[Additional submission of Mr. Miller follows:] 

Statement of the National Partnership for Women & Families 

The National Partnership for Women & Families commends Chairman George 

Miller and Ranking Member Howard ‘‘Buck’’ McKeon for holding a hearing on the 

timely issue of the flu virus and how schools and workplaces can prepare. The National Partnership is a non-profit, non-partisan advocacy group dedicated to promoting fairness in the workplace, access to quality health care, and policies that 

help workers in the United States meet the dual demands of work and family. 

Workers Need Paid Sick Days 

In recent weeks, much attention has focused on the H1N1 virus (‘‘swine flu’’) and 

the best ways to contain it. The advice from the Centers for Disease Control & Prevention (CDC) and Administration officials is sound: ‘If you have a fever and you’re 

sick or your children are sick, don’t go to work and don’t go to school.’ That’s good 

advice but, unfortunately, nearly half of private sector workers in the United States 

(43 percent) don’t have a single job-protected paid sick day.1 The same is true for 

close to four in five low wage workers—the majority of whom are women.2 Nearly 

100 million workers don’t have a paid sick day they can use to care for a sick child. 

For them, staying home means losing pay and, perhaps, losing their job. In this 

economy, that’s a terrible choice to have to make. 

The problem is particularly acute for working women—the very people who have 

primary responsibility for family caregiving. In fact, almost half of working mothers 

report that they must miss work when a child is sick. Of these mothers, 49 percent 

do not get paid when they miss work to care for a sick child.3 Women also are disproportionately affected by the lack of a standard of paid sick days because they are 

more likely than men to work part-time (or cobble together full-time hours by working more than one part-time position). Only 16 percent of part-time workers have 

paid sick days, compared to 60 percent of full-time workers.4

Our failure to guarantee a minimum standard of paid sick days is a significant 

public health concern. Many of the workers who interact with the public every day 

are among the least likely to have paid sick days. Only 22 percent of food and public 

accommodation workers have any paid sick days, for example. Workers in child care 

centers, retail clerks, and nursing homes also disproportionately lack paid sick 
58 

days.5 If a lack of paid sick days means that they must work when they are ill, their 

coworkers and the general public are at risk of contagion. 

Workers with caregiving responsibilities are among those who urgently need access to paid sick days. As our population ages, more workers are providing care for 

elderly parents. Caregiving takes a financial toll on working people, especially when 

they have to take unpaid time off to provide care. More than 34 million caregivers 

provide assistance at the weekly equivalent of a part-time job (more than 21 hours 

per week), and the estimated economic value of this support is roughly equal to 

$350 billion6—a huge contribution to the health and well-being of their families. 

Caregivers contribute more than time; 98 percent reported spending on average 

$5,531 a year, or one-tenth of their salary, for out-of-pocket expenses.7 Yet, many 

lose wages each time they must do something as simple as taking a relative to the 

doctor. 

No state requires private employers to provide paid sick days. San Francisco, the 

District of Columbia and Milwaukee have passed ordinances requiring that private 

employers provide paid sick days. More than a dozen cities and states are working 

to pass paid sick days laws to ensure that this basic labor standard becomes a right 

for all workers. But illness knows no geographic boundaries, and access to paid sick 

days should not be dependent on where you work. Paid sick days is a basic labor 

standard like the minimum wage—and as with the minimum wage, there should 

be a federal minimum standard of paid sick days that protects all employees, with 

states free to go above the federal standard to address the particular needs of their 

residents. 

The Healthy Families Act would allow workers to accrue up to seven paid sick 

days a year that they could use to recover from illness or care for a sick family 

member. It’s simple, it’s smart, and it’s a basic workplace standard. We urgently 

need it to become law. 

Businesses Benefit from Paid Sick Days Policies 

Research confirms what working families and responsible employers already 

know: when businesses take care of their workers, they are better able to retain 

them, and when workers have the security of paid time off, their commitment, productivity and morale increases, and employers reap the benefits of lower turnover 

and training costs. Furthermore, studies show that the costs of losing an employee 

(advertising for, interviewing and training a replacement) is often far greater than 

the cost of providing short-term leave to retain existing employees. The average cost 

of turnover is 25 percent of an employee’s total annual compensation.8

As mentioned previously, paid sick days policies also help reduce the spread of 

illness in workplaces, schools and child care facilities. In this economy, businesses 

cannot afford ‘‘presenteeism,’’ when sick workers come to work rather than stay at 

home. ‘‘Presenteeism’’ costs our national economy $180 billion annually in lost productivity. For employers, this costs an average of $255 per employee per year and 

exceeds the cost of absenteeism and medical and disability benefits.9 In addition, 

paid sick days policies help level the playing field and make it easier for small businesses to compete for the best workers. 

The Nation Needs Policies that Allow Workers to Meet their Job and Family Responsibilities 

The economic crisis our country is currently facing has been devastating for working families. More than 11.6 million workers have lost their jobs, and millions more 

are underemployed. In February 2009, the unemployment rate was 8.1 percent—the 

highest level since December 1983. The unemployment rate for African Americans 

was 13.4 percent, the rate for Hispanics was 10.9 percent, and the rate for whites 

was 7.3 percent in January 2009. For many families that once relied on two incomes, this crisis has meant managing on one income or no income at all. As a result, families are not only losing their economic stability, but their homes: one in 

nine mortgages is delinquent or in foreclosure.10 

Especially at this time, when so many workers are suffering terribly, we must put 

in place a minimum labor standard so that taking time off for illness doesn’t lead 

to financial disaster for families. Workers have always gotten sick and always needed to care for children, family members and older relatives—and they have always 

managed to be productive, responsible employees. But without a basic labor standard of paid sick days, families’ economic security can be at grave risk when illness 

strikes. In this economic climate, when jobs are so scarce, we need a basic workplace 

standard of paid sick days to prevent workers from being forced to choose between 

their health or the health of their family, and their paycheck or even their job. 

Our nation has a proud history of passing laws that help workers in times of economic crisis. Social Security and Unemployment Insurance became law in 1935; the 
59 

Fair Labor Standards Act and the National Labor Relations Act became law in 

1938, all in response to the crisis the nation faced during the Great Depression. 

Working people should not have to risk their financial health when they do what 

all of us agree is the right thing—take a few days to recover from illness, or care 

for a family member who needs them. Now is the time to protect our communities 

and put family values to work by adopting policies that guarantee a basic workplace 

standard of paid sick days. 

ENDNOTES

1 Vicky Lovell, Institute for Women’s Policy Research, Women and Paid Sick Days: Crucial for 

Family Well-Being, 2007. 2 Economic Policy Institute, Minimum Wage Issue Guide, 2007, www.epi.org/content.cfm/ 

issueguides—minwage. 3Kaiser Family Foundation, ‘‘Women, Work and Family Health: A Balancing Act,’’ Issue Brief, 

April 2003. 4 Vicky Lovell, Institute for Women’s Policy Research, No Time to be Sick, 2004. 

5 Vicky Lovell, Institute of Women’s Policy Research, Valuing Good Health: An Estimate of 

Costs and Savings for the Healthy Families Act, 2005. 6Gibson, Mary Jo and Houser, Ari, ‘‘Valuing the Invaluable: A New Look at the Economic 

Value of Family Caregiving.’’ AARP, June 2007. 7 Jane Gross, ‘‘Study Finds Higher Costs for Caregivers of Elderly,’’ New York Times, 11/19/ 

07. 8 Employment Policy Foundation 2002. ‘‘Employee Turnover—A Critical Human Resource 

Benchmark.’’ HR Benchmarks (December 3): 1-5 (www.epf.org, accessed January 3, 2005). 9 Ron Goetzal, et al, Health Absence, Disability, and Presenteeism Cost Estimates of Certain 

Physical and Mental Health Conditions Affecting U.S. Employers, Journal of Occupational and 

Environmental Medicine, April 2004. 10 Center for American Progress, 

www.americanprogress.org/issues/2009/03/econ—snapshot—0309.html, March 2009. 

[Whereupon, at 11:52 a.m., the committee was adjourned.] 

Æ