U.S. GOVERNMENT PRINTING OFFICE

WASHINGTON : 

For sale by the Superintendent of Documents, U.S. Government Printing Office

Internet: bookstore.gpo.gov Phone: toll free (866) 512–1800; DC area (202) 512–1800

Fax: (202) 512–2250 Mail: Stop SSOP, Washington, DC 20402–0001

90–241 PDF 2004

S. Hrg. 108–367

SARS: IS MINNESOTA PREPARED?

HEARING

BEFORE THE

PERMANENT SUBCOMMITTEE ON INVESTIGATIONS

OF THE

COMMITTEE ON 

GOVERNMENTAL AFFAIRS 

UNITED STATES SENATE

ONE HUNDRED EIGHTH CONGRESS

FIRST SESSION

FIELD HEARING IN MINNEAPOLIS, MINNESOTA

OCTOBER 8, 2003

Printed for the use of the Committee on Governmental Affairs

(

(II)

COMMITTEE ON GOVERNMENTAL AFFAIRS 

SUSAN M. COLLINS, Maine, Chairman 

TED STEVENS, Alaska 

GEORGE V. VOINOVICH, Ohio 

NORM COLEMAN, Minnesota 

ARLEN SPECTER, Pennsylvania 

ROBERT F. BENNETT, Utah 

PETER G. FITZGERALD, Illinois 

JOHN E. SUNUNU, New Hampshire 

RICHARD C. SHELBY, Alabama 

JOSEPH I. LIEBERMAN, Connecticut 

CARL LEVIN, Michigan 

DANIEL K. AKAKA, Hawaii 

RICHARD J. DURBIN, Illinois 

THOMAS R. CARPER, Delaware 

MARK DAYTON, Minnesota 

FRANK LAUTENBERG, New Jersey 

MARK PRYOR, Arkansas

MICHAEL D. BOPP, Staff Director and Chief Counsel 

JOYCE RECHTSCHAFFEN, Minority Staff Director and Counsel 

AMY B. NEWHOUSE, Chief Clerk

PERMANENT COMMITTEE ON INVESTIGATIONS 

NORM COLEMAN, Minnesota, Chairman 

TED STEVENS, Alaska 

GEORGE V. VOINOVICH, Ohio 

ARLEN SPECTER, Pennsylvania 

ROBERT F. BENNETT, Utah 

PETER G. FITZGERALD, Illinois 

JOHN E. SUNUNU, New Hampshire 

RICHARD C. SHELBY, Alabama 

CARL LEVIN, Michigan 

DANIEL K. AKAKA, Hawaii 

RICHARD J. DURBIN, Illinois 

THOMAS R. CARPER, Delaware 

MARK DAYTON, Minnesota 

FRANK LAUTENBERG, New Jersey 

MARK PRYOR, Arkansas

RAYMOND V. SHEPHERD, III, Staff Director and Chief Counsel 

JOSEPH V. KENNEDY, General Counsel 

ELISE J. BEAN, Minority Staff Director and Chief Counsel 

MARY D. ROBERTSON, Chief Clerk 

(III)

C O N T E N T S 

Opening statement: Page 

Senator Coleman .............................................................................................. 1

Closing statement: 

Senator Coleman .............................................................................................. 31

WITNESSES 

WEDNESDAY, OCTOBER 8, 2003

Dianne Mandernach, Commissioner, Minnesota Department of Health, St. 

Paul, Minnesota ................................................................................................... 4

Michael T. Osterholm, Ph.D., MPH, Director, Center of Infectious Disease 

Research and Policy, and Professor, School of Public Health, University 

of Minnesota, Minneapolis, Minnesota ............................................................... 6

Jeff Spartz, HCMC Administrator, Hennepin County Medical Center, Minneapolis, Minnesota ............................................................................................. 15

Mary Quinn Crow, Vice President of Patient Care Services, Northfield Hospital, Northfield, Minnesota ................................................................................ 17

Ann Hoxie, Student Wellness Administrator, St. Paul Public Schools, St. 

Paul, Minnesota ................................................................................................... 19

Debra Herrmann, RN, PHN, LSN, District Lead Nurse, Marshall School 

District, Marshall, Minnesota ............................................................................. 22

Rob Benson, Superintendent, Floodwood School District, Floodwater, Minnesota .................................................................................................................... 24

ALPHABETICAL LIST OF WITNESSES

Benson, Rob: 

Testimony .......................................................................................................... 24

Prepared statement with an attachment ....................................................... 58

Crow, Mary Quinn: 

Testimony .......................................................................................................... 17

Prepared statement .......................................................................................... 48

Herrmann, Debra, RN, PHN, LSN: 

Testimony .......................................................................................................... 22

Prepared statement .......................................................................................... 56

Hoxie, Ann: 

Testimony .......................................................................................................... 19

Prepared statement .......................................................................................... 51

Mandernach, Dianne: 

Testimony .......................................................................................................... 4

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

Osterholm, Michael, T., Ph.D., MPH: 

Testimony .......................................................................................................... 6

Prepared statement .......................................................................................... 36

Spartz, Jeff: 

Testimony .......................................................................................................... 15

Prepared statement .......................................................................................... 43

APPENDIX 

Donna J. Spannaus-Martin, Ph.D., CLS (NCA), Director and Associate Professor, Division of Medical Technology, University of Minnesota, prepared 

statement .............................................................................................................. 61

(1)

SARS: IS MINNESOTA PREPARED? 

WEDNESDAY, OCTOBER 8, 2003

U.S. SENATE, PERMANENT SUBCOMMITTEE ON INVESTIGATIONS, OF THE COMMITTEE ON GOVERNMENTAL AFFAIRS, Washington, DC. 

The Subcommittee met, pursuant to notice, at 10:08 a.m., in 

room C350, St. Louis Park High School, Minneapolis, Minnesota, 

Hon. Norm Coleman, Chairman of the Subcommittee, presiding. 

Present: Senator Coleman. 

OPENING STATEMENT OF SENATOR COLEMAN 

Senator COLEMAN. This hearing of the Permanent Subcommittee 

on Investigations is called to order. It is a great pleasure to be at 

St. Louis Park High School this morning; one of the great high 

schools in the State of Minnesota and in America. Superintendent 

Pulliam, I believe, will say a few things, but I do want to say thank 

you to the district and to the school for affording us this opportunity to have a hearing on an issue that is very important to all 

Minnesotans throughout the State. And certainly today we will talk 

a little bit about the impact of the potential of a disease like SARS 

on schools and beyond. 

But as I said, it is a great pleasure to be here. And Superintendent, I would like to turn it over to you for a couple comments, first. 

Mr. PULLIAM. Thank you very much, Senator. Good morning to 

all of you, and especially to you, Senator Coleman. Welcome to St. 

Louis Park School District. 

This is a children-first community, a school district that today 

has 16 national merit scholars, and one we consider to be the bestkept secret in the Metro Area. 

We are very proud and pleased to host your hearing today. SARS 

certainly is a virus that we all need to heighten our awareness 

level of, and the fact that you are going to hold a hearing today 

in our community to discuss how prepared we might be, should an 

outbreak occur, certainly does do us a great credit as a State, and 

especially as a community. 

I would also like to welcome the members of the health community that are here. Welcome to St. Louis Park, but welcome to this 

particular hearing. Again, I want to thank you for taking the time 

to visit with our children, especially. Our students are very proud 

to have you here, and to be able to interact with you. It is a great 

credit to your support of public education. 

2

Senator COLEMAN. Thank you, Superintendent. Let me tout the 

St. Louis Park schools—16 national merit scholars, four of them 

semi-finalists, one of four blue ribbon schools, recently recognized 

by the U.S. Department of Education and the State of Minnesota. 

I think last year you had perfect ACT and SAT scores. Very rare. 

The year before, two perfect SAT scores. So an outstanding program. And we are working very hard. St. Louis Park has an assetbuilders program that we are working with, and I know our office 

is involved and looking for support for that program. It is really a 

wonderful model. So you have a great school here, great kids. And 

this is the future of Minnesota, and I am thrilled to be here. 

Mr. PULLIAM. Thank you very much. 

Senator COLEMAN. Thank you. Today’s hearing will focus on how 

Minnesota officials are preparing for a possible outbreak of SARS 

in the upcoming flu season. 

In the first outbreak of SARS, there were 8,098 cases in 28 countries. The United States experienced 29 total probable cases of 

SARS—with the median age being 33—and thankfully no fatalities. 

Throughout the world, however, 916 people died of SARS-related 

complications. 

We are here today to discuss what we can do to ensure that the 

next outbreak of SARS isn’t summarized with statistics of who got 

sick and died—but rather a case study that illustrates how lives 

can be saved when government and the health care communities—

at every level—work together, not just hoping for the best, but 

being prepared for the worst. 

Today’s hearing gives us an excellent opportunity to assess our 

preparedness. We will hear from two of Minnesota’s leaders in the 

area of public health and infectious disease. We will also hear from 

local officials, and, in particular school, officials who represent the 

front line of our effort to contain any future outbreak. 

In a way, we’re here to see what kind of grade we can give ourselves in Minnesota for our level of preparedness and our access to 

resources. 

In the end, our resolve ought to be to improve the grade in those 

areas where effort is being made, but greater results need to be 

seen. We should grade ourselves in a number of areas: Preparation, 

communication, resources, logistics, and, of course, understanding 

and knowledge of the disease. 

We will discuss the particular vulnerability of school children 

and workers, where students and adults spend the majority of their 

time in close contact. Any parent knows how one child’s cold can 

spread throughout an entire classroom—and throughout the homes 

of those students—within a matter of days. And, as a parent, I can 

attest to that. 

Since failure to detect early cases of SARS can lead to rapid 

transmission, and also the great stress on resources to track down 

transmission, school officials must have a clear plan for treating individuals with symptoms of severe influenza or pneumonia. 

Since there is no reliable test for identifying SARS at the time 

of initial diagnosis, school and health officials must operate amidst 

a great deal of uncertainty. It is important that this uncertainty 

not create panic among schoolmates and their parents. The fact is, 

every sniffle and every cold in schools and homes across America 

3

this fall and winter will be met with suspicion. With that in mind, 

we need to recognize that it is possible that we will have many 

false alerts before the first cases of SARS appear anywhere in the 

world. 

Since false alarms can overwhelm a public health system, and 

with it reduce our capacity to react with precision and accuracy to 

those true incidents of the disease, we must be ready for that, understand that. 

For this reason, the public needs to be aware of SARS; to know 

what it is, to know what it isn’t, to know what our officials have 

done to prepare for the flu season. Knowing that public health officials and others are undertaking these precautions, I believe, will 

instill a greater degree of trust during times of illness. 

The Permanent Subcommittee on Investigations has already conducted two hearings on SARS. In its first hearing on May 21, 2003, 

a large panel of experts testified that SARS is likely to reemerge, 

possibly in conjunction with the typical flu season. Dr. Osterholm 

was a key witness at that hearing. As a result of that hearing, I 

requested that the General Accounting Office conduct a study of 

best practices to identify, treat, and control SARS. 

The GAO reported its finding on June 30, 2003, at our second 

hearing. The GAO testified that a new outbreak of SARS would 

quickly strain local health care resources. It also emphasized that 

many of the best practices for dealing with SARS were already 

known to health care workers: Wash hands frequently—that is one 

of the things I found reassuring—the advice that our mothers all 

told us, wash our hands, is very good advice—listen to your mom. 

Isolate patients who show symptoms of frequent coughing and/or 

sneezing. And move quickly to trace known contacts. 

Knowing what to do and actually doing it are two different 

things. I organized today’s hearing to focus on the concrete steps 

necessary to ensure that we are prepared for a new case of SARS. 

Many of these same steps will also improve our response to other 

cases of the flu, as well as other emerging diseases. 

I have asked each of today’s witnesses to address three questions: First, what have they done so far to prepare for a possible 

outbreak of SARS? Second, what do they still need to do? In this 

connection, I also want to know what help the Federal Government 

should be providing. Third, if a suspected SARS case occurs within 

a school or workplace, how should people react? 

The last question is especially important, because it will take us 

some time to verify whether a suspected case is actually SARS. 

SARS is dangerous. First it is highly contagious. One person roaming untreated can infect dozens, even hundreds of other individuals. Second, it has a high mortality rate. Roughly 15 percent of 

the individuals who contracted SARS died from it. For individuals 

over 60 years old, the morality rate was 50 percent. 

Most individuals with serious symptoms are likely to have something else, less infectious and less lethal. Because SARS is such a 

danger, we must remain vigilant and aware of the risks that SARS 

poses. Toronto’s experience shows us what one or two unrecognized 

cases can lead to. At the same time, we must avoid a sense of 

panic. Our society depends on continued interaction at a variety of 

4

1The prepared statement of Ms. Mandernach appears in the Appendix on page 32. 

levels. SARS threatens this. As a result, the indirect economic and 

social effects of SARS far outweigh the direct cost of the illness. 

Our goal, in the end, is not to give rise to unrealistic expectations 

of what we can, and cannot do, to prevent an outbreak of SARS. 

It is a foregone conclusion that we will see more cases of SARS in 

our country and across the world. 

In the end, we must be prepared with more than hope and prayers to confront this disease. We must have knowledge, coordination, 

communication, resources, and partnership to prevent SARS from 

wreaking havoc on people throughout the world. 

And with that, I would now like to welcome today’s first panel 

of witnesses: Dianne Mandernach, the Commissioner of the Minnesota Department of Health in St. Paul, and Dr. Michael T. 

Osterholm, the Director of the Center for Infectious Disease Research and Policy at the University of Minnesota in Minneapolis. 

I thank both of you for your attendance at today’s important hearing, and look forward to hearing your perspective on the three 

questions that I identified before. What has Minnesota done to prepare for a possible outbreak of SARS this year? What would we 

still need to do, and how can the Federal Government help? And 

how should schools, businesses and communities respond when 

someone they know develops a possible case of SARS? 

Before we begin, pursuant to Rule 6, all witnesses who testify before the Subcommittee are required to be sworn. At this time I 

would ask you to please stand and raise your right hand. 

[Witness sworn.] 

Senator COLEMAN. While your written testimony will be presented in the record in its entirety, we ask that you limit oral testimony to no more than 5 minutes. Commissioner Mandernach, we 

will have you go first with your testimony. You may proceed. 

TESTIMONY OF DIANNE MANDERNACH,1 COMMISSIONER, 

MINNESOTA DEPARTMENT OF HEALTH, ST. PAUL, MINNESOTA 

Ms. MANDERNACH. Good morning, Mr. Chairman. Thank you for 

the opportunity to discuss what Minnesota has done in preparation 

for SARS, or potential return of the SARS issue. 

In many respects, Minnesota got off easy during last year’s SARS 

outbreak. Using the CDC’s definition, we had only 11 possible cases 

of SARS, and none of them were actually or eventually confirmed 

in the laboratory. Still, we recommended isolation for a number of 

people with possible SARS, and we placed many of the health care 

workers who cared for these people under close observation for 

symptoms of SARS. 

Next time, the impact of SARS in our State could be much greater. The Minnesota Department of Health, local public health agencies, and hospitals are preparing for it in a number of ways. I 

would like to address four of those initiatives. 

First, we are working to maintain and strengthen our disease 

surveillance system, which is already recognized as one of the best 

in the country. Our State public health lab is prepared to provide 

diagnostic testing of SARS. The lab will play a key role in providing coordination and technical support for public health and 

5

medical laboratories throughout the State as they respond to the 

threat of SARS. 

We are also working to strengthen the disease surveillance role 

of infection control professionals in our hospitals throughout the 

State. This group of professionals is in a unique position to identify 

the possible cases of SARS, both in patients and in health care 

workers. 

Second, we recognize that in the absence of an effective vaccine 

or treatment, isolation and quarantine will continue to be our primary tools for containing SARS. Minnesota State law currently 

provides a legal framework for isolation and quarantine. This law 

is due to sunset in 2004. We are working with our legislative partners to ensure that we retain the right and the authority after the 

law sunsets for quarantine and isolation. 

The protection of rights that this law provides for people who are 

subject to quarantine is vitally important. We need clear procedures for implementing the law, and we are working out the details 

with the State attorney general, county attorneys, judges and the 

law enforcement officials. We also need adequate resources if we 

are to deal with a large number of SARS cases out in the community, rather than just a limited number in a health care setting. 

Next time around, we may need to isolate or quarantine large 

numbers of people, both in the hospital and at home. We are working with a challenge of providing food and other vital services to 

those individuals who would be quarantined in their home. 

Third, we need effective procedures to prevent the spread of 

SARS in hospitals and clinics. We are working with the infection 

control professionals to develop procedures for controlling the 

spread of SARS to patients, staff, and visitors in the hospital setting. We are also working on upgrading protocols for clinics and 

ambulatory care settings with an emphasis on controlling the airborne spread of respiratory illness. 

Fourth, we must be prepared to communicate effectively with the 

public about SARS. What is happening, what are we doing about 

it, and why are we doing it? That is essential if we want people 

to cooperate and accept the measures associated with isolation and 

quarantine. Those communication methods are being developed as 

we speak. 

That is some of what Minnesota has done in terms of being prepared, anticipating this. But we also need help at the Federal level. 

Adequate Federal support will be critically important in responding 

to a possible outbreak of SARS, and that support can come in a 

number of ways. I have five specific recommendations. 

No. 1, a successful response must be coordinated at the national 

and the international level. We have a global community. We need 

rapid reporting, investigation and sharing of information by the 

CDC. That coordination is best achieved at the Federal level. 

No. 2, we need a stockpile of the personal protective equipment 

and other supplies required for isolating large numbers of people, 

including items like masks, gowns, gloves, and goggles, separate 

from the existing national stockpile of medical supplies. For example, we have learned from the Canadian experience that you need 

5,000 N–95 masks to care for each SARS patient. These items are 

needed for the protection of both the patients and the health care 

6

1The prepared statement of Mr. Osterholm appears in the Appendix on page 36. 

workers. Health care workers may be unwilling to care for others 

if they are fearful of becoming infected themselves. 

No. 3, we need help in developing the surge capacity for handling 

a large outbreak; hospital beds, hospital workers, and the resources 

needed for large-scale quarantine. We will need just-in-time training that is similar across the country. Hospitals are likely to be 

overwhelmed during a large-scale outbreak, which would drastically increase the staffing needs, while reducing the staff available. When hospital workers could become ill, this would increase 

the workforce shortage issue. Non-SARS cases may need to be diverted to other sources of care. 

No. 4, the financial impact of SARS could also be significant and 

burdensome; escalating costs for hospitals, the financial risk for 

physicians and hospital workers, and lost income for people placed 

in isolation or quarantine. An emergency fund similar to natural 

disaster insurance could help compensate for those costs. 

And finally, No. 5, we need to begin aggressive research on vaccine, treatment and a better test for SARS. That will require leadership at the Federal level. I want to emphasize that preparedness 

for SARS and other public health emergencies is a long-term commitment. We need to sustain the generous funding that the Federal 

Government has given us in terms of providing opportunities and 

for preparedness. At the same time, we need to make very certain 

that these resources do not come at the risk of cutting our other 

programs. This occurred in the 1980’s, where critical public health 

issues and initiatives were cut, and it led to the resurgence of diseases like TB and measles. We cannot repeat that experience. 

Thank you for your time and your support in looking to be prepared for the issue that may emerge again this season. Thank you. 

Senator COLEMAN. Thank you, Commissioner Mandernach for 

your testimony. 

Before Dr. Osterholm I would like to note the presence of the 

State epidemiologist, Dr. Harry Hull. Pleased to have you here. 

And certainly, Dr. Osterholm, you are familiar with that position. 

So it is great to have you here. And with that, I will turn it over 

to Dr. Osterholm. 

TESTIMONY OF MICHAEL T. OSTERHOLM, Ph.D., MPH,1 DIRECTOR, CENTER OF INFECTIOUS DISEASE RESEARCH AND 

POLICY, AND PROFESSOR, SCHOOL OF PUBLIC HEALTH, 

UNIVERSITY OF MINNESOTA, MINNEAPOLIS, MINNESOTA 

Mr. OSTERHOLM. Thank you, Mr. Chairman. My name is Michael 

Osterholm. I am the Director for The Center of Infectious Disease 

Research and Policy at the University of Minnesota, and also a professor at the School of Public Health at the University. And I serve 

as a special advisor to Secretary Tommy Thompson and the Department of Health and Human Services. I had a chance to talk to 

both of them last night, and they wanted me to share my warm regards for you. 

As you are aware, I had the opportunity to testify at your first 

hearing on SARS regarding State and local preparedness. Mr. 

Chairman, I continue to applaud your efforts, and those of the 

7

members of staff of the Subcommittee to address this very critical 

issue, the effectiveness of our Nation’s response to Severe Acute 

Respiratory Syndrome, SARS. 

As I indicated in my testimony last May, I believe that this international public health crisis is here to stay. It will impose an everincreasing risk to the citizens of the United States. As you may recall, in the first hearing, Senator Lautenberg asked Drs. Gerberding, Fauci, and me if we believe the SARS virus will return. 

We all answered in the affirmative, and even commented that 

though it appeared to be eliminated from the Toronto area, it may 

have been a prematurely declared victory. 

Two days later, the second wave of SARS hit the Toronto area, 

and it would be another 6 weeks before that outbreak could be 

brought under control. I also suggested at that time that the reduction of new cases of SARS throughout the world was due in part 

to the heroic efforts of public health and nursing communities, and 

the likely waning of cases with the oncoming summer months. I 

still believe that conclusion to be true. 

I am convinced that with the advent of winter in the northern 

hemisphere just a few months away, we may very well see a resurgence of SARS that could far exceed the experience of last year. We 

have every reason to believe that this disease may show up in multiple U.S. cities as we continue to travel around the world in unprecedented numbers and speed. With this backdrop, let me provide a few comments on State and local preparedness. 

First of all, I want to compliment Commissioner Mandernach and 

the staff of the Minnesota Department of Health for what I believe 

is an outstanding response to the possibility of SARS here in Minnesota, both in terms of their activities this last spring and the ongoing efforts to prepare us for the possibility of SARS this next 

winter. I think the Commissioner has provided a very thoughtful 

outline of issues that confront us as a State in terms of preparedness as we move into this winter season. I think it is extremely 

comprehensive, and one that I believe with every point. 

I, too, believe that Minnesota got off very easy in the last SARS 

outbreak. Make no mistake, we were just lucky. We have all had 

an opportunity to witness the SARS outbreaks in Asia and Toronto 

by the extensive news media coverage. However, unless you were 

there, it is very difficult to get a true sense of the impact of this 

disease on the community. To better understand that impact, I 

would urge all of you to review the testimony of the hearings conducted last week by the Canadian SARS Commission. 

Three days of chilling and frightful testimony from elected officials, health care workers, patient contacts, and citizens can be 

found on the SARS Commission website, WWW.SARScommission.CA. In addition, I urge all of you to read the 234-page report 

released this week by the SARS Commission. It is highly critical 

of Canada’s level of preparedness last spring, and its preparedness 

now to deal with the resurgence. 

After reading these firsthand accounts of the many issues facing 

officials charged with stopping the epidemic, health care administrators, and workers responsible for patient care, you will get a 

sense of the complexity of the SARS preparedness and response 

issue. 

8

Very shortly, the Centers for Disease Control and Prevention will 

issue a document, Public Health Guidance for Community Level 

Preparedness in Response to SARS. I have a draft copy of it here 

that is currently going through the Department of Health and 

Human Services’ final approval. 

The CDC has undertaken an extensive review of the outbreak investigation data from Asia and Canada, and together with representatives of professional organizations and State and local 

health partners, have developed this very extensive guidance document. It contains a comprehensive overview of SARS, preparedness 

and response, a review of necessary command and control structure, required for response, the rationale and goals, as well as 

plans for SARS surveillance, necessary preparedness and response 

in health care facilities, the rationale and goals as well as methods 

for community containment, the management for international 

travel-related risk, laboratory diagnosis, and finally, a review of the 

need for comprehensive communication and education. 

Our great challenge will be to translate this information into 

meaningful State and local preparedness plans, and identify the 

necessary resources for comprehensive implementation, should 

SARS cases return. Unfortunately, I am not optimistic that we are 

prepared at the State or local level to do this at this time. And that 

is any State or local level within this country. 

SARS preparedness goes well beyond State and local public 

health systems. It also includes our health care delivery system of 

hospitals, nursing homes and medical clinics. Today, we are all too 

well aware of the lack of any substantial surge capacity in our 

health care delivery system for public health emergencies due to 

serious financial limitations and an aging and vanishing work 

force. 

Mr. Chairman, I don’t expect, nor do I believe, anyone in this 

room expects that your Subcommittee can take on all of these critical issues and solve them overnight. If you did, we would be one 

very grateful Nation. Thus, we must be honest with the citizens of 

this country in establishing the expectations that should a problem 

like SARS occur in any of our communities, the health care delivery system, just like in Toronto, has every potential to be overrun. 

This will not be solved by a simple discussion about what do we 

do to respond to SARS, but will require a much larger government 

and citizen-based examination of how we address health care financing and our expectations of medical care delivery here in this 

country. 

For example, in this country, there is an estimated 43.6 million 

Americans without health care insurance. It is difficult for public 

health authorities to urge citizens who might be in the earliest 

stages of the disease such as SARS to seek effective medical care 

if they can’t pay for it. Yet, infectious disease containment requires 

that these patients are quickly identified and isolated. 

There are many other barriers to providing a comprehensive and 

effective response to a potential SARS problem. For example, Commissioner Mandernach mentioned the important need for using historically time-tested tools of quarantine and isolation. I remind 

you, quarantine is the following or surveillance of individuals who 

9

may have been exposed to an infectious agent, but have not yet developed symptoms. 

With the SARS epidemic in Canada, the quarantine approach 

largely was a voluntary effort where individuals were notified of 

their possible exposure, and asked to stay home and report to 

health officials at the earliest signs or symptoms, should they become ill. While in practice this makes great sense and can be extremely effective, there are issues regarding the reimbursement of 

these individuals who stay away from work and do subsequently 

lose their wages, even their jobs, as happened in Toronto. 

Senator COLEMAN. I would ask that you summarize, if you can. 

And for the record, your entire statement will be submitted. 

Mr. OSTERHOLM. For the public good, we must find every possible 

way we can to financially and socially support these individuals. 

We will need to apply with such action as to contain the SARS epidemic. We have none at this time. 

Mr. Chairman, I would suggest that while there are numerous 

competing priorities for homeland security and public health preparedness, we can’t expect a wish list to be our top priority. Having 

said that, we are not honest as public health, health care and 

health delivery system professionals and elected leaders if we take 

consolation in cosmetic answers. We will be held accountable one 

day, just as is happening now in Canada, to explain why we 

weren’t prepared to handle this or similar infectious disease problems. 

We look forward to working very closely with your Subcommittee 

to set the agenda for determining what and how the Federal Government can help us at the State and local level to prepare for this 

potentially difficult situation. 

Thank you, Mr. Chairman, for this opportunity to appear before 

you today. 

Senator COLEMAN. Thank you very much, Dr. Osterholm. Let me 

throw out the first question. We haven’t heard much about SARS 

for a while—whether it is fabulous outside—the cold and flu season 

isn’t upon us yet. It has been pretty quiet. Both Dr. Osterholm and 

Commissioner Mandernach, are you surprised at the lack of activity? As we sit here today, how likely is it that we will see cases 

of SARS in Minnesota in the coming months? 

Mr. OSTERHOLM. Well, first of all, it has been relatively quiet, as 

you may know. We actually had a confirmed case of SARS that occurred approximately 3 weeks ago in Singapore. A laboratory worker that we believe actually was associated with ongoing contamination within that laboratory from SARS isolates that were obtained 

last spring. This always is a reminder to us that that virus is still 

out there, even in laboratories. And for no other reason, somebody 

who may want to potentially initiate a situation can do so without 

Mother Nature being involved. That was not the case here, but is 

a reminder of that. 

As far as the potential for this to come back, I think that we believe it is very high. Once you have a virus like this in a reservoir 

or a location of animals that are wild in the population or confiscated and used for a food source, that is a constant source of that 

virus being reintroduced into the population, much like influenza 

or other seasonal viruses like that. So I think it is possible. Will 

10

it come to Minnesota? That is the million-dollar question. And 

frankly, it is a crapshoot. I hope not, but I think we have to be prepared for that event. 

Senator COLEMAN. Dr. Mandernach, anything you have to add to 

that? 

Ms. MANDERNACH. I would agree with those comments. I think 

one of the issues that when we look at the global nature of our 

economy, even in Minnesota, and the fact that we have daily transport in and out of the major metropolitan airport, that leads to 

issues in one part of the world coming to Minnesota, too. 

Senator COLEMAN. OK. Dr. Osterholm, you have continued to 

raise concerns about the level of preparation at the State and local 

level. From the course of hearings I have had, I get a sense the 

CDC has done a pretty good job, I think a very good job, of getting 

information out. That even in the most rural areas, that their 

health care professionals are aware of the information that is out 

there. Help me understand the nature of your concern, and talk to 

me about how we address it. 

Mr. OSTERHOLM. Mr. Chairman, again, as I laid out in my testimony, this is a response that is going to require a number of different arms in our local and State partners. The health care delivery system, which you are going to hear more about today in the 

next panel, is going to be a very key partner. And today we don’t 

have the surge capacity to basically allow us to quickly respond in 

a way that is going to effectively shut this down. 

Senator COLEMAN. Can you explain surge capacity, please? 

Mr. OSTERHOLM. Surge capacity is where suddenly if hundreds, 

thousands of individuals need to be seen, and health care provided. 

And in many instances, these individuals may be actually put into 

certain kinds of rooms, called protective isolation rooms, where 

their air that they are sharing with all of us will not go and affect 

others. That is exactly what happened in Toronto. We had a number of examples where patients who were infected with the SARS 

virus were in open rooms like this, and infected a number of other 

individuals, and it became an epidemic. In this State, we have a 

very limited number of those beds available. They are expensive to 

maintain, require certain ventilation characteristics, and require 

other very specified types of equipment. And on any one given day, 

most of those beds are already being used for transplant patients, 

cancer patients, etc., so we just don’t have that ability. And the 

same thing is true that as Commissioner Mandernach mentioned 

about masks, we have a just-in-time delivery system today for so 

much of our economy. There are only a very few companies in this 

world that actually produce N–95 masks for a high level of protection. And one of them is right here in the Twin Cities, the 3M Company. I can tell you that last year, at the height of the SARS epidemic, 3M Company was backlogged by years for orders of N–95 

masks without much capacity to expand their production. So the 

point is that if we get into this next season, and because of the way 

we run our economy, the just-in-time delivery phenomenon, we will 

run out of N–95 masks, I think Commissioner Mandernach said 

very clearly, are we going to have health care workers who refuse 

even to come to work, because now they’re concerned that basically 

coming to work is putting their life on the line. And I think those 

11

issues are much larger than this Subcommittee can directly deal 

with, but we have got to have that discussion, or we won’t be able 

to contain that here in this community. 

Senator COLEMAN. Commissioner, you gave a figure as to the 

number of masks per patient. I thought I misheard the figure. 

Could you give that figure again? 

Ms. MANDERNACH. Five thousand per patient. 

Senator COLEMAN. Per patient. Pretty stunning. You also raised, 

Commissioner, an issue that I haven’t heard a lot of discussion 

about. And that is the economic consequences of dealing with isolation and quarantine. I presume someone has still got to pay a 

mortgage, pay rent for their family, if we have isolation and quarantine. 

Can you give us a better sense of what we have done to address 

that, and what are the possibilities, and where do we have to go 

to deal with that issue? 

Ms. MANDERNACH. I think, Mr. Chairman, that is one of the 

things as we begin to look at the ramifications of quarantine and 

isolation, there is so much that we have not thought through completely, but we have individuals that we can begin to talk with, and 

that is the Toronto people. I had an opportunity to hear my counterpart talk about the Toronto experience. And when you look at 

individuals who were in their home that needed food, and yet they 

couldn’t go to the grocery store, there’s that whole aspect. 

There is also the issue of yes, they can’t have employment during 

that time, so how do you make them whole? Or do you make them 

whole on their wages? And yet at the same time, they have their 

bills that they have to pay for the economy of their household. How 

do you do that? The ramifications that Toronto individuals talked 

about are huge. How they begin to prepare for that aspect, and 

look at all of those ramifications, I think that really needs to be 

done at the national level, whether that is a FEMA type model, I 

am not certain. But it is going to take a much wider source of funding than any one State. 

I think there is also the aspect of what happens to the institutions, the physician practices. If the physician is one of the people 

who gets sick, what happens to his source of income? What happens to his patients? What happens to his practice? What happens 

to the clinics and the hospitals that care for these people, and 

maybe have to divert their elective procedures, which tend to be 

revenue-producing, to take care of these other individuals. The 

ramifications of this really need to be examined seriously. 

Senator COLEMAN. You have mentioned the issue of physicians 

perhaps being sick. And either Commissioner Mandernach or Dr. 

Osterholm, tell me a little bit about the incidents of SARS among 

health care professionals, and as the Toronto and Chinese examples went on, how much better did we get at dealing with that? 

And it has multiple questions, but they all kind of fit together. How 

would you assess that risk today? 

Mr. OSTERHOLM. Well, there are several, almost what I would 

call perfect storm factors, that come together to make this really 

a very difficult issue. First of all, we do not have a good laboratory 

test that will identify a SARS patient when they walk into the office or into the health care facility. So in a sense, we are going to 

12

have to treat a lot of people who may have similar symptoms to 

early SARS as possible SARS cases. That by itself creates a very 

major economic disincentive for an institution to want to see SARS 

patients. 

Senator COLEMAN. If I could interrupt you there, if you call your 

doctor and you have a bad cold—I have had bad colds. What is the 

difference today when I go see my doctor versus pre-SARS in terms 

of the way that they are going to respond? I am just calling and 

saying, ‘‘Doc, I have got a cold that is just killing me.’’ Can you 

help us practically understand what it is that we are looking for 

here? 

Mr. OSTERHOLM. Well, first of all, you have to put it in the sense 

of time and place. If you wake up in a sweat in Minneapolis and 

hear hoof beats, it is probably not SARS. But if you wake up in 

Kenya, it might be. So one of the things is if we don’t have SARS 

already here in this country or evidence of anywhere in the world, 

it is not likely that any physician today is going to immediately 

consider that respiratory illness that you have is SARS. But we 

have to have a very tight interface to know that in some parts of 

the world we are going to have to be extra vigilant, and that will 

be the first alarm that gets sounded. 

So today I think anyone who comes with a respiratory illness in 

this country would not be automatically thought of SARS. But in 

the presence of SARS, that is going to be complicated, because by 

the time someone becomes infectious with the SARS virus, they 

may not have much more than a cough, some cases are going to 

be difficult to distinguish from other respiratory illnesses, and that 

was exactly the experience in Toronto. 

Some of the patients we had up there we had transmitted—we 

had one woman, for example, who was the spouse of a severe case 

who developed a mild cough herself and some fever, and literally 

walked into an emergency room, talked to some emergency room 

admitting clerks, two other people in a period of 20 minutes, and 

transmitted SARS to everybody that she had contact with. And she 

was mildly ill at the time. So we are going to have a problem with 

that and there is no easy answer. So I think that is part of it right 

there. That we have got a problem of diagnosing these patients, 

and that is going to be a key one. 

I think the second piece of it is, you asked about how can we—

what can we do with doctors and so forth? We provide literally no 

support in this country for the concept of infection control. It is a 

nonrevenue generating activity in a hospital. Medicare or Medicaid, 

nobody is going to sit there and cover infection control practices. So 

when health care delivery systems get into tougher economic times, 

what is the first thing you look at as nonrevenue generating activities? Well, I think most health care administrators understand the 

importance of infection control. Today we have gnawed that down 

to the bone. And we, as a Nation, need to reinvest in the concept 

of a nonrevenue generating infection control as a classic first line 

of public health. Just those things would make a big difference for 

health care facilities attacking this problem. 

Senator COLEMAN. Do you want to add to that, Commissioner? 

Ms. MANDERNACH. I think another aspect of this, as the first 

cases begin to emerge, I would go back to the CDC as the clearing 

13

house for information. To have very quick, communicated information when a situation presents itself that can be dispersed throughout the country, so that the heightened recognition is on everyone’s 

radar screen. Just as Dr. Osterholm was talking, by the time the 

person comes in today in Minnesota, it wouldn’t be the first thing 

on your mind. But if there is a case, and then that is communicated, the recognition does come on to the radar screen. And so 

I think that is the role of the CDC, that real-time communication 

that can then move throughout the country. 

Senator COLEMAN. I got a sense in listening to the GAO and the 

CDC in my two hearings that there certainly is the capacity today 

with technology to get the information to smaller communities. I 

was a little more confident with that. But yet I would ask for your 

assessments, Commissioner and Doctor, as to how small communities are doing in terms of the resources to identify and treat possible cases of SARS. 

Ms. MANDERNACH. Mr. Chairman, certainly once—and I can 

speak from the small community that I was in. The health alert 

network is huge. When that information comes, and you get it to 

the people who are going to be treating individuals, the front line 

people, they have the information, so that they can then look for 

the symptoms, they can look for the recognition. Information is key, 

because that is going to raise the level of awareness. 

As far as resources, I think that is an ongoing issue, and that 

is going to be as particular as the community you are in. 

Senator COLEMAN. Dr. Osterholm. 

Mr. OSTERHOLM. Yes. First of all, public health has appropriately 

been accused of being a two-footed driver. On one foot, we really 

hit the accelerator and try to get people to take action and understand the importance of the situations. The other foot was simply 

putting on the brakes and saying, ‘‘Wait, wait, wait, you don’t need 

to panic.’’ And this is something that many of us in public health 

have to live with. It is just one of our birthrights, I guess. But 

being for the public, that two-footed driving is a very important activity, so we make sure we don’t create panic and fear where none 

should be. And at the same time, make sure that we get that information out. None of us have that answer down. But I would say 

that in the experience of last spring, I thought that as a whole, the 

news media handled the story quite responsibly. Some of the very 

best reporting I have seen on public health issues came out during 

that time in terms of trying to cover it. And so one of the other 

areas the CDC is working closely with is national news media 

sources to be sure, should something else happen, that there is access to accurate and very thoughtful, comprehensive information. 

Senator COLEMAN. OK. Commissioner, maybe I would ask you to 

grade yourself here, but we are in a school setting. What kind of 

grade would you give Minnesota and communities in terms of their 

level of preparedness today to deal with potential cases of SARS? 

Ms. MANDERNACH. Mr. Chairman, I would give them a B. I 

would give them a B at this point, because I believe that there has 

been a great deal of work that has been done. There has been planning with partnerships that are new partnerships. And that is how 

this is going to be handled. We are going to work together on this, 

and with nontraditional partners, so that public health and the 

14

acute care system are working closer than they ever have. That is 

good. We begin to look at our first responders, we begin to look at 

our law enforcement. They all have a role to play in this. And I 

would definitely feel that we are in a much better place than what 

we were. There is a great deal of concentration on SARS; that is 

the immediate issue. But what we have learned, and are learning 

as we go through, prepares us for the next infectious disease or 

public health issue, whatever it happens to be. And so we are well 

on the track. We are not at an A, but we are moving down the 

path. 

Senator COLEMAN. Dr. Osterholm, I would like you to respond. 

I will give you another aspect; on the national level. The Commissioner talked about things like stockpiling supplies and things. I 

don’t believe we are at the state of readiness that we should be. 

Can you give me your assessment and grade on the national level 

in terms of helping those at the local level, and also your assessment of Minnesota as you see it. 

Mr. OSTERHOLM. Mr. Chairman, let me just start by saying in 

Minnesota, I am glad my family lives here. That gives you my idea 

of a grade. I think that Minnesota Department of Health and the 

partners involved with this have done as good a job as any place 

in the country. And that gives me consolation. But having said 

that, I feel like sometimes public health is the medical officer on 

a big sinking ship, and everybody comes running to the medical officer and saying, ‘‘Keep this ship from sinking.’’ Well, what can the 

medical officer do about it? And I think part of what we have to 

recognize is that if we run out of masks in this country because we 

don’t have capacity to produce masks, or we don’t have any number 

of other things that we just talked about in place, such as the uninsured not going in early and making it more difficult—in Canada, 

that wasn’t a problem. They didn’t have an issue with uninsured 

people being turned away or not going in. Because, in fact, that 

was a big piece. The same thing is true when we talked about 

quarantine. If we can’t get people to comply because they look and 

say I have to make a choice here, do I lose my house or family or 

do I for the good of society stay home for 2 weeks? Those are issues 

well beyond what the Department of Health can do anything about. 

And so I think in that sense, nationally we have real issues here. 

We can stockpile some things, but we can’t stockpile masks. Those 

are the kinds of things we have to deal with. 

You are going to hear from Administrator Spartz, who is going 

to give you, I think, a very good view of one of the very best health 

care facilities in this country and their ability to expand quickly to 

take care of lots of patients. If that is not there, again, public 

health can only do so much. And so I think that we just have to 

recognize, these are the realities of where we sit today. And it is 

going to take a lot more than just preparing for SARS to be able 

to better prepare us for many of these oncoming potential catastrophes in our communities. 

Senator COLEMAN. I want to thank both of the witnesses. It has 

been very helpful, and this is a discussion that will continue. So 

thank you very much. 

Mr. OSTERHOLM. Thank you. 

Ms. MANDERNACH. Thank you. 

15

1The prepared statement of Mr. Spartz appears in the Appendix on page 43. 

Senator COLEMAN. I would now like to welcome our second panel 

of witnesses at today’s hearing. Our second panel of witnesses consists of Jeff Spartz, Administrator of Hennepin County Medical 

Center. Mary Quinn Crow, the Vice President of Patient Care Services at Northfield Hospital. Ann Hoxie, the Student Wellness Administrator of St. Paul Public Schools. And I would note Superintendent Pat Harvey is here with us today. Superintendent Harvey, thank you for being with us today. Debra Herrmann, District 

Lead Nurse of the Marshall School District. And Rob Benson, the 

Superintendent of the Floodwood School District. 

I welcome all of you to today’s hearing and look forward to hearing your perspective on three questions. What has Minnesota done 

to prepare for a possible outbreak of SARS this year? What do we 

still need to do, and how can the Federal Government help? And 

how should schools, businesses and communities respond when 

someone they know develops a possible case of SARS? 

As I noted, we have a panel. Before we begin, pursuant to Rule 

6, all witnesses who testify before this Subcommittee are required 

to be sworn. At this time I would ask you to please stand and raise 

your right hand. 

[Witnesses sworn.] 

Senator COLEMAN. All of your written testimony will be presented in its entirety in the record. I would ask that you limit your 

oral testimony to 5 minutes. Again, your written testimony will be 

entered into the record. And with that, we will start with Mr. 

Spartz. 

TESTIMONY OF JEFF SPARTZ,1 ADMINISTRATOR, HENNEPIN 

COUNTY MEDICAL CENTER, MINNEAPOLIS, MINNESOTA 

Mr. SPARTZ. Mr. Chairman, briefly, I will respond to your questions. The first one is what has Minnesota done to prepare for a 

possible outbreak of SARS this year. We start with Hennepin 

County Medical Center being the Center for Disease Control Global 

Migration and Quarantine facility for the State of Minnesota. We 

got the honor of handling the first case of a suspected infectious 

disease. Second, through the Minnesota Hospital Association, 

which has 130 or so hospital members in this State, we have put 

together what is called the Minneapolis-St. Paul Metropolitan Hospital Compact. That is a group of 27 hospitals. One of the few nationally that has been put together having a preexisting regional 

plan for dealing with infectious disease emergencies. The hospital 

compact is also working with local public health and emergency 

management agencies to explore other possible options, such as 

using facilities like the Minneapolis Convention Center, if you had 

a large number of infected individuals. We have also done a number of tabletop and functional exercises over the past several years, 

including one last December, Operation Snowball, which looked at 

a biological scenario called ‘‘Very Bad Disease.’’ We have learned a 

great deal from that with 350 individuals involved from around the 

State and region, and we are learning what issues have to be dealt 

with and how they handle these kinds of problems. 

16

And the Minnesota Department of Health is also using something called the Electronic Health Network to immediately inform 

the public and hospital contacts about critically important public 

health issues. MDH is also applying for a grant to conduct surveillance that basically goes on the model of preparing the home line. 

It is designed to follow health care workers who are suspected of 

being infected to make sure that they do not end up spreading the 

disease. 

Representatives from around the area have also been indoctrinated in the use of the Hospital Incident Command System, which 

is a way of handling major emergencies. Individual hospitals have 

also had the opportunity to test their infection control systems to 

look for areas of vulnerability. We have also identified those hospitals, as has been mentioned previously, that have negative air 

flow rooms so we can successfully isolate individuals who have 

SARS, or are suspected of having SARS. Twenty-three hospitals in 

the metropolitan area have such facilities, and they will be available. 

One of the critical areas that will fail in the event of a massive 

outbreak is our laboratory facilities, like our ICU units. They will 

be overwhelmed, and we as yet do not have a good answer of how 

to handle that. 

Second, the question is, what do we need to do and how can the 

Federal Government help? One of the problems we face in Minnesota is that one-third of the hospitals operated in the red last 

year. We don’t have a lot of financial reserves or stockpile capacity 

to prepare for events that may or may not happen. In the event of 

a massive SARS outbreak, because people will be told to stay home, 

people would avoid elective procedures. Many hospitals can go insolvent in a short period of time. The current Stafford Act provides 

for reimbursement in times of tragedies, or disasters, but it would 

be impossible to accommodate the needs of hospitals which are in 

desperate financial condition. Most of the clinics and hospitals in 

the State that provide patient care for SARS patients would be private entities, and thus, their responsibilities during a public health 

emergency would be voluntary. We need better mechanisms that 

involve all hospitals in planning for and responding to public 

health needs and emergencies. 

Hospital responsibilities and liabilities regarding quarantine are 

not well-defined and vary widely from State to State. We need 

more uniform Federal guidance in this area. 

Attention has been focused both by Commissioner Mandernach 

and Dr. Osterholm on surge capacity. We don’t have much surge 

capacity available in this metropolitan area, probably not in any 

metropolitan area in the country. The cost of having an ICU room 

available is very large, and it is impossible for hospitals to sustain 

if it is not used. Stockpiling ICU units somewhere, even if they are 

portable, is not the answer either, because the other component 

that we need is highly skilled people to manage those ICU units 

for patients. 

We have to have a Federal dialogue regarding how you best 

triage people in the event of a massive outbreak of a disease. Neither the public or the government at that point can expect the norVerDate 0ct 09 2002 09:44 Mar 11, 2004 Jkt 090241 PO 00000 Frm 00020 Fmt 6633 Sfmt 6633 C:\DOCS\90241.TXT SAFFAIRS PsN: PHOGAN
17

1The prepared statement of Ms. Crow appears in the Appendix on page 48. 

mal standard of care that we expect at times of nonviolent disasters. 

We also need better public health plans to manage public health 

care workers. Cases can cross city, county and State jurisdictions. 

We need to understand these plans have to go beyond the walls of 

any given health care facility, and we need to better coordinate 

with State and county public health systems. 

We should learn from the Toronto experience to determine the 

most appropriate way to monitor and manage exposed health care 

workers, when to quarantine them, and how else to handle them. 

We are pretty vulnerable in this area, and not much formal work 

has been done. 

The third question is how should schools, businesses, and communities respond when someone they know develops a possible 

case of SARS. We have to have better education of the public and 

professionals, and that needs to come from local media and our 

public health entities. We have to have appropriate guidelines and 

guidance of who should seek medical care and evaluation, and we 

should educate the public in advance, because they will cooperate 

better and respond better in the event of an outbreak. 

Senator COLEMAN. I would ask if you could sum up your testimony, and the entire testimony will be on the record. 

Mr. SPARTZ. OK. In summary, Mr. Chairman, I see this is really 

a three-legged stool. You have hospitals and their ability to respond 

for acute care. You have public health demanding to control the 

outbreak. And ultimately, though it is going to depend upon the response of individual citizens; do they follow the advice given to 

them by public health authorities, do they respond appropriately, 

and do they avoid panic? If we avoid that, we may have outbreaks, 

but we will not have massive outbreaks. Thank you for the opportunity to testify, Mr. Chairman. 

Senator COLEMAN. Thank you very much. Ms. Crow. 

TESTIMONY OF MARY QUINN CROW,1 VICE PRESIDENT OF PATIENT CARE SERVICES, NORTHFIELD HOSPITAL, NORTHFIELD, MINNESOTA 

Ms. CROW. Thank you for inviting me to speak today. I think 

that I am here more to tell a story that I hope will address the 

questions that you have asked. 

I am from Northfield, Minnesota, which is a community of about 

18,000, about 40 miles south of the metro area. Our community is 

the home of two prestigious colleges in the State—St. Olaf and 

Carlton. 

And in March of this past year, as we were beginning to train 

our physician staff and our medical staff about SARS and the 

emerging infection and what things that the Department of Health 

was telling us we needed to know, we started to pay close attention 

to this. Simultaneously, our respiratory staff at the hospital began 

a fairly time-consuming process of testing our staff with N–95 

masks, which we have heard about today. These are filtered masks 

that protect health care workers. We had to stop the training, because we ran out of masks and because they were back ordered, 

18

and 3M was our only supplier at that time. I am happy that we 

didn’t know that they were back ordered for years. We thought we 

were looking at about 9 weeks. 

However, in mid April, we received a call from the Wellness Center at one of the colleges that told us that 30 students who were 

traveling in China were being returned to campus because of the 

SARS outbreak in China, and that they were being returned because they had been visiting several areas where SARS was fairly 

epidemic. The college Wellness Center went to the hospital, requesting assistance for the management of these students. We were 

given approximately 5 days to develop a plan before the students 

would be back home in Northfield. Well, many meetings took place, 

as you can imagine, and we involved hospital leadership, hospital 

staff, ambulance staff, Wellness Centers and nurse practitioners 

and public health. And planning discussions included many, many 

issues. But I will give you the top of those. We looked at protocols, 

what we were going to teach these students when they returned in 

terms of how they needed to monitor themselves and protect the 

public. The Wellness Center was very concerned about their lack 

of ability to actually assess these patients, and the safety issues 

around bringing them into a small health center that did not have 

negative pressure. Hospital and triage and treatment of the ill students was also addressed. At that time, we were in a building that 

had no negative pressure availability, no ventilator availability, 

and we immediately needed to complete the N–95 fit testing for our 

emergency department staff or essential staff and get a supply of 

N–95 masks, so that we could at least triage these patients, should 

they come to the hospital. There was also a need to provide 24-hour 

medical direction to the college during that time, and that was 

done through the hospital emergency staff. 

There were transport issues we needed to consider. If one of 

these students did become ill and needed to be transported to the 

Metro, how were we going to protect our ambulance staff who 

would be in very close quarters with a potentially very infectious 

patient. And then we needed to develop a network with HCMC so 

that we understood what patients they would take, and how they 

would coordinate that transport to safely bring the patient into the 

exam system. Finally, we talked about isolation and quarantine. 

And this was perhaps our stickiest issue, surprisingly perhaps, but 

understand that in these colleges, we have to have some of the best 

thinkers in the State, and they clearly addressed the human rights 

issues of students to return to campus and to be able to come fully 

back into the community that they lived in. At that time, the only 

guidance from the CDC and the Department of Health was that 

unless you were symptomatic, you did not need to be isolated. However, we did realize we were bringing a high-risk group back to our 

community. So in the last week of April, ten students actually returned. Twenty students chose to return to their own communities, 

which I am uncertain as to how those communities dealt with that 

issue. They returned to the college campus from Beijing. The college had decided not to isolate these students. However, they did 

cohort them for sleeping and eating. But they were allowed to be 

completely involved in campus and community activities. They 

were also told, actually, at the airport where they were met by one 

19

1The prepared statement of Ms. Hoxie appears in the Appendix on page 51. 

of their deans, they were all given thermometers and told they 

needed to daily monitor their temperatures for 10 days, that they 

needed to report those daily temperatures to the Wellness Center 

by phone, and that they needed to report upper respiratory symptoms immediately, should they occur. Within about 48 hours, the 

first student reported a fever of 101 and upper respiratory symptoms. This was a patient that you asked about earlier—how do we 

know this isn’t a cold. This is the Kennedy person. They had been 

there. We really did have to consider that these were high-risk 

SARS patients. 

We decided that we would not bring the patient to health care. 

We did not have negative pressure in our hospital. The Wellness 

Center also did not have negative pressure available, and we felt 

that the safest thing to do was to assess this patient in his home. 

So our ambulance staff, which had been well-trained and now having protective equipment, was sent to the home of the patient 

where they did assess the patient to be indeed feverish with a 

upper respiratory infection, but not in respiratory distress. At that 

time, they communicated with our emergency department physician, who communicated with HCMC. And the decision was made 

to take the patient directly to HCMC to be evaluated for the potential of carrying SARS. The patient was kept at HCMC for about 12 

hours, and determined to be a suspect SARS case, and at that 

point discharged back to the community. He was at that time isolated for 2 weeks, and kept apart from everyone. Food was delivered to his door, where he picked it up and brought it in. And the 

only visitors he had were actually from the County Public Health 

Department to assess him. 

Senator COLEMAN. Could you summarize? 

Ms. CROW. Sure. I will. There were a number of issues, as I have 

talked about; supplies and equipment, training, the protective 

equipment for medical staff and ambulance staff, contingency planning, and then I guess high-level discussions that I believe need to 

occur around the ethics of isolation and quarantine. These are 

things I think we will face in the future. 

Senator COLEMAN. Thank you very much. Ms. Hoxie. 

TESTIMONY OF ANN HOXIE,1 STUDENT WELLNESS ADMINISTRATOR, ST. PAUL PUBLIC SCHOOLS, ST. PAUL, MINNESOTA 

Ms. HOXIE. Thank you, Senator Coleman. Our story in St. Paul 

is quite opposite. We did have a staff member whose child was hospitalized with a probable case of SARS following the child’s trip to 

Toronto. And so for us, it was really just a practice run, but we saw 

the issues that will arise. We looked at, what is our responsibility 

to 44,000 students and 600 staff, while continuing to run our business? How not to overreact, or what is the appropriate reaction in 

this sort of case? And then all of the worry and concern of the coworkers of the father and the need to protect the privacy of this 

family. We went into it with some baseline knowledge, because of 

all of the CDC communication we had. And we checked the Toronto 

school’s website to give us some other baseline information. Our superintendent, Dr. Patricia Harvey, spoke with Dr. Harry Hull, the 

20

State epidemiologist, to get information specific for a St. Paul response. And what we really felt is that we had information needs 

at that point. So we included a notice to all our administrators in 

the superintendents’ weekly bulletin that laid out what SARS is, 

what the symptoms are, and what’s appropriate attendance criteria 

for staff and students. But still, we got lots of questions. Despite 

giving lots of resources, putting a page on our website, with links 

to all of the right people. And then we did mention hand washing. 

We continued to stress that. 

So that situation was quickly resolved, but it does leave us better 

prepared to come here today and talk of what the future might 

hold. So I am trying to continue to stay informed, so that I can support our administrative decisions. We are going to offer flu shots 

to all our staff this fall, hoping that will help in the differential diagnosis kinds of things. We are continuing to stress the hand washing. But mainly, we are just educating our students. So, we look 

at what might be a specific response that we might need to do with 

students’ quarantine. And that was kind of one of our first things, 

how do you provide education to quarantined students. We know 

technology provides the potential and the opportunity to help us do 

that, but we are not ready for that at all. That is a possibility, but 

we have not developed that. What is our surge capacity in the 

schools to respond to educating kids at home? We can educate a 

few kids that are homebound, but we don’t have surge capacity to 

do that, either. We know that our parents have a pretty good degree of access to the internet, but much of that for our parents in 

St. Paul will be at the work place or in libraries, not at home. So 

that is not a good resource for us. 

The Federal Government can help us by continuing to support 

local public health. That is who we turn to for infectious disease 

help. We need strong leadership at the local level to help us respond to what occurs in our communities. And that professional 

health leadership is also going to need support from public safety 

officials. And then we need the Federal laws, rules, or policies in 

the State in support of the activities that need to be done. 

We also need real clear guidelines for schools. Isolation in a 

school setting is very difficult. I tried to picture exactly how we are 

going to do that, and we are quite a bit different than Carlton or 

St. Olaf in that we have much younger children, and we have lots 

of different languages, so that presents us with space issues. I don’t 

know exactly—and we have no supplies. Clearly, no surge capacity 

there for isolation. 

We need accurate messages in the media. That will be highly important to us. Accurate messages which are simple and consistent—in a way that our many second language households can 

understand. And you know, for a school district such as St. Paul, 

an urban district, where many of our families live in crowded 

homes, the disease can spread quite rapidly. Forty-one percent of 

our students come from homes where English is a second language, 

so the communication challenges are enormous. And while we have 

good interpreter support for education, we would be highly challenged to get our educational interpreters to understand these 

health issues, and to convey them. 

21

Many of our students—at times we estimate up to 20 percent of 

our students in some buildings do not have health coverage. So 

that issue we heard about earlier, about early access, is a real concern for us. Where do they get the medication, and where do they 

get diagnosis. And we know that will result in a burden on emergency rooms and neighborhood clinics. 

But directly, many of our families use the school nurse as the 

front line health care provider. We provide safety net services to 

meet the gaps in the health care delivery system, and we would anticipate that SARS would be a situation where many parents might 

call us, but many others might send their child to school to see the 

school nurse. And then we are going to sort out which of these are 

a cold and which are SARS. It is a huge challenge, when I begin 

to think about it. 

I think the Federal Government could help by recognizing the 

amount of front line health care that is provided, and not funded 

in schools. Take a look at that, and help us be available to provide 

those safety net services to kids. Schools are accountable to the 

educational standards in Leave No Child Behind, and we don’t 

have resources to put into health care and health education. And 

that is something we need. We need a comprehensive and coordinated school health program that can be ready to respond and can 

teach the kids about concepts of health prevention. 

Many of our students are from cultures that don’t have experience with Western medicine. We can’t give them thermometers and 

say, ‘‘Take your temperature twice a day.’’ There is no experience 

with that. 

In St. Paul, 67 percent of our students are eligible for free or reduced meals. That means that many of them rely on the two meals 

they receive at school. So feeding these kids at home when quarantined or in isolation situations is a challenge for the community. 

I think we have got to think about the data privacy issues, and 

certainly there are ways around that, but that is always an issue 

between systems. 

I might be remiss coming from schools if I didn’t mention that 

Leave No Child Behind has very high standards for us. If we went 

through a winter of a lot of absenteeism, quarantine, isolation, 

problems like these, what would happen to our accountability to 

that system? 

The question of how we respond, I think we do——

Senator COLEMAN. I would ask you if you could summarize. 

Ms. HOXIE. OK. We would respond by sending people home so 

they could be assessed. But that would be real challenging for us. 

We would be worried about kids being at home and not having anyone supervising them. Thank you. 

Senator COLEMAN. Thank you very much. Ms. Herrmann. 

22

1The prepared statement of Ms. Herrmann appears in the Appendix on page 56. 

TESTIMONY OF DEBRA HERRMANN, RN, PHN, LSN,1 DISTRICT 

LEAD NURSE, MARSHALL SCHOOL DISTRICT, MARSHALL, 

MINNESOTA 

Ms. HERRMANN. Thank you for allowing me to be here and inviting us from Greater Minnesota. I represent the southwest portion 

of the State. 

For what has Minnesota done to prepare for the possible outbreak of SARS this year, for us in our area of the State, we have 

received a lot of the information from the Department of Health, 

and the CDC websites. There is also lots of information and classes 

available. Many of the resources have been very medically-oriented 

for the hospitals, health care settings. So there has been limited information available to the schools and the procedures that we 

would actually have to follow, should there be an outbreak. 

In November this year, the School Nurses of Minnesota (SNOM) 

is holding a workshop, and SARS is one of the topics. So hopefully 

that will relate to some of the school issues. Many of the information educational opportunities are held in the metro area, and the 

time and the travel for those types of workshops at some times are 

very difficult. Although with a lot of technology, we are able to tap 

in and get a lot of those resources. 

In seeking out information regarding this prior to coming here, 

many of the things that I was told from our county emergency system, our public health system and our hospital and health care systems is they are still awaiting more information. They would be 

getting that to me, or to the schools. We do have a very good rapport with all of those agencies within our community and within 

the area communities. 

What do we still need to do, and how can the Federal Government help? We really need to be better prepared for identification 

and education to the public. Education and communication to our 

public is going to be a major problem, as you have seen here. We 

do have English language learners in our area, also. Our school 

district has—even just with the issues of pertussis—the education 

and the scare factor of many of the people in the community was 

huge with that. So the safety and the needs for that—the communication of correct and legitimate information is going to be of great 

need. 

We do have, like I say, the language and communication barriers 

in the school and the community. We also have many students that 

have no insurance. They also use the school nurses—the families 

will send their children to school and say, ‘‘I am going to the school 

nurse,’’ and they say, ‘‘if she thinks you need to go home, they will 

make that availability to them.’’ So we often times are a good 

health care resource for these kids who are seeking care or information—or families are sending them to us. We are the resources 

that these families use, due to the financial burden on them at 

other clinics. 

Another concern is the possible quarantine issue, while still providing the educational services. The reimbursement of the facility—

the faculty and the staff—that need to be under quarantine is a 

major question. Or should a larger outbreak occur, how would we 

23

even educate the students that we have in the schools, let alone the 

students that might be put on tutoring at home. And, again, with 

the No Child Left Behind law, the added burdens of that would be 

to the districts; that we would be able to adequately reach the students not in school. 

Again, we do have some of the technology and computer availability in our area, but the lower income population—as you know, 

many of these people do not have access to that at home, so it 

would be a burden on our areas. 

There are many unanswered questions at this time. We have limited financial resources. There has been additional funding cuts to 

the schools, so this does not allow a vast amount of time or manpower for us to be committed to the procedural development and 

research that needs to take place. So we are awaiting further information and recommendations from the Department of Health, the 

Department of Education, and CDC regarding policies that we 

could possibly adopt and use within our area. So additional funding 

or procedures that we could easily merge into our area would be 

of great advantage. The dollars for the proper medical equipment—

and speaking of the hospital—we have two rooms in Marshall that 

would have the proper air exchange, and three in Willmar, Minnesota. So you are talking about the southwest portion of the 

State—five rooms that would have the equipment necessary. They 

are also having trouble getting the proper air flow masks that need 

to be available for them to use. And that is just for the county 

emergency management and the hospitals. That does not include 

covering the schools. 

How should schools, businesses, communities respond when 

someone they know develops a possible case of SARS? Really, a 

comprehensive plan needs to be developed and available to all of 

the agencies. It needs to address the health care facilities, as well 

as the schools, the businesses, and all agencies within the community. We do have a population that travels extensively, and so 

these types of outbreaks could be expected at any time. 

The Marshall Public School District, our health program is working in conjunction with the other local emergency management 

agencies, community health, and other local health care facilities to 

be a part of a workable plan on how to identify and educate our 

community regarding SARS if there were an outbreak. All of the 

agencies that I have listed are currently discussing policy and procedural development, but I cannot at this time find one agency that 

had a fully operational procedure that they could follow at this 

time, if there were to be a case of SARS. Again, we are awaiting 

further information. 

We, as a school, have no actual procedure or plan in place with 

a SARS outbreak. We would handle this under our communicable 

disease protocol and policy, as we handle any communicable disease, and we would be contacting and using our local public health 

agency tremendously, as well as our hospital, clinic and emergency 

management services to try to help get us through. Thank you very 

much. 

Senator COLEMAN. Thank you. It was very helpful. Mr. Benson. 

24

1The prepared statement of Mr. Benson appears in the Appendix on page 58. 

TESTIMONY OF ROB BENSON,1 SUPERINTENDENT, 

FLOODWOOD SCHOOL DISTRICT, FLOODWATER, MINNESOTA 

Mr. BENSON. I would like to thank Senator Coleman for inviting 

me to be a part of this panel. It is indeed an honor. 

I would like to start my presentation with some of my personal 

background and information on disease control. My earliest memory of disease control was when my older sister came home from 

school in Deer River with a case of the measles. So the disease 

would not spread to the little two-room school that my middle sister and I attended, we were quarantined. We could not go out in 

the public, so for 2 weeks, I helped my father in the logging operation. When I became sick with the measles, the disease had to run 

its course before I was allowed back in school. 

The second incident I would like to relate is my mother’s 1928 

teaching contract. My mother, like many young girls of the day, 

went to 8 weeks of summer school after high school graduation. 

That qualified her to teach in a rural elementary school. About 10 

years ago, while cleaning out the attic, I found her 1928 teaching 

contract. The thing that interested me in the contract was that it 

stated, ‘‘If said teacher married before or during the school year, 

it would void the contract.’’ I told my mother what a different world 

she lived in in 1928, than we live in today. I told her that if I put 

that into a teacher’s contract today, it would be discrimination, and 

would be taken out of the contract. To my surprise, my mother told 

me that that was not discrimination. She explained that in 1928, 

when people got married, they usually started a family. There was 

a fear that young, married women would be exposed to German 

measles, and the results would be children with birth defects. According to my mother, the reason that women of child-bearing age 

could not be in that environment, was to protect the unborn children from birth defects. 

The last incident I would like to relate is when I was a student 

at the University of Minnesota. Senator Humphrey gave a presentation at Coffman Memorial Union. Senator Humphrey’s presentation was on the advances in medicine, and what we could expect 

in the future. He talked about how smallpox would be eradicated 

worldwide. It was new at that time—polio vaccine, and how polio 

would soon be a thing of the past. He stated that by the year 2000, 

viruses would be no more. The common cold would be a thing of 

the past. Having a friend that had died from polio, and having several friends that were permanently paralyzed from polio, Senator 

Humphrey’s talk had an impact on them. I also remember that in 

1946, Minnesota cancelled the State Fair, for fear of spreading 

polio. 

The reason that we are here today is that school is a place where 

young people come together, and spread disease. 

We are here today addressing SARS, because disease is not a 

thing of the past. We realize that disease will never be a thing of 

the past. I represent a small school, 431 students. That is our kindergarten through 12 population. The town of Floodwood has a 

population of 502 people. Floodwood is virtually 40 miles away 

from services; be it Duluth, Grand Rapids, Hibbing, Cloquet or 

25

1 Article by Lisa K. Carsrud, RN, BSN, PHN, School Nurse, entitled ‘‘What You Need To Know 

About Severe Acute Respiratory Syndrome (SARS),’’ appears in the Appendix on page 60. 

Moose Lake. Floodwood is 40 miles away from a hospital. Floodwood has a medical clinic in town that is staffed by a doctor and 

a nurse practitioner. The doctor is the first full-time doctor that 

has practiced in Floodwood for nearly 50 years. The school has a 

licensed public health nurse that is on staff 12 hours a week. This 

is an increased time from last year, when the nurse was on duty 

just 71⁄2 hours a week, and that is thanks to a grant from the 

Northland Foundation. 

What are our plans in case of a SARS outbreak? Well, we depend 

on our school nurse. The problem is, like many other small, rural 

schools, or larger schools that assign a nurse to several buildings, 

the funding is not available to employ a full-time nurse to each 

building. Since ours is a part-time position, we have a difficult time 

keeping that position filled, and this puts our students at an additional risk on many days the nurse is not in the building. 

I have handed out an article that our nurse is publishing in our 

Bear Facts, our monthly school newspaper. She gleaned this information from the internet at WWW.CDC.GOV.1

Senator COLEMAN. I will have that article placed into the record. 

Mr. BENSON. It is the Centers for Disease Control. Every month 

she writes that article for the school newspaper. 

I was asked to address how the government could help with disease control in schools. In our situation, the government could help 

by assuring funding so the communities could have a full-time public health nurse in all school buildings. SARS is not the only concern that schools face today. We have children that are diabetic, 

children that are allergic to foods, children that are on various 

medication, and a list that goes on and on. A full-time nurse is an 

essential addition to our schools. We now live in a global economy. 

Schools now need a full-time person in each building that can address the health problems of students in that building, as they 

arise. The problems are not diminishing, as Senator Humphrey 

said they would. Even with the advances in medicine, the medical 

problems that schools must address are growing and becoming 

more complex. 

The U.S. Senate can help by assuring funding for a full-time 

school nurse in each and every building. 

Thank you, Senator Coleman. 

Senator COLEMAN. Thank you, Superintendent Benson. And 

thank you all, by the way. This has been very helpful to me and 

I hope, by the way, to the other health care professionals, Dr. Hull 

and Commissioner Mandernach’s operation. We have certainly had 

a wide perspective, here—Hennepin County and St. Paul Public 

Schools to the rural communities. 

I have passed along—I am raising my family here. I think we do 

a great job in Minnesota; we pride ourselves on a great job. But 

by virtue of what I have listened to today, the challenges still are 

enormous. It is the nature of the world in which we live. 

One of the issues you raised, Commissioner Spartz, you talked 

about three things we need to focus on, in large part ties into the 

reaction of individual citizens. There are different experiences with 

26

that and different challenges. One of the challenges is to get information to the citizens by virtue of language or location. But I 

would like an assessment of where we are today, and if SARS were 

to hit our communities, do you think people would be prepared? 

And if not, on the communication side, can you help me get a sense 

of what else it is we have to do, other than school nurses checking 

with CDC bulletins? I will open it up to the entire panel. I am really interested in your assessment of your universes, the kind of reaction you think if cold season hits this week, all of a sudden there 

is a case of SARS somewhere in your communities. I want to touch 

on Mr. Spartz’s point, because he said the reaction of citizens is 

going to play a key role in how we are able to respond. Ms. Hoxie. 

Ms. HOXIE. I think that we really need the media to provide consistent messages. And that starts with what the CDC can do, and 

what the health department can do, but I will go to the communications people in my district—that CDC guidance for schools last 

year was very helpful—a one-page guidance that said these people 

should stay home and these people can come to school. And that 

kind of very clear and consistent message can be conveyed in the 

media, as well as what we can do and more direct. 

Senator COLEMAN. I can assure you that I will ask my staff to 

go through the record to make sure we communicate that to the 

CDC, that they get the message that comes out of this hearing. 

Addressing other responses to the question. Mr. Spartz, you 

raised the issue, your assessment for us today. Where do you think 

things are at? 

Mr. SPARTZ. At this point, Mr. Chairman, I fear we would have 

a panic set in if we had a moderate to major outbreak. Ms. Hoxie 

is right. We need to do education, we need to do it now, in advance, 

so that people have some of the fundamental concepts in mind before an event happens. And then you need the messages to be gotten out, in the event that happens which reinforces the education 

that was done in advance. I think that is the most valuable thing 

we can do, because if we get a sense of panic in the community, 

public health in the hospitals will not be able to control the problem. 

Senator COLEMAN. I would like to note the presence of Jim 

Rhodes, a State Representative in this area. And I am sure as we 

go back and look at this record, I know he is very concerned about 

these issues. Certainly the State needs to be a full part of the legislature. Ms. Crow. 

Ms. CROW. I would just like to comment with regard to the mindset of health care workers around this subject. We are at least a 

full generation away from an outbreak of polio or measles, and 

really having to look at that. Health care workers today won’t have 

some of the same altruism that perhaps was there 25 years ago. 

And as we look at this in Northfield, I can tell you that people 

looked at themselves and said, ‘‘I don’t want to risk my health or 

my family’s health to take care of what may be a major incident 

here.’’ We do have to take care of our health care workers. We do 

have to give them the protection they need to be able to do the 

work. If that doesn’t happen, I can tell you that we won’t get the 

health care workers to come to work. And that would be a very big 

issue. 

27

Senator COLEMAN. And I would anticipate then, the same holds 

true for teachers and school settings, who are probably less familiar with some of these things, than the health care workers. So I 

would suspect that concern would be amplified in a school setting. 

Ms. HERRMANN. I think very much so, as well as the school 

teachers. We wouldn’t have any protection. I can just tell you now 

from preliminarily putting out information on influenza, that I 

have had a much larger response this year already than we have 

in past years. And should there be a SARS case anywhere in the 

area, it is going to be huge as to whether they will be coming to 

school or not. Because many of our kids do come to school sick. 

They don’t have any place to stay home and be watched, so they 

are at school spreading everything. 

Senator COLEMAN. Ms. Crow, I was interested in your discussion 

of the students, 10 were kept together and 20 went somewhere 

else? 

Ms. CROW. Right. 

Senator COLEMAN. So in spite of whatever we do with 10, there 

were 20 others that we presumably had no knowledge of. The other 

thing that you have—the issue that you mentioned was the philosophical discussion of the rights of individuals. If the same situation were to come about today, how would your response be different? 

Ms. CROW. I would look for more guidance from the Department 

of Health and CDC. We are not sure at what point of an infectious 

process this disease is spread. Is it prior to when you become really 

symptomatic? Can you actually spread prior to that? We looked for 

that guidance last spring, and clearly the faculty, the deans, the 

leadership at the college said we don’t need to isolate these students. We were looking at the health of the community and saying, 

you don’t want to have to isolate your campus—and that could happen. And certainly you don’t want to have to isolate this whole 

community—and that could happen. How that would be handled 

differently, I think we are not there yet. We still need to have these 

discussions, to say, ‘‘let’s think about how we can do some simple 

things to protect the common good.’’ In that case, my idea would 

have been to take the 10 students and simply take them camping 

for 10 days or do something with them, where they were really 

truly isolated and yet not be punished. But those discussions seem 

to occur. We need to get creative about that. 

Senator COLEMAN. Was legal counsel involved in these discussions? 

Ms. CROW. We did seek legal counsel, and legal counsel went 

back to the guidelines of CDC and Minnesota Department of 

Health and said, there is no legal stand to isolate these students 

at this point. 

Senator COLEMAN. I believe Commissioner Mandernach talked 

about State quarantine which sunsets in 2004. So I would suspect 

that issue will be reviewed in the next session to make sure that 

we have the place where it is needed to adequately deal with these 

situations. 

Ms. CROW. I think that would be helpful. I think also we do need 

to think about the logistics of that. And I know the Commissioner 

referred to that, as well as Dr. Osterholm. But the logistics of quarVerDate 0ct 09 2002 09:44 Mar 11, 2004 Jkt 090241 PO 00000 Frm 00031 Fmt 6633 Sfmt 6633 C:\DOCS\90241.TXT SAFFAIRS PsN: PHOGAN
28

antine. And that was one of these kinds of—understand what you 

are asking. To logistically isolate 10 students for 10 days. And first 

of all, I have to deal with the parents of these students who are 

going to look to me to say why. And second, there is just the logistics of making this—so that is only 10. 

Senator COLEMAN. Turning to the school personnel, what I am 

listening to is mostly a look into the health care professionals and 

having a school nurse as someone who is in contact with CDC. Is 

there benefit in training school personnel to identify symptoms, or 

would that simply be too costly, and take away from the main focus 

on education? How far do we go in training staff as to what to look 

for in issues like SARS? I am interested in a response. You all represent different perspectives. Dr. Benson. 

Mr. BENSON. I think there are teachers that are just overwhelmed right now with the No Child Left Behind, and all of those 

things. I think they look towards the school nurse as the professional person to do this. 

Senator COLEMAN. Ms. Herrmann. 

Ms. HERRMANN. I would say also that our teachers are so ingrained in meeting the guidelines of the No Child Left Behind, and 

all of the other issues, that they do come to the school nurses as 

a what am I going to do here, this child is coughing, what could 

this be. We, a lot of times, are the medical help or information 

area, they are coming to us. And it is a matter, a lot of times, taking time to be able to deal with all of that information and give 

them accurate data. 

Senator COLEMAN. Ms. Hoxie. 

Ms. HOXIE. I would agree. We have undertaken a big effort to 

educate our teachers about asthma. And they have so much else to 

be thinking about. They really need our expertise. Clearly, I think 

we would need to reinforce the information to them, mainly so they 

won’t have to panic about these kind of things. And part of the information is saying these are the symptoms. But, again, I don’t 

know how I am going to educate my nurses to sort out the symptoms. 

Senator COLEMAN. That is my next question. I would be very interested in your assessment of how do you educate your nurses, 

who has that responsibility, what role does the CDC play, and 

what role does the State play? 

Ms. HOXIE. Well, I think that would be my responsibility to start 

with. And what I have done so far is to try to keep them apprised. 

I don’t know how we are going to sort out what’s SARS. There is 

no good way to do it. A child comes in and says, my mom says to 

see if my ankle is broken. I have a response. No one can tell without an X-ray, and I don’t have an X-ray at school. But we don’t 

have a good response like that for SARS. An X-ray maybe yes, but 

what we really need is a quick test or something, and so they are 

going to have to leave school and get some kind of evaluation, or 

going to need some time to see how the symptoms happen. None 

of that can be done easily, quickly, or efficiently in schools. Because 

it won’t be one child, it will be 15, 30, or 50. Often in the winter, 

health offices in the St. Paul schools, have 75 or 80 kids in a day. 

We have to sort out how we are going to sort that out. 

Senator COLEMAN. Ms. Herrmann. 

29

Ms. HERRMANN. It is going to be a challenge, because even just 

to identify, is it influenza, is it just a cold, or is it another type of 

respiratory infection? As soon as we get the information, we spread 

it out to the other nurses. Our infection control nurse at the hospital is excellent about getting out any new information that she 

receives, so we can keep on top of that. But it is difficult to keep 

everybody trained on the same page. And not everyone is full-time. 

So we don’t always have somebody there to deal with it. So then 

we are trying to educate secretaries and staff on what to recognize, 

and who is important to be seen or sent home. 

Senator COLEMAN. This has been a fascinating discussion. In 

many ways, we are asking folks to think the unthinkable. Hopefully it doesn’t happen. And even after thinking, if it does happen, 

what I am hearing is that there are some very practical, logistical 

time-issues like Ms. Hoxie talked about. Supplies, capacity, that 

even under the best of circumstances, if SARS were to break out, 

we would be challenged to respond effectively. I was tempted in the 

school setting to ask about grades. But I think under the best of 

circumstances, we are clearly going to be challenged. 

I will certainly go back and carry the message about the resource 

issue, the information issue, and certainly about some longer-term 

issues. I do know that Dr. Osterholm wanted to go through shortterm and long-term. Long-term is access to health care. Short-term 

is how many masks do you have, what’s the surge capacity? And 

I think we have to be thinking in those terms, break that up. 

Clearly, the burden is on folks at the local level. We can discuss 

this in Washington. I am impressed with CDC, with the work that 

they are doing in regard to folks at the local level, the information 

that has been made available. They had a checklist that they put 

together at my last hearing that they kind of laid out, and I would 

hope that checklist—and I presume it is going to the health care 

professionals, probably not going to the schools, but should be going 

to the mayors and others for each community, a list of those things 

that you need to do. Certainly when I get back, I will do my best 

to see that the checklist of what needs to be done is circulated 

more extensively. I think we all need to kind of measure where we 

are right now. 

I do want to thank St. Louis Park High School for hosting this 

hearing. It has been really an extraordinary session. Very helpful. 

I am an optimist. If bad things happen, I think we have folks in 

this community who are certainly geared to do the best they can. 

Hopefully that will be enough, and hopefully we will get smarter 

as time goes on. So I want to thank you all. 

The record of this hearing is open for an additional 10 days, if 

there are others here who wish to submit statements or other information for the record, I will make sure that that takes place. So 

with that, this hearing is now adjourned. 

[Whereupon, at 11:40 a.m., the Subcommittee was adjourned.] 

(31)

A P P E N D I X 

CLOSING STATEMENT OF SENATOR NORM COLEMAN 

I want to thank all of today’s witnesses for participating in today’s hearing. I 

know that all of us are working for the same thing, to protect the health of Minnesotans, especially our children. We cannot control when or where SARS will emerge, 

but we can make sure that we are prepared to recognize it when it does and respond 

appropriately. I know that several international and Federal agencies, led by the 

World Health Organization and the Center for Disease Control and Prevention have 

already done a great deal to get information and resources to State and local officials so that they can do their jobs. I will work to ensure that these resources continue to be delivered in an effective and useful manner. I hope that all of you will 

feel free to notify my office of any needs or concerns you have. 

The main burden of protecting local health will always fall upon the local health 

care officials who are on the scene treating individuals. As the first point of contact, 

it is important that they receive the information and resources needed to prevent 

an outbreak from occurring. We must also make sure that they receive adequate 

protection when they treat patients. 

This is an area that I intend to remain involved in. I have requested that the 

General Accounting Office conduct a study of national and international surveillance 

systems for spotting the emergence of an infectious disease. GAO is likely to complete this study at the end of the year, and I will make sure that the results are 

acted upon. 

I also want to thank St. Louis Park High School for hosting this event. Given today’s focus on protecting our children, it is very fitting that we held this hearing 

in a school. 

Civilization is possible because human institutions are capable of learning from 

past experiences. I am confident that the lessons from last spring will make us better prepared to deal with the continued threat of SARS and other highly infectious 

diseases. 

Thank you.

32


90241.001
33


90241.002
34


90241.003
35


90241.004
36


90241.005
37


90241.006
38


90241.007
39


90241.008
40


90241.009
41


90241.010
42


90241.011
43


90241.012
44


90241.013
45


90241.014
46


90241.015
47


90241.016
48


90241.017
49


90241.018
50


90241.019
51


90241.020
52


90241.021
53


90241.022
54


90241.023
55


90241.024
56


90241.025
57


90241.026
58


90241.027
59


90241.028
60


90241.029
61


90241.030
62


90241.031
63

Æ


90241.032