During the 2009 swine flu pandemic, which of these college events did not lead to a sharp increase in flu cases on their respective campuses?

• July 4th social at the Air Force Academy.
• Orientation at Bowdoin.
• Homecoming at Colorado College.
• Two swine flu vaccine clinics at �ֲ���ý.

Trick question, really. All four events led to an uptick in flu cases at their respective colleges— even the vaccine clinics at �ֲ���ý.

During a vaccine clinic in October 2009, Miljan Zecevic ’10 receives his vaccine injection. Photograph by Phyllis Graber Jensen/�ֲ���ý College.

This curious fact, that a vaccine clinic could be linked to a surge in flu cases, is explained in a recent scholarly article, “The Effect of Mixing Events on the Dynamics of pH1N1 Outbreaks at Small Residential Colleges,” by �ֲ���ý epidemiologist Karen Palin and mathematician Meredith Greer in the Journal of American College Health.

Of the many U.S. colleges that saw outbreaks of swine flu cases in the summer and fall of 2009, Palin and Greer looked at �ֲ���ý, Bowdoin, Colorado College and the Air Force Academy because of their similar size and their residential, undergraduate structure.

It’s a no-brainer that a college mingling event like homecoming or orientation would create robust opportunities for human-to-human spread of a virus. But the vaccine clinics at �ֲ���ý, held on Oct. 10 and 15 four years ago in Chase Lounge, followed protocols that did not allow students to come into infectious proximity with one another. (The researchers stress, too, that vaccines and vaccine clinics are Very Good Things.)

Instead, suggest Palin and Greer, the role of the clinics in the spread of H1N1 at �ֲ���ý in 2009 has to do with how those clinics influenced events outside Chase Hall, specifically student traffic patterns.

To investigate the spread of H1N1 during the �ֲ���ý outbreak, the researchers used a standard mathematical model that categorizes all community members as either susceptible to the disease, infected or recovered (hence the model’s acronym, SIR).

The SIR model assumes a small community that is “well-blended.” At a place like �ֲ���ý, “well-blended” means members live in close proximity and encounter each other in classrooms, residence halls, the library, club activities, athletics facilities, arts venues and, of course, in Commons.

“The SIR model did not match the reality we observed,” Greer says.

“�ֲ���ý is about as well-blended as any modern-day community,” says Greer, associate professor of mathematics.

Mathematician Meredith Greer found that the standard model for tracking the outbreak of disease didn’t work for the �ֲ���ý H1N1 outbreak of 2009. Photograph by Phyllis Graber Jensen/�ֲ���ý College.

Based on the initial �ֲ���ý data, the SIR model suggested a slow, steady increase in flu cases. But what happened at �ֲ���ý was “in stark contrast” to the model’s predictions. Three days after each flu clinic (a common incubation time for H1N1), the number of cases at �ֲ���ý spiked.

Indeed, “the SIR model did not match the reality we observed,” Greer says.

But why? It wasn’t that students got infected at the clinic; a variety of established protocols made that very unlikely.

Instead, the researchers believe that the clinics created subtle changes in student traffic patterns on campus. Students took different routes to get from point A to point B, thus coming into contact not with more students on those days, but with different students.

Hosting a clinic may have “facilitat[ed] the spread of pH1N1 in unexpected and unknown ways,” the authors say.

Let’s say that on Oct. 15, 2009, student “Sarah” altered her routine by including the Chase Lounge vaccine clinic on her usual Parker-to-Pettengill afternoon route. In doing so, she came into contact with different students than usual, giving a hug to one she hadn’t seen in awhile and who, unbeknownst to her, was infectious.

It doesn’t stop there. If Sarah changed her routine, then maybe her roommate “Jessica” also changed hers, even if she didn’t plan to attend the clinic. And so on.

All of this means that “the concept of ‘well-blended’ is more complicated than originally thought,” Greer says.

Take Commons. At �ֲ���ý, all students dine under one roof, blended together like stir-fry. A germophobe’s nightmare, right?

Karen Palin, an epidemiologist and lecturer in biology at �ֲ���ý, discusses the H1N1 outbreak at �ֲ���ý in October 2009. With her is is Associate Professor of Biology Lee Abrahamsen. Photograph by Phyllis Graber Jensen/�ֲ���ý College.

Not really, says Palin, who had her students study Commons in another context. For one, they found that food-serving areas are remarkably free of germs, “which we expected,” Palin says, “given their protocols.”

Second, they found that students tend to sit with the same friends each meal, reducing the blending and lowering the likelihood that Commons was a major reason for the spread of H1N1.

“Again, this led us to the idea that changing social patterns [due to the clinics] could really be the culprit in spreading H1N1 in 2009,” Greer says.

Palin and Greer stress that their findings are not prescriptive; they “cannot by themselves determine circumstances in which vaccine clinics should, or should not, be offered.”

Instead, their results are more observational, intended to identify “when a vaccine clinic apparently functions as a mixing event” that disrupts normal student traffic patterns, hastening the spread of an infection.

And if you still want advice for the current or any flu epidemic?

“Get vaccinated, wash your hands, and cover your mouth if you cough or sneeze,” says Palin.

During a Chase Lounge clinic, Miljan Zecevic ’10 of Pljevlja, Montenegro, receives an H1N1 vaccine injection. As the number of students with H1N1 flu topped 250 in October, �ֲ���ý implemented its H1N1 protocols: education about prevention strategies; isolation of ill students; and vaccinations, with the Maine Center for Disease Control giving more than 1,000 injectable and nasal-spray vaccines to �ֲ���ý specifically due to the large number of campus cases. Administering this flu shot is Steve Doczy-Bordi of the Northern New England Metropolitan Medical Response System. Photograph by Phyllis Graber Jensen.

Once, feeling feverish before a college philosophy final, I brought a small towel to the blue-book exam. We lefties tend to smudge what we write, and I wanted to keep my writing hand dry, so as not to turn deep thoughts about Plato’s cave into a smeary mess.

Such myopic concerns meant that I probably didn’t care if my exam book communicated my germs, along with ideas, back to my professor. But here at �ֲ���ý this fall, unusual worries became downright sensible after a spike in student H1N1 cases in October.

A professor posed the virus/blue-book question on the faculty listserv after, perhaps, imagining his students hacking (respiratorily, not intellectually) their way through an exam. How long, he asked, can H1N1 stay alive on blue books?

Answering was epidemiologist Karen Palin, who explained that the virus can live up to 10 hours on surfaces. To be really safe, she offered, he could cure the books overnight in the freezer — extreme temperature disrupts the external membrane of the virus. “I am letting papers sit for about 48 hours,” she wrote. “But that could also be my procrastinating!”

Palin ended her e-mail reply with this epigrammatic kicker: “The things we learn…and teach.”

Another period of impromptu teaching and learning took place at �ֲ���ý after the September death of President Emeritus Thomas Hedley Reynolds. On page 3, President Hansen shares what she learned about Reynolds’ proudest accomplishment: creating a great faculty.

Reynolds’ memorial was Oct. 24 in the Chapel. Based on the Episcopal Burial Service, it also included military honors: a three-volley rifle salute, taps, and a flag presentation to his widow, Mary. At the service, Carl Benton Straub, dean of the faculty for most of the Reynolds presidency, taught us how to reconcile the two Reynoldses we’d heard so much about.

On the Commencement stage, Reynolds knew that he could create bits of memorable, meaningful magic.

There was the famously introverted Reynolds, the man who, in Straub’s words, would “never hail you from across the campus but would always listen to you in his office.” Then there was the public-minded patrician who, despite his notorious distaste for small talk and glad-handing, loved the Commencement limelight.

Reynolds loved Commencement, Straub explained, for its ritualized authenticity, how each presidential gesture, chosen judiciously, could take on great meaning. “There is neither a wasted word nor gesture” at Commencement, the Rev. Peter Gomes ’65 once noted in a tribute to Reynolds. “It is rich in its austerity, not unlike the president himself.”

On this stage, Reynolds knew that he could create bits of memorable, meaningful magic. The night before Commencement in 1976, for example, he invited jazz pianist Mary Lou Williams to respond to her honorary degree the next day with an impromptu performance — which she happily did.

Other gestures were more poignant. Reynolds always removed his mortarboard when walking past the seniors during the Commencement processional, an act of “academic graciousness,” said Straub.

As Straub spoke to the mourners in the Chapel’s own richly austere setting, he told how Reynolds would also doff his cap as a formal greeting to Straub on Commencement morning. As he recalled the intimacy of that gesture once again, Straub’s voice briefly faltered.

H. Jay Burns, Editor

Dear Members of the �ֲ���ý Community,

As of Nov. 6, there have been 281 students diagnosed with ILI this semester and, following the CDC guidelines, presumed to have had H1N1. There are only three students who are currently ill with ILI, each of whom is recuperating at home. Our protocol for treating students with H1N1 remains unchanged. Only students with multiple roommates will be placed in isolation houses, all others will be asked to self isolate in the residence halls or return home. After a hiatus of a couple of weeks, students have resumed their work in the local community in schools and other agencies.

Contrary to our most recent report to the community, we no longer expect to receive more H1N1 vaccine in the near future. There is a national shortage that is greater than was anticipated. We have a very limited supply of the injectable H1N1 vaccine left and that will only be used for students with chronic illnesses who have not received the vaccine to date. Those students should come to the Health Center and review their medical data by FRIDAY, NOVEMBER 13, 2009. If the student meets our criteria, an H1N1 vaccine will be administered. Any remaining vaccine will then be returned to our distribution center.

Since fall recess we have seen an average of less than one new case reported per day, and barring any significant changes in this pattern, we expect this to be our last update concerning H1N1. Once again we thank all students, parents, staff and faculty who helped us through this difficult period.

With our wishes for good health for all,

Christy Tisdale
Director of Health Services

Tedd Goundie
Dean of Students

Dear Members of the �ֲ���ý Community,

Our reported cases of Influenza-Like Illness (ILI) have slowed considerably.  During the peak of the outbreak 97 new cases were reported over a two-day period.  Since having seven new cases reported on Oct. 20, the day before the fall recess, we have had only four new cases reported from Oct. 21 through today, Oct. 27.  Our total number of cases of ILI reported since the start of classes this semester is 271, including the 27 cases reported prior to our first confirmed positive case on Oct. 8.

To date we have vaccinated 999 students with either the nasal spray or injectable vaccine.  Therefore of our total number of 1,714 students on campus this fall, we can presume 1,270 of them now have some degree of immunity, either from having the illness or from receiving the vaccine.  There are only three students currently ill and isolated, with two of them staying home to recuperate after exhibiting symptoms during the break and the third self-isolated on campus; all other students who reported ILI this semester have recovered and are out of isolation.

We anticipate receiving another shipment of the nasal-spray vaccine for students in the coming weeks, and encourage any student who has not yet received the vaccine to get it.  When the shipment arrives, we will notify you of when and where the vaccines will be administered.

The Health Center will continue with its daytime-only hours through this week, and will resume its normal 24-hour service beginning Saturday, Oct. 31.

Again we thank all who contributed to managing this outbreak, and encourage everyone to continue frequent hand washing, coughing and sneezing into sleeves or tissues, and reporting to the Health Center if you experience flu-like symptoms.

As of Oct. 20, we have had 265 reports of Influenza-Like Illness (ILI) since fall semester began Sept. 5. All but 27 of those were after Oct. 8, when the Maine CDC reported six positive cultures for H1N1.  (After three or more confirmed H1N1 cases, the Maine CDC no longer test cultures, so anyone exhibiting ILI is treated using H1N1 protocols.)

�ֲ���ý was fortunate to have H1N1 vaccine made available by the Maine CDC immediately after those first six confirmed cultures, and we have vaccinated 999 students in several clinics. While no statistics are available, we know that many students with ILI recuperated over three to five days, then returned to classes. No complications have been reported.

Most students went on fall break today (Oct. 21) and return to campus Oct. 26. This return date will be beyond the seven to 10 days it takes for the vaccine to become effective.

In the wake of the appearance of H1N1 flu cases at �ֲ���ý, some community partners have expressed understandable concern about �ֲ���ý students doing community work in the Lewiston-Auburn community.  The College has responded proactively to illness on campus, isolating students who show symptoms of flu-like illness and actively educating students, faculty, and staff about the need for vigilant hygiene and self-monitoring.  We at the Harward Center continue to come to work every day with confidence.

Harward Center staff have already reached out to our most active partnership sites to address their concerns.  Our partners work with many constituencies, and our students perform many kinds of work.  Some partners, including the Lewiston and Auburn public schools, have decided to temporarily cease having �ֲ���ý students work on site.  Others have decided to maintain student work, while asking students to remain vigilant about their health and hygiene.  We are committed to being guided by our partners’ concerns, and we are eager to work with partners to help them make the decision that seems right to them.

Meanwhile we ask all �ֲ���ý students, faculty, and staff doing work in community settings to be vigilant in using best hygienic practices and to err on the side of caution if they show any signs of illness or have been exposed to illness.  Please be especially careful if the community work involves children, the elderly, or other vulnerable populations.

Dear �ֲ���ý Students,

As of Tuesday evening, 115 cases of Influenza Like Illness (ILI) have been reported to �ֲ���ý Health Services. In line with Maine CDC guidelines, all are being treated with H1N1 protocols. The recovery period is generally three to five days. There have been no complications to date.

As previously noted in e-mail, students who have not already been vaccinated are encouraged to sign up 6 p.m. to 8 p.m. tonight at New Commons for the next vaccination clinic, which will be held from 1 p.m. to 5 p.m. Thursday Oct. 15 at Chase Hall Lounge. The Thursday clinic will administer the remaining doses of the nasal-spray vaccine as well as injectable doses.

Dear �ֲ���ý Students,

Following our six positive tests yesterday for H1N1, the Maine CDC has allocated to us 900 emergency doses of H1N1 nasal spray vaccine.  With the help of staff from the state, we will run an H1N1 vaccine clinic TOMORROW (SATURDAY), OCTOBER 10 FROM 8:00 A.M. TO 2:00 P.M. IN CHASE LOUNGE.  Unfortunately, the available nasal spray vaccine is contraindicated for any student with a chronic respiratory condition such as asthma.  The state is working to provide a number of injectable H1N1 vaccine by the end of next week for those high risk students with respiratory illnesses, and we will notify you when these vaccines arrive and schedule a clinic.  There is no charge for the vaccines administered at tomorrow’s clinic.

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: Director of Health Services Christy Tisdale is interviewed by BCTV’s James Dowling-Healey ’12 on actions �ֲ���ý College is taking to limit the spread of H1N1.

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We ask all students who want the H1N1 nasal spray to follow these directions.  We are dividing the 900 doses as evenly as possible across alphabetical increments of 45 minutes each.  Using the first letter of your last name, please follow the time slots that are assigned below.  If you come at a different time, you will need to wait until the end of that time block and IF vaccine is still available, you will receive a dose.  All students should bring ID to the clinic.

A-B   from 8 a.m. to 8:45 a.m.
C-D   from 8:45 a.m. to 9:30 a.m.
E-G   from 9:30 a.m. to 10:15 a.m.
H-K   from 10:15 a.m. to 11 a.m.
L-M   from 11 a.m. to 11:45 a.m.
N-P   from 11:45 a.m. to 12:30 p.m.
Q-S   from 12:30 p.m. to 1:15 p.m.
T-Z   from 1:15 p.m. to 2 p.m.

Please understand that the Health Center staff is inundated trying to meet students medical needs and organize a very large H1N1 flu clinic for tomorrow.  We ask that calls to the Health Center be limited to emergencies only.  As always, any student with an acute medical problem should come directly to the Health Center.

Thank you for your cooperation in helping us to prevent a major outbreak of the H1N1 virus on campus.