Despite the rapid response to what officials feared would be a severe and highly-contagious H1N1 flu outbreak this past Fall, most infected Dartmouth students experienced only “relatively mild illness,” according to College Health Services Director Jack Turco. While H1N1 — which spread to the College for the first time in May last year — has abated and concerns about it have since calmed, the virus’s effects could have been much worse if College officials had not prepared for the possibility of a more serious illness, Turco said in an interview with The Dartmouth.
Although the College was not affected as seriously some expected, it suffered one H1N1-related death. Administrators were also forced to recall 11 students on an off-campus program in Mexico back to campus.
Last May began with five suspected cases of H1N1 involving Dartmouth students. By Oct. 16, 2009, about 240 students at the College had been diagnosed with “influenza-like symptoms,” The Dartmouth previously reported. This number could have been much higher had the College not taken precautionary measures and given students the option to receive the H1N1 vaccine, Turco said.
Although the Centers for Disease Control and Prevention predicted that 10 to 20 percent of individuals would become “really sick” from H1N1, most students with influenza-like symptoms at the College only experienced mild illness, Turco said.
Henry Masters, a student in the master’s of public health program, succumbed to complications from H1N1 after the infection aggravated an existing autoimmune disorder, the College’s single fatality from the disease. Turco said students should not minimize the significance of the death.
The CDC estimates that between 8,720 and 18,050 H1N1-related deaths occurred nationwide between April 2009 and March 13.
Angela Dunnham, a freshman who fell ill during Fall term, was escorted to the infirmary by Safety and Security after her fever reached 103 degrees, she said. Over the course of her five-day stay, she was treated as if she had the seasonal flu because administrators were “not too anxious” to diagnose her with H1N1, although they called it a “possibility,” she said.
“I think that the hype was warranted because I’m a very healthy person and I had a fever of almost 105 within 18 hours,” Dunnham said. “I want to warn people about [H1N1] because I’ve had the seasonal flu before and this one was much more serious.”
A mutation of the H1N1 virus into a more severe form is still possible, according to Turco, although literature on the subject suggests that such a deadly mutation is unlikely to occur. Because the change would occur rapidly and suddenly, College administrators are still meeting to discuss precautions, Turco said. He added that the approach taken this year to address H1N1 on campus was very effective.
While the hype around the potential dangers of H1N1 among national experts may have been excessive, Turco said he believes that taking significant precautions against a disease with unknown severity and contagiousness was “the responsible thing to do.”
College administrators had to make tough choices in preparing to deal with the virus, which included evacuating the students on the Language Study Abroad in Puebla, Mexico after the H1N1 outbreak there and isolating students on campus who showed flu-like symptoms, Turco said.
Students flew back to the United States on a private jet paid for by the College to ensure that they would not be stranded in Mexico if “the border was shut down,” Blake Williams, a junior, said. The main concern was a safe return to the United States, with health issues following right behind, Williams said.
“All the [H1N1] deaths were in rural areas,” Williams said. “No one really knew what was going on, but the media back home — which was what our parents were hearing — made the situation seem a lot worse than the reality.”
Students on the LSA returned to Dartmouth for the remainder of the program and College Health Services periodically checked on the health status of the students via e-mail, Williams said. Acting on recommendations from the CDC and the state Department of Health and Human Services, administrators from Dick’s House and the Office of Residential Life decided to isolate students with symptoms of an “influenza-like illness” in their rooms to stop the virus from spreading, Turco said.
Because quarantining 10 to 15 individuals in the infirmary would have hindered care for students with other health needs, sick students were mostly isolated in their rooms, Turco said. Isolating students in their rooms both stalled the spread of the virus and allowed Dick’s House to continue to address other health needs, he said.
“We fully anticipated an outbreak of H1N1 that would be pretty contagious,” Turco said. “What we didn’t know is how sick some individuals would get.”
Turco kept up-to-date on recent H1N1 news by keeping in close contact with the “Ivy plus” group, which includes all Ivy League universities and other universities like the University of Chicago and Stanford, to share data collected every week by the health centers at each school, Turco said. The onset of the H1N1 virus early in the flu season was immediately apparent from the exchanged information, according to Turco.
Shortly after the virus began to spread in the United States, Turco met with several “internal players of the College,” including members of the Office of Public Affairs, ORL, the Dean of the College Office and the Office of Human Resources to discuss how the College would address H1N1 in the Fall, he said. Turco said he also met with officials from Dartmouth-Hitchcock Medical Center, the CDC and the state Department of Health and Human Services.
Symptoms of “influenza-like illness” — a temperature over 100 degrees accompanied by a cough or sore throat — apply to a broad range of illnesses, so Dick’s House took precautions, treating all patients with these symptoms as if they had H1N1, Turco said.
When the CDC allowed state laboratories to begin testing for the H1N1 virus, the Public Health Laboratories run by the state Department of Health and Human Services in Concord launched testing to determine whether the samples from patients with “influenza-like illness,” including Dartmouth students, had seasonal influenza or the H1N1 virus, Turco said. Other state health centers could rule out Influenza A or B but could not definitively say that a patient had the H1N1 virus, Turco said.
“Because we were doing surveillance cultures, we could tell approximately how many people really had H1N1,” Turco said. “We saw other viruses this year and not much of the seasonal influenza, so if they had influenza, it almost always was H1N1.”
Most of the widespread concern about H1N1 outbreaks stemmed from the fact that young people were especially vulnerable to H1N1 because they lack natural antibodies to protect them from the strain, Turco said.