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Chapter 5
Responding to
Infectious Disease
Outbreaks and Other Disasters
Infectious Disease
Many infectious diseases impact the “bookends” of society: the very young and the very old. As such, extra precautions may be needed to protect our clientele. This may include the temporary closure of our programs, discontinuing group play, limiting the amount and type of toys that children play with, and implementing more stringent cleaning protocols, especially of commonly touched surfaces. Likewise, there are important staffing considerations that must be addressed.
Illness and disease are part of life; consequently, we must ensure we are prepared for handling these types of events. Young children spend countless hours playing, crawling, and discovering. In addition to these activities, children also spend a lot of time touching surfaces and toys. They frequently touch their eyes, noses, and mouths. Unfortunately, these behaviors can lead to an increase in disease spread and transmission.
Much like the rest of their young bodies, a child’s immune system is constantly evolving and developing. In addition to the developing immune system, public health interventions, such as hygiene practices, food-safety regulations, proper nutrition, and vaccinations, help protect children. Simple steps, such as having staff and children wash their hands regularly, can help prevent the spread of disease. Infections in child-care settings are most commonly transmitted by contaminated hands; therefore, frequent handwashing is vital (NRCKids.org, 2020).
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Know the Lingo
- Virus: a microscopic organism that may cause disease. Viruses can contain either DNA or RNA and reproduce in living cells. Viruses spread by using living cells to multiply. Examples include the common cold, chicken pox, rabies, herpes, measles, Ebola, HIV, hepatitis, severe acute respiratory syndrome (SARS), and Middle East respiratory syndrome (MERS) (Healthline Media, 2020).
- Communicable or contagious: for our purposes, these words can be used interchangeably. These terms refer to the ability of a disease to be spread or transmitted.
- Social distancing: a public health term used to describe one method of stopping the spread of an infectious disease. The term means maintaining physical distance from others and also avoiding congregate settings. In practice, this means limiting the number of people who are able to gather at any given place or location (Santa Clara County Public Health Department [SCCPHD], n.d.).
- Isolation: the act of separating an individual who is sick from those who are not sick
- Quarantine: separating an individual or group of individuals who may have been exposed to a disease or illness. These individuals are not currently showing any signs or symptoms of being sick. Quarantine is used in cases when we do not know whether a person is infected (SCCPHD, n.d.).
- Endemic: the amount of disease that is normally found in a community. This can be considered the baseline level of disease (CDC, 2012).
- Epidemic: when the amount of disease in a given area rises, often suddenly, above the normal (or endemic) level (CDC, 2012)
- Outbreak: an epidemic in a limited geographic area, such as a neighborhood, city, or county (CDC, 2012)
- Pandemic: an epidemic that has large reach and impact. Normally, pandemics refer to epidemics that have spread to a large number of individuals. This could include several countries or even an entire continent (CDC, 2012).
In the event of an infectious disease event at your school or program, there are some universal procedures that you will want to put into place. First, attempt to isolate the sick individual from the rest of the group. Many programs have established policies and procedures for handling sick individuals, and most have a designated room or area for those who are sick. If the sick individual is a child, it will be important to have a staff member stay with the child until a parent or guardian is able to pick up the child. If the sick individual is a staff member, the staff member should be sent home.
Depending on the type of outbreak, the establishment of daily health screening may be necessary. The purpose of a daily health screening is to ensure sick individuals are not exposing others and spreading disease. Health screenings require participation from families and staff to be most effective. Depending on the situation, the local health department and/or child-care licensing may be also involved. There are a few considerations when establishing a health screening program.
- Families and staff should be provided with information about the current situation. This should include a summary of the disease and the signs/symptoms of those who are ill. It is also wise to provide families with a list of steps that you are taking to protect children and minimize the spread of the illness.
- Emphasize the importance of staying home when sick. This includes families and staff members alike. If a parent notices her child is experiencing signs or symptoms, then the child should remain at home. Likewise, if a staff member is sick, she should not report to work.
- If the situation warrants daily health screenings, you would require staff and children to undergo a health screening before being admitted into the school or program. The health screener would look for signs/symptoms and may also ask questions concerning potential contact with sick or infected individuals.
- Implement procedures to deal with staff or children who become sick on-site.
- Establish clear criteria on when the sick individual may return to the program. As each disease is different, these criteria will need to be flexible and take into account the specifics of the particular illness or disease. Some programs may require a doctor’s note before granting reentry into the program or school.
Diseases have different levels of transmissibility. These are referred to as R0 (pronounced “R naught”). The R0 number is a measure of how contagious a particular infectious disease agent is. It reflects the number of secondary cases that one case would be expected to produce. This number is used by public health professionals to help understand how easily spread a particular disease may be and to inform the public health response needed to control an epidemic, outbreak, or pandemic (Delamater et al., 2019). The higher the R0 value, the more likely the spread. Data such as hospital admissions, new cases of infection, and deaths are used to determine the R0. The R0 will fluctuate over time, especially as individuals who were sick recover and have immunity and as public health measures, such as isolation, quarantine, and social distancing take effect. The goal is to drive the R0 below 1, which will cause the outbreak to subside, as there will not be enough new individuals infected to continue the outbreak.
Depending on how easily a disease spreads, you may need to implement additional procedures at your program. This could include modifying pickup and drop-off policies, lowering the number of children served, lowering the teacher-child ratios, limiting group activities, or even temporarily closing your program. Public health powers in the United States are strongest at the state level, and governors, thr...
