Are colleges and universities making the grade in flu planning?

Have they gotten the warning in front of travelling eyeballs;
that if you are in a country you don't want to spend a pandemic year in when it breaks out, you may very well find yourself stranded for the duration?
US embassies already stated they will not provide food, water, medicies, transport, ect, to stranded American citizens; I imagine no other countries embassies have enough supplies to share with their nationals, either.

Given that effective vaccines may be so long in coming, they better tell the students and their parents the real problem is to aviod infection and how are you going to get your needs met after supply chains and medical systems will collapse?
Tell parenst they likely can't reunite their family after panflu breaks out; think of the cross-country traffic jam; millions feel the way they do.

Perhaps local families can agree now to take in each others stranded students? A few days of quarantine, to make sure they're not infected?
Stock up; we need live healthy college students, and people to teach survivors.

Don't worry, the pressgangs will scoop them up.

Hi Revere,
Could you please elaborate on this? Its something I have not read about before.

"And once you have an attack rate of 1 percent, any public health strategy loses effectiveness.""

Sue: That was said by a commenter. I don't know what the basis for it is. It is obviously false since attack rates for seasonal flu are typically 20 or 30%.

Thanks Revere,
For clearing that up. It didn't seem to make sense, but maybe there was more to it I did not understand.
Yes, I would hope our systems can handle an attack rate of 1%. The question I would have, is what percent of our population can we absorb into the hospital system? In other words, if we have an attack rate of 30% (hopeful prediction for sure) what percent of that 30% could we give hospital care to at some level? And if we expand our capacity with tents outside hospitals and so forth, how much realistically could that stretch our capacity? I guess the outcome also depends on if we can flatten the curve of the attack wave coming through any given area. I've long thought that nearly everyone will be cared for at home and be no better off than folks were in 1918, in terms of getting modern medical care, but perhaps if we plan ahead enough, and gear up, we could do somewhat better for people.
At any rate, can you shed any light on all this?

If schools are shut down, that will liberate a lot of labor which could be re-directed to pandemic response.

Some imaginative cross-training is indicated now, for people likely to be made redundant early in a pandemic.

Otherwise, they are all at risk of misperceiving themselves as "inessential" -- and an invaluable pool of pandemic responders may be lost.

I am mainly worried about the Fire Department not being staffed or not responding. There are a lot of grass fires or small forest fires that would have been major out of control if it wasn't for the quick response from our firefighters.

How many colleges have their 1918/1919 results to review?

Has anyone examined the resulting social impacts of those actions? (and teased them out from WWI effects?)

My grandmother was a freshman, sent home with everyone else after a month at college. She never returned to college. Tertiary schooling was not that common then, especially for women, in rural Virginia.

If they have no n-95 masks, goggles, gloves, ect, enough for days and weeks and months, we'll lose too many of those altruistic, young, strong, bright (reproductive age) college students, too.

Rather than pressgangs, why not be honest about the need, (now!) and ask for volunteers for cross-training; ask the retired or unemployed if they want to learn how to help run the water treatment plant, go with crews now to get trees away from power wires, train people to talk to community groups about panflu and how can they stock up, and , organize to check on and help each other without infecting each other? Who can help with hospital and institutional patients? What about grief support, what about fire prevention and firefighting, what about orphans, what about security?

We also need to discuss mass fatality issues. Again, volunteers, discussing things now, as peers, with officials, and faith communities, and mortuary staff, might keep up better, and, avoid a lot of unpleasantness.

(And I hope the universities are telling students they'd really be at risk to be pregnant during a pandemic year; how are they set to avoid that?)

I think it possible that Barkin's 1% remark may have been a confused (mangled, perhaps?) attempt to articulate something about a threshhold level of R0; the "attack rate" characterization simply makes no sense.

Hi - with respect to the fire department issue I can perhaps add something. I have worked as a paramedic and volunteer firefighter over the years (not currently practicing). I know in our area that most firefighters work multiple jobs at multiple departments. If one person calls in sick it winds up impacting staffing at departments for about a fifty mile radius due to many people working multiple jobs (low pay equals need to work a lot). Anyway, at least in some parts of the country, if you take out even 10% of a department you not only knock out that department but several others at the same time. Since Fire normally responds to sick calls that puts something of a monkey wrench in the works. And, BTW, the first thing that falls apart during a real situation - particularly one not seen previously - is the "plan." So, IMO, most of the plans are not quite useless but close. Not to say one should not plan but it is to say not to over rely on the "plan."

My first guess about the 1% attack rate was that Barkin meant 1% known to be infected, i.e., symptomatic. By the time 1% are symptomatic, many more are infected, and it is a bit too late to try containment.

The Barkin gaffe got by me the first time. I think I read it as 1% CFR. It might be a reporter error, too. Lots of those, although the article is pretty good. !% infected is way too low. That's like summertime for flu.

crfullmoon says, "Rather than pressgangs, why not be honest about the need, (now!) and ask for volunteers ... ?" You have also asked, "What percentage of the population lives alone and has no one to bring them a glass of water if they're sick?" You might well ask also, how many would think to lay in a few bottles of water? And you have stated, "Preparing to me also means having the public prepare to cope for as long as possible ...", implying the public is not prepared to cope. In the same thread, Revere said "[The public] want to know who will be the next President, too."

I thought you two said pretty much the same thing.. the public can't cope and the public needs / wants the president to cope for them.

Revere has been very consistent, ever since he began, by posting the story about that early public health officer. He has been advocating a functional public health system. I guess the idea is so alien to USians, certainly anathematical to those who profit from its lack, that simply to proclaim the phrase, spraypaint it on the subway walls, is as much as he can do. Anyway, it is not clear to me how much he sees public health as helping the public to cope for themselves. I expect he would be pleased with a large component of self-help; however he hasn't been able to talk about it much and clearly most people see little need / room / prospect for it.

Perhaps Revere can write about it sometime? For now, I wish to make clear that I perceive public health as a continuum beginning with self-help, but nothing which follows must be taken to infer Revere's position in any way.

Consumerism, crfullmoon, requires helpless consumers. Governments prefer helpless voters. Such abysmal helplessness must be learned. That is why billions of dollars are spent to persuade people there is nothing they can do except buy the offered magic potions, obey the experts, and vote in season for whatever honey-voiced painted puppet is presented.

That is why people want a president. That is why you will not see a great public health education program, nor a call for volunteers. That is why Revere will not see a great public outcry for health care.

We can believe Mary in Hawaii. She asked every official she knew. Doubtless she got more than her fair share of polite attention. She reported zero action.

They will do nothing because there is nothing they can do without rocking the foudations of our culture. As Kruger reported some time ago, they can't even ask everybody to buy an extra can of beans without risking the food distribution. If you start teaching people what to do in a health crisis, they are going to start staying home from work, they are going to start asking where are the doctors?

Perhaps we don't hear from Mary anymore because she decided to help herself.

"there is nothing they can do without rocking the foudations of our culture. "

Darn sure I'd rather pro-actively rock it now, that do it the stupid way; after panflu (or whatever disaster breaks out first) rocks the foundations of our "non-negotiable way of life" for us. Don't tell Nature it's non-negotiable; she ain't listening. No martial law quite yet, either; too bad we can't wake up the mindless consumers and turn then back into concerned parents and citizens now.

Think if New Orleans had said, let's let the "good times" sit a spell and let's fix our levees and discuss what we are going to do if we want to live here below sealevel, with all these vulnerable people; a ticking time bomb; let's use that science report warning and let's not live out that flooded ninth ward prediciton when we get unlucky with a hurricane...

Reality-based, ethical leadership, not popularity-based, crony-based, bread and circuses crap, like we're getting now, as the nation circles the drain.

I know it ain't gonna happen, but I won't agree dumbing down the populace and creating this unsustainable economy was a good idea.
I also don't agree the govt should just let Nature weed the public out, and enjoy military despotism afterwards... or as local officials say, "hope pandemic doesn't happen".

Well, back to the issue of students, our most vulnerable populations - is anyone working on how we would get them home??? or take care of them at university?? I am well stocked up but my ds is across the border in Canadia - I wonder if Univ of Toronto, as smart as they are in all things including medicine, is up to this.

spikemom: Some colleges are encouraging their students to think ahead about how they would return home if they needed to do so and to use a buddy system with others to help each other out (e.g., someone who lives nearby and they can travel by car together). I think if students and staff put their heads together they can think of innovative ways to handle things like this, or just old fashioned ones (e.g., ride boards). But you have to think of it ahead of time. The colleges that are thinking about it are worried about how to handle those who can't make it home. Lots of thinking going on, but much is locally specific, so it is hard to make blanket statements. Probably the best thing to do is for school authorities to get in touch with nearby schools and colleges and pool their knowledge and plans.

My daughter was just accepted at McGill University in Montreal for fall '07. We await to hear from USA colleges she applied to, throughout this month. As we live in California, this issue is forefront in my mind. I am considering contacting each place that admits her and inquiring what their plans are for flu pandemic. She will make the decision (assuming she gains admission to more than one place), but I would like to have some idea what we may be facing in the event...

In a way, I rather like the idea of her being in Canada to ride this thing out (should it happen). It appears that Canada has enough vaccine manufacturing capacity to fairly quickly vaccinate its entire population -- once the seed strain has been isolated, grown, and put into vax production, of course. She being a non-citizen might mean she would not get a vax, or be at the end of the line, but at least she'd be residing in a vaccinated population. That would seem to be an advantage.

So many things to consider...

I would like to see some discussion of how to prepare -- and train a college kid to use -- a pandemic preparation kit to send with our students to keep in their dorm rooms or in a locked storage container.

Greg. MIH is back in the states beating the hell out of her kids to get prepared.

FT-The locked storage container is a good idea. Doff and don the outfit. Climb into car, drive home, decontaminate and enter the house. Preferably into an isolation room for bout a week. Once cleared of possible infection, stay in house do not come back out for four months.... Here endeth the pandemic.

If you want a preparedness list feel free to ask. Things are moving behind the scenes folks. Many states are starting exercises on their own and I think the cat may be out of the bag infecting people soon. Tennessee is doing a State wide in April. GA, MS, are currently in one and I think that the time that this stuff has paused for has been productive.

How prepared? Kiss the college students goodbye in more ways than one. Their age will play a major factor it appears as welll as parental preparedness for the big ugly if and when it comes. If they are infected you might have to go as far as isolating them into a church or other facility just to keep them from infecting the family. Only way to ensure you dont get sick is to not get sick and thats done by self imposed isolation in and around your house. Cats and dogs go in or out, but once out they stay out. Of course you cant prepare a college student for pandemic. Its logistically improbable if not impossible. Shelley take note!

Honestly, I spend about two hours a day answering requests for the pan/disaster list from all over the planet. Chinese are my latests. Bottom line though FT is that the kid should get the hell out of there just as fast as the announcement comes that we have two or more clusters in the US with say 50 or more confirmed. It would very likely be out then and so far Tamiflu is like a breath mint to this stuff. So their antiviral blanket is just so much poof in the pot. That means isolation and likely in very shitty conditions. An MRE meal once per day, a bottle of water, maybe the commode will work. It would also likely be a death sentence at the current CFR if it broke into a campus and they were "isolated" in the dorms with their sometimes central air systems. Frat/Sororities for sure. Isolated would likely mean "quarantine" until the local area broke with it and everyone got it.

So preparedness might just entail climbing into a car and driving 800 miles with a load of gas cans in the back of the old clunker that daddy gave you. I would though recommend a room isolation on arrival to the homestead to prevent a possible infection of the family. You wont be able to see your killer until he is on you in this case.

Brave new world after something like this. 8% would likely do us as a country but we would still have one hell of a lot of clout. Many countries would cease to exist. I would put a cessation for us at about 30%. At that point I think using the 1918 as an example nearly everyone would have it or have had it. Pockets of society would still exist but not a cohesive country. Thats the reason I think these states are finally getting the message.

The lucky ones might just be the dead if its more serious than 8%. Dinosaur days.....

MRK - what makes you think that the virus might be as high as 8%.

MRK: Thanks for your thoughts. Things will become clearer in my mind once daughter has determined where she will enroll. It could be as close as 40 miles away or as far away as 3,000+ miles. I never dreamed we'd have to take something like a flu pandemic and risk to her health and safety (other than earthquake, fire, date-rape (god forbid!)etc.)into account as part of the college "process." Life is...interesting.

I don't think I would wait even as long as you suggest -- two or more sizable clusters in the US. Seems to me by then you are risking infection on board an airplane or in an airport (if air travel is the only feasible way home from 3,000 miles away). Or even no airline service at all because they have shut down. I do think airlines will cancel indefinitely virtually all of their regular flights for certain periods, not because government orders them to, but because passengers will disappear.

I'm thinking at WHO Level 4 (we're now at 3) we'd best be ready to make a hair-trigger move. Because I think Level 4 and 5 won't last very long, and I don't see any turning back from Level 4. At that point, the pandemic is a "go," in my mind.

To complicate matters (and to make my stomach churn even more) this girl is going to be a volunteer in rural Honduras or Nicaragua for 6 weeks this summer. The program she's going with is top-notch, and the national office actually has a medical advisory board that IS tuned into the pandemic flu threat. The plan is to evacuate all volunteers in country to a one location where they can be guarded, fed, and looked after until transport out by private airplane is possible. Still...it makes me nervous.

The joys of parenting...

Thanks, Kruger. Good for Mary.

Flutracker, she would starve in Montreal, like everyone else. Latin America might be better, foodwise. "one location" is a good way to kill them all... John Wayne is a silly fairy tale... a private airplane will not be possible. If you have any apprehension that this might be a real pandemic, you best sit down with your daughter and explain in grubby detail about giving up empty bourgeois pretentions, going native.

Greg: I'll ignore the insult to my daughter and her "bourgeois pretensions" or "going native." You don't know her, and I think that comment is over the line.

Although she will still be 17 this summer and therefore legally under our parental guardianship, there is no way that we would step in and prevent her from carrying out something she has committed to and taken extensive training for UNLESS the pandemic (by which I mean Level 4 WHO) begins prior to departure date. As with everything in life, there is risk. She is actually beginning to understand that herself now.

What you say about starving (or freezing during winter) in Montreal has occurred to me. That could happen at nearly all of the out-of-Calif. universities she has applied to, as they are in big cities. But again, as parents we cannot force her to make a particular decision nor rule out some choices NOW based on a pandemic that may or may not happen later this year, next year, or anytime during the next 4-5 years. Any parent that would do that is an over-the-top control freak, in my judgment.

That is why it is so darned important for colleges and universities to be getting their pandemic acts together NOW -- millions of families and their kids (whom we are turning over to them as in loco parentis) are at stake here. I hope revere and others continue to write and speak about this.

flutracker: General policy matters are one thing, but you are asking what to do about keeping your daughter safe in the event of a pandemic, or if not safe, at least back with you. Here's my take. We will have warning, probably several weeks at least. If your concern is getting her back to you from Montreal or wherever, then devise a plan in advance and a trigger event (e.g., first case in North America or spreading in Indonesia) and some means for her to get back to California. This could be an arrangement with a roomate or someone else from the West coast to share a care, a plane or bus ticket or something similar. The main thing, IMO, is to think about it ahead of time. Even assuming a nasty spread in the US with a lot of absenteeism, you will still have warning. It isn't likely to happen instantly and be on you before you know it (that's possible, but in my estimation low probability). My two cents. There are plenty of apocalyptics around here who will undoubtedly tell you different.

revere: Thanks for your reply. Yes, I agree with your suggestions.

Goes without saying, but...it's not just my family and my daughter. It's millions of families who are right now awaiting notification from U.S. colleges and universities (March is the month) as to where their kids will be welcome in the fall. And those with kids already in college and living in dorms.

We families have given a certain level of "trust" over to these instituions. We don't just want them educated, although that is primary purpose. We want them CARED for, certainly with regards to health and safety. I applaud the forthright decision of the University of Maryland (that you cited above) to close down with the first reported case in North America. THAT is proactive thinking, and realistic. Campuses housing students in dormitories are going to have death-traps on their hands if they don't have realistic plans, dilly-dally around, wait too long to take decisive action to protect those kids.

OK, they are university students and 18 year old or older...and they are still kids.

You cannot prepare for what you refuse to think about.

The problem for food is not cities but how far it is shipped, all the support systems the trucks rely on, the fragile mercantile / logistics system which governs changing ownerships and destinations.

Add to Revere's advice, discuss this with your daughter now. Include alternate travel arrangements and alternate destinations. Count on her needing to improvise.

Yo, parents with kids in college:

The answer for anyone smart enough to be reading this, is:

1) Discuss this with your college kids. Be realistic, don't spread fear, do show them the science includng this blog. Consider the possibility that you will have to take in your kid plus their sweetheart or closest friend. Don't fight over that: better to have your kid back home, plus another person who you can "adopt" for a while, than to have your kid plus whoever running around God-knows-where because you refused to let the "whoever" come to stay with you.

2) Agree on a trigger event. My very-strong suggestion is: any reported cluster anywhere in the world that appears to have involved casual or contagious transmission. The reason is, by the time that first cluster is reported, people have already been traveling and spreading it to other places, and the incidence of risk while onboard public transport (including aircraft) would be increasing by the day. Also in this era of jet travel, a cluster anywhere in the world will spread to other major cities around the globe in a matter of a very few days, including people who are contagious but have not shown symptoms.

3) Make appropriate transportation plans:

a) If you can get out by air via a wholly domestic route, that might be best IF you can do it within a day or at most two of hearing about that first cluster anywhere in the world. To make this work you need to have a credit card with sufficient credit to buy a last-minute one-way ticket, which can be ferociously expensive, as in $1500 from New York to San Francisco. Do not accept standby, you do not want your kid hanging around an airport for more than a few hours at most.

b) Rail might be worth considering even for long distances. Rail has fewer international passengers than air, by which I mean, most international travelers use air for their entire travel plan, so the number of foreign travelers on domestic rail is relatively small (the relevance of this is, it's going to start somewhere other than the US first, and travelers from that country will be high risk). However it may be harder to get last-minute bookings on long distance trains, as these are very popular and often booked up well in advance.

c) Grayhound or equivalent long-distance bus, despite its reputation for carrying crazies and suchlike, does have the same advantage as rail: fewer foreign travelers than are on the airlines. Also like the train, you can open the window, and every bit of fresh air ventilation is worth while.

d) Rental car: Not likely. Car rental companies typically have a minimum age of 21 to drive the vehicle, and require a credit card from both the person renting and the person driving, and in some cases both have to show up at the rental agency to sign for the vehicle. The age restriction alone rules it out in most cases (and yes they will check your kid's driver's license).

e) Their own car or carpools with friends who have cars.
---If the kid is a freshling they won't have an established circle of friends and won't be able to tell who is reliable and who is a flake. New friends flaking out in an emergency is a serious risk.
---If the kid is sophomore or later year, they should be evaluating their friends to note who is reliable. Any plans for car pooling should be practiced at least once, i.e. for casual travel home during a winter or spring recess.
---Car pool plans should include a) everyone who plans to ride together agrees on the trigger threshold in advance, b) how to contact each other i.e. redundant telephone calls (DO NOT leave messages with other students, they WILL flake out on delivering messages, you MUST reach the called person directly) and email and notes pinned on dorm room doors, c) where to meet, d) how much luggage each person can carry, e) how much money each person needs to bring, and f) the primary and backup travel routes depending on time of year and weather.
---If you have any doubt about your kid being able to be a passenger in a reliable car pooling group, then get your kid a car, which should be a reliable vehicle with decent fuel efficiency. Set a limit on non-emergency use of the vehicle, and tell your kid to keep the gas tank at least 3/4 full at all times. Teach your kid how to organize a car pool as a driver and how to do it responsibly: if nothing else, a car full of students makes a less-likely target for casual (or desperate) criminals along the way, and a car with a single occupant makes a more-likely target.
---Get your kid a sleeping bag and a few other basic supplies. If s/he has to stop overnight at motels for sleep, the sleeping bag may be a safer bet than the hotel bedding, depending on how fast the virus spreads. You can't count on the hotel laundry to sanitize bedding properly, so don't take chances. A tolerable indoor sleeping bag can be had for less than $100. Also the sleeping bag will make a decent blanket for keeping warm in a car if riding through cold areas in the winter.

4) Make appropriate communications plans.
---Weekly email or phone calls are always a good idea. Agree on a communications protocol for when the pandemic starts: whoever gets the news first (you or your kids) should tell the other, and then put the plan into effect. The plan needs to include multiple backups with relatives etc. so there is always someone who your kid can speak to live and in person whenever they call.
---Also get your kid a cheap-rate phone card (MCI is decent) for use in emergencies only. Replace or recharge it twice a year to be sure the PIN numbers remain valid. Do not count on cellphone infrastructure working everywhere for example in rural areas (I am a telephone systems engineer, I know whereof I speak), instead count on using the payphones, thus the phone card.
---Cellphones should be regarded as a convenience, NOT as a primary communications modality. The cellphone infrastructure is hardly as robust as the landline infrastructure. You need to have a landline at home, and your kid needs to have a landline at school.

5) About overseas travel: I sure as hell wouldn't. And that means you too, moms & dads. Take your vacation here in the US, there are fifty states to see and you can keep busy for 25 years doing one each winter and one each summer. I would also attempt to dissuade kids from doing overseas study: there is very little they can get "there" that they can't get "here," and "experiences" is/are too vague a basis for taking a serious risk of this type. For those who are determined to go overseas, I frankly do not have a clue about how they can be sure to get back safely.

6) Stockpile your house with appropriate supplies. And when your kid gets home, quarantine him/her for as long as the health authorities recommend. Kids should understand that this is what's going to happen with they get home: strip down, into the shower, put on new clothes, and into the quarantine room for however-long.
---Get a simple intercom from their quarantine room to the rest of the house.
---And put a phone and an internet connection in their room, and TV & radio if they like, so they can live with the physical solitude for a week or more.
---Some cordless phones have multiple handsets with built-in intercom between them, for example Panasonic KXTG-6633 (-B for black, -W for white), or go to panasonic.com or your local consumer electronics shop. However not all multiple-handset systems have intercom, you want to be darn sure it says "intercom" in the feature list.

7) When dealing with household sanitation for people who are quarantined awaiting their health status to be cleared: sanitize everything, the laundry, the dishes, etc. Room refuse should be put in plastic bags and tied tightly before being put in the main household bins. Ideally a person in quarantine has their own private bathroom that no one else uses for any reason, but if that's not possible, then establish procedures for sanitizing surfaces after use. See also the flu wiki for more details on household procedures.

Sorry if this is a bit long. In case any of this is useful: Creative Commons release: use freely with attribution.

Don't risk lives on the WHO changing the phase alert (3 since Nov. 2005?)
as politics and economics have overridden honest reporting (which we never expect out of some nations anyway). Who's to say we aren't at 4, or 5, already?
http://web.mac.com/monotreme1/iWeb/Pandemic%20Influenza%20Information/B…

v, since it is transmitted before people are ill, no one should trust that the cfr has to drop to single digits. (Especially when the virus can travel at jet and car speeds.)
Dr.Nabarro said, back in Dec.2005, that colleagues he spoke to agreed it is possible for H5N1 to go pandemic without decreasing in virulence.
http://www.gartner.com/research/fellows/fellow_interview_nabarro.jsp
(Worth a read, and, show to your local officials:..."By the time the pandemic starts, preparation will be too late."...)
The WHO said, late 2006 that it is possible to go pandemic at current fatality rate.
With modern ICU care and antivirals it is very high fatality; without those being available, (and they won't be since no one has immunity, and most hospitals can't take any sort of surge now, let alone one getting worse every day until breaking point) well, home care of panflu/ARDS cases isn't going to have good outcomes.
v, look at Indonesia's cfr last year and this year
http://www.fluwikie.com/pmwiki.php?n=Main.ConfirmedCasesUpdated
Here's an Indonesia news thread from PFI; does not sound under control: http://www.singtomeohmuse.com/viewtopic.php?t=585&postdays=0&postorder=…
No local, state or other entity
should be delaying or trying action to WHO phase levels.
Watch what they do, not what the phase is.
How can this still be phase 3, unless they re-wrote the level definitions, again?
What would you, or your university, or town be doing differently
if they had gotten a phase 4 declaration?

Good points. BTW, crfullmoon, good comments upthread.

Seems to me the trigger should be "any cluster that appears to involve casual or contagious transmission, anywhere in the world." All it takes is for one contagious but asymptomatic case to get on an airplane, and the proverbial game is on.

Anyone who waits for governmental or large private entites to change the alert status, is looking for a Darwin award.

flutracker - You and your daughter can't put your lives on hold for this thing. A year ago I was in your shoes, waiting for college decisions and worrying about panflu. Now, DS is nearly a quarter of the way through his time at Univ of Toronto. It has been a fabulous experience for him, he loves the school and the city. He will undoubtedly study abroad at some point. We vacationed "overseas" just last week and returned to tell the tale. Some of the ideas above, I dunno - carpooling is less effective at a city university where kids don't tend to have cars. Getting to a closer relative at first may be a solution (I have family in Buffalo, for example). I hope your daughter finds the school that is best for her, I decided not to include panflu in our college decisionmaking. I think teh Canadaians have a better handle on public health than we do. UofT offered ALL students seasonal flu shots in the fall, and your daughter will be covered by UHIP, Canadian health insurance,which will cost you about $600 year.
The issue for me is figuring out the trigger to get my DS home, I am always glad to hear what others think of this.

Catch a falling knife? Seems like there's either "too early" or "too late"; not much between.
http://travel.state.gov/travel/tips/health/health_1181.html
..."This fact sheet alerts Americans to the Department of State's preparedness efforts with respect to a possible influenza pandemic.
The Department of State emphasizes that, in the event of a pandemic, its ability to assist Americans traveling and residing abroad may be severely limited by restrictions on local and international movement imposed for public health reasons, either by foreign governments and/or the United States.
Furthermore, American citizens should take note that the Department of State cannot provide Americans traveling or living abroad with medications or supplies even in the event of a pandemic. "...

..."It is also likely that governments will respond to a pandemic by imposing public health measures that restrict domestic and international movement, further limiting the U.S. government's ability to assist Americans in these countries.
These measures can be implemented very quickly. Areas of known H5N1 outbreaks in poultry have been quarantined by governments within 24 hours, restricting (if not preventing) movement into and out of the affected area."...

Thank you to all for this ongoing discussion.

g510: Thank you, I am revising my thinking to take your suggestion for the trigger: "any cluster that appears to involve casual or contagious transmission, anywhere in the world." I might add, particularly if health care workers are falling ill from patient contact. Or maybe not.

I'm thinking that probably when this happens WHO would convene its expert panel (by teleconference, one would hope), but there might be a delay, and the outcome of that meeting...WHO knows? Perhaps the experts would advise (be pressured) to wait for a second or third such cluster to emerge in near time-frame before calling Level 4. On the ground I am sure health authorities would be attempting to throw the "Tamiflu blanket" down. I don't give that tactic one chance in ten million of working, certainly not in a place like Indonesia and probably not anywhere else. Well, maybe China...which will not hesitate to act ruthlessly to contain and restrain people.

Of course, I now have to convince husband and daughter that this would be the trigger, prior to official "endorsement" by WHO, CDC, or any official body. In the actual event, my husband and I would have to agree that the trigger has arrived before we could contact her and say "This is it." My husband does not track H5N1 developments, he relies on me to do that. Hence, it's my credibility (mostly) on the line to make the call, to "catch a falling knife" as crfullmoon puts it. I spend plenty of time at The Flu Clinic at curevents.com, flutrackers.com and lately here at Effect Measure to keep up with what's developing. And I have spent time and money during the past year acquiring prep supplies to shelter in place at home, and continue to do so.

It's not like an incorrect call is without consequences, either. Obviously I wouldn't give a fig about any lost tuition, property, or anything else if I make the right call (pandemic is breaking out) and successfully get my daughter home or to a relative's home for the duration. Personally I wouldn't care about lost assets even if I make the wrong call, but I already know I will never hear the end of it from the other family members -- her education will have been interrupted and it would be uncertain whether the university would allow her to re-enroll. Also, that they wouldn't believe me the next time.

Yes, trying to catch a falling knife alright, more like a falling sword.

In the meantime, I applaud revere and others for bringing these issues to forefront of attention at colleges and universities, and urge college administrators everywhere to get on the ball and deal with this issue RIGHT NOW. What are you going to do in the event of world-wide flu pandemic that is PARTICULARLY dangerous to young people? Particularly when they are living and dining every day in close quarters? Furthermore, what about your faculty? You value having them, don't you? How are you going to protect their health and lives?

spikemom: Thank you for the information specific to having a US citizen student enrolled at a Canadian university. As noted before, part of me thinks it might be better for her to ride out a pandemic in Canada...but I'm sure we'd want her at home or at the Boston relative's home instead. Only natural.