“It’s everyone’s worst fear in college health,” said Joshua M. Sharfstein, associate dean at Johns Hopkins Bloomberg School of Public Health. “Meningitis strikes very quickly. Someone looking well one day could be dead the next.”
What spun out over the next several days included thousands of panicky students and parents, the Santa Clara University president praying with the family of a student who had slipped into a coma, a top administrator bolting to the emergency room with his own son, the fastest-ever mobilization of a vaccination clinic in the United States — oh, and the Super Bowl, hosted in Santa Clara, with a pre-game event for 10,000 people planned on campus smack in the midst of the outbreak.
What they learned in that head-spinning, sleepless week could help guide others looking to prevent and stop contagious diseases in the closer-than-close quarters of campus dorms.
It’s all too easy to share germs at college: Last month, Harvard students with mumps were quarantined, and other Boston universities reported cases as well. Lafayette College in Pennsylvania shut down for several days in an effort to stop the spread of norovirus, which had sickened dozens of students.
The outbreak of bacterial meningitis at Santa Clara effectively forced the private college of about 9,000 students to turn suddenly, in the words of one academic official, into a health-care provider.
By noon that Sunday, Jan. 31, Sara Cody, the Santa Clara County health officer who had been alerted by a nurse at the hospital that there was a possible meningitis case, was working to ensure testing was done to determine if this was an isolated case or a public health threat.
“Once you’ve determined someone has meningitis, you want to take action right away to make sure close contacts have antibiotics, to build up immunity … and manage anxiety,” Cody said. “This makes people really worried, really anxious. Someone who is sick with this can get very sick very fast. … So the faster you move, the better it is all around.”
When Sharfstein was training, he heard about a pediatric resident who wasn’t feeling well at the end of her shift. “She was dead by the morning. That’s what meningitis does — just plucking people from the prime of their lives,” he said.
Michael Hindery, the vice president for finance and administration at Santa Clara, got the call that afternoon that there was a possible meningitis case. University officials had done emergency-management training that summer with a hypothetical crisis: a meningitis outbreak. They had come out of it with some improvements to their plan, including the realization that they needed to rely more heavily on social media to alert students.
Still, they found that weekend that they needed to be faster still.
Social media was “beginning to explode,” one official said, spreading rumors and misinformation with incredible speed, and rapidly piling up complaints from frightened students demanding answers from the college.
But they didn’t know what they were dealing with yet. “We don’t know if it’s bacterial or viral,” Jillandra Rovaris, director of health and counseling, said. “We don’t know the condition of the student. We’re trying not to panic — and trying to stop the community from panicking.”
The student’s illness “became very serious, and we escalated our responses,” Hindery said.
On the afternoon of Jan. 31, university officials decided to open their health clinic — normally closed on weekends — and send students crowding the emergency room back to campus. By the end of that night, 100 students had been seen there. As directed by county health officials, they were working to determine any connections and similarities among the hundreds of students reporting symptoms. They were getting preventive antibiotics to students who may have been in close contact with the hospitalized student.
The parents of that student had flown in from Arizona, but — it being Super Bowl week — all the hotels were booked, the university’s president said, so they found a place for them to stay on campus. “We gathered at his bedside to pray for him,” said Michael Engh, the president and a Jesuit priest, “and anoint him with the sacrament of the sick. He was comatose.
“It was heart-rending to see his parents when their son was in such a state. … There was a lot of anxiety. Would this spread, was he going to come through it? It was pretty traumatic all around.”
On Monday afternoon, Hindery encouraged his son, a student athlete at Santa Clara, to get to the clinic and get some Cipro. Cipro is the preventive antibiotic given to those believed to be in close contact with the sick person. That night, his son called him feeling very ill. Hindery took him to the emergency room, where he was given a blood test and released about 2 or 3 in the morning.
Hindery was working on university response Tuesday morning when he checked back in with his son. He was still feeling awful. Hindery took him back to the emergency room, where they did a spinal tap.
“That came back clean,” Hindery said. He went back to the university’s meningitis plans.
Things were moving so quickly, Engh said. “The scary thing was we didn’t know how many would come down with it,” he said.
Shortly before noon on Tuesday, testing confirmed meningococcal meningitis, serogroup B, in the first student hospitalized. By Tuesday afternoon, they knew of two more cases, one of them confirmed. There were dozens more students awaiting results of blood work and spinal taps, said Jeanne Rosenberger, the dean of students.
That afternoon they knew they would have a mass vaccination clinic, said Chris Shay, assistant vice president for operations and the emergency operations center director. Two vaccines were recently approved, in 2014 and 2015, for that type.
“We did not have a clinic,” he said. “We did not have professionals,” to administer the vaccines. “We did not have non-professionals,” to help.
“We did not have a vaccine.
“We decided to open it up on Thursday.”
So that night, as another hundred or so students went to the campus health clinic worried about symptoms, university officials dashed around scouting different locations on campus. They chose the basketball arena. Shay begged the chief technology officer, who was planning to roll out better wireless around campus, to add the arena immediately.
“With this generation of students, we knew we needed to give them enough WiFi,” he said. And a charging station.
They spoke with officials at another university who had gone through something similar; over two months, the University of California in Santa Barbara came up with 17 different models for a vaccination clinic, Shay said.
He told his colleagues: We’ll take their 17th plan.
On Wednesday morning, Hindery got a call. The state health department had, with more refined tests, confirmed that his son had meningitis.
He rushed him to the emergency room, again.
Shay described that day as a series of gut checks, as they scrambled to gather volunteers, alert students and parents, and get the supply of vaccine from the state. With federal funding designed for emergencies, they were able to administer the doses for free, rather than having students pay the $150 or so.
But the paperwork didn’t come through in time, to verify that the vaccine was safe. Officials worked late into the night to get an alternate supply.
People knocked on doors, taped up posters, tweeted. “I ran across students sunbathing on the roof and talked them into coming in to get vaccinated,” Shay said.
They lined up nurses and supplies from the county, the Red Cross, temp agencies, Stanford, local hospitals and pharmacies. County officials had told them they would need about 100 volunteers. On Wednesday night they asked, and by 9:30 enough had signed up — from the provost’s office, emergency management, the theater department, the law school — that they had a waiting list.
They trained people at noon the next day, and at 2 p.m. they opened the clinic.
There was already a line of hundreds of students outside the door.
Many students waited for hours. University officials brought in pizzas and cookies for students who were missing a meal. And as they left, every single student posed for a photo, with the slogan #Igottheshot, to share on social media. By 8:45 that night, they had administered 1,495 doses.
On Friday, knowing there would be lines, some students dressed in costumes — such as Lefty Shark — and improv groups and bands played to the captive audience.
On Saturday, they turned the basketball arena over to the Super Bowl celebration for the city of Santa Clara — with a celebrity football game, fireworks, and music by Huey Lewis and the News, of all surreal things — assuring the public it was safe to come on campus.
Hindery’s son was well enough to leave the hospital Saturday. All three students were recovering. The clinic would shut down soon, after delivering the last of 4,923 doses, and they knew the required follow-up doses could be handled easily, with clinic appointments in the spring. Hindery had an emotional moment thinking: We pulled this off.
On Sunday, the Denver Broncos beat the Carolina Panthers in the 50th Super Bowl, the final game for legendary Denver quarterback Peyton Manning.
“I think everyone slept right through the game,” Shay said. “The world was watching Santa Clara. But Santa Clara was sleeping.”