Pandemic Preparedness--Starting Now

Advance planning holds the key to mitigating pandemic OH&S risks.

• By Myles Druckman, M.D.
• May 01, 2006

WHEN the first human cases of avian flu arose in Asia, employees in the affected areas became anxious and, in some cases, terrified. Anxiety and rumors spread, as did the virus, and people were dying--young, healthy people. Asian operations of multinational companies raised the alarm to their corporate offices in the United States. Feeling the pressure, corporate head offices scrambled to try to resolve this "Asian" problem.

Then, the true nature of the threat began to sink in . . . this was not "an Asian problem." This was a global problem, the likes of which we have never had to prepare for before. Pandemic means global, and the effects will be felt everywhere. We are already affected today.

The prospect of an avian flu pandemic is frightening. Scientifically sound predictions speculate that healthy young adults may be hit the hardest; that health care systems will be critically short of beds, supplies, and staff; that millions could die and the world economy could be devastated.

The World Health Organization (WHO) is clear that the threat of an influenza pandemic is great and that this threat will persist. WHO is urging all organizations to develop plans to prepare for a pandemic. The time to prepare is now. Whether the avian flu (H5N1) virus that is circulating today will become the next pandemic virus is unknown, though it remains the greatest potential threat on the horizon. The concern with the present H5N1 avian flu virus is that it has two of the three characteristics of a pandemic virus: It is a new virus for which humans have no immunity, and it can cause significant illness and death. Fortunately, it lacks the ability to be easily transmitted between humans. If the virus mutates into this form, it would herald the coming of the pandemic.

What this means for companies is that both their personnel and operations will be at significant risk in a pandemic. The effects of SARS, though very limited from a health perspective, caused huge financial damage to those regions that were affected. Magnify this effect exponentially, and you have the potentially devastating effect of an influenza pandemic.

Fortunately, this message is starting to hit home--albeit gradually. Recent polls of multinational companies who participated in our webinars demonstrated more than 80 percent believe a pandemic is a very important or critical issue for their organization, though only 36 percent of companies are now developing pandemic plans. This is an improvement because five months ago, that number was 16 percent. Still, the majority of companies are trying to understand the issues and figure out what they need to do to prepare themselves.

One challenge is that there is so much information out there, it is difficult to sort out what is relevant and what is only "good to know." Another significant challenge for companies is that a pandemic does not fit into their typical crisis management plan, nor will their SARS plan work for a pandemic. A pandemic will affect all areas of your operation, for months to years. Your company's pandemic team must consist of senior representatives of all major areas, including human resources, business continuity, occupational health and safety, security, operations, finance, and medical. Getting all these people together on a global basis is also a logistical challenge.

Three Basic Steps to an Effective Plan
So how can a company prepare for such an event? There are three basic steps a company needs to make in order to develop an effective pandemic plan.

The first step is to build a cross-functional pandemic team with authority--and educate the members. Education includes a clear focus on the expected implications and impact of a pandemic. The second step is to build a pandemic plan that uses the WHO pandemic phases for triggers. The third is to implement the plan, test it, and monitor the global situation closely, being ready to respond to changing circumstances.

Basic background on pandemic influenza: The avian influenza H5N1--sometimes A/H5N1 because it is in the influenza A family--is more commonly called "bird flu" or "avian flu." These two phrases are interchangeable. Historically, H5N1 only infected birds. Many wild birds carry the virus naturally and asymptomatically. Domestic birds, however, usually develop symptoms quickly after infection and die from the disease. A number of countries have experienced widespread infections among domestic birds since 2003, most notably China, India, Indonesia, Nigeria, Thailand, Turkey, and Vietnam. Millions of birds have died or been culled in an effort to control the disease.

H5N1 has also begun infecting people, killing about 50 percent of those who contract it. Patients have been recorded in Cambodia, China, Iraq, Indonesia, Thailand, Turkey, and Vietnam. Most of those infected have had close contact with sick birds--that is, they lived with them and may have killed or prepared them for consumption.

Bird flu has killed millions of birds, though it has infected fewer than 200 people, so today, in its present form, it still is a greater threat to birds than to humans. However, this is small comfort, because the influenza virus is very changeable. When the virus attacks and infects cells, it regularly makes replication errors. The new viruses it creates are often different from the ones that initially attacked the cells. The fear is that a replication error could produce a new virus that has the ability to easily infect humans and would create the pandemic virus.

We base many of our expectations of what could happen in a major pandemic on what occurred in the 1918-1919 pandemic of "Spanish flu," which killed at least 50 million people globally. Scientists see similarities between that virus and H5N1, and they were both avian influenza viruses. Pandemics have regularly occurred throughout human history, typically occurring every 30 years since the 1700s. The most recent was in 1968-1969, though it was not nearly as severe as the flu pandemic of 1918-1919. For this reason, experts consider the world "overdue" for another pandemic.

If H5N1 develops into the next pandemic virus, its effects are likely to be catastrophic. Conservative estimates established by WHO put the death toll between 2 million and 7 million deaths worldwide. Unlike annual flu outbreaks, which take their largest toll on the elderly and young children, pandemic flu may have the most impact on healthy young adults--the age group that comprises the bulk of the workforce. This implies that, from a logistical standpoint, your company's problems could start before anyone in your office even gets sick. In fact, they'll probably start before anyone in the nation gets sick.

Based on projections from the 1918-1919 flu pandemic, as much as 30 percent of the global workforce could be incapacitated during a pandemic. Even if all of your employees are healthy and present, your overseas offices may be incapacitated due to illness and absences. The company that supplies raw materials needed to produce your product may be unable to ship for an unknown period of time due to quarantine measures and international border closures. There are an infinite number of permutations of this scenario, which all have the same end result: You have a facility full of viable employees who cannot perform their jobs because of disruptions in the global workforce. Before the pandemic comes within 1,000 miles of your company, your employees may be affected.

Even if your company is purely domestic, the companies you do business with may not be. Any delay or backup they experience will eventually trickle down to your company. These shortages, interruptions, and supply outages will not occur on a neat, limited timetable.

Pandemics occur in disease "waves." It is expected that waves will infect locations at different times and in different degrees of severity, which cannot be predicted. So even as your Houston office is getting back on its feet after a four-week wave of illness that affected many, your Seattle branch could be just reporting its first case.

Getting Ready
The key implication is to prepare for the "wave." Up to 50 percent of your workforce could be absent at the peak of a wave (which could last weeks): some from illness, some from caring for ill family members or looking after children (the schools will be closed), some unable to get to work (public transport could be shut down), and some just too fearful to come into work. During the Spanish flu, there were at least three waves, each of which lasted weeks, separated over a year. This scenario could play out again in the next pandemic.

Many companies are now considering plans for ensuring employees do not come to work. How do I re-educate my staff so that the slightest cough keeps them home? How do I get hourly workers to stay at home? Do I pay them to stay at home? These are questions that should be answered now--not later, when it may be too late. Companies also are evaluating whether they can actually "shut down" their facilities during a wave. If they must stay operational, then who are the bare minimum (i.e., "business critical") staff necessary to keep your business running? Once you've identified those staffers, how do you get them safely to work and keep the work environment as safe as possible? What is a safe work environment in a pandemic?

Clearly, an impending pandemic will have major occupational health issues. But advanced planning can lessen its impact. Once a company recognizes a pandemic as a significant health threat, specific points can be addressed to prepare the workforce. Questions to consider include:

* What will we do to reduce transmission in the workplace? How do we identify infected people, and what policies will we enact regarding attendance, isolation, etc.?
* How will we react if someone becomes sick at work and the health care system is overwhelmed? Can we care for sick employees?
* Who will maintain a safe working environment and occupational health and safety standards if critical staff members or supervisors are absent?
* What methods of stress management will help staff members cope with extreme, prolonged anxiety and depression?
* How will we handle travelers and staff overseas?

These are difficult questions, but by considering them before a pandemic begins, companies can start to formulate plans. Ideally, these should include both high-level policy decisions and specific actions that will be taken as governed by those decisions. Your plan should be able to "activate" certain processes as soon as clear triggers are met. That way, precious time won't be wasted trying to decide what to do.

Accurate, up-to-date medical information is critical to preparation efforts. Like all flu viruses, H5N1 constantly mutates, and its march around the globe continues. It's a hot story, and the 24/7 news media know this. One of the first and most important things you can do when developing a preparedness plan is to decide where you will get your information and who will be responsible for keeping it current. You may also find it useful to cultivate relationships with local health authorities so you know what their plan is, and their limitations, allowing you to best manage your operations.

There are a number of other steps that can be taken to protect workers' health. Encouraging all employees to optimize and maintain their general health is a good starting point. In general, healthy people have a better chance of surviving a serious infection. Also, educate your employees about the importance of personal hygiene and proper cleaning methods to reduce the risk of illness in the workplace. Taking steps to preserve their health and prevent illness will empower people and give them a sense of control.

Update your sick, family, and medical leave policies, preferably ensuring that employees who are ill will not be penalized for staying home. Use these policies to stress a sense of communal responsibility--that is, that sick employees should make every effort to confine their illness and prevent spreading disease among colleagues. Develop specific procedures for managing an infected person in the workplace; identify quarantine areas, consider transportation issues, devise a notification chain.

Consider stockpiling personal protective equipment that can be used either generally to reduce the risk of workplace transmission or in specific instances when co-workers must care for a sick colleague. Identify sites, jobs, and personnel that are critical to business continuity, as well as locations where staff shortages could compromise staff safety. Make contingency staffing plans in case these employees are absent.

To address the needs of employees who are traveling or stationed off site, educate them about risks. This should be implemented immediately for any employee traveling to an affected area.

These suggestions are not comprehensive, but all are useful starting points in preparing for an influenza pandemic. The most important thing is to start now--it's certainly not too late. Investing in pandemic preparedness now may help reduce the economic, social, and personal toll that a worldwide disease outbreak can take on your business and ensure your organization is able to quickly recover once the pandemic ends.

There is a great pandemic threat on the horizon. All of us have been made aware of it. It is critical we take this threat seriously and prepare for it, to protect our businesses, personnel, and ourselves.

This article appeared in the May 2006 issue of Occupational Health & Safety.

This article originally appeared in the May 2006 issue of Occupational Health & Safety.