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Volume 27, Issue 4

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Preparing for an Influenza Pandemic

An influenza pandemic presents a unique threat to businesses and a unique challenge for continuity planners. The purpose of this article will be to discuss approaches to the kinds of challenges presented by an influenza pandemic and presenting ways to address those challenges.

Understanding the Risks
Let’s understand this fact at the very beginning: there will be a pandemic. We have experienced three pandemics in the last 100 years, the last one occurring in 1968. Like 100-year floods, the closer you are to the 100-year mark, the more likely the event becomes, and right now, we are past the 33-year marker for pandemics. It is very probable we will experience an influenza pandemic in the next five to 10 years.

Like all natural disasters, a pandemic can be severe or “mild.” Conditions in which a disaster occurs can change results significantly. For example, if a storm surge coincides with high tide, the damage will be much more significant than at low tide.
This is true with pandemics as well. There has been a significant change in the population since the last pandemic in 1968. Many persons with compromised immune systems are now in our midst. Immune-compromised persons may have HIV. They may be under treatment for cancer with radiation and chemotherapy. They may have received an organ transplant and are receiving immune-suppression medications. Given this new population among us, a “mild” pandemic could cause upwards of 200,000 deaths in the United States alone.

A severe pandemic, such as the one we experienced in 1918, would change the world dramatically. If the current Avian influenza were to become transmittable human to human, we could expect up to 1.7 million deaths in the United States and 180 to 360 million deaths world-wide.

Finally, there is the mistaken belief that a vaccine will be developed in time to inoculate everyone against the flu pandemic. Currently, it takes approximately six months to create vaccine, and not enough vaccine, to inoculate the population of the United States for seasonal influenza. While the federal government is spending significant dollars in an attempt to find a way to develop vaccine faster, it seems unlikely that, once such a solution is found, private companies will be able to build this entirely new capability in time to provide a vaccine for a pandemic.

Furthermore, this solution is only a theoretical possibility and it begs a number of questions. Who will man the factories to create the vaccine, manufacture the syringes, drive the trucks to deliver the vaccine and syringes, and set up the delivery of vaccine to people – when it may be a danger to have contact with any other human being?
Unlike seasonal flu, we cannot predict what a pandemic flu will look like. The amount of time from an outbreak to global transmission will be measured in weeks or a few months due to the speed of global travel. This is simply not enough time to find, manufacture, and distribute a vaccine.

An influenza pandemic is a vast event. Unlike other natural disasters, a pandemic has the power to affect billions of people. Planning for one is categorically different than planning for a local or regional disaster.

Many companies incur significant business risk with the threat of a pandemic. In this article, I will not address such issues (such as impact to life insurance reserves); I will only address business operations issues.

Stages of the Crisis
Pandemic influenza has specific stages and we ought to plan our contingencies accordingly. The World Health Organization has established the following stages of a pandemic:

Our contingency planning will be determined in large part by what stage we are experiencing because we need to execute differently in each stage. Currently, we are at stage three for the Avian flu.

Planning for a Pandemic Communications
If you work in a global organization as I do, employees are going to want to know what the corporation is doing to meet the risk of the Avian flu, and they are also going to want to know about it and what to do. In the area of communications, there are several areas which have to be addressed in terms of education. Families need to know how to prepare. Employees need to know that the corporate is preparing. Employees will need to know what procedures will be followed if an outbreak occurs both at the local office level and at the corporate level. The following is a minimal list of what corporate communications must prepare in stage 3:

  • Stage 3 Communications
  • Communicate that corporation has a plan
  • Educate employees on personal risks
  • Educate and disseminate information regarding how to care for the sick
  • Communicate personal protection guidelines
  • Communicate CDC family checklist
  • Communicate special pandemic employee policies
  • Create and communicate guidelines for immune-suppressed employees
  • Establish single point of presentation for reliable influenza information and corporate actions
  • Communicate and train key employees in each location on how to handle a person who becomes sick at work
  • Create a crisis communications plan

Some of these tasks may already be covered in your emergency plans; however, dealing with medical emergencies for flu is probably not covered. If someone shows up to work feeling well and gets sick, it is not enough to call the nurse or dial 911. That individual will need to be immediately isolated. Everyone who has been in contact with that person will have been exposed and this will need to be communicated. Persons who are immune-compromised may have to take special actions.

During stage 4, communications will be critical when outbreaks occur, since the actions taken by individuals may be life-saving of their own lives or families. At this point employees should be informed of the actions they are required to take and that they need to take them.

  • Stage 4 Communications
  • Status of offices (open, closed)
  • Status of the outbreak
  • Border closings and other government actions which affect the business
  • Initiate crisis communications
  • Ongoing communications

Stage 4 provides some time for final preparations for stages 5 and 6. Everyone must recognize that there will be more to come and to act accordingly. In stages 5 and 6 the role of communications will be primarily one of providing status.

There has been much discussion of the role of fear in communications. The great concern is not to cause people to panic. However, in depth studies of communications in times of crisis indicate that honesty is the best policy and that people can be trusted to make sound judgments. The big mistake is to tell everyone that “everything is under control.” Such pronouncements have the opposite intended effect, they make people suspicious and, far worse, if believed, such statements may put people in danger.

Human Resources Policies
It will be critical to encourage persons not to come to work during an outbreak if there is significant lethality associated with the influenza strain. Human resources must take a close look at existing policies. Persons who will be required to come to work may incur significant risk in doing so. Some companies may need to create incentive pay policies for persons who must come to work. At minimum, HR must address policies as follows:

  • Stage 3 Human Resource Employee Policies
  • Create absenteeism policy for use during pandemic (some people may not be sick but should stay home for safety)
  • Create sick-leave policy for influenza
  • Establish employee compensation policies for use during pandemic (some employees may be unable to work because they are attending to sick family members)
  • Establish employee policies for families who experience losses
  • Determine feasibility of internal healthcare support services

In stage 4, HR will have to initiate their influenza policies. They will have to begin a regular series of meetings to monitor the crisis and determine if policies are effective. If polices are not effective they will have to be adjusted.

HR will also have to create travel policies for employees who travel a significant amount.

  • Stage 3 Human Resource Travel Policies
  • Communicate to create awareness of the threat to travelers
  • Create travel kits (masks, gloves, and Tamiflu)
  • Distribute travel kits
  • Establish travel restriction policies based upon stages, locations of outbreaks, and border closings.
  • Create first-priority awareness (i.e. don’t go to work but get home if exposed or in an area where an outbreak occurs)
  • Establish stay-at-home policies for travelers who come from an infected area
  • Establish airport personal protection policy

External Agencies and Government Relations
For all global corporations, location offices will have to establish communications channels with government agencies or health departments. We can anticipate that governments and health departments will manage any pandemic differently, and therefore, location offices will have to be sensitive to these differences.

At minimum, local offices will have to consider the following preparation tasks:

  • Stage 3 Government Relations
  • Establish relationships with government officials
  • Collaborate with officials in planning
  • Establish relationships with healthcare providers where appropriate
  • Establish process for communicating with official during the outbreak

When an outbreak occurs, it will be difficult if not impossible to establish relationships with the appropriate authorities. Once stage 4 is under way, local offices will have to execute these tasks and funnel up critical information to any corporate crisis management team:

  • Stage 4 Government Relations
  • Obtain status and any critical information from officials
  • Communicate critical information to communications team for dissemination

Physical Resources
We can expect that the wise employee will stay home during a severe pandemic. Why risk serious illness or death for a job? This means that corporations must have significant work from home capability. You will not be able to obtain such a capability during a pandemic as resources will be at a premium. Therefore it makes sense to have the capability set up in advance. This has a number of implications. A BIA should have been executed to indicate not simply which applications are critical, but who runs and uses those applications. You must identify critical users beforehand, they must have a work from home capability, and you must document their procedures in the event that they are incapacitated.

All offices will need the capability to clean their facilities to a level achieved by hospitals. Infection control supplies, masks, and gloves must be available for use in the workplace in the event that a person comes to work and gets sick. It will be difficult if not impossible to obtain masks and gloves in stage 4 of a severe pandemic since there will be a run on such supplies.

Global corporations must also contract the capability to extract senior officers and managers. Having a senior manager stuck in a country where borders are about to close and unable to get an airline ticket is a distinct possibility. If the individual contracts influenza, and is visiting a third-world country, it is unlikely that they will be able to obtain western-style medicine. You may want to consider contracting one of the international air ambulance services that are available.
Planners should consider, at minimum, these steps:

  • Stage 3 Physical Resources
  • Stockpile infection control supplies at all locations (masks, gloves, and receptacles for disposal) in the event infected employees come to work
  • Enhance work-from-home infrastructure
  • Determine feasibility of stockpiling Tamiflu
  • Determine feasibility of stockpiling food in certain locations
  • Contract evacuation from foreign countries capabilities

Medical Knowledge Resources
Most companies do not have a physician on payroll, let alone a physician with expertise in infectious disease and epidemiology. Yet, to make informed decisions and adapt to the changing circumstances of a pandemic, corporate crisis management teams will need access to such expertise. Such resources will have to be contracted prior to any outbreak.

We know a pandemic is going to happen, but, unlike Y2K we don’t know when. The memory of the 1918 influenza pandemic is no longer alive among us. We have, I believe, been spoiled by a supremely efficacious medical technology. We have forgotten that significant logistics are required to enable that technology, logistics that we take for granted, and logistics which will, in all probability, be unavailable in a severe pandemic.
The conditions under which pandemics have occurred in the past have changed significantly, particularly with respect to the vulnerability of the overall population and the prevalence of global travel. Given these conditions, the only reasonable response is to plan.

"Appeared in DRJ's Summer 2006 Issue"

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