Unlike an earthquake or tornado, pandemics can last for months, even years. While the long-term nature is not preferable, it does give us one major advantage – the ability to adjust our response as we go along, not just clean up and prepare for the next disaster. On June 11, the World Health Organization (WHO) declared the novel H1N1 virus outbreak the first influenza pandemic of the 21st century. Many experts who had been following the H5N1 virus for years expected the next pandemic to be of avian origin and to start in Asia, so the emergence of “swine flu” in our own backyard came as quite a surprise to many in the emergency management community.
As of Sept. 20, 2009, there have been more than 300,000 laboratory confirmed cases of pandemic influenza H1N1 – including 3,917 deaths – in 191 countries and territories reported to WHO. The WHO announced in July that case counts were no longer representative of the infection levels and that it would stop counting individual cases. The Centers for Disease Control and Prevention (CDC) estimated that the virus had infected more than 1 million Americans as of this summer, and it continues to spread.
Unfortunately, no one can predict exactly what the 2009/2010 flu season will look like. Influenza viruses are inherently unpredictable, which means we have to be prepared for any scenario. Emergency managers can take stock of the lessons learned from the initial H1N1 pandemic outbreak to improve their response plans now.
Based on my work with clients throughout the H1N1 outbreak, and my interaction with disaster planners around the world at various industry conferences, I have identified four major lessons from the H1N1 pandemic that disaster planners should pay particular attention to as they prepare for the winter flu season:
Lesson 1: Employee absenteeism can be unpredictable, as employees won’t be affected uniformly.
According to a recent Trust for America’s Health (TFAH) report, “Pandemic Flu: Lessons from the Frontlines,” one key learning from the initial H1N1 outbreak was that school closings have major ramifications for students, parents and employers. School closures during the initial H1N1 outbreak in the spring were not system-wide, making it difficult for companies to assess which employees would be absent from work to stay home with their kids.
Companies must take a more nuanced approach to preparing for employee absenteeism. It’s not enough to simply assume that 30-40 percent of your workers across all departments will be absent. One unique consideration with H1N1 is that it has had a more severe impact on certain population sub-groups, including young people ages 4-24 and people with underlying health conditions. We saw effects of this with hundreds of school closings this past spring. Then countless summer camps were affected by H1N1, which is a likely indicator of what to expect during this flu season.
I recommend developing the appropriate human resource policies necessary to manage employee absenteeism due to school closures. Also, create a detailed list of employees with children and their school districts/daycare centers. That way, you will have an accurate list to refer to and cross-check when you want to determine which employees may be absent due to specific school closures.
Lesson 2: Employees paid close attention to how their companies handled the situation and turned to their employers for guidance.
According to the TFAH report, providing clear, straightforward information to the public was essential for allaying fears and building trust. The same holds true for companies and their employees.
Businesses must determine when and how they will communicate with their employees and who will be doing the communicating. Will your company use text messages, voice mails, emails, Intranet updates, or a combination of these methods to keep your employees informed of key H1N1 developments?
It’s important to strive for accuracy in your communications but to also acknowledge the evolving nature of the situation. For example, according to Dr. Isaac Weisfuse, the deputy commissioner for the Division of Disease Control at the New York City Department of Health and Mental Hygiene, because of the ever-changing H1N1 situation, it is helpful to explain to employees that decision-making may precede full fact-finding and that decisions may change over time as new information becomes available. Another helpful tip that Dr. Weisfuse offered is to educate employees about both seasonal and pandemic flu as soon as possible. It’s important for employees to know how the flu spreads, how to practice good hygiene, and to understand when and how social distancing (remaining six feet apart from other employees) may be implemented in the workplace. Indeed, one recommendation should be to tell employees to stay informed of the situation, and companies should help their employees do that.
Lesson 3: Companies that took measures to ensure their employees remained healthy at work are currently reaping the benefits of enhanced loyalty and productivity among employees.
If you haven’t done so already, formulate a plan to determine how your company will protect employees with personal protective equipment (PPE) like masks and respirators, and with pharmaceutical interventions such as prescription antiviral medications. If you already have a plan like this in place, take the time now to follow up with suppliers, distributors, storage facilities and medical providers to be sure there won’t be any hiccups in the process if you need to activate this part of your pandemic plan in the coming months.
PPE is recommended for staff members who cannot be separated by a minimum of six feet within the workplace. It’s not enough to simply have the equipment. Be sure to identify when the PPE will be distributed, who will provide training on the equipment and how you will ensure the PPE supplies stay secure throughout the pandemic. The U.S. Department of Health and Human Services (HHS) and the Centers for Disease Control and Prevention (CDC) have interim guidance on the use of facemasks and respirators on their Web sites. It’s a good idea to visit these sites regularly to stay on top of any updates.
The WHO and CDC report that antiviral medications Tamiflu and Relenza are effective against the 2009 H1N1 pandemic strain, and the antivirals are being used to treat and prevent cases and to quell outbreaks. These medicines will remain the primary defense against the evolving pandemic until vaccines can be made widely available to the general public. In addition to reducing the severity and length of the flu, antivirals can be used preventatively to keep people from getting sick. Including antivirals as part of your pandemic plan can help staff remain healthy and feel safe coming to the workplace. Having an antiviral program can also boost employees’ and customers’ confidence in your business.
If your company chooses to offer antivirals to employees, a number of subsequent decisions need to be made. You must decide if you will also provide antivirals to employees’ families and determine when and how the medications will be ordered, stored, safeguarded and distributed. And again, remember to include an education component in your plan -- it’s essential that employees understand why, how and when antiviral medications will be used.
The companies that manufacture Tamiflu (Roche) and Relenza (GlaxoSmithKline) have special reservation programs available for companies looking to secure antivirals for their employees. The antiviral courses can be reserved for a nominal annual fee, and the manufacturer will handle the maintenance and storage of your antiviral stockpile. The customer can purchase their stockpile in full at any time. Visit www.pandemictoolkit.com for more information.
Lesson 4: Companies often need medical consultation on how to handle different situations as they arise, but local Departments of Public Health (DPH) are likely to be overwhelmed and unable to provide that information in a timely manner.
In the spring, many local DPH were completely inundated with phone calls and requests. This situation will likely worsen during the fall/winter flu season. While having a relationship with your local health department and following their updates is important, I strongly recommend that companies identify a medical provider whom you can call for direction on how to handle a variety of issues at the workplace. Someone with an infectious disease or occupational health background would be ideal. When you are faced with a tough medical decision, you’ll be thankful you took the time to form a relationship with a medical expert who can provide sound guidance.
Fortunately, the H1N1 pandemic has been moderate in severity so far, with most healthy people recovering on their own. But we may not be so lucky this fall and winter. Whether or not the H1N1 virus gets stronger or becomes more virulent, the fact remains that humans have little to no immunity against it, and millions continue to be at risk for illness, hospitalization and death. Now that we’re in the middle of a pandemic, planning takes on a whole new sense of urgency. Applying key learnings to your planning now is critical. How a company fares in the aftermath of this pandemic will certainly be an indicator of how well the company prepared.
Regina Phelps, RN, CEM, BSN, MPA, is an internationally recognized expert in the field of emergency management and contingency planning. She is the founder of Emergency Management & Safety Solutions (www.ems-solutionsinc.com). With more than 27 years of experience, she has provided consultation and speaking services to clients in four continents. She has written hundreds of pandemic plans, conducted more than 250 pandemic exercises, and maintains a daily pandemic blog at http://emssolutionsinc.wordpress.com.