Unfortunately, organizational continuity plans (OCPs) almost uniformly ignore a group of threats that challenge nearly all the basic tenants of continuity planning. These threats include invisible challenges such as germs, diseases, and other communicable infections.
These types of threats are most often left to the discretion of local doctor’s offices, hospitals, and public health departments. However, public health threats such as these can wreak havoc on organizational continuity and have a significant economic impact. For instance, according to WebMD, an average American flu season is responsible for 70 million days of missed work and $3-$12 billion via indirect economic loss. Similarly, the Toronto outbreak of Severe Acute Respiratory Syndrome (SARS) in 2003 reportedly cost an estimated $722 million in total economic loss in Canada, according to CBC. At a more conceptual level, multiple sources estimate that a future outbreak of pandemic influenza in the United States could cost $71-$166 billion in economic loss.
Public health threats like germs and diseases are unaddressed in many OCPs for many reasons. Many continuity planners and organizational leaders are unaware that diseases are constantly present in most communities. In many areas, state law dictates that local public health agencies report certain diseases and health conditions that may be a threat to the local community. The type of reportable conditions include, but are not limited to influenza, sexually transmitted diseases (STDs), tuberculosis, E. coli, salmonella, meningitis, anthrax, tularemia, lyme disease, mumps, measles, staph infections, whooping cough, and chicken pox. The reporting interval for these diseases ranges from 24 to 72 hours after determination; however, other diseases are only reported on a quarterly basis.
Most continuity planners and organizational leaders are not actively aware of the number of cases of disease present in their particular area. For instance, a survey of one metropolitan area (population approximately 2 million) over a six-year period established the presence of more than 17,000 reportable cases in that period of time. Interestingly, disease experts have stated that only 10 percent of all reportable conditions are ever officially reported due to home remedies, avoidance, professional misdiagnosis, or time. Therefore, in this particular metropolitan area, more likely there have been approximately 170,000 disease cases in the last six years, which is an average of 28,000 per year. Based on the adjusted figure, more than 1 percent of the population has a reportable condition at all times.
There have also been numerous regional and national outbreaks in recent years. Specifically, foodbourne outbreaks in peanut butter, ground beef, and fresh spinach have caused numerous issues including employee absenteeism and increased medical insurance claims. Similarly, an outbreak of mumps in the Midwest in 2006 created similar issues as well as the marked concern from the public-at-large.
Before OCPs can be adjusted to address these biological challenges, continuity planners and organizational leadership need to understand how these diseases and conditions spread along as well as additional factors that exacerbate the impact of these conditions. In simple terms, communicable conditions can be spread in two ways: person-to-person and vector spread. While these two categories are not independent of each other, they do represent two broad concepts that are necessary to understand and mitigate the impact of public health threats.
Person to person transfer usually occurs via inhalation, skin contact, or surface contact. This mechanism covers germs that are breathed in or transferred as people touch infected surfaces and then touch soft membranes such as their eyes, nose, or mouth. Influenza, for instance, is commonly spread via person-to-person transfer. Conversely, vector spread conditions are diseases that are spread from a non-human source such as birds, insects, or vermin. A common example of a vector spread disease is West Nile Virus.
As previously stated, while these mechanisms are naturally-occurring, there are mitigating circumstances which contribute to the spread of disease via these processes. Specifically, the primary culprits are inadequate handwashing as well as poor cough and sneeze etiquette.
A typical hand can carry between 10,000 to 10 million germs (both resident and transient), which makes it an excellent mass transporter of sickness and organizational disruption. Moreover, influenza viruses can live on human hands for up to five minutes which provides ample time for an average employee to touch multiple office surfaces and come in contact with the vast majority of the employees in a given office area. Lastly, fecal-oral transfer is another common source of infection. This type of transfer is very common without proper handwashing because fecal material can transfer through seven layers of toilet paper. Most public health experts recommend that people wash their hands for 20-30 seconds with soap and warm water, which can be easily accomplished by internally singing a simple song like “Happy Birthday” or the “ABCs” while a person washes their hands.
Poor cough and sneeze etiquette also contribute to the spread of diseases in an office environment. Unfortunately, most people have been taught since childhood to “cover their cough” with their hand; however, this is an extremely efficient way to maximize the person-to-person spread. People should be taught or encouraged to sneeze or cough in the crook of their elbow or into a sleeve. However, socially unacceptable this may be, it minimizes the disease transfer points and therefore reduces the chance of diseases spreading.
Unfortunately, germs are everywhere and cannot be avoided. Even areas that people think are clean such as sinks, bathtubs, and women’s purses often contain 20-100 percent more germs than a common garbage can. Similarly, common public areas such as grocery carts, ATM machines, exercise equipment, drinking fountains, and hotel rooms are often covered in opportunistic germs.
These types of challenges to organizational continuity do not easily fit into traditional organizational continuity of operations plans. Specifically, diseases and other communicable conditions have extended durations and can last up to several weeks or months depending on the condition and the mitigation and response available within the community. Consequently, returning to normal operations within 30 days may not be possible. Likewise, moving operational activities to a “safe area” may also be difficult if not impossible. In the case of communicable conditions, the threat is contained within (or on) the operational personnel and therefore will invalidate the “safe area” unless intense control procedures are put into place. Lastly, diseases are invisible and therefore difficult for employees and their families to understand and accept. As such, organizational continuity plans are commonly deficient in addressing the educational pieces that are necessary to address this type of challenge.
Although challenging, communicable threats do provide another opportunity for mitigation and prevention. Organizational continuity planners need to evaluate the need for increased educational activities and the effectiveness of organizational policies as they relate to the community threats mentioned above. Specifically, all employees, with special focus on essential personnel, should be provided education regarding how diseases spread and encouragement to participate in activities that minimize the transmission in operational areas. Fortunately, this process can range from simple to complex without losing effectiveness. This is particularly important in shared office environments where multiple persons use the same desktop, mouse, keyboard, and phone.
Additionally, organizations must be careful when providing hand sanitizer to their personnel as the sole preventative measure. Hand sanitizers with 60-95 percent alcohol are effective at reducing the spread of diseases, but only as a supplement to good handwashing. Hand sanitizers are excellent temporary measures at workstations and cafeterias but should not be placed in restrooms where handwashing stations are readily available.
Personal protective equipment (PPE) is also commonly talked about when addressing public health issues, particularly pandemic influenza. Without any special training, common PPE includes gloves, masks, gowns, and booties. However, these are most likely not necessary for most communicable threats in an office environment. The mitigation and prevention measures already discussed will adequately minimize the spread. The one exception to this rule may be the need for masks (respiratory protection) during a pandemic influenza outbreak; however, this particular issue is complicated and is more thoroughly addressed in other reports provided by the CDC and OSHA.
Organizations must also evaluate internal policies to see how they respond to the impact of public health challenges. For instance, many organizations require domestic and international travel by employees and other related personnel. Unfortunately, since communicable diseases are more common in some developing countries, they can be inadvertently transferred to personnel visiting those countries. When the traveling personnel return to the office they may be sick and contaminate other members of the office. Or in more severe circumstances, the local or state health agency may isolate or quarantine the sick traveler and/or those exposed in the office. This would severely impact OCPs due to the impact on the availability of essential personnel.
Organizational policies must also be evaluated for day-to-day sicknesses like common colds and flu. Most employees, particularly those with supervisory and management responsibilities, will continue to come to work even after they begin to have symptoms such as coughing, runny nose, and general lethargy. Unfortunately, working with these kinds of symptoms often will expose most of the office to the sickness. Therefore, organizations should review their internal policies to encourage personnel to use available sick time to stay away from work and minimize the overall and long-term impact to organizational operational effectiveness.
Every organization, regardless of the size and service provided, can be severely impacted by communicable conditions. Every employee, particularly essential personnel, should be provided education and encouragement to practice good handwashing, cough and sneeze etiquette, as well as other prevention techniques. Like all hazards, organizations must evaluate the risks of communicable conditions and other public health threats. Once this evaluation is completed, clear communication with personnel and their families will alleviate some of the fear and misunderstanding that comes with these types of public health threats.
Organization should approach preparedness from a comprehensive approach which includes not only flu shots, but education and awareness of communicable diseases. A comprehensive program should be created and incorporated into organizational continuity plans to facilitate to this preparedness and the protection of both the company and its personnel.
About The Author: Adam Crowe, MPA, serves as the homeland security planner and resource manager for the Johnson County (KS) Office of Emergency Management and Homeland Security. He has also worked as the emergency response and information coordinator for the Platte County (MO) Health Department. Crowe also is the president of the Partnership for Emergency Planning (PEP), which serves the public and private emergency planning sectors in the Kansas City Metropolitan Area. He is also an adjunct instructor for Park University. Crowe holds as master’s degree in public administration from Jacksonville State University. Although well-versed in all-hazards emergency management, his specialty is public health threats to the community.
"Appeared in DRJ's Spring 2008 Issue"