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 A blogger reported in January that three terrorists infected with a communicable form of avian flu had entered the country and were traveling the country infecting people. The blog claims the United States government is aware of the threat but is not publicizing it to avert panic. The blogger goes on to explain that avian flu is highly communicable, kills 70 percent of those infected, and that there is no effective treatment for it. Moreover, the writer adds the only way to avoid catching the disease is to stay away from anywhere that large numbers of people congregate.

Is your company prepared to deal with a situation like this? Do you know how your employees would respond to such an announcement, particularly if the report is not true? Does your company’s disaster plan take bioterrorist attacks into account?

Most of you reading this article are aware of terrorist threats and have been hardening your companies against them. But let me draw your attention to another vulnerability which lies in the perceptions of your employees about real and imaginary threats.

In the present political climate, you cannot afford to focus solely on the direct effects of terrorism or an epidemic of infectious disease you must also be concerned about how workers will respond to an event like a false report of avian flu by a blogger, which convinces workers they are under attack. 

 In fact, perceptions can pose as much danger to your company as an actual attack. If a worker believes his workplace has not taken adequate steps to protect him from potential exposure to a terrorist act or a biological agent, he will not report to work; if he does, his productively will be impaired. Likewise, if the public believes they are at risk of catching a communicable disease, they will minimize the time spent out of their homes and refrain from shopping for anything other than essentials, negatively affecting the economy and your business.

Two examples illustrate how individuals without any signs or symptoms of disease still fear they might be victims of a terrorist event or an emerging, infectious disease. In the sarin gas attack in a Tokyo subway, 75 percent of the people who showed up at the hospital after the attack were never exposed to the nerve gas. In a radioactive contamination in Brazil in 1987, only 250 people showed any signs of exposure, and yet 125,000 people came into the emergency room because they believed they had been exposed. So while your business and your community might be prepared to handle the immediate consequences of a disaster, have you addressed the fact that perception of illness or the perception of the threat of illness can cause as much harm to your company as the actual illness itself?

In Tokyo and Brazil, a physical agent was the source of panic. What if attackers had used a biological agent, and signs and symptoms mimicked any one of a number of common illnesses? In that situation, many more people would believe that they were infected or in danger of exposure. How many of those workers would stay home to avoid being infected or to keep their families from infection?

In the anthrax attack in October of 2001, only a few people were actually exposed to anthrax spores but thousands of people feared exposure. Many postal workers didn’t go to work for fear of exposure, and thousands were treated with antibiotics even though it was probably unnecessary. And while only a few sites experienced anthrax exposures, hundreds of thousands of people around the country were afraid to open their mail. Furthermore, hundreds of workplaces were closed while emergency response personnel determined if white powder found at a worksite was anthrax.

Many readers may have experienced such events. However, what would have happened if, instead of anthrax spores, terrorists or disgruntled workers were believed to have released a contagious disease among a population? What would happen in your business if employees were convinced that instead of the common flu they face every winter, they had were being exposed to avian flu which has neither treatment nor vaccine? Who would risk coming to work where they might come in contact with an infected individual, infecting themselves and bringing the infection home to their family? And what would happen to the few who came to work when one of their co-workers coughed or sneezed? How long would they stay on the job? This brings us to one of the more important interventions for reducing misconceptions and panic: effective communication.
Communication is the single most important factor for reducing the perceived threat among workers facing a bioterrorist event, an outbreak of an emerging infectious disease, or a hoax. A recent national survey supports the conclusion that effective communication can reduce panic. However, effective communication depends upon a credible communicator, trusted by workers who can answer technical questions. Trust is the single most important aspect of such communication.

In 2001, when government officials tried to convince the public there was little threat from the anthrax letters, the public did not trust the government to provide full disclosure of the facts. In addition, communications were riddled with inaccurate and scientifically unsound statements – especially during the initial communications – a fact that further undermined public trust. A communicator must address worker misconceptions about lethality, infectivity, and transmission of an agent immediately in order to avoid further confusion so that, as in the case of the early years of the AIDS epidemic, the problem is not intensified by misconceptions. Indeed, during the early days of the epidemic, people feared even getting close to an AIDS victim or coming in contact with anything that an AIDS victim had touched. If such misconceptions are not dealt with quickly and decisively, they take root and are very difficult to correct later.

Another important factor is how communications are tailored to the audience; different ethnic and religious groups have different preconceived notions about disease. Others believe they will not receive the help they need when they need it. Workers must be reassured early on in the emergency, or preferably before an emergency, they and their families will be kept informed by your company and that the company will provide support to deal with medical emergencies and help victims cope with stress.

Such preparedness requires a great deal of planning. All businesses need a detailed strategy for how they will deal with every conceivable type of emergency, actual or perceived. I am sure most of your companies have a disaster plan. However, does that plan cover dealing with employees’ perceptions about the event, or does it only cover dealing with the actual event?

A recent survey indicated that 61 percent of employers are not very concerned about bioterrorism, and only 19 percent of employers are even responding to national security alerts. If this is true, they are unlikely to have an effective plan to address communication with employees about bioterrorism or emerging infections.

I have been told by security personnel that many companies believe they do not need to have a plan to deal with bioterrorism or infectious disease because they believe local or state public health agencies will manage such events. I can tell you from my participation in terrorism exercises around the county that you cannot depend on local public health or first responders to deal with the consequences of a large-scale emergency involving an infectious agent. Any assistance will almost certainly arrive too late to keep workers on the job and might not adequately address the needs of their families. Indeed, research indicates that any plan to deal with an emergency must include workers’ families, because workers will stay home to care for them.

For any plan to be successful there needs to be worker buy-in. To get this buy-in, workers must be part of the planning process. Trust and cooperation can be further enhanced by educational programs that prepare employees so they know what to expect and their misconceptions about infectious disease outbreaks are corrected.

Unfortunately, there is much we don’t know about workers’ perceptions, including how they vary among ethnic and religious groups and what steps can be taken to reduce the anxiety surrounding an infectious disease event or to ease fears that such an event might occur. We need research that will indicate how workers will respond to an event and to instructions given to protect themselves from infection. We do not know who in the organization should be communicating with the workers about an event. Should it be the facility medical professional, the chief safety officer, the chief operating officer, or someone outside your organization? Whom do the workers trust?


R. Gregory Evans, PhD, MPH, is professor of community health and director of the Institute for BioSecurity at Saint Louis University School of Public Health. He teaches epidemiology of bioterrorism and biosecurity and risk assessment in the master of biosecurity program. Research into worker and public perceptions is one the most recent undertakings at the institute. Future research and surveys regarding questions posed in this article will be published at bioterrorism.slu.edu.