H1N1 Update

John Newquist

SEASONAL INFLUENZA

• In the U.S., 5-20% of the population develop seasonal influenza each year and approximately 36,000 die

• Complications to “high risk” populations such as the elderly and others with chronic conditions such as congestive heart disease, asthma & diabetes account for most deaths

H1N1 2009

• Strain of flu not previously seen in humans

• Limited response to current flu vaccines

• Case count as of August 24 2009– USA 7.983 cases and 522 deaths– http://www.cdc.gov/h1n1flu– 512 deaths since May 26, 2009.

H1N1 2009

• Pregnant women 13% of the fatalities.

• People born before 1956 seem to have stronger resistance.

INFLUENZA TRANSMISSION

During a sneeze millions of tiny droplets of water and mucus are expelled at about 200 mile per hour.

IMPACTS OF A PANDEMIC

PREVIOUS INFLUENZA PANDEMICS

IN THE 20TH CENTURY• 1918-19 “Spanish flu” resulted in 675,000

deaths in the U.S. and up to 50 million worldwide

• 1957-58 “Asian flu” accounted for 70,000 deaths in the U.S. and 1-2 million worldwide

• 1968-69 “Hong Kong flu” resulted in 34,000 deaths in the U.S. and 700,000 worldwide

What Happened?

• April 15, 2009 - First cases reported in Mexico

• June 11, 2009 - WHO elevated 2009 H1N1 influenza to pandemic status

• July 31, 2009 – Cases in 168 countries and territories

Symptoms H1N1

– Fever– Chills– Headache– Upper respiratory symptoms

• (cough, sore throat, runny nose, shortness of breath)

– Muscle and joint pain– Fatigue– Vomiting – Diarrhea

How is this flu different?

• The 1918-19 pandemic virus was also caused by the H1N1 type of influenza virus and has similar characteristics to the present one.

Medium Level Pandemic

• It is estimated that a medium level pandemic in the U.S. today could cause:– 89,000 – 201,000 deaths– 314,000 -734,000 hospitalizations– 18-42 million outpatient visits and another 20-

47 million people being sick– 15-35% of the population could be affected

and economic impact could range between $71 – $167 billion

Worst Case

• It could cause a repeat of the 1918 Flu:– 30-60% of world’s population to be infected– 180 – 360 million deaths worldwide– Over 1,760,000 deaths in U.S.

PLANNING FOR A PANDEMIC

Why Plan?

BUSINESS IMPACTS

• Employees can’t or wont come to work

• Loss of people and expertise

• Loss of customers/sales/revenues/profits

• “Just in time” inventory will be heavily impacted

• Customer/vendors/suppliers defaulting on deliveries and contracts

• Liquid asset depletion

PANDEMIC PLANNING

• Businesses can play a key role during a pandemic in protecting employee’s health & safety as well as limiting the negative impact to the economy.

• Planning is critical

• Important to raise awareness and begin preparing so businesses have the capacity to respond effectively during a pandemic

KEY QUESTIONS

• How can company continue to operate effectively with minimal contact between employees, customers, and suppliers for prolonged periods ?

• How can company continue to operate effectively if key employees are out for a long time or permanently ?

• How can company operate effectively if your supply chain’s are disrupted ?

OVERVIEW OF PROCESS• Form the planning team

• Develop employee pandemic education plan

• Identify all essential business functions/services

• Identify critical suppliers, vendors, etc.

• Develop response plan for employee, material, work demand shortages

• Modify current policies on sick leave, telework, return to work, etc.

OVERVIEW OF PROCESS

• Acquire critical supply items

• Establish trigger points to plan activation based on WHO phases and mild to worse case scenario for employee absenteeism

• Senior management review

• Revise, update and test the plan

Phases of a Pandemic

Adopted by the Department of Health and Human Services

Interpandemic Pandemic Alert Pandemic

Phase I Phase 2 Phase 3 Phase 4 Phase 5 Phase 6

Mitigation and Preparedness Response

II

BUSINESS IMPACT QUESTIONS• Have your company’s essential functions

and individuals who perform them been identified and a plan developed to ensure work can be completed with a projected absentee rate of 25-30%?

• Can core business activities be sustained when community outbreaks last 6-8 weeks and multiple waves strike in a calendar year?

• Is plan in place for interruption of essential government services?

BUSINESS IMPACT QUESTIONS

• Can essential operations and services be maintained when necessary resources are not available?

• Can you afford to stockpile adequate levels of essential reserve material?

• Have outside services critical to maintaining operations (transportation) been identified and alternatives explored? (Just-in-time operations will be heavily affected)

BUSINESS IMPACT QUESTIONS

• Are procedures in place to maintain a healthy work environment?

• Have sick, medical and family leave policies been updated to reflect pandemic considerations?

• Are policies and tools available for employees to work offsite?

• Is it possible to expand online and self-service options for customers & business partners?

EDUCATION/COMMUNICATION PLAN

PREVENTION & INFECTIONCONTROL PRACTICES

• Hygiene practices for work and home

• Flu vaccinations and antiviral medications

• Personal protection• Individual & family

checklists and planning guide

.

HYGIENE PRACTICES

• Washing hands is one of the most important ways to prevent the spread of influenza

• Hands should be washed with warm water and soap before and after touching food and after using the restroom, handling garbage, outdoor activities, touching pets, or sneezing, coughing or blowing your nose

HYGIENE PRACTICES

• Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue away and wash your hands afterward or use a hand sanitizer if not near water

• Avoid touching your eyes, nose and mouth if possible to prevent possible germs from entering your body

HYGIENE PRACTICES

• Get regular exercise, plenty of sleep, and manage stress

• Eat healthy balanced meals

• If you feel unwell, stay at home, rest and drink plenty of fluids

• Designed to reduce employee’s exposure to small airborne contaminants

• Both disposable and reusable respirators are available

• Certified by NIOSH

Respirators

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FLU VACCINATIONS

• Influenza vaccines provide the best protection against viruses closely related to the vaccine strains

• Seasonal flu vaccines must be modified each year to match the strains of the virus that are known to be in circulation

FLU VACCINATIONS

• It is important to remember that the seasonal flu vaccination will not protect you against the current strain of pandemic flu

• However, the seasonal flu shot can help you stay healthy

FLU VACCINATIONS

• Vaccines for the any new flu will take at least 6 months to develop, test and produce after the pandemic influenza virus emerges and is identified

• Once produced, the vaccines availability and distribution will be limited

ANTI-VIRAL MEDICATIONS

• Attack enzymes in flu viruses to limit their ability to multiply in the body

• For cases of human infection with H1N1, the drugs may improve prospects of survival, if administered early

• Two Antivirals– Tamiflu® (capsule)– Relenza® (powder)

Photos courtesy of Roche and GlaxoSmithKline

PERSONAL PROTECTION• Personal Protective Equipment:

• Nitrile gloves (when disinfecting surfaces)– N95 Particulate Respirators– Sanitizing Gel (at least 60%

alcohol)

Photo courtesy of Safeskin ®Photo courtesy of 3M ® Photo courtesy of Warner

Lambert Co. LLC

Respirators

1. Don't reuse after contact with infectious patient.

2. If a shortage of respirators, reuse on if not soiled or damage.

3. Preventing contamination from contact with the outside of the respirator is critical.

WORK-RELATED PRACTICES

• Risk assessment

• Controls

• Social distancing

• Sanitation protocols

• Workplace communications

• Sources of information

RISK ASSESSMENT

• Medium Exposure Risk:– Employees with high frequency contact with the

general population (such as schools, high density work environments, and some high volume retail)

• Lower Exposure Risk:– Employees who have minimal occupational

contact with the general public and other coworkers (office employees)

CONTROLS

• Workplace Controls:– Providing tissues, hand sanitizer, disinfectants,

disposable towels– Encouraging seasonal flu vaccinations– Education on influenza risk factors, proactive

behavior, proper behaviors such as cough etiquette

• Engineering Controls:– Physical barriers such as clear plastic sneeze

guards

CONTROLS

• Administrative Controls:– Scheduling work to minimize exposure levels– Encouraging ill employees to stay home– Discontinuation of unessential travel to

locations with high illness transmission rates– Minimizing face-to-face contact

• Personal Protective Equipment:– Gloves, N95 respirators, sanitizing gel

SOCIAL DISTANCING

• During a pandemic, it will be important to adhere to policies that reduce interactions among employees– Maintain up to 6 feet separation– Reduce employee staff interactions – Employee & staff meetings should occur by

conference call, e-mail correspondence, etc.– Have limited visitor access

SANITATION PROTOCOLS

• All multi-person use phones (reception desks, conference rooms, shared offices, cubicles, computer work stations) should be disinfected after use by their different users

• Daily disinfection protocols should be in place for areas such as:– Restrooms– Lunchrooms– Vending machines– Doorknobs

INTERNAL COMMUNICATIONS

• Encourage two-way communication between employer and employee

• Communicate your pandemic plan and any changes to company policies regarding sick leave, compensation, time off, telework arrangements etc.

• Communicate and implement personal and workstation hygiene practices along with specific sanitation protocols

INTERNAL COMMUNICATIONSTO EMPLOYEES

• Always provide timely, accurate, and consistent pandemic information with regular updates

• Establish “hotline” for dissemination of information

• Be prepared to address fear, panic and anxiety

• Respond to rumors and misinformation

STARCC PRINCIPLE• In a crisis, your message to employees must be:

– Simple – Frightened people do not want to hear big words

– Timely – Frightened people want information now

– Accurate – Frightened people will not get nuances, so give it straight

– Relevant – Answer their questions and give action steps

– Credible – Empathy and openness are your keys to credibility

– Consistent – The slightest change in the message is upsetting

EXTERNAL COMMUNICATION

• Establish hotline for communicating with customers on current services provided during the pandemic

• Establish hotline for vendors and suppliers regarding hours of operation, closures, alternate delivery schedules

• Communicate with state and local health authorities

LOCAL COMMUNITY

• Collaborate with state and local public health agencies to understand their capabilities and plans

• Communicate with local and state public health agencies about the assets and or services your business can contribute to the community

• Share best practices with other businesses in your communities and chambers of commerce

PANDEMIC IMPACT ANALYSIS

ESSENTIAL SERVICES/FUNCTIONS

• Identify all essential services/functions:

• Manufacturing • Warehousing

• Distribution System • Information systems

• Sales • Human resources

• Customer service • Administration

• Finance • Security

• Legal • Other

ESSENTIAL SERVICES/FUNCTIONS

• Determine all essential functions or services within each department or business unit

• Prioritize in order from most important to least important by assigning a number (1-5) for example: 1-lowest priority, 5- highest priority

• Revenue generating departments could base the priority on income generation functions

• Non-revenue generating departments could base the priority scale on importance of service to customers or the organization

ESSENTIAL STAFF

• Determine the number of staff needed to maintain essential services or functions by department

• Ask if any special qualifications or certifications are necessary to perform these services ?

• List the number of employees necessary to maintain these functions (FTE)

• Determine number available with an absenteeism rate of 25-40%

ESSENTIAL STAFF

• Determine the effect your chosen absenteeism rate will have on each essential function or service

• Will the function remain the same, significantly decrease or possibly temporarily surge during a pandemic ?

• Can the service or function be increased, reduced, delayed, or rescheduled ?

ESSENTIAL STAFF

• Can resources be re-allocated to cover the shortage of staff ? (cross-training, use of retirees)

• Is working from home an option for some employees to maintain these services ?

• Can the essential service or function be contracted out to preferred providers, contractors, etc. ?

SUPPLY LINE ISSUES

• Can supplies necessary for maintaining essential operations be stockpiled?

• Can goods or services be delivered through normal transportation means?

• Are there alternative means of delivering or receiving materials or products?

• Are their alternative or back-up suppliers?

CRITICAL SUPPLIERS

• Do they have a pandemic plan in place?• Does the plan address their suppliers?• How will they provide for our company’s

needs?• How will they communicate their capabilities

to us during the pandemic?• Obtain primary contact and alternate contact

information for communicating during an emergency

PANDEMIC BUSINESSMANAGEMENT STRATEGIES

HUMAN RESOURCE CONSIDERATIONS

• Emergency procedures/policies to be used in a crisis:– Streamlined hiring – Short term disability– Time off – Emergency employee assistance– Medical– Death in family– Paycheck distribution

MODIFICATION OF PRACTICES

• Consider granting additional unpaid leave to employees who are unable to work due to special circumstances related to the pandemic

• Consider additional paid medical leave for employees who are infected with or exposed to the disease

• Consider expanding teleworking policies for employees that can perform all or part of their job from home

MODIFICATION OF PRACTICES

• Consider the establishment of flexible work hours or staggered work shifts

• Consider establishment of policies for employees who have been exposed, become ill at work, or when a previously ill employee can return to work

• Deciding at what trigger point the workplace should close and how this will be communicated

IMPLEMENTATION &TESTING THE PLAN

• Using checklists, verify that you have covered all elements of a pandemic plan applicable to your business

• Ensure all pertinent documentation is present and final document reviewed

• Present to senior management approval

• Make any necessary changes based upon management recommendations

IMPLEMENTATION &TESTING THE PLAN

• Test the plan to ensure recommended actions function as designed

• Revise actions as necessary

• Audit the plan to keep updated with any new pandemic information or guidance for employers

Summary• If your ill, stay home (CDC

recommends 72 hours)

• For H1N1 up to 21 days

• Good hand washing

• Cover your cough

• Don’t touch mucous membranes

• Keep yourself strong

• Be aware of sensitive populations

WEB SOURCES OF INFORMATION

• www.pandemicflu.gov• www.osha.gov• www.cdc.gov/flu/avian/index.htm• www.health.state.mn.us/divs/idepc/diseases/flu/avian/

index.html• www.who.int/csr/disease/avain_influenza/en/• www.niaid.hih.gov• www.hhs.gov• www.nlm.nih.gov/medlineplus/flu.html• www.cidrap.umn.edu/cidrap/content/influenza/panflu/

index.html

LEARNING EXERCISE1. The seasonal flu can be easily transmitted from person to person

but a pandemic flu cannot.A. TrueB. False

2. H1N1 flu viruses are not new but have been around for millions of years.A. TrueB. False

3. The H1N1 virus has had a sustained person-to-person transmission to dateA. TrueB. False

LEARNING EXERCISE4. Most human influenza infections are spread by

bacteria-laden respiratory droplets expelled during coughing and sneezing.A. TrueB. False

5. In addition to the typical flu symptoms, people infected with H1N1, have exhibited pneumonia, severe respiratory diseases, and other life-threatening complications A. TrueB. False

LEARNING EXERCISE6. Over 2600 people have died from H1N1 infections in the U.S.. .

A. TrueB. False

7. Some potential impacts of the H1N1 flu include possible:A. School closingsB. Limited transportation C. Large number of people sick at the same time and unable to go to workD. All of the above

LEARNING EXERCISE8. Benefits of pandemic planning include:

A. Protecting employees

B. Maximizing exposure to lawsuits

C. Minimize operation costs during and after

D. A & C

LEARNING EXERCISE9. Washing hands is one of the most important ways to prevent the

spread of influenza.A. TrueB. False

10. Both antiviral medication and vaccinations will prevent all persons from contracting the H1N1 avian flu virus.A. TrueB. False

11. One of the work-related practices used to control infection includes social distancing.A. TrueB. False

LEARNING EXERCISE

12. Elements of internal communication to employees should include responding to rumors and misinformation.

A. True

B. False

LEARNING EXERCISE

13. Some policy modifications that are recommended during a pandemic include:

A. Sick leave

B. Granting additional unpaid leave

C. Establishment of flexible work hours

D. All of the above

Why Be Prepared?

Protect Employees

Protect the Community

Continue Business Operations

Continue To Be Prepared:

Develop, reassess and update a disaster/business continuity plan that addresses an Influenza Pandemic

Strongly encourage and facilitate seasonal flu vaccination and pandemic flu vaccination when available

Monitor and promote good hygiene practices

Evaluate employee exposure risk levels and provide appropriate controls

In Conclusion

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Handouts

• BUSINESS PREPAREDNESSCHECKLIST

BUSINESS PREPAREDNESSCHECKLIST

• Plan for the business impact of a pandemic:– Identify a coordinator/team– Identify essential employees and services– Train and prepare ancillary work force– Determine potential impact on company

financials– Locate pandemic info from community public

health & emergency management– Establish emergency communication plan– Test your plan

BUSINESS PREPAREDNESSCHECKLIST

• Plan for the employee /customer impact of a pandemic:– Forecast & allow for employee absenteeism– Establish guidelines to modify the frequency and

type of face-to-face contact– Encourage annual flu vaccinations– Evaluate employee access to and availability of

healthcare services & social services– Identify employees and key customers with

special needs

BUSINESS PREPAREDNESSCHECKLIST

• Establish policies to be implemented in a pandemic:– Compensation & sick leave absences– Flexible worksite & work hours– Preventing influenza spread– Exposed employees, infection control response– Restricting travel, evacuating employees– Procedures for activating & terminating the plan

BUSINESS PREPAREDNESSCHECKLIST

• Allocate resources to protect employees & customers during a pandemic:– Provide sufficient infection control supplies– Enhance communications & IT infrastructures

to support telecommuting & remote center access

– Ensure availability of medical consultation and advice for emergency response

BUSINESS PREPAREDNESSCHECKLIST

• Communicate / educate employees:– Develop & disseminate materials covering

pandemic fundamentals– Anticipate employee fear and anxiety – plan

communications appropriately– Ensure communications are culturally

appropriate– Disseminate info on the company’s response

plan

BUSINESS PREPAREDNESSCHECKLIST

• Communicate / educate employees:– Provide info for the at-home care of ill

employees and family members– Develop hotlines or websites for

communicating pandemic status & actions to employees, customers, vendors, suppliers, etc.

– Identify community sources for timely and accurate pandemic info

BUSINESS PREPAREDNESSCHECKLIST

• Coordinate with external organizations and help your community:– Collaborate with insurers, health plans and local

healthcare facilities– Collaborate with federal, state and local public

health agencies in planning for a pandemic– Communicate with emergency responders

regarding assets/services your business could provide

– Share best practices with other businesses