Reasons for Concern, Reasons for Preparedness

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Reasons for Concern,Reasons for Preparedness

• Pandemic Influenza
• Threat versus Preparedness

• Scott A. Mugno Managing Director
• Corporate Safety, Health and Fire Protection
• FedEx Express

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QUOTE

• The worst could be happening and you may not
  know it for days
• weeks. Under-responding now may doom any
  full-scale response you
• may hope to take later. () In responding to a
  potential pandemic, you
• have to assume the worst guilty until innocent
  and react accordingly.
• Marc Lipsitch
• Associate Professor of Epidemiology
• Harvard School of Public Health

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Why Be Concerned About a Pandemic?

• A pandemic is a Global Disease outbreak
• Flu Pandemic is new influenza virus which people
  have little or no immunity and there is no
  vaccine
• It spreads easily person-to-person, causing
  serious illness/death
• Can sweep across the country/world in a very
  short time
• Difficult to predict when it will occur or how
  severe it will be
• When it starts, all around the world will be at
  risk

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Why Be Concerned About a Pandemic? (continued)

• Experts concerned about spread of highly
  pathogenic avian H5N1 virus
• Influenza A (H5N1) virus raised concerns about a
  potential human pandemic because it is especially
  virulent
• It is being spread by migratory birds
• It can be transmitted from birds to mammals and
  in limited circumstances to humans
• Like other influenza viruses, it continues to
  evolve (mutate)

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Why Be Concerned About a Pandemic? (continued)

• H5N1 virus does not usually infect people
• But infections have occurred in humans
• Most of these result from direct or close contact
  w/H5N1 infected poultry or surfaces
• When species barrier crossed, H5N1 causes largest
  number of severe disease and death
• So, right now this is still an avian (bird) flu,
  not a human flu

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Pandemic History

• Pandemics are inevitable occur throughout
  history at regular intervals
• 1918 Spanish Flu 40 to 50 million deaths
  675,000 U.S. deaths
• 1957 Asian Flu 1 to 4 million deaths 70,000
  U.S. deaths
• 1968 Hong Kong Flu 1 to 4 million deaths
  34,000 U.S. deaths

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Pandemic History (continued)

• 1918 Spanish Flu Influenza Pandemic
• Name is misnomer started in Fort Riley, Kansas
• Swift! Morning, well sick by Noon dead by
  Nightfall
• Spread across the globe in 4 - 6 months lasted
  18-20 months
• One quarter Americans believed to have contracted
  this
• At least 40 - 50 million people died worldwide
  650k in US
• Death rate 25 times higher than previous
  epidemics
• Pandemic affected and killed younger, healthy
  people

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The Situation Today (November 5, 2007)

• Phase 3 of 6 a new influenza virus subtype is
  causing disease in humans, but is not yet
  spreading efficiently and sustainably among
  humans.
• 60 Countries have confirmed cases of birds
  infected w/H5N1
• 12 Countries have confirmed cases of humans
  infected w/H5N1
• Human Cases 2007 72 cases/48 deaths (66
  fatality rate)
• Human Cases 2003-2007 335 cases/206 deaths (61
  fatality rate)
• No travel restrictions recommended by WHO nor CDC
  

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The Only Constant is Change

• H5N1 strain may not be the Pandemic Flu
• Dont know when it will/wont be the Pandemic Flu
• May or may not have a vaccine
• Antivirals may or may not work
• Quarantine/Dont Quarantine
• Use masks/Dont use masks
• Solution Stay informed/Updated

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What to Watch For

• H5N1 virus evolves or mutates
• Doctors or nurses becoming infected
• Clusters of infections
• Outbreaks in under developed areas or countries
• Quarantines
• Smuggling of birds
• Under reporting of H5N1 cases

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Why Prepare/Plan Now?

• This is NOT a Drill (or Y2K)
• Yes, many uncertainties but waiting is too late
  
• Cant prepare after it is confirmed
• The SPEED of a pandemic is unpredictable
• The MAGNITUDE may be like nothing before
• Preparedness is NOT just about H5N1 Avian Flu
• Much of what is required here applies to all your
  other contingency/continuity incident planning

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Pandemic Flu and Potential for U.S. Economic
Recession

• March 2007 Trust for Americas Health Analysis
• U.S. economy could lose an estimated 683 billion
• This is roughly a 5.5 percent decline in annual
  GDP
• Nevada would face the highest (8.08 or 9
  billion)
• California the largest economy could lose 87
  billion
• Vermont the smallest economy could lose 1.3
  billion
• Previous estimates range from 4.25 to 6.00 GDP
  loss

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Status of U.S. Pandemic Preparedness

• Key Progress
• Federal investment of 7 billion for
  preparedness mostly for vaccine development
• National Strategy for pandemic preparedness and
  implementation plan
• Mostly successful execution of 6 month benchmarks
• Release of initial community guidance
• All states have at least a draft pandemic plan
  

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Status of U.S. Pandemic Preparedness (continued)

• Key Concerns
• Lack of vaccine vaccine production capability
• Inadequate capabilities to distribute vaccine
  medical equipment
• Insufficient stockpile of anti virals other
  medical equipment/PPE
• Gaps in hospital health care provider capacity
  to manage surge
• Shortage in health care providers
• Health Insurance, Workers Comp, funding issues
  

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Likely Community Pandemic Activities

• Issue isolation and quarantine guidelines/requirem
  ents
• Cancel public events and schools
• Limit non essential work activities
• Coordinate area treatment centers
• Coordinate delivery of vaccines and or anti
  virals
• Oversee anti viral allocation
• Prioritize groups to receive vaccine and
  administer if available
• Expand on going surveillance to include
• Deaths and hospitalizations
• Vaccine effectiveness
• Anti viral resistance

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Business/Infrastructure Continuity Planning
Elements Overview

• Human Resource Issues
• Deciding whether a workplace should stay open or
  close
• Any risks to employees and others must be
  reasonable
• Keep Communication Open and Frequent
• Influenza Manager
• Medical Advisor
• Activation of the Plan
• Communication with Staff
• Maintaining Essential Business Activities
• Identifying Core People/Skills
• Planning for Absence
• Knowledge Management
• Communications

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Business/Infrastructure Continuity Planning
Elements Overview (continued)

• How might shortages of supplies affect business
  operations?
• How will staff and visitors be protected from
  becoming ill?
• Restrict Entry of People with Symptoms
• Personal Hygiene
• Workplace Cleaning
• Air Conditioning
• Increase Social Distancing
• Managing Staff Who Become Ill at Work
• Staff Travel
• Personal Protection Equipment

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An Overview of the FedEx Express Pandemic
Preparedness Plan

• Pandemic Planning Structure
• Communications
• Business Continuity
• Optimizing Employee Health
• Reduction of Infection Risk
• Management of Infected / Potentially Infected
  Staff
• Attendance
• Pay Administrations

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An Overview of the FedEx Express Pandemic
Preparedness Plan (continued)

• Training
• Employee Services
• Workplace Practices
• Management of Expatriates
• Management of Travelling Staff
• Antiviral Medications
• Management of the Deceased

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Pandemic Planning Structure

• Resourcing Pandemic Planning
• Pandemic Preparedness Team
• Development and Maintenance of a Pandemic Plan

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Communications

• Keeping Management Informed
• Keeping Staff Informed
• External Communications

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Business Continuity

• Pandemic Preparedness Plan in Relation to
  Policies and Plans
• Influenza Management
• Product Not to be Contaminated

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Optimizing Employee Health

• Optimizing Employee Health
• Seasonal Influenza Vaccination

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Reduction of Risk Infection

• Reduce Risk of Employees becoming Infected
  Outside Facilities
• Reduce Risk of the Introduction of Virus into
  Facilities
• Reduce Risk of Virus Transmission in Facilities

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Management of Infected/Potentially Infected Staff

• Employees Declaring Illness Not To Be
  Disadvantaged
• Treatment of Staff Suffering Pandemic Influenza
• Contact Tracing
• Antiviral Medications

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Attendance

• Medical Absence Pay
• Leave of Absence
• Alternate Work Arrangements
• Attendance
• Business Closings

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Harvard School of Public Health Project on the
Public and Biological Security Survey

• A survey conducted of a representative national
  sample of 1,697 adults age 18 and over, including
  821 who had children under age 18 in the
  household Released last week at IOM meeting.
• The margin of error for the total sample was plus
  or minus 2.4 points
• Now I want to ask you some questions about a
  possible outbreak in the U.S. of pandemic flu, a
  new type of flu that spreads rapidly among humans
  and causes severe illness. Currently there have
  not been any cases of pandemic flu in the U.S.
  However, imagine that there was a severe outbreak
  in the U.S. and possibly in your community and a
  lot of people were getting very sick from the flu
  and the flu was spreading rapidly from person to
  person.

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Harvard School of Public Health Project Survey
(Continued)

• Survey asked employed Americans about problems
  they might have if asked to stay out of work for
  7-10 days, 30 days, and 90 days
• The longer people are out of work, the greater
  the number people who face financial problems
• These findings are a wake-up call for business,
  that employees have serious financial concerns
  and are unclear about the workplace plans and
  policies for dealing with pandemic flu.

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Harvard School of Public Health Project Survey
(Continued)

• 74 believe they can miss 7-10 days of work
  without serious financial problems (25 would
  face problems)
• 57 think theyll have serious financial problems
  if they had to miss work for 30 days
• 76 think theyll have serious financial problems
  if they had to miss work for 90 days
• 29 say if they had to stay away from work for a
  month they would be able to work from home that
  long

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Harvard School of Public Health Project Survey
(Continued)

• 19 (employed) are aware of a plan at their
  workplace to respond to a serious outbreak of
  pandemic flu
• 22 are very or somewhat worried that their
  employer would make them go to work even if sick
• 50 believe their workplace would stay open if
  public health officials recommended that some
  businesses in their community should shut down
• 35 think if they stayed home from work, they
  would still get paid 42 think they wont get
  paid 22 dont know

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Pay Administration

• Overtime Pay
• Hourly Pay Administration
• Exempt Pay Administration
• Non-Exempt Pay Administration
• Emergency Recall
• Funeral (Bereavement) Pay
• Incentive Pay
• Time Cards

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Still Under Development

• Training
• Employee Services
• Workplace Practices
• Emergency Work Rules
• Workplace Practices
• Management of Expatriates
• Management of Travelling Staff

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Personal Protection Equipment (PPE) Other Tools

• Cold/Seasonal Flu Etiquette
• Communication, Communication, Communication
• Masks
• Gloves
• Hand Sanitizer
• Disinfectant
• Antivirals
• (Stockpile?)

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Management of the Deceased

• Misconceptions about the need for hasty disposal
  of bodies
• Infection control procedures
• Pronouncement and certification of death
• Need for autopsies
• Identifying and tagging bodies
• Social and religious considerations
• Funeral homes

• Cremation vs. burial
• Mass burials
• Temporary mortuaries
• Body storage and delayed burial
• Isolated communities and remote sites
• Planning for Mass Fatalities

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Closing Thoughts Minimizing Risks

• A pandemic will affect your business, staff and
  customers
• How much will depend on the severity of the
  pandemic and how well prepared you are
• Steps to cover include pre pandemic, pandemic and
  recovery phase
• No one, single response respond flexibly,
  depending on the situation
• Remember, preparing for a pandemic is worthwhile
  for other crises as well
• Good communications between all is critical Keep
  yourself informed
• Recognize the human dimension to a pandemic

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Closing Thoughts Minimizing Risks (cont.)

• Eliminate the risk of possible infection
  consider
• Work from home
• Use the internet for other service options
• Work varied shift patterns extended/flexible
  hours
• Avoid presenteeism
• Isolate the risk of possible infection consider
• Install screens
• Use night service windows where applicable

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Closing Thoughts Minimizing Risks (cont.)

• Minimize the risk of possible infection
  consider
• Provide and use Personal Protective Equipment
• Provide training and improve facilities to
  maximize personal hygiene
• Provide training and facilities to enable people
  to maintain social distancing

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QUOTE

• Plans are nothing, planning is everything.
• Dwight D. Eisenhower
• No plan survives contact with the enemy
• Helmuth von Moltke

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SOME RESOURCES

• http//www.moh.govt.nz/pandemicinfluenza
• http//www.flu.gov.sg/
• http//www.pandemicflu.gov/
• http//www.continuitycentral.com/feature0251.htm
• http//www.cidrap.umn.edu
• http//www.osha.gov/pandemic
• http//www.who.int

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Reasons for Concern,Reasons to Preparedness

• Executive summary
• Prepare Now
• Resist Pandemic Fatigue

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Reasons for Concern,Reasons to Preparedness

• Questions and Answers
• Thank you for listening
• (Did I mention Prepare Now?)