Get the Facts, Not the Flu: Preparing Your Business for the Next Pandemic

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Get the Facts, Not the Flu Preparing Your
Business for the Next Pandemic
Catherine Slemp, MD, MPH 2006 Human Resources
Summit and Governors Safety Conference November
1, 2006
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Objectives / Overview

• Review Influenza Basics
• Putting Pandemics into Perspective
• Why the Concern Now (Avian Flu-H5N1)
• Discuss Pandemic Control Measures
• Implications for Business
• Pan Flu All Hazard Preparedness

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INFLUENZA Key Facts

• Incubation period 1-4 days
• Transmission Respiratory
• droplet (coughing, sneezing)
• Contact? Aerosol?
• Seasonal Flu causes
• 200,000 hospitalizations
• 36,000 deaths / yr
• Flu Viruses are constantly changing, evolving,
  reassorting

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Influenza Pandemic Viruses

• Requirements
• A new influenza A subtype that can infect humans
• AND
• Causes serious illness
• AND
• Spreads easily from human-to-human
• H5N1 meets the first two prerequisites,
• but not the last
• Next pandemic virus may or may not be due to a
  variation of current H5N1 virus

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Putting Flu Pandemics in Perspective

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1918 heavy impact on young healthy adults
nations workforce
Impact of 1918 Pandemic on US Life Expectancy
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Daily Deaths in Ohio - 1918
Brodrick OL. Influenza and pneumonia deaths in
Ohio in October and November, 1918. The Ohio
Public Health Journal 19191070-72.
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West Virginia in 1918

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Court System
COMMUNITY INFRASTRUCTURE
Flu stops court, Bluefield Oct. 8, 1918
Business
Local Government
Newspapers
The Bluefield Telegraph Oct. 8, 1918
Huntington mayor dies Oct. 19, 1918
The New Dominion, Morgantown, WV Oct. 24th
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Less than half a dozen families in Fayetteville
have illnessDr. Grose was one of the first
victims. Oct. 10, 1918, The
Fayette Tribune
The Mt. Hope-Kilsyth community is credited with
over 500 cases and the death rate is on the
increase. Oct. 31, 1918, The
Fayette Tribune
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Why the Concern Now?AVIAN OR BIRD FLU
THE H5N1 VIRUS

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Update
As of 10/31/06 256 cases 152 deaths most
poultry related
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H5N1 in Humans 2003-2006

• As of October 31, 2006 256 cases, 152 deaths
  (60)
• Ten countries
• Sporadic, with occasional clusters
• Most had touched or handled sick poultry
• A few cases of probable, limited human-to-human
  transmission
• All lived in countries with poultry outbreaks

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Sample Estimate of Morbidity/MortalityWest
Virginia

• Characteristic Moderate (1957-68-like) Severe
  (1918-like)
• Illness 540,000 (30)
  540,000 (30)
• Outpatient 270,000 (50)
  270,000 (50)
• Hospitalization 5,314
  60,813
• ICU Care 791
  9,123
• Ventilators 399
  4,558
• Deaths 1,284
  11,690
• based upon DHHS U.S. estimates applied to WV
  population numbers. These are in the absence of
  potential interventions.

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Much we dont know about the next pandemic

• When will it occur?
• Which virus will cause it, H5N1 or another?
• Who will be most at risk (Elderly and infants?
  Healthy adults? Children?)
• How severe an illness will it cause?
• Will there be multiple waves?
• Will antiviral medication work?
• How long until we have a vaccine?
• What are the best control measures?

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Understanding Disease Spread

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Ro 2
R0 1
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Ways to Increase Social Distance

• Implement Community Shielding recommendations
• Close or alter high risk transmission
  environments e.g. schools, daycare centers if
  supported by epidemiology
• Cancel large public gatherings (concerts,
  theaters)
• Minimize other exposures (markets, churches,
  public transit)
• Encourage ill and exposed persons to stay home
  (isolation and quarantine)
• Encourage telecommuting other worksite
  adaptations
• Scaling back or altered transportation services
  (holiday schedule)
• Consider additional community measures
• COOP to minimize economic impact
• Distribution of surgical masks, barrier
  precautions, hand hygiene

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Planning Pandemic Control Measures

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Potential Tools in Our Toolbox

• Our best countermeasure vaccine will probably
  be unavailable during the first wave of a
  pandemic
• Antiviral treatment may improve outcomes but will
  have only modest effects on transmission
• Antiviral prophylaxis may have more substantial
  effects on reducing transmission
• Infection control and social distancing should
  reduce transmission, but strategy requires
  clarification

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Community interventions

• What does history and modeling tell us?
• What planning can be done now?

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A Tale of Two Cities
Weekly mortality data provided by Marc Lipsitch
(personal communication)
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Value of combining strategies Longini model
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Workplace / Classroom Social Density
Residences
Offices
Hospitals
7.8 feet
Elementary Schools
16.2 feet
11.7 feet
3.9 feet
http//buildingsdatabook.eren.doe.gov/docs/7.4.4.x
ls
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Spacing of people If homes were like schools
Based on avg. 2,600 sq. ft. per single family
home
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Spacing of people If homes were like schools
Based on avg. 2,600 sq. ft. per single family
home
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Labor Status of Parents in U.S.
66 million
18 million
5 million
9 million
8 million
Source U.S. Census Bureau, Population Division,
Current Population Survey, 2003 Annual Social and
Economic Supplement http//www.census.gov/populati
on/www/socdemo/hh-fam/cps2003.html
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What are limits of this data?

• Observational data from 1918 data incomplete
  cannot link cause and effect
• Modeling impact of different interventions.
  Useful, but
• Doesnt yet incorporate impact of peoples
  behavioral responses to interventions
• Doesnt incorporate secondary consequences of
  interventions (e.g., effects of school closure on
  education, workforce, etc.)
• Does help shape discussion.

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A Targeted and Layered Approach
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A Layered Approach
Individual / Household / Business Hand
hygiene Cough etiquette Infection control Living
/ working space adaptation Isolation of
ill designated care provider
Community Isolation of ill Treatment of
ill Quarantine of exposed Prophylaxis of
exposed School closure Protective sequestration
of children Social distancing - Community -
Workplace Liberal leave policies
International Containment-at-source Support
efforts to reduce transmission Travel
advisories Layered screening of travelers Health
advisories Limited points of entry
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Epidemiology Drives Approach(Targeted)
SAMPLE
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Remember We have a Tool Kit of Control Measures
to Use

• Community Shielding (many methods)
• Hygiene measures
• Antivirals (treatment prevention, if supplies
  sufficient)
• Vaccine
• Continuity of Operations Planning

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Current Thoughts on Control Measures

• Earlier rather than later implementation of
  measures more likely to be effective
• Targeted and layered application of measures
  (e.g., combinations are more effective than a
  single measure at a time scale response based on
  severity of pandemic)
• Communities must consider practicality and ethics
  of implementing any measure.
• Transparency
• Public discussion and dialogue
• Planning
• Coordination across jurisdictions

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Tackling This from the Business Perspective

• Educate Leadership and Staff
• COOP, COOP, COOP (Continuity of Operations)
• Personnel Policies
• Knowing your Workforce
• Employee and Family Safety
• Employee Communications
• Contributions to / Participation in Community
  Response

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Interesting Correlation

• Businesses truly embracing a culture of
  preparedness
• High performing businesses everyday

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Leadership
What does this take? (Now and when the time
comes)
Imagination
Resiliency of Businesses and Communities
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Contributors to Historical Analysis and Modeling
HSC/NSPI Writing Team Richard Hatchett, MD Carter
Mecher, MD Laura McClure, MS CDR Michael Vineyard
Modelers Joshua Epstein, PhD Stephen Eubank,
PhD Neil Ferguson, PhD Robert Glass, PhD Betz
Halloran, PhD Nathaniel Hupert, MD Marc Lipsitch,
MD Ira Longini, PhD
NVPO Bruce Gellin, MD Ben Schwartz, MD
Department of Education Camille Welborn, MS
HSC Rajeev Venkayya, MD Ken Staley, MD, MPA
Department of Labor Suey Howe, JD
Department of the Treasury Nada Eissa, PhD Chris
Soares, PhD John Worth, PhD
NSC Rita DiCasagrande, MS
NIH James Anderson, PhD Irene Eckstrand,
PhD Peter Highnam, PhD Ellis McKenzie, PhD
CEA Steven Braun, PhD
Department of Finance - Canada Steven
James Timothy Sargent
CDC David Bell, MD Martin Cetron, MD Rachel
Eidex, MD Lisa Koonin, MN, MPH Anthony Marfin, MD
RTI Philip Cooley, PhD Diane Wagener, PhD
University of Michigan Howard Markel, MD
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Get Informed, Be Prepared!

• RESOURCES
• WV Bureau for Public Health http//www.wvflu.org
  
• Your Local Health Department or Emergency
  Management Agency
• USDHHS http//www.pandemicflu.gov
• Seattle-King County Health http//www.metrokc.go
  v/health/pandemicflu/
• CDC www.cdc.gov