Business Preparedness for and Response to a Pandemic

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Business Preparedness for and Response to a
Pandemic

• Eric S.Toner, MD
• Rich Paul, MSW, CEAP

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Agenda

• About Pandemics
• What a Modern Day Pandemic Might Look Like
• Key Considerations for Businesses
• Behavioral Health Implications
• Organizational Leadership and Support
• ValueOptions Preparedness Activities
• Discussion

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Influenza

• influenza from influenza di freddo (influence
  of the cold) (Italian, 18th century)
• caused by family of influenza A viruses
• infects the respiratory tract and spreads by
  respiratory droplets (in people)
• spreads rapidly
• causes annual epidemics,
• and occasional pandemics

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Pandemics Happen

• 1580-1889 27 pandemics
• 1918 (H1N1)
• 1957 (H2N2)
• 1968 (H3N2)

The pandemic clock is ticking, we just dont
know what time it is. Dr. Ed
Marcuse, Advisory Committee on Immunization
Practices
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Highly Pathogenic Avian Influenza H5N1

• The most lethal influenza virus we have ever
  seen
• Robert Webster, St. Jude Childrens Research
  Hospital, 2005

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H5N1 Outbreak Is Unprecedented

• first known panzootic of highly pathogenic avian
  influenza (HPAI)
• 64 countries in 3 continents involved in the last
  4 years
• all previous HPAI outbreaks have been very
  localized and brief
• highly pathogenic to mammalian hosts
• carried asymptomatically and spread by ducks
  (mallards)
• carried by migratory birds and poultry trade
• The size, method of spread, host range and rate
  of spread of the outbreak is unprecedented

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Reported H5N1 Outbreaks (Birds and People) Jan.
1, 2005 - Year One
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Reported H5N1 Outbreaks (Birds and People) Jan.
1, 2006 - Year 2
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Reported H5N1 Outbreaks (Birds and People) Jan.
1, 2007 - Year 3
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Reported H5N1 Outbreaks (Birds and People) July
30, 2007
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Countries Affected With H5N1
Source U.S. Department of Health Human Services
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Current Situation H5N1 in People

• 328 human cases (as of Sept. 10)
• case fatality ratio (CFR) of 60 (200)
• For comparison
• 1918 CFR was 2.5
• SARS CFR was 10
• In the past HPAI has only caused mild disease in
  humans
• gt70 need ventilators
• almost all need ICU
• very few mild cases
• gt20 clusters (mostly blood relatives)
• limited person-to-person transmission

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Confirmed H5N1 Human Deaths
Source U.S. Department of Health Human Services
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Prerequisites for a Pandemic

• novel virus with no immunity
• able to cause significant disease in humans
• efficient human-to-human transmission

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WHO Pandemic Alert Phases

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Known Unknowns Pandemic H5N1

• Will it happen suddenly or gradually?
• any warning?
• How severe will the illness be?
• fatality rate currently gt25 x that of 1918 virus
• What will the epidemiology be?
• huge implications for disease containment, and
  rapidity of spread
• Can disease containment measures lessen the
  severity of the outbreak?
• societal and economic consequences of containment
  efforts?

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How Pandemics Move

• complex patterns (like pop corn)
• many locations simultaneously (some near and some
  far)
• within an individual community, the outbreak
  consists of a wave lasting 6-12 weeks
• outbreaks recur in each community multiple times
  until most people are immune (recovered or
  vaccinated) the interval varies
• pandemics happen fast 1?1 million in 60 days

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Influenza Outbreaks in 1957 August 31
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Influenza Outbreaks in 1957 September 14
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Influenza Outbreaks in 1957 September 28
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Influenza Outbreaks in 1957 October 12
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Influenza Outbreaks in 1957 October 26
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Severity of Pandemics Is Variable

• 1918 50 million deaths (675,000 U.S.)
• 1957 2 million deaths (70,000 U.S.)
• 1968 1 million deaths (34,000 U.S.)
• variability mainly due to differences in the
  virus and the degree of human immunity, not
  medical advances

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We Are More Vulnerable Now Than in 1968 or 1957

• Even a mild pandemic will be a challenge
• rapid global travel
• urban crowding
• just in time supply chain
• less vaccine production capacity
• weakened public health system
• less hospital surge capacity
• older population with more chronic disease
• many more immuno-suppressed people

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• What Might a Modern Pandemic
• Look Like?

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HHS Planning Assumptions Impact on U.S.
Hospitals
Moderate (1968-like) Severe (1918-like)
Illness 90 million (30) 90 million (30)
Outpatient medical care 45 million (50) 45 million (50)
Hospitalization 865,000 9, 900,000
ICU care 128,750 1,485,000
Mechanical ventilation 64,875 745,500
Deaths 209,000 1,903,000
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Impact on Average U.S. Hospital

• FluSurge model (CDC)
• HHS planning assumptions
• at peak (week 5 of 8) with 25 attack rate

Moderate Scenario (1968-like) Severe Scenario (1918-like)
19 of non-ICU beds 191 of non-ICU beds
46 of ICU beds 461 of ICU beds
20 of ventilators 198 of ventilators
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Federal Preparedness Efforts

• well-matched vaccine will take many months to
  produce after pandemic starts
• potentially partially effective vaccine is being
  stockpiled
• antivirals are being stockpiledenough for 25 or
  less of population
• time to administration is a big issue
• disease containmentclose schools, isolate the
  sick, social distancing, voluntary quarantine

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Federal Role in Pandemic Response

• "Any community that fails to prepare with the
  idea that somehow, in the end, the federal
  government will be able to rescue them will be
  tragically wrong."
• Michael Leavitt, U.S. Secretary of Health and
  Human Services, at Maryland State Meeting 2/24/06

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Business Infrastructure Is Vulnerable

• just-in-time supply chains (e.g., manufacturers,
  grocery stores, pharmacies, hospitals)
• dependent on multiple intact links
• international suppliers
• transportation
• personnel, travel restrictions
• intermediate sellers and manufacturers

• telecom
• bandwidth for extensive telecommuting
• cash banking
• dependent on timely deliveries
• utilities
• sufficient critical personnel
• travel industry
• especially airlines

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Key Considerations for Business

• sick and family leave policy
• incentives for sick personnel to stay at home ?
  sick pay
• incentives for the immediately exposed to stay at
  home (voluntary quarantine)
• telecommuting if possible
• avoid unnecessary travel
• limit use of mass transit where possiblemasks?
• contingency plan for high absenteeism
• stockpile critical supplies
• behavioral health issues

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Behavioral Health Issues

• issues to expect
• grief
• anxiety/depression (uncertainty, fear of illness,
  family and financial stress, guilt, helplessness)
• anger (at authorities, including employer, for
  perceived lack of preparedness)
• substance abuse
• loss of productivity/poor performance
• continuum of employee support needs, ranging from
  prevention and education, to mental health
  counseling, to resiliency
• importance of organizational support and
  leadership during a time of crisis

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Leadership Vision and Action

• Fear Safety
• Isolation Connectivity
• Chaos Structure
• Helplessness Efficacy
• Victim Survivor

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ValueOptions Preparedness Activities

• commitment and oversight by ValueOptions
  Management Executive Committee, including the CEO
• companywide task force responsible for testing
  and executing ValueOptions business continuity
  strategy should a regional or nationwide pandemic
  occur
• comprehensive and evolving project plan based
  upon each phase of a potential pandemic

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Business Continuity

• ValueOptions business continuity plan considers
  potential needs of employees, clients and
  members, and includes
• tracking/trending tools and protocols for each
  ValueOptions location
• agreed upon mission-critical business partner and
  client protocols for uninterrupted services
• protocol for maintaining the VO locations
  operations
• member/provider push communication
  tools/messages in event of outbreak
• internal/external prevention mechanisms/tools for
  pre-outbreak

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ValueOptions Online Resources
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Summary

• H5N1 outbreak is unprecedented
• pandemic will happen sometime soon (maybe H5N1,
  maybe not)
• much preparedness left to do at all levels
• harsh disease containment unlikely to work and
  could make matters worse
• effective vaccine early in the outbreak
  fundamentally changes the game
• most people will survive and business will go on

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Discussion

• What steps has your organization taken to protect
  employees and ensure business continuity?
• Identified a pandemic coordinator and/or team for
  preparedness and response planning
• Identified essential employees and other critical
  inputs (raw materials, subcontractors) required
  to maintain business operations
• Established an emergency communications plan
• Established policies to be implemented during a
  pandemic - sick leave, family leave, travel,
  flexible worksite, flexible hours
• Stationed infection control supplies in business
  locations
• Enhanced communications and IT infrastructure to
  support remote employee and customer access
• Provided employees with information on pandemic
  preparedness your plans as well as what they
  can do
• Excerpted from U.S. Business Pandemic Influenza
  Planning Checklist

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Center for Biosecurity
www.upmc-cbn.org
www.upmc-biosecurity.org
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Resources

• Center for Biosecurity www.upmc-biosecurity.org/w
  ebsite/focus/avian_pandemic_flu/index.html
• National Business Group on Health
• www.businessgrouphealth.org/globalhealth/avianflu
  .cfm
• (Public access to some content extensive
  resources for members)
• U.S. Government Pandemic Flu Web Site
  www.pandemicflu.gov
• ValueOptions
• www.achievesolutions.net(See Pandemic
  Preparedness topic)
• World Health Organization Avian Flu Web
  sitewww.who.int/csr/disease/avian_influenza/en/in
  dex.html