Swine flu probably isn’t near the top of your worry list these days, not with the economy still in the tank, job security up in the air, home values still plunging, and the future anything but certain. Only eight percent of respondents to a June, 2009 Gallup Poll said they were worried about getting swine flu.

“U.S. public opinion today is far closer to flu pandemic complacency than to flu pandemic panic,” writes risk communications expert Peter M. Sandman in an excellent essay on swine flu pandemic communication updated July 7, 2009, on his risk communication Web sitewww.psandman.com. (His wife Jody Lanard contributed to the update.)

Not everyone shares the public’s apathy. “Every business, every organization, every worksite needs to develop and test a comprehensive emergency plan to protect their employees during a pandemic,” Labor Secretary Hilda Solis declared during a speech June 29 to 3,300 members of the American Society of Safety Engineers (ASSE) at the group’s annual meeting, held this year in San Antonio.

On this count, U.S. industry has a long way to go. In a May 1 survey by International SOS, a firm that provides medical advice and pandemic planning services to businesses, only 54 percent of 350 companies indicated they had pandemic plans in place. Only 18 percent said they were “extremely prepared” for an influenza pandemic.

OSHA enforcement
You should know that although OSHA has no specific standard for influenza exposure, the General Duty Clause of the Occupational Safety and Health Act, which requires employers to provide employment free from recognized hazards, will be used by agency inspectors to protect workers, said acting OSHA chief Jordan Barab at the American Federation of State, County and Municipal Employees (AFSCME) National Nurses Congress on May 5, 2009.

Barab made these points about pandemic preparedness in his AFSCME speech:
  • “OSHA will quickly adjust its inspection scheduling priorities as needed to ensure that employers are following (OSHA’s 2004) guidelines (on pandemic flu, and more recently issued guidelines specific to healthcare workers) if a pandemic in the workplace becomes a reality.”
  • Workers and employers need to know when it is appropriate to wear a respirator, how to get the respirator fit-tested and how to wear it properly, when to wear gloves, and how to properly put on and take off personal protective equipment,” said Barab.
  • During a pandemic, transmission can be anticipated in the workplace, not only from patient to workers in healthcare settings, but also among coworkers in general work settings.
  • Planning for pandemic influenza by business and industry is essential to minimize a pandemic’s impact.
  • ”In OSHA’s 38-year history, pandemic influenza is a unique challenge,” said Barab. “However, I would characterize it… as cause for deep concern, but not panic.”
“What, me worry?”
But as Sandman states in his pandemic communication update, “People are nowhere near panic. Most are complacent.”

It’s likely the average American looking back at the global influenza pandemic outbreak that started in Mexico in April, 2009 — Influenza A H1N1, a novel strain decoded by researchers as a mongrel mix of mostly swine flu, a bit of bird flu and enough human flu to jump from animals to people — and which by mid-May was proving to be much milder, less transmissible, with far fewer deaths and far less a threat to health and business continuity than originally thought, has concluded the U.S. government and global health organizations were overly-alarmist in their “scare tactics” warnings.

By June 25, the U.S. Centers for Disease Control and Prevention (CDC) estimated more than one million cases of H1NI flu had occurred in the U.S., with the vast majority going unreported due to the mildness of symptoms and only a fraction of cases actually confirmed.

The Feds’ fear

But here’s the fear, as described by Secretary of Health and Human Services Kathleen Sebelius at the July 9, 2009, all-day H1N1 Flu Preparedness Summit held at the National Institutes of Health in Bethesda, Maryland: “Over the course of the coming weeks and months, we will move aggressively to prepare the nation for the possibility of a more severe outbreak of the H1N1 virus. It’s a responsibility we all share.”

The worry, which federal officials understate so as not to leave the U.S. public with “alarm fatigue,” is a repeat of the deadly 1918 flu pandemic, which one public health official said “came in like a lamb in the spring and returned like a lion in the fall.” That pandemic killed 50 million people worldwide, and 500,000 in the U.S.

“It’s nearly a sure thing that swine flu will be much more pervasive in the U.S. next winter than it was this spring,” writes Sandman in his update. “A lot of people are going to get sick. The big unknowns: How sick will they get, how many will die, and how much impact will pandemic absenteeism have on supply chains of food, medicine and other essentials.”

Cooler weather, arriving in the fall, is more hospitable to all types of flu viruses. H1N1 could recur in possible combination with seasonal flu. As it is, each winter flu affects 5-20 percent of the U.S. population, viruses kill 36,000 to 40,000 Americans (500,000-1,000,000 globally), hospitalize 200,000, and cost industry more than $10 billion in lost productivity, according to Trust for America’s Health (www.healthyamericans.org).

Action items
Here are steps you can take now to answer the Obama administration’s call that it is time to start planning and preparing for the fall flu season and the ongoing H1N1 outbreak.

1— Get serious.Much of U.S. industry needs an attitude adjustment. What CEO is going to hold meetings on flu preparedness plans when the economic climate is uncertain: sales continue to struggle, plants remain shuttered, employees laid off, credit tight, and who knows when business will pick up?

2— Build on what you’ve got. Given economic pressures, competing priorities, and a lack of resources and time for planning, it might work to bolt on your pandemic preparedness emergency plan to already existing business continuity plans, risk management “what if” scenarios, and your safety and health management system, if you’re fortunate enough to have one.

Most large corporations have these systems in place. In May, the Washington office of ORC Worldwide, which specializes in occupational safety and health services to businesses, conducted a survey of member clients and reported “an overwhelming majority” (84 percent) have some type of a business continuity plan or pandemic preparedness plan. “We believe we are seeing the benefit of responsible planning, much of which was initiated in response to the threats of SARS and avian flu,” ORC consultant Ann Brockhaus, MPH, testified at a House Committee on Education and Labor hearing held May 7, 2009.

Brockhaus strongly recommended making pandemic flu planning part of an overall safety and health management system. These systems constitute “a continuous process of identifying, assessing and reducing risks,” she said. “Companies with such systems in place and with the active engagement of senior leadership have been able to sustain the effort necessary to mobilize action in response to public health emergencies such as the current H1N1 outbreak.”

3— Check to see if your existing preparedness plans are applicable to a pandemic.

4— Review preparedness planning 101. Many small to mid-size business operations don’t have the risk management or safety and health resources to implement and oversee process systems. Here are some basics to consider: define operationally what constitutes an emergency event; identify and support mission critical employees; identify employees by location; identify work schedules; estimate the intensity of business operations consumption required for operational continuity; devise scenario designs, minimal readiness levels, stockpile levels of essentials, and “what if” analyses.

5— Get real. Can your core business activities be sustained for weeks in the face of a severe pandemic outbreak? Plan for interruptions in government services: sanitation, water, power, and the food supply.

6— Recognize pandemic outbreaks are a different type of emergency. You might have contingencies to see your business through fires, earthquakes, floods, hurricanes, tornados, technical “crashes,” human error, even terrorist biological, chemical and nuclear attacks. But a pandemic flu is not a one-time disruptive event, like a flood or fire. It arrives in waves lasting months. It is widely dispersed geographically. Absenteeism could reach 25 to 30 percent of your workforce. There’s also the risk of employees coming to work sick due to a lack of sick leave, or economic incentives for coming to work that are stronger than those for staying at home.

7— Consider stockpiling antiviral medications. According to the CDC, the seasonal flu shot will not protect you against pandemic influenza. But flu shots can help you stay healthy. CDC recommends getting a flu shot to protect yourself from seasonal flu. Anti-viral drugs like Tamiflu can help reduce the symptoms and duration of the infection, especially if medication is started within the first 48 hours after the onset of symptoms. The Department of Health and Human Services has stockpiled 50 million doses as part of its national emergency preparedness efforts.

8— Identify essential functions and the individuals performing them, if you have not done so already. Build in training redundancy (also crosstraining) so operations can continue if 25-30 percent of your workforce is absent.

9— Establish and expand policies and tools for your employees to work at home, with appropriate security and network access.

10 — Don’t rely on residential Internet access to serve telecommuters. Make sure they are capable of working fully functioning from home. Consider cable, DSL service, wireless G3 technology or possible WiFi capabilities to improve communication with headquarters.

11— Test home networks of critical employees to ensure everything is in working order.

12— Have all employees’ mobile devices’ phone numbers handy to contact in an emergency.

13— Consider using employees’ mobile devices to send copies of disaster or contingency plans to employees’ phones.

14— Consider the enhanced use of social conferencing tools that keep employees at a distance: video, audio and Web-based conferences.

15— Monitor pandemic information and warnings on Internet sitessuch as:www.cdc.gov,www.who.org,www.redcross.org,www.pandemicflu.gov,www.osha.gov,www.niosh.gov.

16— Based on the latest news of where pandemic outbreaks are occurring, consider business travel restrictions, bans, or post-travel employee quarantines. Fifty-five percent of the ORC member clients surveyed have implemented some travel restrictions. Thirty-seven percent mandate quarantines of up to five to ten days following travel to outbreak areas. In 97 percent of cases, companies pay employees for this quarantine period.

17— Check with your critical vendors as to their level of emergency preparedness.

18— Communicate “first stage stuff” to employees early and often. Post tips on how germs are spread, and how to disrupt transmission. Avoid close contact with sick people. Stay home when sick. Cover mouth and nose with tissue when coughing or sneezing. Wash hands often. Place soap, water, hand sanitizers, hand wipes in easy access. Avoid touching your eyes, nose and mouth if sick; it’s a way of spreading germs.

19— Make employees aware of telltale symptoms. Signs of flu include fever, cough, sore throat, stomach cramps, diarrhea, fatigue and muscle aches.

20— Remind employees they can remain contagious up to a week after the symptoms are resolved.

21— Maintain a healthy work environment. Ensure adequate indoor air circulation. Keep ventilation ductwork and filters clean. Keep clean work surfaces, desks, lab counters, lunch tables, telephones, computers, restrooms, and any frequently touched equipment.

22— Discourage the use of co-workers’ equipment.

23— Hold fewer meetings. Yes! Chalk it up to minimizing crowding.

24— Stockpile soap, tissues, hand sanitizers, cleaning supplies and other infection control products.

25 — Assess your employees’ level of risk exposure to H1N1 flu by referring to “OSHA’s Worker Safety and Health Guidance for H1N1 Flu” on the agency’s homepage. There are four categories: very high risk (physicians, nurses, dentists), high risk (emergency medical technicians, healthcare delivery and support staff), medium risk (employees with high frequency contact with the general population) and low risk (office employees).

26— Consider stockpiling personal protective equipment, especially for employees in high, frequent contact with the general population. PPE can include gloves, goggles, faceshields, protective suits, surgical masks, N95 respirators, powered airpurifying respirators (PAPR) and supplied-air respirators. Demand for respirators soared during the SARS outbreak in 2003, making stockpiling difficult.

27— Talk to your employees now. “Now isn’t the best time to talk to the public about preparedness for a potentially severe pandemic,” writes Peter Sandman. “The best time would have been several years ago. But better late than never.”

Sandman gives six reasons why it is urgent to get people preparing now:
  • People need to think through in advance what they will do if the pandemic causes widespread disruption.
  • People need to take some advance action to prepare themselves for possible disruptions.
  • People need to feel their way into what a pandemic might be like. Sandman calls this “emotional preparedness.”
  • People need to remember that they were properly warned. People who feel they were blindsided or betrayed by a lack of information from authorities will be less likely to follow recommendations of health officials, says Sandman.
  • People need to know about the pandemic plans of their own organizations. Writes Sandman: “If a company expects employees to implement its pandemic plan when the time comes, then employees need to know about it beforehand.
  • Build collaborations. People have a right to influence the planning of government and other institutions, writes Sandman.
28— Share what you know. Nearly 82 percent of companies responding to ORC’s May survey indicated they would be interested in networking with other companies about pandemic preparedness. Nearly 75 percent would be willing to share company policies and procedures anonymously with other companies that were willing to share.

29— Talk straight. Here’s the current situation you face as a safety and health professional whose job it is to prepare and protect your employees from a pandemic outbreak, as outlined by Peter Sandman: Very few of your employees are seriously worried about this pandemic. Maybe they were worried at first, maybe never worried. They now talk about the swine flu scare in the past tense. They feel they somehow dodged the bullet, and it wasn’t high caliber to begin with. Your employees have little respect or understanding of the potential dangers posed by this pandemic. You risk coming off “crying wolf” and losing credibility if you dwell on nightmare scenarios and worst-case “what ifs” when your workforce by and large just isn’t concerned.

Sandman describes this as a “high-hazard, lowoutrage event.” Safety and health pros confront many such “events.” With the age-old mantras of “Accidents will happen (shrug)” and “It won’t happen to me,” pros are well-versed at instructing and warning apathetic work populations. Sandman advises: Do what you can to keep the issue in front of people, work with the minority of people who are interested in the issue, don’t waste time and energy talking yourself blue, wait for a “teachable moment,” an incident or news story that will grab the attention of the apathetic and present you the opportunity to drive home your points about pandemic preparedness.

30 — Open lines of communication with local health organizations. According to the ORC survey, there is not enough talking across the fence line occurring. Less than 50 percent of companies surveyed have established lines of communication with local government health departments. As HHS Secretary Sebelius said, pandemic preparedness and prevention is a “responsibility we all share.”