Pandemic

​​​A disease of epic proportions is coming, say experts. Do you know what to expect, or how to prepare?

​At virtually every large employer, huge percentages of employees were absent. Thirty-eight hundred Pennsylvania Railroad workers were out. The Baltimore and Ohio Railroad set up its own emergency hospitals along its tracks. The entire transportation system for the mid-Atlantic region staggered and trembled, putting in jeopardy most of the nation’s industrial output.”

—The Great Influenza, by John M. Barry, Penguin Books, 2005

In 1918, the world experienced the deadliest pandemic ever known. Between 50 million and 100 million people died worldwide, and U.S. deaths were estimated at more than 500,000.

Could it happen again? The general consensus among experts is that another pandemic will strike—sooner, rather than later. The only real question is the severity of the threat, which remains anyone’s guess.

Two other pandemics have swept the world since 1918, but both were relatively mild in comparison. The Centers for Disease Control and Prevention (CDC) estimates that in the United States, a 1957–58 pandemic killed 70,000, while a 1968 pandemic killed 34,000.

Pandemics occur roughly three to four times a century, explains Michael Earls, a spokesman for Trust for America’s Health, a Washington, D.C., nonprofit organization that works on disease prevention. And while outbreaks don’t occur at predictable intervals, he says “we are kind of overdue.”

He’s not alone in his assessment. In a letter to the U.S. Department of Health and Human Services (HHS), the Public and Scientific Affairs Board of the American Society for Microbiology (ASM) wrote, “The ASM agrees that the pandemic influenza threat is real and preparedness is essential.” The World Health Organization (WHO) says the risk is “serious” and believes the world is now closer to another influenza pandemic than at any time since 1968. CDC director Dr. Julie L. Gerberding specifically sees the current avian flu virus—known as H5N1—as a “very ominous” threat to humans worldwide.

Most employers, industries and governments, however, aren’t prepared to deal with this type of catastrophic event. The time to start getting educated and prepared is now.

Unprepared for a Pandemic

Whether it’s the current avian flu or some other form of influenza that turns into a pandemic, “we are overdue and underprepared,” HHS Secretary Michael Leavitt told conference participants at the Business Planning for Pandemic Influenza: A National Summit, in Minneapolis in February.

According to government estimates, a moderate flu outbreak would cause more than 200,000 deaths in the United States; a severe outbreak would cause nearly 2 million deaths. (See Table 1.)​

These figures are speculative. Currently the death rate for H5N1 is 50 percent of the couple hundred humans infected, but it is expected to come down dramatically if it mutates to a form that can be transmitted from human to human. (In that situation, the virus would adapt so as not to kill its host, and deaths should decline; however, some infected persons will die anyway.) A more appropriate, though conservative, mortality estimate is 2 percent of the population.

In addition to potentially staggering mortality figures, a pandemic can cause other serious—and perhaps less obvious—repercussions, including medical and other shortages.

 

Medical Shortages

Influenza pandemics come in waves, each one lasting anywhere from four to 12 weeks and continuing for one to two years. During the first wave of a pandemic, officials expect 20 percent to 30 percent of people will fall ill.

It’s unlikely that a vaccine will be ready during that initial wave because it could take up to six months to isolate the specific strain and begin substantial production, explains Earls.

Nor can we depend on anti-virals. The CDC found that the predominant strain of influenza this year (H3N2) is resistant to the two most common types of anti-virals: amantadine and rimantadine. The concern is that H5N1 also will be resistant.

In addition, Tamiflu, which may or may not be effective, is in short supply. The CDC has purchased enough of the drug to treat approximately 5.5 million adults, but with a population of 330 million, those doses would cover less than 2 percent of the population.

What Else To Expect

In addition to medical shortages, a severe pandemic will cause prolonged government service disruptions, a run on essential goods and services, and business shutdowns, Sherry Cooper, global economic strategist and executive vice president of Harris Bank and BMO Financial Group, told participants at the Business Planning for Pandemic Influenza summit, which was sponsored by the Center for Infectious Disease Research and Policy (CIDRAP) at the University of Minnesota.

In all, she says, a pandemic could cost the global economy more than $3 trillion and the United States as much as $670 billion. Even a mild pandemic will slow the annual growth of the world economy by 2 percentage points and cost the United States $220 billion.

What’s more, current business practices put the nation at increased risk. Peter Sandman, a risk communications consultant based in Princeton, N.J., says our reliance on just-in-time inventories means that any delays or interruptions in transportation will lead to shortages in products. And lean staffing levels mean that if employees are out sick, there will be no one to cover for them.

These problems could be exacerbated by current labor shortages in some industries. For example, Dan Dorman, senior manager of data security and disaster recovery with DHL Express, notes that the transportation industry is already experiencing a shortage of trucks and trained drivers.

In addition, many industries—including health care—have little surge capacity. Most hospitals do not have sufficient backup supplies of basic equipment or enough beds to handle a pandemic, says Earls. There would be such a strain on the medical community during a pandemic that there would be inadequate resources for taking care of those with chronic health problems. Even the relatively small surge that occurred in Northern Virginia during the 2001 anthrax scares led to problems treating chronic patients, says Earls.

In addition, the nation’s electric utilities are already strained, according to Mossoud Amin, director of the Center for the Development of Technological Leadership at the University of Minnesota. Thus, a large absenteeism rate in the electrical industry could lead to power outages and brownouts. Potential power problems are listed as one of the top concerns by the WHO.

Those expecting help from the government may be sorely disappointed. Tommy Thompson, former secretary of HHS and current chair of the Deloitte Center for Health Solutions in Washington, D.C., warned businesses at the CIDRAP summit not to place too much faith in the government’s response. “Look at what happened during Katrina,” he noted.

He’s not alone in his concerns. The American Federation of State, County and Municipal Employees has said the Bush administration’s plan for responding to a pandemic is “inadequate” and “would leave health workers, first responders and all Americans woefully unprotected.”.

Crisis Plans Lacking

Thus, it is imperative that businesses develop their own plans. Unfortunately, many have not even started. While a 2005 Disaster Preparedness Survey Report from the Society for Human Resource Management found that 85 percent of companies have a formal disaster preparedness plan, a Deloitte Center for Health Solutions/ERISA Industry Council survey of U.S. employers in November 2005 reported that only 14 percent had adequately planned for a possible pandemic.

Even at CIDRAP, where more than 200 companies were represented—including 40 percent of Fortune 50 companies—only 18 percent reported completing such a plan.

The Deloitte Center for Health Solutions study also found that 39 percent of those responding believe there isn’t much a company can do to prepare. But Bill Anderson, director of global security at Ryder System Inc., a logistics and transportation company in Miami, disagrees: “The more we can identify ahead of time and have plans and processes for, the more we can free up our crisis management team to address the unanticipated.”

Current crisis plans that do not include specifics for pandemics are a good start, but are not enough. If you haven’t dusted off that plan for a while, now is the time to take it down from the shelf and reassemble your team, which should include representatives from human resources, business continuity, environmental health, security, IT and any business areas vital to your operations. There will be no time once a pandemic has started. An influenza outbreak could spread worldwide in as little as 20 to 30 days.

Communications

Start communicating your plan to employees now to help reassure them.

“Employees are concerned about this,” says Kelly Donaghy, security and fire protection spokeswoman for Boeing in Costa Mesa, Calif. She says employees need to know that their company is planning for a pandemic, but they also need to realize that a pandemic could happen tomorrow—or it could be delayed for 10 or 20 years. “They also need tools and resources to help their families plan for it,” she points out. “That’s the only way people can go on being normal and working.”

Another way to help employees keep going and keep their minds on the job is to give them honest information about their health risks, which may not be as dire as employees believe.

“The one thing we learned with SARS [severe acute respiratory syndrome] is that the fear of the disease or being exposed is much greater than the actual statistical odds are,” explains Gary Niekerk, manager of corporate responsibility at Intel in Chandler, Ariz. “People will overestimate the risk and won’t want to come in to work.”

A potential result: “You can shut down an operation with two or three people sick in a 10,000-person operation,” he says.

Accurate information and clear communications are imperative, says Katherine Andrus, assistant general counsel with the Air Transport Association in Washington, D.C. When the airline industry was dealing with the SARS scare in 2003, “we were lucky to have a good line of communication to CDC and get frequent updates,” she says. “The CDC, HHS and WHO all have put out some great individual preparedness material,” Andrus notes, “so we point our employees to the pros.”

Absenteeism

According to HHS, employers should reasonably expect an absenteeism rate of up to 40 percent in the middle of a severe pandemic as employees fall ill or die, leave work to care for family members, deal with grief from the loss of loved ones, look after their children (if schools close) or are just too scared to come to work.

In addition, your employees could be placed in quarantine. Or the transportation systems they count on to get to work may shut down. “The absenteeism rate will include everyone—including your leadership,” warns Donaghy.

Companies must decide the minimum number of people they will need to keep their operations running, says Dr. Myles Druckman, vice president of medical assistance for International SOS in Trevose, Pa., which provides medical assistance, international health care and security services. Some employers may even want to consider closing down during the pandemic. But most companies don’t have that luxury.

Keep Them Well

The central issues for businesses, then, become how to keep workers well and how to find enough replacements.

To keep workers well, companies may need to consider the following options:

First and foremost, emphasize hygiene. Tell employees to avoid close contact, wash their hands, cover their mouths and noses when sneezing or coughing, stay home if they are sick, and avoid touching their eyes, nose or mouth.

Identify which employees can work from home or other remote locations. Decide ahead of time if they will use laptops or their own computers. Do they have Internet connections? Can your servers handle everyone being online? (Be aware that government officials may ration telephone lines.) When will you start to give employees remote access? How will you protect your company’s information?

Schedule employees in shifts. Fewer people in more shifts means less exposure to the illness.

Identify illness at the door. Intel is looking at using a thermal scanning unit to determine if workers have an elevated temperature. Ryder gave out digital thermometers to employees during the SARS scare.

Send ill workers home. Hourly workers may not feel they have the luxury of not coming to work, says Earls, so find ways your compensation and leave policies can address this issue. In addition, people may use all their leave and still need additional time off.

Check heating and air-conditioning systems. There may be an advantage to turning these off, depending on work conditions.

Pay close attention to rules for cleaning staff. For example, it will be vital for cleaning staff to maintain good personal hygiene, such as regular hand washing, to reduce the risk of infecting themselves and others.

Cleaning staff also can help reduce outbreaks by using damp rather than dry dusting to avoid spreading dust particles, and by cleaning surfaces with freshly prepared solutions of detergent and hot water, followed by a chlorine-based disinfectant solution. What’s more, these staff members may need to more regularly clean offices, air-conditioning filters and telephones in common areas to reduce infection. They also should use anti-bacterials on railings and in restrooms, common areas, etc.

These workers also should be careful about exposing themselves not only to infected areas, but also to the cleaning products they use. Protective clothing and gloves may be in order for such workers.

Stockpile certain supplies. Once a pandemic is announced, it may be difficult to get supplies. Your organization may want to purchase ahead of time such items as hand sanitizers, gloves, masks, or even food and water, depending on where your offices are located.

Ryder plans to offer its employees supply kits, as it did during Hurricane Katrina. One note: Asian countries had no problem getting workers to wear masks during the SARS outbreak, but Western countries found people wouldn’t wear them because of concern they would be singled out for being ill. One option is to make them mandatory for all your workers.

Intel planned to set up stations to provide employees with hand sanitizers but discovered that the use of these alcohol-based cleaners in facilities with large populations could violate their air emission standards under the Environmental Protection Agency and state authorities.

With regard to anti-virals and vaccines, however, availability is not the only issue. Druckman says employers should consider the following:

• Medications possess limited shelf lives and can be expensive. Thus, employers could end up with a load of unusable, expired medications.
• Medication needs to be prescribed by a physician and should be administered within two days of developing symptoms (preferably within six hours). How will you get it to your employees in a timely manner?
• Anti-virals and vaccines may be in short supply. Can you ethically defend giving them to your employees instead of others? For whom should you stockpile medicine? For all of your employees, or just those in key positions? What about family members?

Restrict travel. In a severe pandemic, that won’t be an issue, says Sandman. There won’t be any travel.

Finding Replacements

Having enough workers may take creativity. One option may be to bring back retirees. A quirk of the 1918 pandemic was that—unlike most influenzas, which are deadliest to the very young and very old—that contagion targeted the healthiest segment of society: people 20 to 35 years old.

Another option is to cross-train employees who work in nonessential positions so they can take over more essential functions needed to keep your business running.

One way to find labor, suggests Dorman, is to partner with other industries that won’t require many employees during the pandemic. For example, the leisure and entertainment business could come to a grinding halt during a pandemic, he notes. By contrast, shipping services will be in desperate need of workers as individuals who are quarantined or simply too afraid to go out to the grocery store or pharmacy increasingly ask for products to be delivered to their homes.

Finally, previously ill workers could prove to be a ready source of labor. Those who recover should be immune to the disease, making them well suited for jobs that interact with the public.

Outsourced Services

Your suppliers will be facing the same challenges you will. Keep this in mind for your vendors that supply goods and services for your employees. Depending on what you outsource, you could have interruptions with payroll, benefits administration or food services, for example.

Of particular concern during a pandemic may be your company’s employee assistance programs (EAP). Employees are going to be dealing with fear, grief, exhaustion and a host of other emotions before, during and after a pandemic. EAPs will be overwhelmed and short staffed as well. Consider alternative arrangements with local professionals.

Legal Issues

Companies also should start seeing if their workplace policies need to be tweaked to deal with a pandemic, says Peter Susser, a partner in the Washington, D.C., office of Littler Mendelson. Review your insurance coverage, and take a look at your disability benefit protections, your health care plans and your leave policies.

It could be a very difficult time, and there will be some tough decisions ahead for employers as to what kind of standard they will apply. For example, if schools close and employees need to stay home to watch their children, will you adjust your leave policies to adapt to this reality? Sick leave wouldn’t apply, but workers may quickly run out of vacation time if schools remain shuttered for a long period of time.

Don’t think you can skirt your obligations as an employer either, Susser warns. If you have unions, you have an obligation to negotiate with them, especially if you are thinking about bringing in retirees or workers from other industries. If you move employees into new positions, all training and safety regulations still apply. And if you provide candid information about the status of the pandemic on your campus, don’t forget your obligations under the privacy rules for the Health Insurance Portability and Accountability Act. Also be prepared to comply with the possibility of new local, state, federal and international laws or regulations.

This, Too, Shall Pass

If we do experience a pandemic, no matter how severe, it will pass. The good news is that the more businesses plan for it, the better off they will be.

And if there is no pandemic in the foreseeable future? You’re still better off, says Dorman. “This kind of business preparedness can pay off immediately. You can create new business opportunities and new relationships with your customers, suppliers and government organizations that you may not have thought of before.”

Nancy Hatch Woodward is a freelance writer based in Chattanooga, Tenn., and a frequent contributor to HR Magazine.