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Preparing for catastrophe
Most U.S. businesses are not ready for avian flu outbreak

By DIANE STAFFORD
The Kansas City Star

If Roslyn Stone wants to lie awake at night, she worries about the wood paneling lining the insides of some trucks.

"You can't sanitize wood like you can metal," says the chief operating officer of Corporate Wellness Inc., a consulting firm in Mount Kisco, N.Y.

"If a wood-paneled truck carries diseased chickens or uniforms of people who process those chickens, it's going to need to be sanitized before it carries anything else. I worry that we don't have that kind of system in place."

Stone, who leads the Centers for Disease Control and Prevention/American Management Association's Workplace Flu Prevention work group, is helping prepare for worst-case scenarios if a bird flu pandemic should hit.

While avian flu is only a back-burner thought for many Americans, Stone is telling U.S. businesses that the possibility of an epidemic must be part of their disaster-preparedness planning right now.

So far, she and other public health experts say, most U.S. businesses are far behind the curve in assessing the possible ripple effects of H5N1, the influenza virus that currently is spread only by direct contact with diseased birds.

However, if the virus mutates to allow human-to-human transmission - and some experts expect it to, possibly by next fall - the effects on business could be catastrophic.

Businesses could be ordered to close their doors, trade and public transportation could be disrupted or halted, and hundreds of thousands of workers could be quarantined or lost to illness or death.

The U.S. Department of Health and Human Services estimated last week that 40 percent of the U.S. work force could stay at home during a flu pandemic because they or family members were ill.

A report by the Congressional Budget Office last week said in a worst-case scenario an avian flu pandemic could infect 90 million and throw the economy into recession. While the study pegged the chances of such widespread infection at less than one-third of 1 percent, it estimated such an episode would slice 5 percent off gross domestic product, with transportation, retailing, tourism and entertainment taking the hardest hits.

According to a survey sponsored by Deloitte & Touche USA, most U.S. businesses are ill-prepared for a pandemic, whether it's bird flu or "ordinary" influenza.

Two-thirds of businesses admitted in the survey that their preparations were inadequate, and four out of 10 essentially threw up their hands, saying "there wasn't much they could do."

Infectious disease experts contend otherwise.

Businesses should start now by educating workers about good disease-prevention hygiene and by considering alternate human resource policies that could kick in if an epidemic hits.

"Businesses will have to change the idea that if you're sick and stay home then you're not dedicated," said Rebecca Horvat, director of microbiology, virology and immunology at the University of Kansas Medical Center.

If a flu epidemic is confirmed, Horvat and other public health experts recommend that businesses have contingency plans that would allow workers to stay home without incurring sick-leave penalties or loss of pay.

But the Deloitte & Touche survey found scant appetite for that idea. About two-thirds of the surveyed companies said they were undecided about waiving sick-leave restrictions, and one in 10 said outright that they would not alter their policies.

The salient question, said Nina Shik, infection control manager at the University of Kansas Hospital, "Is how much is it worth to business to spend money now in case they need a bird flu plan later?"

What some are doing

Overland Park-based Black & Veatch has engineering projects all over the world, including in some of the Asian nations where the earliest cases of H5N1 influenza were found.

"We have a 12-member task force with members in our corporate office and in Singapore, Bangkok, Beijing, Jakarta, and Red Hill in the United Kingdom," said Katie Caton, Black & Veatch's manager of safety support services.

"We're linked with the CDC, the World Health Organization and International SOS (a company that specializes in health and risk management services for client companies)," Caton said. "We get updates daily about the flu worldwide."

Caton has discovered what many other companies are finding: It's difficult to prepare now by buying supplies of Tamiflu or other antivirals that can mitigate the effects of the flu - partly because supplies are limited and partly because the drugs have shelf lives that might expire before they're needed.

"There's no real point to stockpile drugs now," Caton said. "But it is time to educate our work force about the flu and think about how we would isolate or evacuate our people."

At Sprint Nextel Corp., Greig Fennell, director of business continuity, is dealing with similar concerns.

"It fits into our 'incident management response plan' for dealing with any kind of disaster that could take place," Fennell said. "How do we continue our mission-critical business?"

The plan includes such possibilities as having workers work from home or in alternate locations, and reaching out to competitors to lease lines or otherwise move phone traffic.

"We watch the World Health Organization's reports on the six stages of escalation relating to any world health issue, and we put together an approach that says what our response would be at each stage," Fennell said.

Sprint has influenza information posted on its intranet to keep employees informed, but, Fennell said, most of the preparation plans aren't widely known.

"It's like a cattle drive," he said. "We don't teach every cow, but we have a lot of cowboys who herd the cows. A key group of people know the plan and the process."

Some companies aren't as forthcoming about their plans or preparation.

A query to Liberty Mutual Insurance Co. - known to Kansas City area public health officials as a company that's actively working on a bird flu contingency plan - received this response from a corporate spokeswoman:

"We're taking the issue seriously. We're planning accordingly ... but it's not appropriate to share details right now."

Dress rehearsals

The terrorist attacks of Sept. 11 and natural disasters such as hurricanes and floods are what most people think of when they hear "disaster planning." But public health officials are pushing businesses to plan for mass disease outbreaks as well.

"They need to think, for example, about how to get food, medications, oxygen to people who are isolated at home," said Shik.

The Severe Acute Respiratory Syndrome outbreak in Asia and Canada in 2003, Shik said, "was a dress rehearsal for things we might face in a flu pandemic. They had terrible shortages when SARS hit Toronto. They quickly ran out of masks.

"We saw the need to stockpile masks and extra hospital gowns, even if you can't stockpile Tamiflu or other antivirals. We worked on our surge capacity plan - how to ramp up to handle more patients."

Health officials note that there is no vaccine currently available for avian flu. Influenza vaccines are formulated year by year in response to the known and expected flu strains for each flu season. Research into a bird flu vaccine is an ongoing part of preparedness.

In the Kansas City area, hospitals and first responders have participated in exercises to test their readiness for a bioterrorist attack. Shik said many of the practices and lessons learned in those exercises will be applicable in a flu epidemic.

"The truth is that pandemics are part of the natural cycle of infectious diseases," said Horvat. "This is not an exercise in futility. It will happen sometime. A more virulent influenza strain will get into the human strain."

What workplaces can do now

To prepare for a possible flu epidemic, workplaces should factor it into their disaster preparedness planning.

  • First, have a disaster-preparedness plan.
  • Have representatives of each discipline in each department on the preparedness committee.
  • Identify "mission critical" needs and workers and have a plan that would allow them to continue functioning if the workplace is shut down or if an estimated one-third of the workers are absent.
  • Create an emergency sick-leave policy that could be enacted if the business must shut down or workers are quarantined or isolated at home.
  • Identify off-site locations and equipment that could be used, including telecommuting from home.
  • Cross train workers to be prepared to handle different jobs.
  • Stockpile surgical masks and hand sanitizers at the workplace.
  • Encourage annual flu shots and consider purchasing Tamiflu or another appropriate antiviral.
  • Communicate facts and plans with employees.

Source: Rex Archer and Don Pickard, Kansas City public health officials

Online information

For avian flu information on the Web, go to:

Are workers a part of the plan?

The Society for Human Resource Management recently asked member companies "To what extent are employees and people issues (e.g. communication, employee assistance) a part of your organization's business continuity or disaster plans?"

The responses:

  • To a great extent - 34 percent
  • Somewhat - 36 percent
  • Not very much - 11 percent
  • Not at all - 2 percent
  • We do not have a disaster plan - 17 percent
The best defense

If the avian flu virus changes so that it is passed from human to human, it will spread just like any other influenza. Standard hygiene, plus vaccinations (if available and appropriate for the type of virus) will be the best defense.

Experts advise:

  • Washing hands frequently, with soap.
  • Using hand sanitizers.
  • Sanitizing keyboards, telephones and other equipment daily.
  • Covering coughs and sneezes.
  • Keeping plenty of facial tissues and waste baskets handy.
  • Staying home when symptomatic.
  • Getting annual flu shots.

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Roslyn Stone has been published or quoted in several hundred publications regarding employee health and wellness issues including the Wall Street Journal, Los Angeles Times, Washington Post, Gannett Newspapers, CNN, MSNBC, the Today Show and on radio programs nationally.