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Lessons learned from responding to the H1N1 influenza outbreakBy Deidre Bello, associate editor
Even before the H1N1 influenza outbreak began spreading in the spring of 2009, global health authorities who analyzed the effects of the 1918 Spanish influenza and the outbreak of the H5N1 avian influenza in Asia warned organizations to prepare – another pandemic was inevitable.
Some employers who heeded the warnings discovered the business continuity plans they had in place were underdeveloped and lacked key elements necessary to protect workers if more viral flu strains emerge or an H5N1 pandemic occurs. Glen Mudd, manager of loss control services for Louisville Water Co. in Kentucky, said the H1N1 outbreak served as a wake-up call for his company.
In 2006, Louisville Water Co. took note of the H5N1 avian influenza warnings and began drafting a BCP with the help of various groups of employees from all operating areas of the company – including union leaders. A written plan was completed in 2007. When the Centers for Disease Control and Prevention began reporting cases of H1N1, Mudd said, it motivated the company to test the plan.
“It was more of a realization that this could actually hit,” he said, noting that lessons the company learned include the need for continuous testing and involvement of the human resources element in a BCP. In October, the BCP was finalized with union approval to include more detailed risk management initiatives and more HR polices.
Absenteeism and presenteeism
Workplace experts say the costs of a pandemic are unique because, unlike seasonal flu, a pandemic could come in waves throughout the year. CDC defines a pandemic as an extended event with multiple occurrences of outbreaks in the same geographic area, each outbreak lasting six to eight weeks.
CDC and OSHA estimate as much as 40 percent of a workforce could be affected by a pandemic and be absent from work due to illness, having to care for a sick family member, or having to care for children in the event of a school closure. In addition to absenteeism, organizations must contend with presenteeism – when a sick worker is physically present. According to CDC, an individual who comes to work with the H1N1 virus will infect 10 percent of the workforce.
Research also has shown presenteeism can be up to 7.5 times more costly than absenteeism, said Heidi Henson, a workplace analyst for Riverwoods, IL-based CCH Inc. of Wolters Kluwer Law & Business, a global information services and publishing company. Direct costs of presenteeism include lost productivity and the medical expenses of not only the sick employee, but also the other employees infected, she said, adding some estimates are as much as $2,000 per year per employee. Top reasons for why people engage in presenteeism include fear of job security, need to meet deadlines and having too much work to do, Henson said.
Wes Scott, manager of the National Safety Council’s consulting services, said organizations should plan for absentee rates of up to 50 percent for about two weeks at the height of a pandemic wave and lower rates for the few weeks on either side of the peak. “To ensure business continuity in a pandemic, short-term planning with a health focus is necessary,” Scott said. “Succession planning in the event of staff deaths or long-term disability during the pandemic and backup planning is also essential.” Emergency management and overall national recovery is greatly facilitated if essential services are available without significant interruption, Scott said.
When planning for an absent workforce, Louisville Water Co. identified which scenarios would trigger certain response actions, similar to how the World Health Organization uses six alert levels. The company reduced the number of alert levels to four tiers to concentrate on how those worst-case scenarios would impact the local community, the metro area and the local water company at the same time, Mudd said. To establish a hierarchy of control, essential core functions and the responsibilities of essential staff needed to be well-defined, he said. Each tier details the duration of time – ranging from 24 hours to 30-60 workdays or longer periods of time – and the corresponding supports and processes necessary for the company to operate, he said, adding the key to response is understanding how H1N1 is spread.
The company tested its BCP throughout the year with strategic drills that exposed employees to the likely situation of an entire key group in a department being gone due to illness. When organizations put a plan in place they should test it right away to get people involved, Mudd said. “That’s when they get the buy-in. Even if they’re [acting out a scenario], they get the feeling that this could really happen,” he said.
Organizations also need to keep in mind how absenteeism will affect the transportation of products and supply chains, not only in the United States but abroad, said Aaron Desmond, director of business preparedness at the University of Minnesota’s Center for Infectious Disease Research Policy in Minneapolis. Organizations should examine what their critical items are in terms of suppliers and make sure they have redundancy at different points, he said.
Detail the 'human element'
CDC in November estimated that in the previous six months more than 22 million people had been infected with the H1N1 virus and, at press time, 3,900 had died from it. Health authorities have repeatedly urged employers to develop pandemic preparedness plans; encourage vaccination; and create policies that promote telecommuting, flexible workplace policies and staggered shifts. OSHA advised use of appropriate control measures, such as good hygiene, cough etiquette, social distancing, use of personal protective equipment and staying home from work when ill.
Although such engineering controls and work practices can help slow the spread of H1N1, experts warn that employers should not forget to plan for the “human element” in a BCP and to include well-defined HR policies for a health crisis. When researchers at the Harvard School of Public Health in Boston conducted a study of H1N1 preparedness among HR personnel at 1,057 businesses last summer, they found 74 percent of businesses offered paid sick leave for employees, but only 35 percent of businesses offered paid leave that would allow employees to take care of sick family members. Only 21 percent offered paid time off that would allow employees to care for children if schools or day cares were closed.
Study findings also showed 43 percent of businesses surveyed required a note from a doctor to take sick leave and 69 percent required a doctor’s note to return to work after a contagious illness. The study suggests such a policy might not be in sync with what could occur during a pandemic, said Gillian SteelFisher, a research scientist and assistant director of the Harvard Opinion Research Program in HSPH’s Department of Health Policy and Management. During a pandemic, the number of sick individuals crowding emergency rooms and physician’s offices may make it difficult to see a doctor, she noted.
As businesses of all sizes build polices, they need to consider how workers will act during a pandemic, then draft policies that reflect those possible outcomes and also reflect a real partnership with employees, SteelFisher said.
Organizations can take a variety of steps to encourage workers to stay home when sick, Desmond said. These steps can include adjusting policies, allowing people to go into negative sick time and suspending requirements for doctor’s notes.
Henson added that when drafting BCPs, organizations also should be aware of potential liability issues that could arise from violation of the Americans with Disabilities Act, the Family Medical Leave Act of 1993, and the Health Insurance Portability and Accountability Act of 1996, better known as HIPPA. She cautioned employers to protect employee privacy by not identifying in any way that an employee has contracted H1N1.
Transparency and communication
Another lesson employers learned from the initial H1N1 response was the value of strong communication about the risks employees face and how an organization is responding to an issue, Desmond said. Transparency about where information is coming from and how an organization is establishing policies and expectations also can help prevent panic among workers. “It’s really important because if [employers] lose credibility, in these situations, that’s when people really get concerned,” he said.
When news of the H1N1 virus outbreak first broke in 2009, global toymaker Mattel Inc. responded within 12 hours of reports of the outbreak in Mexico. A pandemic team launched a global communications network to share updates and took actions to implement an enhanced set of precautions, including hygiene education, handwashing, deployment of sanitizers and door screening. Employees also worked with local authorities and shared best practices with other companies.
According to its Global Citizenship Report released in October, the El Segundo, CA-based company began planning in 2007. It brought together a cross-functional team and consulted with health experts to create a plan aimed at protecting employees in the event of a serious infectious disease outbreak. Corporate guidelines were initially based on WHO’s six pandemic alert phases. Then, in 2008, planning efforts continued as a corporate team worked with major population centers and manufacturing locations to create site-specific emergency response plans. Mattel developed an intranet site for preparedness teams and online links for employees to provide information about precautions to take at work and at home to keep families healthy, the report states. The toymaker also communicated to employees globally to encourage vaccination against the seasonal flu. In an e-mail to Safety+Health, Kathleen A. Shaver, director of corporate responsibility for Mattel, said an effective planning process requires leadership support and cross-functional resources, and has to work in concert with an organization’s corporate culture.
“Executing the plan does not have to be expensive. There are many excellent resources for corporate planning available,” Shaver said. “I believe that any enterprise can take steps to protect its employees and business.” One no-cost way Louisville Water Co. educates through communication is by providing links to science-based information on CDC’s Website in all e-mail correspondence and updates, Mudd said.
Defining the safety professional’s role
One final lesson Louisville Water Co. learned while responding to the H1N1 outbreak was choosing the right leadership during a health crisis. Experts say when establishing a “hierarchy of control” employers should assess what minimum staffing is required for safe operation, whether suspension of operations or relocation is necessary, what key personnel will take leadership during and after the crisis, what types of communication will be used, and what supplies they should maintain.
“Like any plan, it needs to have an owner and someone needs to be the champion for it; and that person needs to not just put it aside as soon as the flu season is over,” Mudd said.
People who take on leadership responsibilities should have an appreciation for detail, he said. They also have to follow through with pieces of the BCP. For instance, after a drill, that person needs to see what went right, what went wrong and make sure important details are captured so there is an opportunity to improve, he said. “More than anything else, [employers] have to find a person that wants to do the job and the company has to dedicate the resources to get it done,” Mudd said.