Ready, willing and able?

Study indicates possible high absentee rate among essential employees during a pandemic

By Lauretta Claussen, associate editor

A serious pandemic could leave more than half of essential workers – such as police officers, firefighters and hospital workers – unwilling or unable to work, indicates a study from Columbia University’s Mailman School of Public Health in New York.

The study, published in the Journal of Occupational and Environmental Medicine (Vol. 52, No. 10), surveyed 1,100 essential workers, including police officers, firefighters, emergency medical technicians, hospital workers, public health employees and corrections officers, from the New York City metropolitan area. Between November 2008 and June 2009 – a time frame that encompassed the first few months of the H1N1 influenza pandemic – participants were anonymously questioned about their willingness to work through a serious pandemic.

Although 80 percent of respondents said they would be able to report to work during a pandemic, only 65 percent would be willing to do so. Overall, fewer than half of the workers reported being both willing and able to work during a serious pandemic. Perhaps even more shocking, 12 percent of respondents said they would consider retiring or quitting rather than reporting for work during a severe pandemic.

“These data indicate that non-illness-related shortfalls among essential workers could be substantial,” said study author Robyn Gershon, professor of clinical sociomedical sciences at Columbia.

When researchers examined what factors made workers more or less inclined to work during a serious pandemic, they discovered the workers’ motivations were closely associated with their trust in workplace safety measures and their employers’ ability to keep them safe.

Creating a contingency plan

A 2006 paper from the Department of Homeland Security noted that although most large organizations had contingency plans in effect for natural disasters and terrorist attacks, few accounted for the impact of a pandemic. That changed somewhat as a result of the recent H1N1 pandemic, when employers were faced with the prospect of a long-term emergency situation and worker shortage.

In 2008, Steve Dargan, an emergency health services planner for the Los Angeles Emergency Management Department, developed a pandemic influenza continuity of operation plan. A similar document for seasonal influenza was put into place in 2009. These plans provide arrangements for absenteeism rates as high as those predicted in the study.

“Each department within the city is required to have an emergency plan on file with the emergency management department,” Dargan said. The plan “asks them to identify their core functions from each department and how they would perform those with a 20, 35 and 50 percent absenteeism rate.”

Gershon noted that “these preparedness steps [such as pandemic planning and training] are important in building worker trust. Workers who trust that their employers can protect them during a communicable disease outbreak will be significantly more likely to come to work and perform their jobs – jobs that are vital to the safety, security and well-being of the entire community.”

Yet, even though the Centers for Disease Control and Prevention made workplace pandemic planning and training materials readily available, the study found that only 9 percent of workers were aware of their organization’s pandemic plans, and only 15 percent had ever received pandemic influenza training at work.

Communicating the real hazards of a pandemic, as well as outlining the organization’s preparedness plan, may be a significant component to preventing potential worker shortages. Dargan fought fear and misperception during the H1N1 pandemic with education.

“For about a year, we issued a weekly – and then it got down to every other week – bulletin that we sent out to everybody in the city that had the current information from the CDC, recommendations, where it was going, was it increasing, was it decreasing, things like that,” Dargan said.  

Keeping workers healthy

The Columbia University study results indicated that one deterrent to working through a pandemic related to employees’ personal and familial obligations, such as the need to care for sick family members or children in the event of school closings.

Researchers noted that offering flexible scheduling so people can tend to their personal obligations can make working during a pandemic easier. “Even something as simple as making sure workers can communicate with their families while they are on duty can have a big impact on ability and willingness,” Gershon said.

Other recommendations included providing vaccinations to employees and their families, and determining workers’ needs in terms of respiratory protection in advance of a pandemic to lessen their fears about contracting illnesses.

Some people believe mandatory flu vaccinations are the answer. In 2009, the New York State Hospital Planning and Review Council approved a statewide measure that required vaccination for all health care workers who interact with patients. The regulation later was withdrawn after the New York State Nurses Association and other groups strongly objected. Despite this, in October 2010 the Elk Grove Village, IL-based American Academy of Pediatrics issued a policy statement recommending all health care workers receive a flu shot.

At the opening session of the National Safety Council 2010 Congress & Expo in San Diego in October, NIOSH Director John Howard noted that mandatory vaccination is one of the most controversial issues in the health care industry today.

His concern is that a heavy focus on vaccinations will lead employers and employees to disregard other methods of flu prevention. “Right now, I’m concerned about that because it suggests that ‘All we need to do in an influenza prevention program is get vaccinated and everything else is fine,’” he said. “That’s not true. Sole reliance on vaccination isn’t the answer.”

During the H1N1 pandemic, Los Angeles had 10,000 vaccinations available free of charge to city staff, but receiving the immunization was strictly optional. “If you say it’s required, for some reason people just don’t want it just because you said it was required,” Dargan said. “We just try to make it available and provide education.”

Dargan and Howard agree that stressing standard flu prevention techniques to workers – such as frequent handwashing; cough etiquette; and disinfecting of computers, phones and other equipment – is more effective than vaccine requirements in controlling the spread of illness. 

Sending workers home

Ensuring workers stay home when they are sick is another crucial measure to protect against the spread of influenza, although some workers may be resistant to this.

Because the H1N1 pandemic never became severe enough to create a significant issue in California, no statewide plan was put into place to address sending sick workers home. However, Dargan worked with the Department of Water and Power to adopt such a policy. Workers with flu-like symptoms were sent home, paid for the rest of the day and expected to provide health updates on the following day.

The safest measure for protecting workers and the community is to keep sick workers at home and have a contingency plan in place that allows essential departments to continue core functions. “If someone was in the early signs of maybe flu-like symptoms, it is certainly in the best interest of everybody to get them out of the workplace,” Dargan said.