Dr. Michael Perdue (left), the World Health Organization’s head of response to the bird flu outbreak in Turkey, and Bruce Mann, head of the UK government’s Civil Contingencies Secretariat, answer readers’ questions on the latest risks of a global pandemic and how businesses can best prepare.
What elements would you recommend a business include in its preparedness plan?
Kathleen Monast, Human Resource Manager, Palmer Paving Corporation, Mass., USA
Bruce Mann: Start by really really understanding two areas - the disease, its characteristics and its potential impact (see the UK Pandemic Flu Plan on the Department of Health website; or any US Government plans); and your company and how it really ticks. Check what the Directors of the company intend to do as a basic coping strategy when the pandemic emerges, especially in allowing staff to work from home. Then really work through the impact - which is all about people being absent from work - on your company (a bit like a process flow analysis). Who would you really miss in keeping the company going? Best start is to look for those with the key skills, especially specialists, vital to continued functioning. Remember that specialists can cover either technical skills (e.g. IT; production) or deep knowledge. Remember to look at all levels of the company not just junior and middle management. Clerical and maintenance employees can get overlooked. So can senior executives. And don’t just look at job titles - get the watercooler stuff about who really makes the place tick. And someone somewhere should know how the boardroom really ticks - who’s really in charge.
Look at your suppliers too - which of them is really critical to continued operation; are they prepared? Then work out how you would cope if those people weren’t there. Then complete the loop - is the strategy which the Directors of the company intend to adopt actually going to be workable against the reality of the workplace and how it will be affected? Finally, factor in any areas where the Government may look to companies for help.
Michael Perdue: Making sure you know what the local and regional plans are and providing employees with information packet on influenza (could be easily developed and tailored for your business from WHO website information (www.who.int) ..Further, there is a WHO document under development that will specifically address this question. It should be available shortly.
In large urban conurbations such as London where businesses are heavily reliant on the public transport infrastructure how would businesses go about planning to get people into work, given that people are likely to shy away from packed buses/underground etc in a pandemic situation?
Andrew Guyton, London
Michael Perdue: Very good question. Difficult to say, WHO has no specific recommendations regarding this. Since countries/cities etc have different infrastructures it is difficult to develop global guidelines and must depend on fully developed country pandemic preparedness plans (which we encourage strongly).
Bruce Mann: Obvious point – crowded is crowded, whether it’s on a London Transport bendy-bus or a company-hired coach. The two keys to this are knowing who needs to be in to work; and when they need to be there. Then you can look at the options.
On the first, check your company’s strategy. Will it suggest that people should work from home, even if only a couple of days a week? How many people will it want to get in to work? In what jobs? For companies with several offices, will it suggest that staff work from offices closer to their home?
Second, check whether people have to get in to work in the classic rush hours or can spread their journeys to times when public transport is less crowded?
Options will depend on the answers to the above, and on the company’s particular circumstances. Can the essential people get in on foot, bike or car; or at times when public transport is less crowded? Or even stay in town to avoid travel altogether?
Final point – people with flu-like symptoms should not try to be heroes and struggle in. They should stay at home and get well.
Many people will be concerned about how they will get access to Tamiflu or similar medications, especially given the day-to-day experiences of getting access to GPs etc. Would business have a role to play in the distribution of Tamiflu stocks?
Mark Hooper, London
Bruce Mann: Not those that would be distributed by the NHS. Those would be distributed by health sector professionals, because of the obvious point – health care is about more than giving out drugs.
Michael Perdue: This is certainly a possibility, the delivery of antivirals during a pandemic is currently a topic of intense discussion and I would expect some formal recommendations soon.
What steps should employees take to help maintain a flu-free workplace?
Bruce Mann: The obvious one - tell people loud and clear, including from senior managers, that they shouldn’t try to be heroes and struggle in to work if they have flu-like symptoms (that is, real flu-like symptoms, not just colds). If they do, they’re not helping themselves, and they’re helping spread the disease. Stay home and get well.
Michael Perdue: Follow recommended procedures to prevent transmission of respiratory diseases. Prevent aerosols during sneezing, coughing etc, wash hands frequently with warm soapy water, remain at home when experiencing flu symptoms.
Have antivirals been provided to the flu patients in Turkey and how effective have they been in curing or preventing the disease?
Sandra Mounier-Jack, European Centre on Health of Society in Transition, London School of Hygiene and Tropical Medicine, London, UK
Michael Perdue: Yes, some 70+ people referred to or presenting at hospitals were put on Tamiflu. We do not know until we receive full laboratory reports on the viruses, it is tempting to hope that the lower fatality rate we have seen in Turkey is due to rapid administration of the drug, but supporting data is just not available yet.
Where are the antiviral currently stored? How will the antivirals be distributed and on which criteria?
Bruce Mann: In NHS storage facilities. By health care professionals, on the basis of clinical need – i.e. to those who are ill. There may just possibly be some limited prophylactic use of anti-viral drugs in very early outbreaks in the UK to try to hold or slow the spread of the disease, if that seems as if it would work. But if the disease spreads widely, the drugs will go to those who are ill.
Are there any provisions made for British people living abroad, in particular in risk prone countries?
Bruce Mann: Yes. FCO Consular Services will be there to help, as normal for British Nationals abroad. The Government will be publishing more information in this area soon. Clearly, the issues vary from country to country, depending on the circumstances, especially the quality of local health systems. But, with an estimated 15m Brits overseas, it’s going to be a huge job. So people are going to have to help themselves as well – not least by listening to and acting on FCO Travel Advice about travelling to affected areas.
What is the probability, in your mind, of human to human transmission becoming a reality, anywhere in the world a) during 2006 b) in the next 3 years?
Andrew Perrins, Bournemouth
Michael Perdue: I think about this a lot as you might imagine. We have, without a doubt, seen an increase in avian influenza outbreaks in the last 20 years compared to the previous 100 years. Also, we have never seen anything like the current H5N1 outbreak which has involved multiple countries and now appears to be spread by migrating waterfowl. That part of the equation makes one think a pandemic is near. The other part however is that we now know much more about what genetic changes have to occur to generate a human pandemic virus, certainly not all the changes but at least some, and we can follow the emerging viruses and their genes to make an assessment of potential. Based on that, the evidence is not so strong that the current H5N1 will become the pandemic virus imminently, but the more opportunity it is given to change of course, the more likely the genetic changes will occur. I would never attempt to predict anything for influenza over a 3 year period!
What are the avian flu symptoms, and how can we best detect them in our employees?
Michael Perdue: Avian Flu symptoms seem to begin similarly to seasonal flu symptoms, with acute onset of fever (>38 C with coughing and/or shortness of breath), but part of the case definition also in use includes contact with sick or dying poultry. It is important to keep this latter point in mind. We have no evidence of avian flu being transmitted in the same fashion as seasonal flu.
Bruce Mann: More or less like “normal” (seasonal) flu. See the Department of Health website for more details www.dh.gov.uk
What estimates of employee absenteeism during a pandemic would it be prudent for companies to plan for?
Peter Chapman, London
Bruce Mann: Companies need to do some maths here. Add up the following equation:
A: How many employees are normally absent for non-flu reasons – broken legs; stress etc etc. That will vary from company to company.
B. How many people may be absent because they have pandemic flu or are caring for someone who has it. The UK Pandemic Flu Plan (see DH website) gives a base case of 5-7% of the average workforce on an assumption of a 25% clinical attack rate (those who get the virus and are unwell). A reasonable worst case would be double that (50% unwell; 15% absence at peak). But see further below.
C. The number of people who are absent not because they are ill or caring, but because they are too worried to come in to work or because their employers have told them to work from home. The latter depends on the coping strategy adopted by the company
Add up A+B+C to get the peak rates of absence. But then factor in two variables:
1. The disease is likely to spread more quickly in small communities and workforces (e.g. a maintenance crew; a control room) than in large (e.g. a typical open plan office). In a workforce of 10, it is likely to peak in Week 2. Modelling suggests it will be Week 3 for workforces of 100; week 5 for workforces of 1,000; and week 6 for workforces of 10,000.
2. For companies with offices spread around the UK, we reckon the disease will take around 2-3 weeks to spread across the UK. So it may peak earlier in one city than in another.
Apply all this maths to your company. What’s the peak rate? Might it vary from regional office to regional office? Might it affect critical teams in particular (e.g. small specialist crews or office-based technical teams).
We’ll be putting more on all this on websites shortly for those who want to go into the fine detail.
Michael Perdue: Difficult to say, infection rates as high as high as 30% have been seen in some influenza epidemics.
We know from our work within large IT and business change projects that when we plan for the worst, we can accidentally achieve just that. But planning for success using backcasting produces a much slimmer, more focused and practical plan than traditional ‘what if’ scenario-based disaster planning. Are you planning for a successful outcome, or to contain a range of imagined disasters?
Alan Fowler, MD of Edinburgh-based project management consultancy, Isochron Ltd
Bruce Mann: Yes, we agree. So we plan for a range of outcomes, making sure we understand the key differences between each and what we would have to do differently depending on what we were faced with. So if the pandemic were to be mild, let’s not over-hype it and create panic and gloom, let alone damage to society and the economy. Equally, if the pandemic is serious, let’s be clear about those extra steps we would need to take to ensure that we did what we could to mitigate both its direct effects (i.e. reducing death and suffering) and its indirect effects (e.g. keeping essential services going).
Michael Perdue: WHO encourages countries to plan for an eventual influenza pandemic--but we should remember that all of this planning, which is ultimately aimed at strengthening public health systems, is not disease-specific, and will be helpful in any public health emergency. All of the investments that countries put now into pandemic preparedness will ultimately be useful--whether it is used in an influenza pandemic, or to combat another emerging disease
Does it make sense for government to close schools during an outbreak to prevent greater spread of infection? What measures could be made to look after and teach children if that occurs?
John Rogers, Kent
Michael Perdue: This is one of the non-medical interventions that WHO has been considering, however we have to see what the epidemic patterns of the outbreak follow to make specific recommendations as to whether controlling mass gatherings and school closures will be effective.
Bruce Mann: Sorry, there’s no easy answer to this. The only thing to say at this stage is “It all depends” on how serious the pandemic virus turns out to be, and whether it attacks particular age groups more seriously than others. What we are doing at the moment is making sure we understand the pros and cons. How much would shutting schools slow the spread of the disease? What would be the effect on society? On worker-parents? On the ability of essential services to keep functioning (e.g. if nurses have to stay at home to look after their children). There are really quite significant downsides. And we are getting into a position so that the decision can be taken quickly and implemented smoothly, including managing the impact on learning. More information on all this will be published in the next few weeks. But the final decision can only be taken when we see what kind of virus we are dealing with.
How much notice and time might the Europe and the US have to prepare for a pandemic if it is initially identified in South East Asia?
Michael Perdue: We know that in 1957, the pandemic had ‘gone global’ within 3 months. Air traffic was not widespread in 1957. We now know it can have dramatic accelerating affects...witness SARS outbreak. On the other hand, the medical surveillance and reporting systems now are much enhanced after 50 years, so we may have a better chance at slowing transmission.
Bruce Mann: If it does start in South East Asia, modelling suggests a month, probably a bit less – as experience with SARS showed.
What type of recovery plan should businesses have in place? What should we be communicating to our employees about the potential for a pandemic?
Bruce Mann: It depends on the company and its business. Usual tick list includes things like - can work be done from home, especially in information sectors; or can production be stopped, rephrased or rescheduled (for industrial sectors).
Watch what your Government says. Certainly in the UK, it’s getting reported in the serious newspapers; and there’s a lot of stuff on websites. But please maker sure you communicate not only the risk but also what your Government and your company are doing to prepare.
Michael Perdue: No specific WHO plans currently available but will be covered in the future document.
What is the latest consensus view on when a new human flu pandemic might occur, where the outbreak is most likely to begin, and how serious to human health it will prove?
A Jack, London
Michael Perdue: The situation now is that 2 of three criteria for a new pandemic have been met, namely 1. the infection of humans with a 2. new subtype from an animal. The third criteria, the ability to transmit between humans has not been met. It is impossible to predict where or when an outbreak that would generate a pandemic strain will occur, but based upon information on past pandemics the consequences would be dramatic. WHO estimates as many as 7.4 million people could die from a ‘mild’ pandemic where the fatality rate would be less than 1%.
Bruce Mann: A future pandemic could occur at any time. And it could first emerge anywhere – so we need to guard against looking only at, say, South East Asia and not spotting something starting elsewhere. But at present we think it is most likely to emerge in China or the Far East. That area has been the birthplace of recent pandemics. And it has characteristics – such as the close proximity of humans, poultry and pigs in farming communities – which facilitates mingling of human and animal viruses and means viruses can directly transfer from birds or animals to humans. And, of course, the H5N1 virus is prevalent there.
We won’t know until the pandemic virus emerges how serious it will be for human health. History gives some guide. But we need to take into account, too, the fact that we have better health care systems now than we did before. So we plan on a range of scenarios
What should we do (and what should we not do) if a strain of bird flu that is transmittable among humans reaches our countries?
Michael Perdue: I think clearly the answer is not to panic. This of course always makes things worse. I think we will have some clear indications of the severity of a pandemic before it is full-blown. The problem with this H5N1 outbreak is it has been associated with high mortality which obviously gets a lot of attention. The next pandemic may not involve a highly lethal version of bird flu, but a much milder strain. Some prominent influenza virologists do not believe this current H5N1 strain will ever become a pandemic strain because it has had many years to try and has not done it yet! We believe however the more the virus stays in the environment infecting people, the greater the odds it may adapt to humans. This adaptation process may actually lower virulence for the virus also.
Bruce Mann: Nice question! A couple of obvious points on what not to do, based on human nature: DO NOT
1. As I’ve said before, be a hero and struggle in to work if you’ve got flu-like symptoms.
2. Assume you are somehow immune to it all, or because you’re young and fit it will all be OK, and so be blasé about not doing the basic things – covering your mouth and nose when coughing or sneezing; washing hands; wiping surfaces; making sure your kids do the same. It’s not just you...
Useful website links as recommended by Bruce Mann
Click here for the FT’s in-depth analysis of the bird flu threat.