Pandemic Preparedness: Planning for Business Continuity, Productivity, and Resilience 

Rick Allen, PhDPeter Wald, MD, MPHSeptember 2009

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Agenda

I. Welcome

II. Current pandemic state and potential

III. Business impact

IV. Mitigation strategies

V. Individual and organizational resilience

VI. Discussion

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Pandemic Defined

• Adjective:– 1: epidemic over a wide geographical area; “a pandemic

outbreak of malaria”– 2: existing everywhere; "pandemic fear of nuclear war"

• Noun: an epidemic that is geographically widespread; occurring throughout a region or even throughout the world

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Pandemic Influenza

• Global outbreak caused by new subtype A virus (antigenic shift) that is transmitted to humans:– to which humans have no immunity– high lethality– easy person-to-person transmission– pandemic age shift (W shaped mortality curve)

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Pandemic Influenza History

• Expect 3-4 pandemics per century; one every 10-50 years– 1918-19, Spanish flu (H1N1)

• 40-50 million deaths• 30-35% infected• 1%-2% mortality, ages 20-40 years highest % deaths (10%-20%)

– 1957-58, Asian flu (H2N2)• 70,000 excess deaths, U.S.• 40% deaths under age 65• avian + human flu virus combo

– 1968-69, Hong Kong flu (H3N2)• 34,000 excess deaths, U.S.• 1/6th case fatality rate of 1918-19• avian + human flu virus combo• still circulating and in current vaccines

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• Active virus circulation in U.S.• Slight increase in activity• H1N1 dominant circulating virus worldwide

Current Status

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H1N1 Clinical Characteristics

• Typical flu symptoms– sudden onset– 1-4 days (average = 2 day) incubation– fever >101, headache, tired, aches, cough, sore throat,

runny nose– atypical presentations

• ~Early virus epidemiology – attack rate ~30%– mortality 0.2-0.5% (similar to pandemics of 1957 and 1968)– spreads very easily– attack rate in children and teens about 2X adults – less than 5% of cases in adults over 50

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Business Impact

• Mortality review– Regular flu: <0.1 % = 1 death/1,000 cases.– H1N1 flu: 0.2-0.5% = 2-5 deaths/1,000 cases– Pandemic flu 1918: est. 2% = 20/1,000 = 1 death/50 cases– SARS: 10% =100 death/1,000 cases

• Absence review– 30%-35% illness rate for pandemic flu– Add 15%-20% for those not yet ill who will stay home, or

who will be caring for or covering for ill family members – Easy to imagine 50% of workforce out if two peaks come

together

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Fall 2009 Planning Scenario

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Mitigation Strategies

• Use basic public health tools initially:– Communicate to employees

on “infection avoidance.”• Wash your hands. • Cover your cough.

• Avoid touching your eyes, nose or mouth. – Stay home/go home if sick.– Adopt social distancing (avoid mass gatherings: café,

fitness, face-to-face meetings, travel).

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Social Distancing: Philadelphia vs. St. Louis, 1918

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(Hatchett, 2007)

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Mitigation Strategies

– Decreasing environmental viral load.– Prepare for vaccine availability.

• High-risk groups first (pregnant, age 6m-24y, caretakers of children<6m, adults>24 with chronic diseases)

• Consider dependent vaccination also. – Business continuation plans linked to absence

levels • Identify and protect essential employee groups.

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Resilience Defined

• An active process • An adaptive process that individuals employ when

they are faced with challenging and traumatic situations

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Resilience Attributes

• Resilience can be learned and is characterized by:• active coping• seeking social support• recognizing that change is a part of life• focusing on success and making things work• focusing on the future and where you are headed

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Organizational Resilience

• Characterized by an adaptive organizational mindset

• Anticipates change and challenges• Members work to maintain organizational viability

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Resilient Coping

• Active, problem-solving and future oriented• May draw on past challenges but the focus is on

resolving or mitigating the problem• Emphasis on managing stress and social support

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Discussion

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ResourcesGovernment resources

• CDC: http://cdc.gov/h1n1flu/– http://cdc.gov/h1n1flu/business/guidance/– http://cdc.gov/h1n1flu/business/toolkit/

• Flu.gov: http://www.flu.gov/

• National Institute of Allergy and Infectious Diseases: http://www3.niaid.nih.gov/

• National Institute of Environmental Health Sciences: http://kids.niehs.nih.gov/pandemic.htm

Other resources

• American Psychological Association Help Center: http://www.apahelpcenter.org/featuredtopics/feature.php?id=6

• Catastrophe Readiness Clearinghouse: http://www.catastrophereadinessclearinghouse.org/myhome_parents.asp

• Harvard School of Public Health: http://www.hsph.harvard.edu/hcphp/

• Management Continuity: www.ManagementContinuity.com

• ValueOptions® Client Summit Web Page: http://www.healthandperformancesolutions.net/summit%20info/Pandemic%202009/pandemic09.html

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