In preparing for what appears to be an inevitable pandemic influenza (PI) of H1N1 in the northern hemisphere in the coming months we know the concerns and recommendations of the various international and national health departments and ministries. But what are industries concerns or recommendations and guidelines? Actually, as pointed out in the following article by Dr. Peitersen, industry concerns and recommendations are straightforward and follow a common sense approach in attempting to limit the PI impact. Planning and Preparation are mandated and when implemented will limit impact.
Preparing for the H1N1 Pandemic Influenza
Laura E. Peitersen, PhD
SAIC
Introduction
The 2009 novel H1N1 influenza A virus (aka "swine flu") appeared first in April 2009 in Mexico and has quickly spread across Europe, South and North America, Oceania, and portions of Asia. In July 2009, the World Health Organization (WHO) declared the outbreak to be a pandemic (WHO Phase 6), making this outbreak the first declared influenza pandemic since 1968-1969.
During the months between May and September 2009, the Southern hemisphere was experiencing its traditional flu season, and the novel H1N1 swine flu cases increased as anticipated. However, in the Northern hemisphere's summer season, when there are usually only insignificant cases of flu, the number of influenza cases during this period were uncharacteristically high. This increase was attributed to the novel swine flu strain.
In general, there are two concerns for most businesses and organizations, such as Defense offices, in preparing for any catastrophic or long-term challenge, including Pandemic Influenza (PI):
- continuation of mission-critical functions (sometimes called business continuity), and
- protection of the workforce. Therefore, organizations should be preparing for workplace concerns, as well as protection of workers and their families. This article aims to provide guidelines for early and reasonable planning and preparation, to minimize panic and disorder.
Common Sense Advice for Limiting Infections
Avoiding infecting others
This is perhaps one of the hardest rules to enforce, but probably the single most important one for minimizing spread of any virus: if you are not feeling well, do not go to work or school. In some workplaces, there is a culture of "disease machismo" - the idea that one can force oneself to work through the illness, or that one's presence is necessary for the rest of the workforce to function. Often staying in touch with colleagues remotely via email or by phone can be an alternative without exposing others to the virus. Furthermore, this permits sick individuals to recuperate more comfortably. Your coworkers, fellow students and the general population will thank you for staying home. CDC's current advice is to stay home for 24 hours after the fever has ended, usually 3-5 days.
The H1N1 virus, as with most strains, is transmitted from person to person via aerosol droplets through sneezing or coughing, as well as transferring aerosol droplets from a contaminated surface to the hand and then to the face. The virus can survive up to 24 hours on a surface, although it is inactivated by sunlight, disinfectants and detergents.
Avoiding contact - social distancing
While it is not known which means of transmission is the most important, it is believed that most infections occur from exposure to infected individuals. Therefore, the most effective way to prevent the spread of the virus is to avoid exposure to people who are sick or suspected of having been exposed to the virus (even though they might be asymptomatic). This can be accomplished most effectively through social distancing (discussed below). Use of respiratory protection (surgical masks, N95 or N99 respirators) can also be helpful, but will not prevent exposures unless they are used for the entire work period. Respirator use is uncomfortable at a minimum, and given that it is not 100% effective, is impractical in many settings.
Typically, workplaces will not close or institute contamination avoidance practices during a normal seasonal flu outbreak. With seasonal flu, people become sick over a longer time period, and while absenteeism can be a problem, it is seldom more than an inconvenience. However, during past pandemics (1918, 1957, and 1968), school closures and avoidance of public gatherings has been found to decrease the number of illnesses. During the spring of 2009, school and work closures in New York City and Mexico City were instituted to minimize exposure.
In the current 2009-2010 novel H1N1 flu pandemic, social distancing is also expected to be the most important factor in avoiding workplace exposure. A range of social distancing approaches exists and can be used singly or in combination to most effectively avoid large groups in the workplace.
- Minimum-Manning
- Alternative Work Locations
- Alternative Work Schedules
- Virtual Meetings/Teleconferences
- "The Six-Foot Rule"
Minimum-manning, a term used in defense organizations, involves using the fewest people possible to accomplish the mission. Fewer individuals in a location lowers the probability of exposure to the virus, particularly if people are asymptomatic. For minimum-manning to be successful, it is critical to identify ahead of time those tasks that are essential to the operations, mission or business and make sure that workers understand their roles during a PI event. Cross-training of job functions is recommended, so that the mission or business can continue in the event of illness of some workers.
Alternative Work Locations can be identified and used (in fact, this approach is standard practice for continuing mission-essential functions during hurricanes and other weather contingencies). Such arrangements can include working from home or even small offices, if possible, either for the entire period, or for times when large gatherings are to be avoided.
Much of the business of office work can be done from remote locations, so this approach will work well for jobs in which the primary function involves literature research, correspondence, book keeping, accounting and writing. It will, of course, not be an option for work required at locations where people interact or where there must be physical interaction with equipment at that site.
However, some of these functions may be deemed non-essential during an emergency-this will vary depending on the nature of work at each location and based on the organization. Individuals who expect to use alternate locations should ensure that they have the appropriate supporting equipment and should be trained in its use, in advance.
Alternative Work Schedules can minimize the number of personnel in an area at a given time, which in turn can limit exposures. There are numerous examples of alternative work schedules, depending on the function and the minimum-manning model, offices and operations can either be closed on alternate days or specific services can be curtailed for short durations.
Virtual Meetings using internet data exchange tools and/or conference call capabilities present a good alternative, in many cases, to face-to-face meetings. Many organizations already have this capability and have used it successfully to cut business expenses. As with any other approach involving technology, training, using and exercising virtual meetings before emergencies is critical.
The Six-Foot Rule, maintaining a minimum distance of six feet from other individuals (both in the workplace and in the community), to avoid exposures can be used in combination with any of the above approaches or by itself. Coughs and sneezes expel aerosol droplets that travel away from their source, but these droplets rapidly fall to the ground, so they are not a hazard at distances greater than six feet. This may be impractical in some work environments, such as emergency operations centers and other service and equipment functions, but can be a good practical guideline for many social, community and work situations.
Other methods of protection, such as the use of respiratory protection, are likely to be impractical for many workplace settings. They may also not be available for the general public, or in short supply. They have been used effectively in the community during the SARS outbreak in 2005 and might be mandated for situations such as air travel.
Hygiene. In addition to social distancing, and respiratory protection if recommended, it is always appropriate to practice good hygiene. Surfaces should be kept clean, particularly those that are shared or in common areas, such as office and control equipment, kitchens or bathrooms. Commercial cleaning products, disinfectants, dilute bleach solutions and soap and water all can be used to disinfect hard surfaces, such as countertops, desks, telephones, etc.
Other disinfectant and cleaning wipes are readily available to clean computer keyboards, control equipment, and other common or shared electronic equipment. Eating utensils, cups and glasses should not be shared. Porous surfaces, such as fabrics, can be cleaned according to normal practice.
Conclusions
The Pandemic Influenza is one of many disaster and emergency scenarios for which civilian and defense organizations prepare and practice. As with any situation, using common sense and avoiding panic will result in improved outcomes. A pandemic influenza outbreak has long been anticipated, but it does not have to be a catastrophe if individuals and organizations take proper planning and preparedness steps now and communicate effectively to members and workers throughout the outbreak. We do have the knowledge to protect ourselves and our communities.
Editor's Note: In travelling and working with several of our Pacific Rim neighbors, we noted the advance thinking and preparations "in the event of" a pandemic event of any type. They were working on several methodologies included in Dr. Peitersen's recommendations above. If you have added ideas in these areas - forward to ASA and we will include in the 09-6 December issue.
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