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PANDEMIC PREPAREDNESS FOR BUSINESSES

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The following is a short explanation about what is Bird-Flu and its likely affect on businesses. It is important to note that birdflu is/will be a very human tragedy. It is people who will be directly affected by it, not systems or infrastructure. That is of course until those systems and infrastructure which need human intervention in order to keep operating do not receive the intervention they need. If those maintenance personnel or operators are unable to get to work then the systems and utilities which we rely on will also start to fall over.

In order to help mitigate panic in the workforce is important to ensure all staff have an adequate understanding of what we are up against and so do not fall prey to the rumours and sensationalism that will appear once things start to get serious. In SARS we saw unchecked panic grip the workforce, and this resulted in some (unnecessarily) isolating themselves for months. We do not want this to happen again and arming staff with the facts is the only real way to alleviate the panic and knee-jerk reactions which are inevitable from the ignorant.

2. Definitions

An epidemic is defined as an infectious illness that spreads so quickly that the number of new cases rises in an exponential manner rather than just increasing linearly. This means that during epidemics, the number of new cases doesn’t just go up by ones or twos each day. During an epidemic, the number of new cases doubles every few days.

A pandemic is an epidemic that spreads across the globe affecting every continent rather than being confined to one geographic area. One of the most important reasons for influenza's success as a human invader is its infectivity. The infectivity of an organism is determined by how easily it is transmitted from one person to another. Infecting agents that can cause illness after a small exposure are more contagious than ones that requires a larger exposure. Infectivity is increased when infection can be passed between people without any direct contact. The most common way for flu to be transmitted is by breathing air contaminated with the virus. Coughing is how the virus gets into the air in the first place. Flu can also be transmitted by direct contact with someone ill with the disease. This includes shaking their hand or even touching something that the sick person previously touched. Under the right conditions, flu can remain infectious for days outside of the human body, living on surfaces like counter tops or doorknobs. Transfer of the virus can occur when a susceptible person touches a contaminated surface.

3. Infectivity

After the virus is spread from one person to another, it can infect the new person only if that person is susceptible or vulnerable to it. With respect to influenza, virtually 100% of the human population is susceptible to a new strain. However, fully half the susceptible patients who contract the flu have no or few symptoms.

Influenza causes pandemics because it scores so highly in all these causes of infectivity. These characteristics of influenza help explain why this organism can quickly spread from one region of the globe to another. Even during the relatively primitive travel conditions existing in 1918 it only took 6 weeks for epidemic influenza to spread from the USA to Europe and Africa. Imagine how fast the next pandemic virus will move across the globe given the many thousands of passengers travelling internationally by air every day! Taking this into account, the World Health Organisation predicts that once the first cases of human to human pandemic flu take hold somewhere, it will take only 2 to 4 weeks for the strain to reach the rest of the world.

4. Waves of Infection

A further feature of influenza pandemics not well appreciated generally is that they occur in waves. The 1918 Spanish flu (H1N1) was associated with three waves while the 1958 Asian flu (H2N2) and 1968 Hong Kong flu (H3N2) pandemics have two distinct waves each. The reason for this wave behavior is not known but some have speculated that it is due to a change in the season of the year. The timing of a wave may also be related to a genetic change or mutation in the new strain of influenza virus. In past pandemics, the time between two waves was 3 to 9 months. A point to keep in mind about pandemic waves is that the second wave can be much more severe than the first or third wave of the series. During the 1918 pandemic, the deadly second wave was responsible for over 90% of the deaths for the entire pandemic.

While the typical flu season predictably occurs from November through March, during pandemics, flu can vary from this script. The first wave of the 1918 flu occurred in the spring of that year ending in March. That flu was very severe by usual standards but the second wave beginning 6 months later in September was the most fatal. The third wave occurred during the following winter/spring and was the mildest of all. It is of note that pandemics end simply because all or most susceptible persons within the population have contracted the infection and have either died or developed immunity.

5. Susceptible Age Groups

During pandemics, a major difference compared with seasonal flu that is the highest death rates are among the healthy 20 to 30 year old adults. This is in contrast with the seasonal flu that strikes the very old, the young, and the infirm the hardest. Of course, the usual victims of seasonal flu are not spared during pandemics. On the contrary, death rates are much higher for every age and risk group during pandemics compared with seasonal flu. The point here is that the age 20 to 30 year group, usually immune to the ravages of seasonal flu, experiences the highest death rates of any group during pandemic years. Ironically, one possible explanation for this pandemic observation may relate to the increased health and vigor of this group’s immune system.

6. What Makes the H5N1 Avian Flu so Fearsome?

The reason for the present state of alert among world health authorities is the belief that we are witnessing the development of a 1918-type major flu pandemic in Southeast Asia -a once in a 100-year major flu pandemic -due to the emergence of a H5N1 Influenza virus type A.

On average there are two minor pandemics for every one major pandemic. The minor pandemics are associated with lower clinical attack and case fatality rates than in major pandemics. For instance, the 1958 pandemic was associated with three times as many deaths than seen for seasonal flu but during the 1968 flu pandemic, there were only a few more deaths than would be expected. It has now been 37 years since the last flu pandemic, which suggests we may be due for big one soon.

7. Mortality Rates

What makes avian influenza H5N1 so troubling to the medical community? It is its stunning killing ability, a statistic known as the lethality of the disease. The 1918 flu, like most pandemics, infected 40% to 50% of the world's population or approximately 640 million persons at the time. If we assume that approximately 80 million people died during the 1918 influenza pandemic, this results in a case fatality rate of about 12.5% of those infected. What is so worrisome to the influenza experts at the WHO is the case fatality rate for humans that become infected with the strain presently brewing in Southeast Asia has been about 50%. This overstates the true lethality to an unknown extent, as there may well be a number of milder cases who have not come to the attention of the health authorities. Nevertheless, these fatalities show what kind of casualties the virus can cause.

Right now, the virus is confined mostly to birds but has adapted to tigers and pigs. Almost all the humans infected have had contact with infected birds during processing, cooking, eating, caring for them. However, a few people are thought to have caught the Bird-Flu from close contact with infected relatives. At time of print, this appears to be changing.

8. Person to Person Spread

Close attention is being given for any sign that H5H1 avian influenza has become more efficient in person-to-person spread, either from mutation or from swapping genes with another flu variety in an infected person or animal. When this event occurs, a development that influenza experts predict is imminent, the new virus would gain the ability to quickly spread directly from person-to-person. This development would signal the beginning of the pandemic.

9. Pandemic Characteristics

A Bird-Flu pandemic will not be like a physical disaster. A pandemic has unique characteristics when compared with a more "typical" disaster. For example:

The impact of a pandemic would likely be widespread, not localised to a single area or region; therefore there may be little outside assistance. Many business continuity plans (BCPs) assume some part of an organisation is unaffected and can take up the required capacity.

A pandemic is not a physical disaster. It has some unique characteristics that require implementation of activities to limit contact such as restriction of movement, quarantine, and closure of public gatherings.

A pandemic would not be a short, sharp event leading immediately to commencement of a recovery phase. Many BCPs assume the event is short/sharp and that recovery can start immediately.

It is quite likely that there will be some advance warning from the development of the pandemic, but it is always possible that any warning period may be very short. Should pandemic influenza spread within SE Asia it will probably be some weeks before the full impact on workforce will be felt, although there may be some early impacts resulting from closures of schools and similar containment measures.

10. Absenteeism Projections

Unlike natural disasters, where any disruption to business service provision is likely to be hardware-related, disruption to business operation in the event of a pandemic is anticipated to be mainly human-resource oriented. WHO advises that businesses should plan for up to 50% staff absences for periods of about two weeks at the height of a severe pandemic wave, and lower levels of staff absence for a few weeks either side of the peak. Overall a pandemic wave may last about 8 weeks. Note that the pandemic may come in waves of varying severity over time.

10.1 Staff absences can be expected for many reasons:

10.2 Illness / incapacity (suspected / actual / post-infectious);

10.3 Some employees may need to stay at home to care for the ill;

10.4 People will feel safer at home (e.g. to keep out of crowded places such as public transport);

10.5 Some people may be fulfilling other voluntary emergency roles in the community; and

10.6 Others may need to stay at home to look after school-aged children (as schools are likely to be closed).

A pandemic could last many months and may contain peaks followed by periods of reduced illness. The 50% is an estimate of staff absences at peaks of a significant pandemic.

11. Supplies

A pandemic may have other impacts on businesses, for example:

11.1 supplies of materials needed for ongoing activity may be disrupted, e.g. if they are imported as air freight; similarly, availability of services from sub-contractors may be impacted (this may affect maintenance of key equipment, and is an area that merits close planning attention); and

11.2 demand for services may be impacted - demand for some services may increase (internet access is a possible example); while demand for others may fall (e.g. certain types of travel activity may reduce).

12. Business Continuity Plans

Business continuity plans may need to be reviewed to ensure that they are robust to significant staff absences and other pandemic-related risks. Know your company’s business continuity plans for dealing with the pandemic and ensure those you are responsible for also know those plans.

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