1. Pandemic Preparedness: Planning for Business Continuity, Productivity, and Resilience Rick Allen, PhD Peter Wald, MD, MPH September 2009 1

2. 2 Agenda I.Welcome II.Current pandemic state and potential III.Business impact IV.Mitigation strategies V.Individual and organizational resilience VI.Discussion

3. 33 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

4. 4 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) 4

5. 5 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. 1/6 th case fatality rate of 1918-19 avian + human flu virus combo still circulating and in current vaccines 5

6. 66 Active virus circulation in U.S. Slight increase in activity H1N1 dominant circulating virus worldwide Current Status

7. 7 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 7

8. 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

9. 9 Fall 2009 Planning Scenario 9

10. 10 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). 10

11. 11 Social Distancing: Philadelphia vs. St. Louis, 1918 11 (Hatchett, 2007)

12. 12 Mitigation Strategies – Decreasing environmental viral load. – Prepare for vaccine availability. High-risk groups first (pregnant, age 6m-24y, caretakers of children 24 with chronic diseases) Consider dependent vaccination also. – Business continuation plans linked to absence levels Identify and protect essential employee groups. 12

13. 13 Resilience Defined An active process An adaptive process that individuals employ when they are faced with challenging and traumatic situations 13

14. 14 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 14

15. 15 Organizational Resilience Characterized by an adaptive organizational mindset Anticipates change and challenges Members work to maintain organizational viability 15

16. 16 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 16

17. 17 Discussion 17

18. 18 Resources Government resources CDC: http://cdc.gov/h1n1flu/http://cdc.gov/h1n1flu/ – http://cdc.gov/h1n1flu/business/guidance/ http://cdc.gov/h1n1flu/business/guidance/ – http://cdc.gov/h1n1flu/business/toolkit/ http://cdc.gov/h1n1flu/business/toolkit/ Flu.gov: http://www.flu.gov/http://www.flu.gov/ National Institute of Allergy and Infectious Diseases: http://www3.niaid.nih.gov/http://www3.niaid.nih.gov/ National Institute of Environmental Health Sciences: http://kids.niehs.nih.gov/pandemic.htm http://kids.niehs.nih.gov/pandemic.htm Other resources American Psychological Association Help Center: http://www.apahelpcenter.org/featuredtopics/feature.php?id=6 http://www.apahelpcenter.org/featuredtopics/feature.php?id=6 Catastrophe Readiness Clearinghouse: http://www.catastrophereadinessclearinghouse.org/myhome_parents.asp http://www.catastrophereadinessclearinghouse.org/myhome_parents.asp Harvard School of Public Health: http://www.hsph.harvard.edu/hcphp/http://www.hsph.harvard.edu/hcphp/ Management Continuity: www.ManagementContinuity.comwww.ManagementContinuity.com ValueOptions® Client Summit Web Page: http://www.healthandperformancesolutions.net/summit%20info/Pandemic%202009/ pandemic09.html http://www.healthandperformancesolutions.net/summit%20info/Pandemic%202009/ pandemic09.html 18