Many questions were submitted by the 200 participants, but due to time restraints, there was not enough time to answer them all, so the questions and our answers are listed below.
Avian Influenza Information
What does the H & N stand for in avian influenza viruses?
As described by the World Health Organization, the letters “H” and “N” stand for haemagglutinin and neurominidase, two proteins found in the molecule of the influenza virus. Currently, scientists have recognized 16 HA subtypes and 9 NA subtypes. It appears that the antigens can join in any combination with one H and one N. The H antigen is responsible for binding the virus to the uninfected cells, and the N antigen determines how easily and quickly the virus spreads to uninfected cells. Though the subtypes of influenza virus that infect animals do not typically infect human beings, some viruses can mutate and become virulent in humans. The viruses vary in pathogenicity, though to date, all highly pathogenic outbreaks have been caused by influenza A virus subtypes H5 and H7.http://www.who.int/mediacentre/factsheets/avian_influenza/en/
You mentioned there has been one reported and confirmed case of human-to-human-to-human transmission. Did any infected persons die?
In May 2006, the World Health Organization reported the first suspected case of human-to-human-to-human transmission. Though there have been a handful of cases where one family member, infected by direct contact with infected birds, passed the virus on to other family members, this is the first instance where someone who became infected from a family member was then able to pass the virus on to a different family member. Of the eight members infected in this family, seven have died, including the individual who was the “third level” of transmission. Global and U.S. officials reported no significant changes in this version of the virus compared to other human infection cases, so it does not appear that the virus mutated to become more easily transmittable. http://www.cdc.gov/eid/content/13/9/1348.htm
What happens if you are a tenant in a multi-tenant building and the pandemic breaks out one of the floors? Once you are aware of the situation, how would you advise your staff and exit your employees safely?
Avian influenza symptoms can start anywhere from two to eight days after the virus enters the body, and infected individuals can pass on the flu to others before knowing they are sick. Because of this, it is unlikely that avian influenza will ever “break out” on an individual floor in a building. Instead, regions throughout the United States will begin reporting increased spikes in hospital visits and reported cases. Because individuals can acquire and then pass on the disease before they know they are infected, it is important that everyone implement protective actions, such as increased hand washing and teleconferencing, once a pandemic begins to decrease their risk of becoming infected in the first place. http://www.who.int/mediacentre/factsheets/avian_influenza/en/
How do you handle those who are not infected by the flu, yet want to stay home to avoid getting sick (panic factor)?
Communication. Studies show that during a crisis, employees will listen to their employer above all other sources. As a result, it’s important that the company communicate what the threat is and what they are doing to reduce the risk. The company will also need to think through their work at home policy and how they will deal with employees who do not want to leave their children (who will not be in school).
Are there products available that protect workers while allowing them to still come to work?
There are a variety of products that help to protect employees, though they not are foolproof. N-95 respirators, gloves and such will provide a level of increased protection for at risk workers (primarily healthcare). In addition, antiviral drugs have been proven effective in preventing illness (they are called prophylactic agents when used as preventative medicine). However, they are only effective if taken daily, and they will be in extremely high demand in the event of a pandemic. For most companies, protecting workers will involve closing conference rooms and cafeterias and increasing the frequency of cleaning services.
Do you recommend N95 masks for office environments? What about OSHA fit testing requirements for N95 masks?
N95 masks are a resource often considered by businesses as a “tool” to slow the spread of diseases and increase employee confidence in returning to work by minimizing fear. However, it’s important to note that many studies have confirmed that N95 masks are not 100% effective at stopping the spread of viruses (like avian flu) due to small microscopic holes that could allow viral particulants through. With that said, there is significant protection offered by N95 masks, particularly when fitted and used appropriately.
Are you seeing more companies stockpiling antivirals in preparing for a pandemic event?
Some companies have elected to stockpile antivirals and other resources designed to treat the effects of a pandemic and slow the spread of the disease. Those that have acquired antivirals and other products are defining who will receive such product (employees, families, business partners), the triggers to begin product dissemination, and the processes to control the distribution effort. To be clear, pandemic preparedness is not defined as antiviral acquisition, although some (not all) companies have elected to do so as part of their preparedness efforts.
What steps could individuals take to mitigate their risk of infection? Does it require more of a centralized effort (governments; global organizations (WHO); etc.)?
Current government pandemic planning includes a number of non-pharmaceutical or social controls to prevent the spread of disease. Though these methods, including travel advisories and precautions, screening of persons arriving from affected areas, closing schools, restricting public gatherings, quarantine of exposed persons and isolation of infected persons, will assist in the preventing the spread of disease, there are still many things that individuals can do to lessen their risk of contracting the virus. These include maintaining good hygiene (especially washing hands frequently), using technology (email, phone, web-conferencing) to interact with individuals instead of in-person meetings, shopping online or at “off-hours”, working from home, and limiting unnecessary contact with others. Individuals may also utilize protective masks, specifically N-95 masks, to filter the air they breathe.
Policies and Communicating with Employees
I wanted to get your opinion on whether or not to put out communication to employees about pandemic awareness. Do you think some people might view this as an actual current threat instead of a potential risk and this would create worry throughout the company?
If the communication conveys that a threat exists but is not yet a reality, employees should feel reassured that the company is aware of the threat and is actively planning to protect its employees. Not only is communication regarding pandemic preparedness important, the business should also advise employees on ways to prepare personally. Business continuity professionals should carefully describe the threat and potential impacts (personal and professional), and describe strategies the organization plans to employ in the event of a pandemic. Because pandemic preparedness strategies should be designed to protect employees in the workplace and encourage personnel to report to work if possible, communications can go a long way to mitigating fear that is likely both before and during an outbreak.
Any recommendations regarding communicating company plans and policies to the workforce?
By definition, a policy cannot be effective (nor enforceable) unless all employees have access to the information. As a result, review and communicate changes to payroll, death benefits, visitor/contractor, expatriate handling, disability and health insurance, attendance and return to work policies and procedures. Normal policy change (change management) communications processes should be used. Additionally, consider communicating policy enhancements via the business continuity or pandemic preparedness team’s intranet site. Highlight the change, the rationale for the change and the effect on employees.
Company plans should also be communicated to any employee who may have a role in responding to the pandemic or participating in continued operations in such a situation. However, sensitive information may be included in such plans, including business priorities and contact information. As a result, and unlike policy information, limitations on dissemination may be warranted.
What type of attendance policy changes are you seeing being considered in case of a pandemic? Also, when are you seeing businesses plan on implementing changes in policies in relation to the “stages” (federal gov’t)?
Everyone agrees that an employee cannot be forced to report to work. As a result, organizations are developing scenarios where, based on triggers (often linked to WHO phases or HHS stages) certain employees may be told to go home, report to a different business area or continue to perform normal processes. Organizations are also making assumptions regarding employees choosing to stay home, due to fear or due to sick family members. Some of these organizations may allow employees to use sick time or vacation, others may choose to allow employees to take unpaid leave and yet others may choose to extend additional time off. Regardless, each organization must choose a strategy consistent with its business objectives and financial constraints.
Protecting the Supply Chain
What were the business continuity codes that we should ask suppliers about?
NFPA 1600 and BS 25999 are both standards for business continuity management that have gained widespread acceptance. National Fire Protection Association standard #1600 is primarily used in the US, and British Standard 25999 is used throughout the rest of the world. BS 25999 is notable because it is now certifiable, meaning that companies can become certified as compliant to the standard. This is a major milestone for our evolving industry.
What are your suggestions for monitoring key e-services suppliers (i.e. real-time) in a Pandemic?
Many electronic based services suppliers will have real-time monitoring in place on a day-to-day basis if their criticality requires it. A more important question is how you will communicate with those suppliers in the event of a pandemic. While the supplier may primarily communicate with its customers electronically, unique situations like a pandemic require a more personal communication method, such as conference calls to discuss the status of the service, the supplier’s situation, and to remind the supplier of the criticality of their product or service. As in most crises, communications is one of the key success factors.
Similar to what happened in Y2K, how can companies “pre-certify” suppliers to verify they are pandemic prepared? Also, are you aware of any “ISO-type” ratings for DR/BCP beyond just having an internal/external controls audit, such as with SOX compliance?
A lot of people have started working towards a certification for businesses in BCP – beyond just SOX and DR. Two of the largest efforts are BS 25999, which should be confirmed as a certifiable standard by the end of 2007, and the US voluntary certification program run by Homeland Security. The latter is still in its infancy, so there is not much information available at this point, though it will hopefully develop more over the next year. Regardless, asking your suppliers to certify themselves as BS25999 or NFPA 1600 compliant would be a good first step.
Developing and Testing Pandemic Plans
Do you have any information on links that deal specifically with the banking industry?
FSSCC Financial Sector Planning Efforts https://www.fsscc.org/influenza/financial_planning.jsp
Testimony of D. Scott Parsons, Deputy Assistant Secretary for Critical Infrastructure Protection and Compliance Policy U.S. Department of the Treasury Before the U.S. House of Representatives Committee on Financial Services Subcommittee on Oversight and Investigations http://www.treas.gov/press/releases/js4342.htm
Interagency Advisory on Influenza Pandemic Preparedness http://www.occ.treas.gov/ftp/bulletin/2006-12a.pdf
September 24-October 12 Financial Sector Pandemic Planning Exercise – Conducted by the FBIIC and the FSSCC; Sponsored by the US Dept of the Treasury and the SIFMA http://www.fspanfluexercise.com/
What ways can you actually test out this type of scenario without impacting or threatening production workflow?
The best scenarios for companies just starting out have zero impact on production: plan walkthroughs and table-top exercises. A plan walkthrough is when you sit down with the team and talk through the plan with the people involved, discussing how it will be used. This is typically a good way to familiarize team members with the plan and increase their confidence in using it. A table-top exercise is similar, except that it utilizes a made up scenario and requires the recovery team to discuss their response to the scenario as it evolves. The scenario is usually broken up into several sections, so one section of the scenario is presented, and then the team will discuss their response before moving on to the next one.
Finally, simulation exercises provide team members to actually practice their alternate ways of working. This may include having team members work from home or alternate space to validate their ability to do so.
Managing the Hype
How do you feel about recent articles that state we are over-reacting to this pandemic outbreak possibility, using SARS containment as an example, as well as stating that H5N1 cannot be compared to the 1918 outbreak since communication and technology today is so much more advanced. Do you think there is over-reaction?
Unfortunately, the topic of a potential pandemic is vulnerable to fear-mongering. While there seems to be a lot of evidence that H5N1 could be similar to the 1918 pandemic, factors such as technology, increased travel, and enhanced medical care could significantly change how the virus spreads and how severe it is. Though increased surveillance should make identifying an outbreak easier, the length of the incubation period for H5N1 (2-8 days before symptoms appear) combined with increased global travel could make containment efforts difficult.
Most scientists involved in tracking H5N1 admit that tracking the development of a virus in the wild has never really been done before – and so the results are unpredictable. However, planning for personnel unavailability is a key component of business continuity that is frequently skipped. Pandemic planning provides that missing link, and the work becomes valuable in a variety of situations, such as the wildfires seen in California last week.
In Canada the Federal and Provincial Governments have the right to seize stockpiles of PPE and antiviral drugs from corporations in order to restore dwindling supplies for first responders and health care staff. Does this kind of legislation exist in the United States?
There is no specific legislature regarding the seizure of private corporation stockpiles of PPE and antiviral drugs. Though there is a chance that governments (especially state and local) may consider using certain emergency authority powers to authorize private sector seizures, it is not likely that legislation will ever be passed to authorize it, as it would just discourage private organizations from acquiring safety products for their employees and thus put a larger burden on the public stockpiles. Because of this, a group of experts from various federal government agencies is working to develop guidelines for the private industry regarding acquiring and using corporate caches of antiviral drugs. http://blog.pandemicflu.gov/?p=73
There is a current MRSA/Staph infection occurring and causing school closures and issues in highly populated facilities such as schools, jails, prisons, etc. How does this compare to pandemic planning and what can we learn from this from your experience and research?
There are both similarities and differences between the current response to increased outbreaks of MRSA staph infections and a proposed pandemic influenza outbreak response. The CDC lists five “C’s” that are all factors in spreading MRSA staph infections (most of which are also common factors in transmitting influenza): Crowding, frequent skin-to-skin Contact, Compromised skin (i.e., cuts or abrasions), Contaminated items and surfaces, and lack of Cleanliness. Control measures, such as closing schools, improving hygiene/hand-washing and limiting contact with infected individuals using gloves and masks, can help prevent the spread of both these diseases.
As pandemic influenza can spread more easily than staph infections (through the air as opposed to touching contaminated surfaces), it is likely that governmental controls will be more widespread and proactive during a pandemic than in preventing the spread of staph infections. However, as MRSA infections are becoming more common (in 2005, more people in the US died from MRSA infections than AIDs) and there is concern that the overuse of antibiotics will create a “superbug”, MRSA infections are a real public health threat that will likely require organized public health response planning. http://www.nlm.nih.gov/medlineplus/staphylococcalinfections.html
Are you aware of any corporations that have discovered issues during the SARs outbreak a few years ago?
SARs is often viewed as a wake-up call regarding the need to plan for large-scale public health events. A couple of the lessons learned often cited include:
- Develop cross-functional mitigation and response plans designed to monitor the situation and protect high-risk employees in locations where an outbreak has occurred recently.
- Track international travelers by destination, as well as international employees and even critical suppliers.
- Provide employee warnings and guidance, particularly if located in a high threat location; consider restricting travel or recalling employees from a high-risk location.
Since “Bird Flu” seems to be a joke to most people, how do you motivate upper management to take this seriously?
Just like any initiative, a strong business case is required to motivate senior management regarding the need to invest limited time and resources to address the threat of a pandemic. However, positioning pandemic preparedness as a method of addressing the broader risk of human resource availability (as a method of improving business continuity) is an effective approach. Taken one step further, executive managers are concerned about single points of failure related to skills, knowledge and experiences. As a result, position pandemic preparedness as a method of beginning to address this business issue. Lastly, perform an analysis of the risk associated with a large-scale public health event on the organization’s interests, and document potential impacts should the event occur overseas or worldwide.