New Flu Planning Documents

Two new planning documents have recently been issued regarding pandemic flu:

• A Prescription for Pandemic Flu from the American Public Health Association (APHA)
• Guidance on Preparing Workplaces for an Influenza Pandemic from the Occupational Safety and Health Administration (OSHA)

First, the APHA doc: The APHA "prescription" describes some of the problems that are likely to arise in the event of a flu pandemic and offers recommendations for dealing with them. Most of the APHA suggestions apply at the federal level (e.g., actions that Congress and/or federal agencies should take in preparation for a flu pandemic), but some of them can apply at the state or local level as well. A few highlights:

The report points out that public health agencies are generally understaffed now, and that this problem would be greatly exacerbated during a flu pandemic:

[P]rojections estimate that up to 40 percent of the active workforce may be seriously ill and therefore unable to work during some portion of a flu pandemic.Therefore, if staffing levels remain stagnant, the current health care workforce cannot be depended on in event of a flu pandemic.

To deal with the problem, the APHA recommends legislative changes to increase public health staffing levels, as well as other steps, including:

• Public health officials plan for improving surge capacity of the public health workforce to engage in core public health activities during a pandemic. Advance registry systems should be developed to coordinate volunteer health professionals, as these are preferable to relying on ad hoc or spontaneous volunteers.

• Existing voluntary entities such as the Medical Reserve Corps be utilized to facilitate an adequate workforce surge capacity.

• Training programs be developed for volunteers listed on registry systems.

Schools are a major concern:

Schools and school systems are critical to improving our nation’s readiness for and response to pandemic influenza, as planning efforts anticipate that illness rates will be highest among school-aged children (about 40 percent). In fact, school closures are being considered as a primary containment strategy early on in a flu pandemic in order to slow the spread of the disease.

The history of the 1918 Spanish flu suggests that schools are critical to slowing the spread of a pandemic flu, as evidenced by this presentation from the Financial Services Sector Coordinating Council for Critical Infrastructure Protection and Homeland Security and this story in the Washington Post, which included this nugget

St. Louis closed its schools at a time when flu was causing 21 more deaths per 100,000 people per week than what had been seen in previous years. That step -- the earliest taken by any of 33 cities analyzed so far -- appears to have reduced St. Louis's flu mortality by 70 percent.

Businesses must also be prepared, though many are not:

Most businesses do not have pandemic preparedness plans in place. ... APHA recommends [that] businesses be intimately involved in planning efforts for pandemic flu on the local and state level, in collaboration with state and local health departments, schools and government.

The APHA "prescription" also finds that communication is critical to the response. Among other steps, APHA recommends that:

• Uncomplicated, empathically informed information on normal stress reactions be disseminated widely, which can serve to normalize reactions and emphasize hope, resilience, and natural recovery. The public be informed about the rationale and mechanism for distribution of limited supplies (e.g., Tamiflu).

• Federal, state and local public health partners plan at societal, local and individual levels for the psychological and behavioral responses of the health demand surge, the community responses to shortages, and the early behavioral interventions after identification of the pandemic, and especially during the time frame prior to availability of vaccines.

• Good safety communication be disseminated, as promoting clear, simple and easy-to-do measures can be effective in helping individuals protect themselves and their families.

The new OSHA Guidelines, which are only advisory, come to many similar conclusions, specifically regarding business preparation for pandemic flu. The Guidelines point out that a flu pandemic is likely to occur in 6-8 week waves, over the span of a year or more. Different geographic areas will be affected at different times. Challenges for businesses will include:

• Absenteeism - A pandemic could affect as many as 40 percent of the workforce during periods of peak influenza illness.

• Change in patterns of commerce - During a pandemic, consumer demand for items related to infection control is likely to increase dramatically, while consumer interest in other goods may decline.

• Interrupted supply/delivery - Shipments of items from those geographic areas severely affected by the pandemic may be delayed or cancelled.

To deal with these problems, OSHA suggests many obvious steps, such as planning to minimize employees' contact with one another; maintaining stocks of soap and towels, and preparing for supply line disruptions. But a few suggestions are worth highlighting, such as the call for collaboration with state and local officials:

It is important to work with community planners to integrate your pandemic plan into local and state planning, particularly if your operations are part of the nation’s critical infrastructure or key resources. Integration with local community planners will allow you to access resources and information promptly to maintain operations and keep your employees safe.

Be aware of and review federal, state and local health department pandemic influenza plans. Incorporate appropriate actions from these plans into workplace disaster plans.

The list of all State pandemic flu plans can be found here, and a local planning checklist is here.

Other suggestions include planning for downsizing services "but also anticipate any scenario
which may require a surge in your services." This is notable, because the first assumption for many businesses may be to think that activity will only slow down.

And of course communications are critical. OSHA's suggestions include:

Organize and identify a central team of people or focal point to serve as a communication source so that your employees and customers can have accurate information during the crisis.

Assist employees in managing additional stressors related to the pandemic.

A flu pandemic on the order of the 1918 flu could be truly catastrophic, and it could break out at any time. Preparing for the flu is the only responsible course of action.