The World Health Organization continues to monitor the Influenza worldwide to ensure early notification in the event of another pandemic. Why should you care? What would the role of a safety professional be in a Pandemic? Let me share with you some information about the most deadly Influenza Pandemic in history and what can be done.
In 1917 a flu virus infected the residents of rural Haskell County, Kansas. Later that year young men from Haskell County went to Camp Funston, Kansas to receive Army training in preparation for combat duty in World War I. The soldiers at Camp Funston slept and worked in close quarters through a very cold winter without adequate heating (John Barry 2004). The author of this article believes the flu pandemic that killed approximately 40 million people worldwide began in Haskell County, Kansas.
There is a new strain of influenza that is estimated to cause 40% absenteeism in the workplace. This virus is believed to be capable of killing 50% of its victims and has the ability to turn the human immune system against young and healthy adults. This virus is unlike any since the great influenza Pandemic of 1918 (Department of Commerce 2006).
People are exposed to influenza every year in the United States. Of those that contract the virus approximately 35, 000 will die. The elderly, young children, and people with immune system weaknesses are more susceptible to the virus. Each year many Americans make a choice not to receive an influenza vaccination and never get the flu; however, medical experts recommend that the elderly, young children, and people with immune deficiencies get a flu shot every year. Influenza has become a normal part of life in the U.S.
Influenza is a virus that normally affects birds. The virus in birds may be contracted by human beings through contact with infected bird’s body fluids. When contracted in this way the human suffers the effects of the strain of virus but cannot pass it on to another human being.
If this bird virus infects a swine or human who is infected with a human form of influenza the two forms may join to form a third virus capable of transmitting from human-to-human. In his book the Great Influenza, John Barry (Barry 2004) describes it as “The influenza virus not only mutates rapidly, but it also has a “segmented” genome. This means that its genes do not lie along a continuous strand of nucleic acid, as do genes on most organisms, including most other viruses. Instead influenza genes are carried in unconnected strands of RNA. Therefore if two different influenza viruses infect the same cell, “reassortment” of their genes becomes very possible.”
Influenza develops in Asia and moves around the world. In the U.S. health officials monitor the strains. Vaccinations are developed for each strain and provided to the U.S. population prior to the arrival of that strain of influenza. People who are vaccinated for one strain are not protected from any other strain moving through the population.
The U.S. Department of Health and Human Services (Pandemic Flu 2006) web site “PandemicFlu.gov” provides essential information. This site defines Pandemic flu as “A virulent human flu that causes a global outbreak, or pandemic, of serious illness.”
The White House fact sheet, Safeguarding America against Pandemic Influenza (Fact Sheet 2006), states that “Pandemic influenza poses a greater danger than seasonal flu. Most Americans are familiar with influenza or the “flu” a respiratory illness that makes hundreds of thousands of people sick every year. For most healthy people, the flu is not usually life-threatening. Pandemic influenza is another matter. It occurs when a new strain of influenza emerges that can be transmitted easily from person to person and for which people have no immunity. Unlike seasonal flu, it can kill the young and healthy as well as the frail and sick.”
The Bird Flu may not be the actual strain of virus that causes the pandemic; however, if it or one like it does cause a pandemic the death toll could be staggering. This caused the U.S. Government to take steps to prepare and respond to a pandemic. The White House published a National Strategy for Pandemic Influenza on November 1, 2005. This document provides a high-level overview of the approach that the U.S. Government will take to prepare for and respond to a pandemic. The U.S. strategy plans for state and local governments to prepare themselves and their communities.
The goal of this strategy (National Strategy 2005) is to “Enable the US Government to collaborate fully with international partners to attempt containment of a potential pandemic whenever sustained and efficient human-to-human transmission is documented, and will make every reasonable effort to delay the introduction of a pandemic virus to the United States. If these efforts fail, responding effectively to an uncontained pandemic domestically will require the full participation of all levels of government and all segments of society.”
All levels of government have the responsibility to ensure continuation of essential functions and services for its citizens. Law enforcement and firefighting are just two examples of essential functions. Once the essential functions and services have been identified officials must identify supporting activities and capabilities. Supervision and control, facility security, communications, personnel accountability and recall, facility management, legal support, procurement, records protection, and computer and IT support are support activities. Communications, phone service, teleconferencing, secure networking, internet access, business supplies, and trained personnel are capabilities.
Once the essential functions and services have been identified the safety professional can begin to protect the health of employees who come to work to provide those functions and services. The first rule is that any employee not needed to perform or support an essential function or service should work from an alternate location to prevent the spread of the virus.
Managers and supervisors need to prevent employees from contracting the flu virus while at work. They must prevent exposure by limiting social contact between employees while at work and raise awareness of personal hygiene to promote overall health.
Occupational safety and health personnel should monitor pandemic information from the Department of Health and Human Services (HHS), the World Health Organization (WHO), and the Department of Labor, and distribute this information.
In addition, they should coordinate with the organization’s health office or local health facilities to support ill or injured employees. These individuals should also coordinate for vaccination of personnel if and when vaccines become available.
Occupational safety and health personnel should coordinate with the security and facility personnel to provide medical personnel at building entrances for “report to work” evaluations. “Report to work” evaluations consist of a health care professional who will view occupants as they enter the building and identify those that show outward symptoms of the influenza. An individual showing outward symptoms of the virus should be refused access.
Managers and Supervisors are in the best position to enact policies and procedures to limit exposure and the likelihood that employees will contract the influenza at work. They should take action based upon guidance and policy issued by HHS and the Department of Labor (DOL), including following HHS recommendations for personal protective equipment (e.g., surgical/procedure masks, gloves) for essential employees who must report to work.
To make personal protective equipment viable organizations should stockpile the personal protective equipment recommended by HHS at a ratio of 120 % percent of their employees for approximately 15 days. This will allow for employee and visitor replacements as needed. Managers and Supervisors must order the equipment; notify employees of the equipment to be issued, how the employee will obtain it, and how the employee will be trained.
Only bring the employees in to work that need to be there. To accomplish this one can use the concept of “reasonable risk.” Reasonable risk is the trade-off of the risk of having employees report to work and possibly get the flu versus the risk of not completing essential functions and services.
Use the concept of social distancing to limit exposure for employees that must come to work. Social distancing is keeping employees at least three feet from each other. There are a number of methods that may be used to create social distancing that may include:
- Place non-essential personnel on administrative leave
- Use alternative work schedules to the maximum extent possible to allow for extended workdays to ensure essential functions are carried out
- Implement employee shift schedules
- Identify and limit the use of shared equipment
- Approve telework for essential personnel who do not require physical presence to perform their functions and for employees who will be caring for family members at home
When possible, let employees work from home. To facilitate this managers and supervisors must determine how many personnel will need access and the type of access, e.g. e-mail or Virtual Private Network (VPN) prior to the onset of a pandemic.
Get the right medical resources for the organization. Use existing medical resources, implement agreements to staff health offices, and identify additional employee assistance resources that may be needed.
Maintain contact with HHS to learn about the availability and distribution of anti-viral agents and pre-pandemic and pandemic vaccine to ensure designated employees receive them.
The H5N1 virus served as a wakeup call to public officials to the dangers that an influenza pandemic might pose. If governments are to prepare for a pandemic they must be able to provide essential functions and services while experiencing absenteeism rates up to 40% and the death of 50% of employees contracting the virus.
Work on the 1918 Influenza Pandemic continues. Dr. Johan Hultin worked for over 50 years to obtain tissue samples from victims of the 1918 pandemic buried in the permafrost of Alaska (Kleffman 2006). Dr. Jeffery Taubenberger credits Dr. Hultin’s work for enabling his team of experts to identify the entire genetic code of the virus. Dr. Taubenberger has even brought it back to life to help fight the Avian Influenza (Kleffman 2006). Perhaps the greatest work is yet to come. If local and state governments are to provide essential functions and services during a pandemic they must identify and apply methods to prevent and control the virus now.
– Barry, John, The Great Influenza, The Epic Story of the Deadliest Plague in History, Penguin Books, 2004.
– Department of Commerce Department Plan for Pandemic Influenza, U.S Department of Commerce, March 24, 2006.
– Fact Sheet: Safeguarding America Against Pandemic Influenza, White House. Retrieved on March 30, 2006 from http://www.whitehouse.gov/infocus/pandemicflu/
– Kleffman, Sandy. Researcher’s quest to revive virus spanned decades. The Free Lance Star, Fredericksburg, Virginia, March 26, 2006, page A-8.
– Kleffman, Sandy. U.S. Scientists bring 1918’s deadly influenza virus back to life, The Free Lance Star, Fredericksburg, Virginia. March 26, 2006, page A-8.
– National Strategy for Pandemic Influenza, Office of the President, Homeland Security Council, November 2005. Retrieved on March 30, 2006 from http://www.whitehouse.gov/homeland/pandemic-influenza.html.
– Pandemic Flu, Department of Health and Human Services. Retrieved on March 30, 2006 from http://www.pandemicflu.gov/.
– World Health Organization (WHO), Epidemic and Pandemic Alert and Response (EPR), Cumulative Number of Confirmed Human Cases of Avian Influenza A/ (H5N1) Reported to WHO. Retrieved on March 30, 2006 from http://www.who.int/csr/disease/avian_influenza/country/cases_table_2006_03_24/en/index.h