Plan Now for the Future Pandemic

Experts say the world is overdue for a pandemic, so it’s a matter of when – not if – one could hit South Texas. Should businesses do anything now to protect their employees and operations?
By Lisa A. Bastian, CBC

While the international community bickers over who or what is responsible for “global warming,” a deadly and imminent disaster deserving far more attention is sneaking upon the world’s stage.

After a few years of quiet observation, healthcare experts are starting to ring alarm bells about the high probability of our planet experiencing another global disease outbreak, or pandemic, in the very near future.

Specifically called a pandemic influenza — or “pan flu” — researchers think it will be caused by a strain of the influenza A virus so nasty that humans will have no (or little) resistance to it.  Once on the loose, the disease may be around 12 to 24 months.

More bad news: There will not be a vaccine for the pan flu until drug companies can create one; a process which could take from three to six months. Once developed, a broken supply chain could make it very difficult to be distributed in a timely fashion. 

So just how “doomsday” will the situation get? According to the U.S. Chamber of Commerce, a pandemic flu in America could kill over a half million people, hospitalize two million more, and cost our economy an estimated $160 to $675 billion. 

Historically, in the last 400 years three pan flus have marked each century. In the 20th century they were: the 1918-1919 Spanish Flu (50 million deaths); the 1957-1958 Asian Flu (1 to 2 million deaths); and the 1968-1969 Hong Kong Flu (700,000 deaths). Several tens of thousands of Americans died in each one.

Interestingly, in a complete reversal of previous patterns for pandemics, 99 percent of people killed by the Spanish Flu were younger than 65 years.  For the next pandemic, it’s predicted young, healthy people between the ages of 15 and 35 will be affected the most severely.
Health officials say H1N1 — most probably the 1918 strain — is similar to today’s bird flu strains, H5N2 and H5N1. Only the latter can make both humans and other animals very ill or kill them. Thus far, a lethal strain of H5N1 infecting people or birds has not been reported in North America.

However, birds in 58 nations have tested positive for the virus, while 12 countries have reported human H5N1 cases. 

As of April 13 of this year, 172 of the 291 people who caught the H5N1 infection due to direct contact with infected birds have died. That translates into a 60 percent mortality rate.  Experts fear that H5N1 is the avian flu strain most likely to mutate into something that will easily and quickly spread from human to human like H1N1 did almost a century ago.

The World Health Organization (WHO) uses a pandemic alert system with six phases to inform the world about the seriousness of the pan flu threat. Presently we’re in phase 3, the “pandemic alert” stage, which means a new influenza virus subtype is causing disease in humans but is not yet spreading efficiently and sustainably among humans.  Unfortunately, if a virus starts to aggressively spread, it could only take a few weeks or so to enter phase 6, the pandemic stage.

Perhaps the best assessment of potential destruction comes from leading pandemic preparedness proponent Dr. Michael T. Osterholm, director of the University of Minnesota’s Center for Infectious Disease Research and Policy.

Speaking before the House Committee on International Relations in December 2005, he opined that even if an influenza pandemic began that day, ”borders will close, the global economy will shut down, pharmaceutical supplies ... will be in extreme short supply, healthcare systems will be overwhelmed and panic will reign.”

“Foreign trade and travel will be reduced or even ended in an attempt to stop the virus from entering new countries — even though such efforts will probably fail given the infectiousness of the virus and the volume of illegal crossings at most borders,” notes Osterholm. He further predicted that curtailment of international trade will trigger shortages of critical products needed to maintain water, power, and communication systems, and limit worldwide access to vaccines and antivirals for years to come.

Effectively, he maintained, this pan flu “will be like a 12- to 18-month global blizzard that will ultimately change the world as we know it today.”

To minimize fallout, the industrialized world must create a detailed response strategy “far beyond just enhancing influenza vaccines and treatment drugs, and one that involves both the public and private sectors,” continued Osterholm. “We can no longer assume that business continuity plans for both our multinational companies and small businesses, largely based on a concept of a regional event of a limited duration, will approximate the actual impact and consequence of an influenza pandemic.” 

He concluded his testimony with this critical recommendation for America — and the world:  “We must understand the implications and plan for the shutdown of our global economy and supply chains now, not during a pandemic.”

All 50 states are now planning for a pandemic, and most have published their preparedness plans online for public viewing (www.pandemicflu.gov/plan/states/stateplans.html). But papers can only do so much, so states also are engaging their leaders in frank, face-to-face discussions to add a dose of reality to the planning at the local level.

Emily Palmer, assistant press officer of the Texas Dept. of State Health Services, has worked closely with the state’s pandemic planning efforts for years and reports her agency has sponsored two major pandemic meetings recently in Austin.

The first event, held December 2005, drew 400 participants and focused on the medical aspect of a future pan flu. The second, the “Texas Pandemic Influenza Summit,” was co-sponsored by the U.S. Dept. of Health and Human Services and held March 2006. In attendance were 250 people representing groups in healthcare, government, education, business and the media from around the state.

Palmer says the summit’s purpose was to get participants to start planning what they’d do if a pandemic hit their communities, the region, and the state. 

“It was not necessarily about our department having all the answers, but rather starting a state-wide discussion. We gave them planning checklists and asked, ‘What applies to your region? Who needs to be part of this joint planning?’  If you’re from San Antonio, your answers are going to be different than someone from McAllen or Brownsville.  We were trying to be a catalyst for groups to do community-level planning with their own agencies.”

One thing about a pandemic that’s different from a flood or tornado, she points out, is the fact “it would be everywhere. You won’t be able to count on outside resources to help you, necessarily.” For example, normally if a South Texas coastal county were hit by a hurricane, neighboring counties further away from the storm’s path could help. “In a pandemic, that may not be possible; they’d be dealing with the same problems.”

As those at the Texas Summit discovered, pandemic planning is a multi-layered, interconnected strategy requiring unique guidelines to address specific needs of the federal government; state and local governments; individuals/families; businesses and other employers; healthcare workers, and community/faith-based groups. 

Closer to home, the “Texas Summit” motivated three South Texas Senators to host a pandemic flu preparedness meeting just three months after the Austin meeting. Held June 20 in Falfurrias, Brooks County, it was designed to help government officials create local response plans.
Specifically, Senator Juan “Chuy” Hinojosa (D-McAllen), Senator Judith Zaffirini (D-Laredo) and Senator Eddie Lucio, Jr. (D-Brownsville) invited elected city and county officials to meet with a panel of avian flu experts from military, law enforcement and medical sectors.
Topics discussed included: the authority of county judges regarding quarantines and isolation of persons, an update on the state’s response plan to avian influenza outbreaks in poultry, chains of command for distributing vaccines, and how to secure resources (e.g., food and water) for isolated or quarantined residents.        

South Texas needs to be especially vigilant due to its location on a major migratory flyway, points out Senator Zaffirini. “[This region], comprising more than three million residents, creates a funneled convergence zone for the Central and Mississippi Valley migratory bird flyways,” she says. “Since South Texas is a hot-zone of migratory activity, the region must be monitored carefully. Investigating how this disease could be spread and reducing the risks of regional infection are essential elements for pandemic preparedness.”

If pandemic flu ever does come to Texas, “it will be up to our cities and counties to respond on the local level,” says Senator Hinojosa. “This is why it’s critical we begin planning now. This meeting was an important step in educating our leaders in how to create an effective response plan.”  Melissa del Bosque, the senator’s legislative policy analyst, adds that the ideal regional plan “will incorporate hospitals, the business community, health professionals, school districts, local governments, and any other interested stakeholders.” 

In addition to this meeting, she says in 2006 Senator Hinojosa worked with the Texas Association of Counties to create a manual for county judges on what their responsibilities are, and what the law says, regarding pandemic flu quarantine, etc.

How have Texans fared with past pandemics?  If the “Great Pandemic of 1918” is any indication, not very well. The Secretary of the U.S. Dept. of Health and Human Services — Mike Leavitt — gave an overview of how that particular pan flu impacted at the Texas Summit. 
“Reports of pandemic fears preceded the disease into Texas by about two weeks,” said Leavitt. “But by September 23, there were definite accounts of it near Austin and Dallas. On October 4th, 35 counties were reporting the presence of influenza, with anywhere from one to 2,000 cases per county.  The pandemic kept rising. The victims kept falling. And people kept searching for ways to contain the pandemic and sustain themselves through it. El Paso imposed a quarantine.

“The Dallas Morning News declared that surviving the pandemic required “medical attention, good nursing, fresh air, nutritious food, plenty of water, and cheerful surroundings.

“The Texas State Board of Health offered schools several suggestions on ways to prevent flu outbreaks. [It] wrote: ‘Every day... disinfectant should be scattered over the floor and swept. All woodwork, desks, chairs, tables and doors should be wiped off with a cloth wet with linseed, kerosene and turpentine. Every pupil must have at all times a clean handkerchief and it must not be laid on top of the desk. Spitting on the floor, sneezing or coughing, except behind a handkerchief, should be sufficient grounds for suspension of a pupil. A pupil should not be allowed to sit in a draft. A pupil with wet feet or wet clothing should not be permitted to stay at school.’

“But despite those efforts, the pandemic took a terrible toll on Texas. By the end of October, more than 106,000 Texans in the state’s urban centers had been afflicted. More than 2,100 had died....

“When it comes to pandemics,” summed up Leavitt, “there is no rational basis to believe that the early years of the 21st century will be different than the past. If a pandemic strikes, it will come to Texas.”

Palmer can’t emphasize enough the importance of having Texas companies of all sizes, in diverse industries, acknowledge the reality that they’re integral parts of the pan flu planning process.

“They must understand it’s not just a ‘health process,’” she relates, but also a crisis situation that can deeply impact their operations. “What will they do if 40 percent of their workers don’t show up, if their supply chain is broken, or if employees have to stay home because the schools are closed?  How will they deal with infected employees who won’t stay home for fear of losing their jobs?” 

For answers to those questions, and countless more, Palmer says the state is sending people to one key federal governmental source:  www.PandemicFlu.org.  “It offers very helpful, down-to-earth planning; so rather than ‘reinvent the wheel’ we suggest Texas businesses, schools and other groups go to this site.“

For example, the “business pandemic influenza planning checklist” pages found in the “workplace planning” section gives ideas on how to lessen a pan flu’s impact on a business, its employees and customers; allocate resources to protect employees and customers; communicate to and educate employees; and coordinate with external community organizations.  Dozens of other valuable reports, planning tools and resource links are found throughout the immense user-friendly Web site.

Besides playing a crucial role in protecting their employees’ safety and health, well-prepared businesses in Texas will also help limit the negative impact a pan flu might have on the state’s economy and society.  And since Dr. Osterholm predicts a severe pandemic would bring “an abrupt halt” to global, national and regional economies, there’s a good chance that anything “positive” one business does to combat this nightmare will have a chain-reaction effect on other local and regional operations.

What if a pan flu doesn’t strike, or the virus strain that emerges sickens just a small percentage of the population?  Will the time spent on planning be wasted?  “Not at all,” contends Palmer, noting that preparing thoroughly for this catastrophe will make organizations ready to face just about any other kind of crisis, including a terrorist attack or natural disaster.

While many businesses may be hesitant to initiate pandemic planning, at San Antonio-based AT&T planning for – and responding to – crises is a way of life.

To ensure the company can remain operational during a health pandemic, in October 2005 AT&T commissioned a cross-functional team (led by a business continuity director) to address the issue. According to corporate communications spokesperson April Borlinghaus, all critical work functions have disaster recovery plans that are exercised every year. The team has been reviewing these plans against a health pandemic scenario, and supplementing them accordingly.

As part of that planning, “we’re undertaking extensive corporate-wide risk assessment, incident response and contingency planning for a pandemic on three broad fronts,” says Borlinghaus. They are:

• Employees and facilities: AT&T is planning steps to help prevent the illness at its facilities, limit its spread among employees, and support employees’ health needs.
• Critical business functions: The firm is working to ensure these functions remain operational and that customers’ service is uninterrupted.  Its business continuity professionals are partnering with customers to gather information, perform analysis, develop solutions, and test and validate plans.
• Network infrastructure: “As customers implement their own business continuity plans in the event of a pandemic, it could result in dramatic shifts in traffic patterns on our network,” explains Borlinghaus. “For example, many companies may rely on virtual offices and telecommuting to keep their businesses running. We’re working to anticipate shifts in voice and data traffic patterns to evaluate alternatives [and] maximize network performance under these types of conditions.”

AT&T tests its business continuity and conducts Network Disaster Recovery (NDR) exercises several times a year, she continues. “They’re designed to test, refine and strengthen our business continuity and disaster-response services to minimize network downtime. By simulating large-scale disasters and network service disruptions, AT&T can apply and refine best practices for rapidly restoring communications to government and business customers.”  In the last 10 years, the firm has invested $300 million in its NDR program.

Borlinghaus says that regardless of size, “all companies need to identify their critical business components and effectively manage the risk around them,” whether that risk is related to a pandemic, a hurricane, or another kind of crisis.

 “Plans should specify redundant systems, back-up sites, employee communications and alternative work sites. They also should include a process for maintaining customer communications immediately following the crisis, and until things return to normal.” (More disaster preparedness tips are at www.att.com/vitalconnections.) 

The reality of an imminent pandemic can’t be understated, say many experts. However, the devastation expected certainly can be lessened by those who are planning today to combat an unseen mortal enemy that shows no mercy to any human.

Lisa A. Bastian, the editor of Business SouthTexas, is a veteran business communicator living in San Antonio.

Online Pan flu Resources for Businesses
• U.S. Chamber of Commerce, search for “pandemic planning” ~ www.uschamber.com
• U.S. Govt.’s clearinghouse Web site ~ www.PandemicFlu.gov
• TX Dept. of State Health Services ~ www.dshs.state.tx.us/preparedness/pandemic_flu
• TX planning guide for the public ~ www.dshs.state.tx.us/preparedness/pandemic_flu/public/pandemic_flu/Publlic_Guide.pdf
• TX State Office of Risk Management ~ www.sorm.state.tx.us
• Dr. Osterholm’s planning guide ~ www.foreignaffairs.org/background/pandemic
• Centers for Disease Control & Prevention ~ www.cdc.gov
• Trust for America’s Health, see March 2007 report “Pandemic Flu and Potential for U.S. Economic Recession” ~ www.healthyamericans.org
• WHO’s avian pandemic influenza info ~ www.who.int/csr/disease/avian_influenza/avian_faqs/en/index.html
• What to say when a pandemic is imminent ~ www.psandman.com/col/panflu4-1.htm