AvianFlu8 1 06

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Business Preparedness For The Avian Flu

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AGENDA Welcome and Introduction - Deborah Talbot, R.N., COHN-S/CM, CPUR Avian Flu Medical Update - Jerry Berke, MD, MPH Sample Management Training and Preparing Your Company’s Pandemic Plan Barry Beder, LICSW Legal Perspectives – Stephen Paterniti, Partner: Jackson-Lewis, LLP International Travel – Karen Ransom, RN, OHN, CCM, CPUR Panel Discussion

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Avian Flu Medical Update

AVIAN FLUCONCERNS : 

AVIAN FLU CONCERNS What is it? Why the concern? What to do? How to plan?

The “Common” Flu: 

The “Common” Flu Complications of the flu: - Pneumonia, dehydration, worsening of other health problems (diabetes, heart disease, asthma),death Annually infects 10-20% of the world’s population, 5 million hospitalizations, 500,000 fatalities per year!

Epidemic vs. Pandemic: 

Epidemic vs. Pandemic Sometimes the flu develops into an Epidemic - An outbreak confined to one geographic location

Pandemic: 

Pandemic Sometimes the flu develops into a Pandemic: - An outbreak across the globe

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Begins abruptly Peaks in 2-3 weeks Duration 6-10 weeks Attack rate 10-20% Avian Influenza Common Influenza Duration 8-10 weeks Attack rate - Unknown Death rate 50%

Avian Influenza A (H5N1): 

Avian Influenza A (H5N1) A bird infection – 144 others Does not usually infect humans Cases of Human Disease since 1997

H5N1-The Avian Influenza Virus: 

H5N1-The Avian Influenza Virus Kills almost 100% of infected birds (Domestic) Carried great distances by wild, migratory waterfowl, especially ducks

Avian Influenza: 

Avian Influenza The avian flu virus prefers to infect birds - Spread from bird-to-bird via contact with droppings Humans can get it “accidentally” if they have extensive contact with birds It has shown limited human-to-human transmission

Avian Influenza: 

Avian Influenza So, who’s at risk now? - People who work and live around birds Small scale poultry farmers-Vietnam Cock fighting a special case

Avian Influenza: 

Avian Influenza Avian flu history - 1997: first human cases in Hong Kong In 3 days, entire poultry population was culled; pandemic averted - December 2003: Outbreak in birds in South Korea; no human cases - January 2004: Virus detected in poultry in Vietnam; human cases confirmed

Avian Influenza: 

Avian Influenza Human infection - Incubation period: 2-10 days - Symptoms: fever, sore throat, muscle aches, cough - May progress to pneumonia Involves treatment in intensive care unit with mechanical ventilator

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Avian Influenza The virus tends to kill people with very healthy immune systems Teens and young adults

Countries With Influenza A/H5N1 Since 2005: 

Countries With Influenza A/H5N1 Since 2005

Avian Influenza: 

Avian Influenza The virus continues to spread to birds and then to people *as of July 20, 2006

Avian Influenza: 

Avian Influenza When should we be concerned? If the virus mutates and is easily transmissible from human to human

Pandemic: 

Pandemic A new virus emerges from an animal, no human immunity exists, develops ability to infect humans Virus reproduces in humans and causes significant disease 3. Virus spreads efficiently from human to human Two out of three!

20th Century Flu Pandemics: 

20th Century Flu Pandemics

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The 1918 flu pandemic - Most devastating infectious disease outbreak ever recorded - Infection spread across the U.S. in 3 weeks (no air travel) - 1 billion people infected worldwide (one-half the population) - 50 million died (5% of those infected) -more deaths than from all the wars in the last 100 years put together

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“Influenza pandemics are rare but recurring events. They have typically occurred every 10-50 years throughout recorded history.” World Health Organization press kit document

Potential Impact of Next Pandemic: 

Potential Impact of Next Pandemic Outbreaks will occur simultaneously throughout the US Overwhelming demand on the healthcare delivery system No “outside” help Up to 35% absenteeism in all sectors at all levels Public service, public safety Healthcare personnel Just-in-time economy Vaccine not available for several months Order and security disrupted for several months, not just hours or days On multiple news outlets 24/7

Avian Influenza: 

Avian Influenza Hospitals will be overwhelmed - 100,000 intensive care beds in U.S. - Projected need: 500,000 to 8,500,000 beds

Estimates of the Impact of Pandemic Influenza on the United States When the Virus is Similar to the 1957 & 1968 Strains and 1918 “Swine” Influenza: 

Estimates of the Impact of Pandemic Influenza on the United States When the Virus is Similar to the 1957 & 1968 Strains and 1918 “Swine” Influenza

How is the flu transmitted?: 

How is the flu transmitted? Respiratory droplets spread from human to human During a sneeze, millions of tiny droplets of water and mucus are expelled at about 200 miles per hour.

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Quarantine As A Control Strategy

Avian Influenza: 

Avian Influenza So what do we do? Isolation Separate infected people from healthy individuals in order to stop the spread of infection Isolation ward-China

Avian Influenza: 

Avian Influenza So what do we do? Essential employees will need to protect themselves against virus exposure N95 respirator - Effective for about 2 hours - Generally uncomfortable to wear - May not be appropriate in people with certain medical conditions - Can be difficult to use and remove properly - Should be fit tested

It’s Not As Easy As It Looks!: 

It’s Not As Easy As It Looks! Personal discomfort Interfere with communication Not everyone can tolerate them When they get wet, their effectiveness diminishes

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Avian Influenza Tamiflu

Avian Influenza So what do we do?: 

High risk people should be vaccinated - Pneumococcal vaccine - Yearly flu shot Avian Influenza So what do we do?

Avian Influenza: 

Avian Influenza Increase social distance - May want to limit access to: Major public events Major shopping venues Schools Public transportation

Prevention for the Public: 

Prevention for the Public Wash hands frequently, and teach children well Use antibacterial hand cleaner particularly after contact w/public surfaces (e.g. shopping carts) If you get sick, stay home from school/work Cover mouth when coughing to avoid exposure to others Stay 3 feet from anyone coughing or sneezing Get an annual flu sot as indicated If a pneumonia vaccine is recommended, get it

Will The Business You Leave in August be Viable in December?: 

Will The Business You Leave in August be Viable in December? Banking the fires Minimizing interpersonal contact Personal preventive strategies A time of no competitive advantage A time to consider what you can give

Not All Doom And Gloom: 

Not All Doom And Gloom There may be milder forms Many new technologies for vaccine New drugs in the pipeline The silver lining of Rita and Katrina Different conditions than 1918

Avian Influenza Summary: 

Avian Influenza Summary We are due for a pandemic Avian influenza is a likely candidate Now is the time to develop a plan to ensure the ongoing survival of your business

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Maximizing Communications During Stressful Times A Training Program For Managers and Supervisors

STRESS ALTERS LISTENING: 

STRESS ALTERS LISTENING Alters sense of time Reduces visual field Muffles Sound Produces internal dialogue, increasing anxiety Decreases memory Heightens sense of urgency

11 Key Communication Skills: 

11 Key Communication Skills Awareness that normal communication is reduced Keep things clear and simple Encourage 2-way interaction Maintain engagement Read written communications out loud, emphasize key points, use compelling calm tone Allow for humor and individual differences

11 Key Communication Skills (Cont.): 

11 Key Communication Skills (Cont.) Encourage sleep, rest, reduction of caffeine and alcohol Encourage dialogue Normalize stress reactions Repeat key messages If questions are asked and you don’t know the answers don’t leave doubt, let employee know you will try to get an answer  

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Essential Elements in Preparing Your Company’s Pandemic Plan

Start your plan Now!: 

Start your plan Now! Make sure your plan is written and customized; a Pandemic plan is different from a disaster plan Select team for development and execution of your plan

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Team Members

Develop Your Communication Plans: 

Develop Your Communication Plans Identify a Local Health Department contact and Emergency Health Services contact: (Insert name, title and contact information in plan) Identify vendors, customers and employees and develop a plan to communicate with all groups. Make arrangements for telephone, facsimile, or e-mail messaging Ensure that your key vendors have continuity plans in place and request confirmation of established plans

Provide Training and Education: 

Provide Training and Education Your plan should provide education and training programs to ensure that all personnel understand the implications of, and control measures for, pandemic influenza. Include: A person designated to coordinate education and training (e.g., identify and facilitate access to education and training programs, maintain a record of attendance at education and training programs). (Insert name, title and contact information). Language and reading-level appropriate materials on pandemic influenza (e.g., available through state and federal public health agencies and professional organizations). Information on infection control measures to prevent the spread of pandemic influenza.

Provide Training and Education (Cont.): 

Provide Training and Education (Cont.) Plan for implementing respiratory hygiene/cough etiquette training. Educate managers and supervisors in handling pandemic communications and anticipated stress and panic. Etiquette in instructing symptomatic persons to use tissues to cover their cough to contain respiratory secretions and perform hand hygiene. Distribution of masks (adult and pediatric sizes should be available), providing facial tissues, receptacles for their disposal and hand hygiene materials in public areas. Encourage staff to develop their own family care plans for the care of dependent minors and seniors in the event community containment measures (e.g., "snow days," school closures) are implemented.

Provide Training and Education (Cont.): 

Cross train employees for essential duties, identify regional employee strengths in case flu is geographically limited Train staff in hygiene, precautions, masks, home pandemic planning, home health-care Train managers in “stress communications” Provide Training and Education (Cont.)

Provide Training and Education (Cont.): 

Provide Training and Education (Cont.) Before the Avian Flu progresses to the worst-case scenario, secure and train employees to use the following supplies:    N-95 masks   Disposable latex or vinyl gloves    Bleach    Waterless, alcohol-based hand sanitizer    Trash cans with covers or lids    Personal thermometers    Disposable drinking cups

Provide Training and Education (Cont.): 

Provide Training and Education (Cont.) Anticipate Pandemic Stress Decrease in work quality Decrease in productivity Increase in mistakes Absenteeism Obsession about details Decrease in motivation Team conflict Increased blaming Exhaustion Reduced communications

Assess and Develop HR Policies: 

Assess and Develop HR Policies Create a liberal/non-punitive sick leave policy for managing personnel who have symptoms of or documented illness with pandemic influenza. Include: The handling of staff who become ill at work. Policy for when personnel may return to work after recovering from pandemic influenza. Policy for personnel who are symptomatic, but well enough to work, will be permitted to continue working. Policy for personnel who need to care for their ill family members. A system for evaluating symptomatic personnel before they report for duty before pandemic. Provisions to provide mental health and faith-based resources that are available to provide counseling to personnel during a pandemic. The management of personnel who are at increased risk for influenza complications (e.g., pregnant women, immunocompromised employees) by placing them on administrative leave or altering their work location. The offer of annual influenza vaccine to all employees. Plans for managing a staffing shortage within the organization due to illness in personnel or their family members.

Determine Continuity/Operational Activities: 

Determine Continuity/ Operational Activities Establish the minimum number and categories of personnel necessary to keep the location or department open on a given day. Create a system to monitor and review influenza activity in employees, weekly or daily number of employees calling or presenting with influenza-like illness. Plans for either closing the department/location or recruiting temporary personnel during a staffing crisis once assessed.    Plan to acquire and distribute consumable resource needs (e.g., masks, gloves, hand hygiene products, medical supplies) Develop a primary plan and contingency plan to address supply shortages. Review procedures for acquisition of supplies through normal channels, as well as requesting resources when normal channel resources have been exhausted.

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International Travel Preparedness

Traveler’s Health: 

Traveler’s Health Currently, the Center for Disease Control (CDC) has not recommended that the general public avoid travel to any of the countries affected by H5N1.

Traveler’s Health: 

Traveler’s Health Persons visiting areas with reports of outbreaks of H5N1 among poultry or of human H5N1 cases should plan their travel in advance and taker proper precautions. Before Travel During Travel After Travel

Traveler’s Health (Cont.): 

Traveler’s Health (Cont.) Before Travel A. Obtain current information by accessing: 1. Department of State’s Consular Information Sheets http://travel.state.gov 2. Center for Disease Control’s (CDC) website http://www.cdc.gov/flu/avian/index.htm 3. World Health Organization (WHO) website http://www.who.int/csr/disease/avian_influenza/en B. Up to date immunizations

Traveler’s Health (Cont.): 

Traveler’s Health (Cont.) Digital thermometer Alcohol based hand gel Personal prescription medications (labeled) Antimalarial medication, if applicable Antidiarrheal medication Antihistimine Antimotion sickness medication Acetaminophen, aspirin, ibuprofen, or other medication used to treat pain or fever Cough Medicine Antacid Insect Repellent Sunscreen (SPF 15 or higher) Basic first aid items, bandaids, gauze, etc. Eye drops Mild sedative Water purification tablets C. Travel Kit

Traveler’s Health (Cont.): 

Traveler’s Health (Cont.) D. Preplan in country medical facilities E. Plan for evacuation, if needed F. Check your health plan or purchase additional insurance http://travel.state.gov/travel/tips/health/health_1185.html

Traveler’s Health (Cont.): 

Traveler’s Health (Cont.) During Travel A. Frequent hand washing • Alcohol-based sanitizers when soap and water are unavailable B. Avoid poultry farms or areas with bird markets. C. Avoid surfaces contaminated with bird feces or secretions D. Cook poultry and all poultry products well. (Viruses are destroyed by heat) E. Seek medical attention if ill (contact American consular officer)

Traveler’s Health (Cont.): 

Traveler’s Health (Cont.) After Travel A. Monitor health for 10 days B. If you become ill, immediately call health care provider and tell them that you have recently traveled and the area where you traveled. C. Limit contact with others if you do not feel well.

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Health Resources 1.800.451.1834 - EAP 1.800.350.4511 – Occupational Health www.healthresourcescorp.com