Business summit panelists stress practicality to slow flu spread

Sept 23, 2009 (CIDRAP News) – To mask or not to mask, hand washing versus hand sanitizers, how long to stay away from the workplace if sick with novel H1N1 influenza, tips for travel—these were some of the issues addressed in a panel discussion yesterday during a business preparedness summit in Minneapolis.

In providing employers answers to vexing questions about preventing transmission of the H1N1 virus in the workplace, the panel emphasized scientifically grounded yet practical responses.

The 2-day conference, "Keeping the World Working during the H1N1 Pandemic: Protecting Employee Health, Critical Operations, and Customer Relations," is sponsored by the Center for Infectious Disease Research and Policy (CIDRAP) at the University of Minnesota and wraps up today.

Addressing whether guidance from the Centers for Disease Control and Prevention (CDC) that people sick with the H1N1 flu should stay out of the workplace until 24 hours after their fever has passed without medication use still holds true in light of recent reports that people can shed the virus up to 10 days, the CDC's Toby Merlin, MD, said it does.

Merlin, deputy director of the CDC's Influenza Coordination Unit, said that, although the virus can be shed at low levels for 7 to 10 days after onset of symptoms, transmission is much more likely when viral shedding is high, within the first day or so after symptom onset.

"There are detectable levels at the tail end of infection," he said, "but it is not very transmissible."

Another CDC policy that was deemed reasonable by the panel was the recommendation to allow people to remain at work when they have sick family members. The important thing, according to CIDRAP Medical Director Kristine Moore, MD, MPH, is to continually balance limiting transmission and being reasonable about letting work continue.

"The most important thing is educating people and helping people understand what the symptoms are and how it is transmitted, so as soon as they develop symptoms, it is their responsibility to take themselves out of the workplace," said Moore.

For people at high risk of developing complications from infection of the virus, such as pregnant women, educating them about the importance of symptom recognition and quick action with a consultation with a physician and antiviral therapy is particularly critical.

Tips for travel
For Myles Druckman, MD, vice president of medical services for the Americas region with International SOS Assistance, the initial outbreak of novel H1N1 in Mexico in April brought to the forefront travel health and issues involved in managing a global workforce.

Companies, he said, need to provide tools to their employees for handling a number of issues that may arise. Challenges not only include the actual health risks in other parts of the world, but the possibility that employees who travel may be stranded or quarantined in another country. Another issue is how to handle people who are re-entering the workplace after returning from traveling to a potential outbreak region.

It is important that global companies have a consistent message for all of their employees who travel, he emphasized.

In terms of providing a good health check to monitor their employees' health, Druckman emphasized that no perfect solution exits. Rather, he stressed the importance of establishing a proportional plan or one that is targeted to a very specific situation.

Depending on circumstances, he said, answering a health questionnaire may be enough to satisfy safety concerns, whereas in a more severe situation, temperature screening may be necessary.

Underlying all of this is the need for the company to be perceived as doing something to safeguard its employees. "It is a bit like security in an office building," he said.

Merlin agreed. "Perception clearly drives a lot of decision making," he said.

Nuts and bolts of prevention
Among the simple steps people can take to prevent transmission are washing hands or using hand sanitizers, according to the panel. Moore emphasized that both are good options, but with the caveat that hand washing requires at least 20 seconds of washing and not a simple water splash and that hand sanitizers work best on hands that are not physically dirty.

A more controversial prevention tool is wearing masks or respirators. "A religious war goes on between face mask people and respiratory people," said Merlin, "and it will go on for awhile."

According to Merlin, loose-fitting surgical masks provide a barrier over the nose and mouth and prevent a person from touching the nose and mouth and transferring the virus that way, but they do not reliably filter out small particles. As such, they are not considered needed in the general population.

The only recommendation by the CDC is the use of a face-fitted N-95 respirator for healthcare workers who work with patients who have influenza and may transmit the virus, he said.

"There is a slippery slope problem when it comes to masks," said Merlin, adding that the recommendation by the CDC for the use of a respirator in a particular circumstance has led some people to think that respirators are needed for other situations as well, say for a bus driver who comes in contact with the public.

"This goes way beyond any support from the evidence," he said.

Despite the controversy in the United States about masks, Druckman pointed out the need to recognize culture differences and cited the prevalence of masks worn by people in Asian countries, as well as in Mexico during the spring wave of the H1N1 outbreak.

Merlin summed up simple behaviors that, taken together, can provide a strong chance for prevention. "None of the interventions are perfect. But a reasonable policy of sick people staying at home, reasonable advice on hand and cough hygiene, a vaccination policy, and good education, you end up with a combination quite powerful."

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