How to keep the world working during the H1N1 pandemic: Key takeaway messages from CIDRAP's 3rd national summit

(CIDRAP Business Source Osterholm Briefing) – We face real uncertainty about the future of the H1N1 pandemic. No one knows today if the virus will mutate or reassort into a more effective killer or cause milder illness over the next 4 to 6 months. Even if the genetic makeup of the virus remains unchanged, the days ahead will not be easy. Globally, there will substantial increases in illness and even deaths among people younger than 60 years old, and that includes your workforce, as well as others you rely on to conduct business.

What's more, we know that healthcare systems around the world will face unprecedented challenges, particularly in providing intensive care. For some of the world, the H1N1 vaccine will have a positive impact. But the billion-dollar question is this: Will the vaccine be too little, too late for this new wave of illness in Northern Hemisphere countries like the United States?

I may not have answers to questions about what the virus will do or the ultimate impact of the H1N1 vaccine. But I have discovered in no uncertain terms something quite remarkable after spending 2 days last week at CIDRAP's third national summit. Given half a chance to learn from each other, planners from public and private sectors will not be deterred from finding effective and timely ways to respond to the current pandemic. And that's good for business.

The candor, collegiality, and quality of information exchange between some 250 participants and presenters from organizations of all sizes and ilk exceeded my expectations. I invite you to check out the wealth of summit resources now available on the CIDRAP Source Web site from Keeping the World Working During the H1N1 Pandemic: Protecting Employee Health, Critical Operations, and Customer Relations, which was held in Minneapolis Sep 22 and 23. You'll find dozens of PowerPoint slides, handouts, tips, and tools to help you enhance and benchmark your efforts today.

Meanwhile, let me address five key takeaway messages that emerged during the summit about the realities we face right now.

1. As goes healthcare, so go our communities

If you want a bellwether of the impact of the H1N1 pandemic, look no further than our vulnerable healthcare systems. We are fortunate that to date the vast majority of people who become ill with H1N1 pandemic influenza recover just fine. But certain groups of people get very, very sick, so sick that the care they need is already pushing the limits of our intensive care capacity.

It won't take much to push this system to a breaking point. The tipping point will occur if we start losing patients who could have lived if they could have accessed our highest-tech medical care, including respiratory equipment that is in limited supply. And if that happens, we can expect 24/7 media coverage and a community response much different than what we're seeing now. While I don't believe we will fall into community chaos, I do think it's likely that we'll see fears about being in public places and becoming infected drive up absenteeism.

2. Can you make it possible for sick workers to stay home?

It sounds like a paradox, but keeping some workers from coming to work may be your best tactic for holding down overall absenteeism. Most employees who get H1N1 illness will get better in several days. And if it's possible for them to stay home when they're sick without being penalized, they're less likely to infect other employees. Once they have been free of fever for 24 hours without the use of fever-reducing medications (such as aspirin or acetaminophen) they can come back to work.

Some summit participants said their organizations consider making extra sick days available a far better option than dealing with the headaches and costs of worker safety complaints and other legal or administrative issues. Also, it's clear that expecting workers to document their illness is not reasonable. Now is the time to suspend (at least temporarily) policies that require employees to bring a physician's note either to document the illness or prove they can come back to work. Such notes will be hard to come by in a seriously stretched healthcare system. And you're likely to keep employees away from work much longer than necessary.

3. A clarion call for flexibility, communication

You don't like it, and neither do your employees, but the fact remains that we cannot predict how this pandemic will continue to unfold. Uncertainty is simply a given right now. The Centers for Disease Control and Prevention (CDC) recommends that organizations plan for two contingencies: (1) the severity of the pandemic remains at a level like what we saw when it began in the spring and (2) the severity worsens, absenteeism rises, critical supply chains break down, and business continuity is threatened. Are you prepared to scale up your response? Are your employees? In scenario two, the CDC says it is prepared to call for travel restrictions and measures that limit close contact.

Strong communication efforts take center stage as key to dealing with uncertainty. Keeping in close contact with local public health authorities will help your organization stay informed about any changes in pandemic severity, availability and access to vaccine and antivirals, and emergency actions (such as school closures) that affect your ability to operate. A recent poll pointed out the dismal numbers of employees who even know their organization has a plan. Presenters and participants emphasized the importance of "throwing information at fear," making plans transparent, and communicating to families as well as employees. They also stressed using different formats (not just relying on Web sites) and accommodating cultural differences and multiple languages.

4. When it comes to supply chains, 'the government trumps all'

Outsourcing may be an asset during nonpandemic times, but right now it clearly is a liability. International government actions, including border closings, that are completely out of your control could put parts if not all of your supply chains (and thus your operations) in jeopardy. Fortunately, the US government says it will not close borders, but other countries might, particularly in Asia. Will workers who make parts that your enterprise depends on have access to government-acquired vaccine in India or China? And what if absenteeism rises and government actions cause manufacture of items you need to be delayed or shut down? Unfortunately, your plans need to account for these possibilities.

5. Uncertainties about vaccines and antiviral drugs

It's one thing to make a vaccine that provides protection; it's another to actually get the vaccine into the people who need it. It's also been quite some time since our federal or state governments rolled out a massive campaign to vaccinate adults. Already, access to seasonal influenza vaccine is problematic. Expecting that (a) distribution of vaccine will go smoothly and (b) people will actually line up for it is questionable at best, folly at worst. And at this time there seems to be no coordinated national strategy to more effectively get antiviral drugs into the hands of persons at high risk for serious illness should they become infected (eg, pregnant women, obese persons, and people who have asthma).

Bottom line for organizations

We're in the midst of a pandemic, and we have no idea what will happen next. We don't even know what we don't know yet. Still, many of us are learning through the execution of plans that we've worked hard to develop. Many excellent tools and resources have been developed, and it isn't necessary to reinvent them if we share them.

The good news is that the 2009 CIDRAP summit made possible valuable sharing, and the CIDRAP Business Source has captured and made these resources available to you. I encourage you to keep talking to and learning from each other. It's the only way we can protect employee health, operations, and customer relations. And we’ll do our part to share with you what we learn and tools we develop or find that may help your response efforts. Stay tuned.

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