Mr. Dahm

Security & Safety

White Paper: Protecting Yourself And Your Business Against Swine Flu

By Richard Dahm, Senior Risk Consultant, National Hospitality Division, Wells Fargo Insurance Services

It is impossible to read the newspaper or watch the news without hearing something about swine flu. As of today, there have been multiple confirmed cases across the United States and many more worldwide. Although this is not yet pandemic influenza and may never be, the widespread incidence of this virus is causing concern. The U.S. Department of Health and Human Services has declared a public heath emergency for swine flu.

While swine flu is a significant health threat, if we are armed with the knowledge about what it is, how it is transmitted, and what is being done to combat the threat nationally and globally, we can be better prepared to deal with this crisis. Additionally, there are concrete steps we can take to ensure our personal safety and health, and the continued vitality of our business operations in the event of an influenza pandemic.

What is Swine Flu?

Swine flu is a respiratory illness found in pigs resulting from a subtype of influenza A virus, H1N1. There are many types of swine flu, all of which occur naturally in pigs and result in a high incidence but few deaths. Usually, people do not get swine flu, but occasionally human infections do occur. In rare cases, swine flu can spread from human to human, but in the past this was limited to small groups of up to three people. The Centers for Disease Control (CDC) has confirmed that this strain of swine flu is contagious and can spread from human to human.

Currently, there have been reports of human infection of swine flu in the United States, as well as internationally. The CDC maintains an updated case count of human infection in the United States at http://www.cdc.gov/swineflu/investigation.htm

The symptoms of swine flu are very similar to those of seasonal influenza, including fever, cough, sore throat, body aches, chills, and overall fatigue. Some have also reported stomach upset, diarrhea, and vomiting. Similar to seasonal influenza, the severity of symptoms varies greatly; pneumonia and respiratory failure have been reported especially among those with suppressed immune systems or having chronic medical conditions. Also, like seasonal influenza, bacterial infections can occur simultaneously with swine flu causing pneumonia, ear infections, and sinus infections.

What Is A Pandemic?

A pandemic is a global outbreak, where most, if not all, countries and populations will be at risk of the disease and illness. There have been many pandemics throughout history and three such pandemics in the 20th century alone. These past pandemics have attacked up to 35% of the total population, across all age groups and health statuses, many of who were young and in good health.

The first was the Spanish flu of 1918, which in the span of several months, killed half a million people in the United States alone, and approximately 50 million worldwide. The second was the Asian flu in 1957, which, though a milder strain than the 1918 pandemic, still resulted in about two million deaths. The third pandemic of the century was the Hong Kong flu in 1968, which killed about one million globally.

Pandemic influenza will occur when all three of the following conditions are met:

1. There is a new strain of influenza virus.

2. The virus infects humans and causes serious illness.

3. The virus can be spread by human to human contact.

This strain of swine flu is not pandemic at this time, however, we should take precautions as influenza A viruses are a potential pandemic threat. As of today, the World Health Organization has classified this virus as a Phase 4 on their pandemic alert scale, ranging from a Phase 1 to a Phase 6 (pandemic). Phase 4 represents the level at which the virus has sustained verified human to human transmission.

How Does Swine Flu Spread?

In general, influenza viruses spread easily from person to person through infected respiratory droplets, which can be exhaled through general breathing, coughed, or sneezed into the air. The droplets remain airborne for a short time and then settle on surfaces. People become infected by inhaling these droplets or by touching a contaminated surface and then touching their mouth or nose.

As with seasonal influenza, infected persons are able to transmit the virus before they have exhibited any flu-like symptoms themselves. Heath officials estimate swine flu can be transmitted from one day before exhibiting symptoms to seven days after symptoms develop.

How Can It Be Treated?

Vaccines:

• There are no vaccines available as of this writing to prevent swine flu.

Antivirals and Other Medications

• There are four antiviral medications licensed in the United States for the treatment of influenza: amantadine, rimantadine, oseltamivir, and zanamivir. These are prescription medicines (pills, liquid, or inhaler) that are commonly used to treat seasonal influenza by keeping the virus from reproducing in the body. These antiviral medications can lessen influenza symptoms, shorten the duration of the symptoms, and may prevent serious flu complications.

• The most recent swine influenza virus has shown to be resistant to amantadine and rimantadine, and the CDC recommends oseltamivir or "Tamiflu" and zanamivir or "Relenza" for the treatment of this swine influenza virus. Antiviral medications are most effectively used in treatment when taken within two days of developing symptoms.

• As with seasonal influenza, bacterial infections can occur. Those individuals will also need to take antibiotics. Check with your doctor if you have concerns.

• Never give aspirin (acetylsalicylic acid) to children or teens with the flu; this can cause Reye's syndrome, a rare and serious illness. Always check medicine labels to verify it does not contain any aspirin.

Protecting Yourself

• Good Health. Safe Hygiene.
  Maintaining good hygiene is crucial. Influenza is easily spread by coughing and sneezing, as well as by germs on peoples' hands. To reduce the risk of spreading a virus, cough and sneeze into disposable tissues and immediately place used tissues in a waste basket; wash hands or use alcohol based cleanser. Do not cough or sneeze into your hands, rather if a tissue is not available, cough or sneeze into your elbow.

• Avoid touching your eyes, nose, mouth or face; this is how germs spread.
  Wash hands frequently, especially after using a tissue, the restroom, or helping someone who is sick. It is also important to wash hands after handling raw or undercooked poultry, meat, fish, and eggs, as well as touching an animal or reptile. When washing hands, apply soap to wet hands, thoroughly cover all areas including under fingernails. Rub hands together for at least 20 seconds then rinse hands well. Use a disposable paper towel to dry hands and then use the paper towel to turn off the faucet. Anyone experiencing flu symptoms should avoid contact with others, however, keep in mind that the virus can be spread before any symptoms are present.

• Although the swine influenza virus is not transmissible by eating pork or pork products, always properly prepare and cook pork. The swine flu virus is killed by cooking temperatures of 160oF / 70oC.

• Maintain good health; eat nutritious foods, drink plenty of fluids, get enough sleep, stay physically active, and manage stress.

• Avoid those who are sick, and if you develop symptoms, avoid contact with others; stay home from work and school.

Safe Travel

• As of this writing, there are no travel restrictions to those areas experiencing outbreaks of swine flu in pigs or humans. However, to reduce the risk of contracting the virus, travelers to these areas should avoid contact with pigs, live animal markets, farms, or other areas where surfaces may be contaminated with droppings or respiratory secretions.

• The CDC recommends travelers going from the United States to Mexico, who are at high risk of severe illness from influenza, take oseltamivir (Tamiflu) or zanamivir (Relenza) for prevention of swine influenza during travel. Speak with your doctor about your travels and proper usage and dosing. Always seek medical care if you are severely ill.

General Travel Precautions

• Before Travel: Obtain reliable, current information about swine flu. The CDC maintains a website with up to date information and travel advisories at: http://www.cdc.gov/travel

• Visit your doctor and obtain recommended vaccines and medications. If you have not already received a seasonal flu vaccine, get one at least two weeks before travel. Although this will not prevent swine flu, it will protect you against seasonal viruses.

• Take a medical kit containing basic medical/first aid supplies, including medications appropriate for the area, alcohol/antiseptic hand wash, thermometer, telephone numbers, and locations of local hospitals and clinics. Check with a health insurance provider about covered services in the area. The U.S. Department of State offers medical information for Americans Traveling Abroad, at http://travel.state.gov/travel/tips/health/health_1185.html

• Some countries have implemented health screening for those entering the country from areas affected by influenza. Check with the Embassy of the country to which you are traveling to determine if any health screening has been implemented.

• During Travel: Avoid contact with pigs, (live or dead), places where pigs can be found, such as farms and markets, and any surfaces contaminated with animal feces or secretions. If flu symptoms appear: (a fever accompanied by a cough, sore throat, or difficulty breathing) or any illness that requires prompt medical attention, contact a U.S. consular officer to assist with locating medical services. Do not continue to travel until symptoms are gone, unless travel is local to seek medical treatment.

• After Your Return: Monitor your health for 10 days. If you have flu symptoms, such as a fever plus a cough, sore throat, or trouble breathing during the 10-day period, consult a health care provider immediately. Call the health care provider before your visit to report your symptoms, where you traveled, and if contact was made with pigs or a person with influenza symptoms. While experiencing symptoms, limit contact with others.

Protecting Your Business

Business Continuity Planning vs. Pandemic Planning

While this swine flu is not, and may never become pandemic, it is important for businesses to prepare for the next human-centric event. If an organization already has a tested Business Continuity Plan (BCP), does the plan need to be updated to address the threat of a pandemic? Probably. Pandemic planning isn't just traditional business continuity planning. While a well-drafted BCP addresses disasters in a general, rather than specific threats (flood, fire, swine flu), a pandemic situation is likely to cause additional concerns that may not be adequately covered in existing plans.

One of the primary differentiators between business continuity planning and pandemic planning is the length of time needed to recover. Traditional BCPS are written to address short-term recovery needs; the plan presumes a company will either resume business as usual within a month or, at that time, the company will initiate some permanent recovery or relocation strategy. The BCP presumes the disrupting event is relatively brief. A pandemic is not a brief event; it can cause illness for months before it subsides and prior pandemics have occurred in stages, each lasting months. The traditional short-term recovery strategies will not sufficiently maintain critical functions for this length of time.

In addition, traditional BCPs are written with basic underlying assumptions, without which the recovery strategies will not work. The primary assumptions that underlie most plans include an available, unaffected site for relocation; an available workforce from which an organization can draw employees; a critical staff that will follow the recovery steps and report to work as directed; available transportation and telecommuting as a viable recovery option. These traditional assumptions won't apply in a pandemic, and the recovery plan will be less effective, if effective at all.

Reinforcing Your Business Continuity Plan

To strengthen an existing BCP, a company needs to look at different recovery options and create additional contingency plans for use if their traditional contingency plans don't work. The first step is to examine functions defined as critical and make sure the list is accurate and up-to-date. Companies should categorize the functions in three groups: those that must be performed on-site, those that can be performed remotely, and those that are not really critical. The employees who currently perform each of these tasks should be identified and grouped as outlined below:

Group A - Critical Employees Who Must Come To Work

To simplify the process of pandemic planning, companies must develop specific strategies to protect and recover the functions performed by each group. The number of employees in Group A will be relatively small for most companies, so cross-training their essential functions will be a key recovery strategy. Since these employees must work on-site and the availability and safety of public transportation may be in question, companies should plan to provide transportation to and from work for this group. While employees are on-site, they should be isolated as much as possible by practicing social distancing - e.g., maintaining at least six feet between co-workers.

Companies should invest in cleaning supplies, including a cleaning solution effective against viruses on surfaces, paper towels, and gloves. These supplies should be placed in all common areas and employees should be instructed to clean shared work items, such as copiers and fax machines, after each use. Employees can contract the virus by touching the virus-laden surface then touching their mouth, nose, or face. To further minimize contact with others, companies should allow employees to work off hours, which will also help these essential employees manage family and child care issues.

Group B - Critical Employees Who Can Work From Home

These employees are a larger group and will be working from home. Companies can protect the functions performed by these employees by adequately preparing for telecommuting needs, such as acquiring computer hardware and communications equipment, such as Blackberries, cell phones with text messaging capabilities, and hard-wired telephones - cordless phones will not work in a power outage.

Employees should also have the required software installed on their laptops or home computers, as company security policies allow. If personal computers will be used as a primary or back-up telecommuting tool, companies should have a member of their information technology (IT) department verify that home computers have the capability to run the required software programs and that appropriate security programs are installed to protect company data. As part of the telecommuting strategy, work-at-home employees should have high-speed Internet connections and, depending on the criticality of the functions, there should be more than one high-speed provider and delivery method (fiber, cable, DSL) to address the tremendous burden of mass work-at-home strategies being used by multiple area companies.

Finally, as with any plan, the telecommuting strategy should be tested by requiring employees in this group to work at home at least one day each month to ensure they are both capable and comfortable with telecommuting. The more comfortable employees are with the process of telecommuting, the easier the transition to long-term telecommuting will be.

Group C - Non-Critical Employees Who Can Be Cross-Trained And Can Telecommute

To create redundancies in the telecommuting strategy, the critical functions can be backed up by select nonessential employees capable of telecommuting - Group C. Companies should selectively train these employees to perform critical functions, either in their entirety or in part, by dividing a single critical task among many employees to protect confidentiality. To further the likelihood that these tasks will be completed, companies should consider the geographic locations of employees performing back-up functions to protect against the failure of single-source Internet and telephone providers. Arranging off-hours communications will also help to avoid overburdening phone and Internet services.

Group D - Non-Critical Employees

These employees will stay at home and will not be performing any tasks while the company is temporarily shut down.

Human Resources Issues

For those nonessential employees in Group D, companies need to take a hard look at their employment policies, such as those relating to salary and benefits (especially medical) continuation and paid time off (PTO). If a pandemic brings potential quarantine or departments of public health are suggesting that nonessential employees remain at home to prevent the spread of disease, how will the company handle nonworking employees? What benefits will continue and for how long?

In fact, existing human resources policies in general may not adequately address many of the employment issues stemming from a pandemic. Employees, even critical staff, may be absent for extended periods to care for families or school-age children; the absence may extend beyond their paid time off periods or even time off mandated under the Family and Medical Leave Act (FMLA).

Companies should consider adding a pandemic clause to their human resources plans to address long-term salary and benefits continuation, as well as the seniority and job-status criteria. Policies should clearly define how employees who are both not ill and not working will be paid and for how long. These extended absences may also have an impact on the definition of job abandonment. Companies should consider modifying this definition under the circumstances of a pandemic to avoid being forced to terminate employees for extended absences.

Policies should also address mandatory quarantines and how they will affect benefits. To avoid labor issues, companies need to be very clear in their policies and consistently apply them to all employees. Review policy changes with the employees and any unions before a pandemic occurs.

Planning For a Pandemic

A pandemic BCP must address such items as employee education, corporate travel policies, sharing of information regarding emergency plans, and legal issues.

Educate Employees

Before a pandemic occurs, companies should proactively educate employees on protecting themselves and their families from influenza and other viruses. Employees should be encouraged to get a seasonal flu shot. Although a seasonal flu vaccine will not protect against the H5N1 virus, it does protect against the seasonal virus and can prevent additional illnesses and complications in a pandemic. Companies should coordinate with their health benefits provider to identify clinics offering flu shots and consider subsidizing all or part of the cost. To facilitate employee participation, many companies host on-site flu clinics.

Companies should teach employees about how the flu virus is spread, including the benefits of social distancing; maintaining three feet to six feet of personal space; and avoiding direct and incidental contact with others, such as shaking hands, using lobby telephones, and sharing office equipment. Companies should teach employees about good hygiene practices in the workplace, such as washing hands properly and cleaning shared work items before and after use.

Companies should educate employees about protecting themselves and their families. In a pandemic, employees should be prepared to sustain their family at home for two weeks to four weeks by taking such actions as maintaining a sufficient supply of all prescription medication, as well as over-the-counter medication typically used for colds and flu (ibuprofen, acetaminophen, and cough medicine) and stockpiling potable water and nonperishable food items.

Don't Underestimate the Power of Panic

Finally, companies should not underestimate the likelihood of panic. After the September 11 attacks, multiple calls were made reporting unidentified white powdery substances, presumed to be anthrax. The substances triggering the multiple false alarms were actually benign powders, but just the potential of anthrax contamination made people afraid, and panic ensued. The H1N1 virus has already created a certain amount of panic, which will certainly increase if widespread human-to-human transmission occurs. To avoid panic from consuming employees, companies should proactively educate employees by providing open and updated factual information about influenza and its current status.

Update Corporate Travel Policies

In a pandemic, employees may be unwilling or unable to travel overseas, and some may be reluctant to travel at all. Even if employees are willing to travel, restrictions may be imposed on traveling to and from certain areas or countries, and air travel may be significantly reduced. Companies should look into alternatives to face-to-face overseas meetings, such as telephone or video conferencing, and practice using these technologies by hosting monthly meetings to familiarize employees with the process. For those companies with employees continuing to travel, companies should create specific policies for travel, including guidelines to protect employees and to prevent the spread of disease. The policy should address specific action steps before and during travel.

Share Information

Many organizations consider their BCPs confidential; even their own employees are given information on a need-to-know basis. For this group, the thought of sharing critical functions and recovery strategies with other companies is unheard of. But pandemic planning is not like traditional business continuity planning. In fact, one single expertly crafted pandemic plan will not help an organization survive if no one else is prepared.

Pandemics are regional; every organization in the immediate geographical area will experience the same event. Affected companies may have common utility companies; use the same trash collectors, hazardous waste disposal, and cleaning companies; and they all have employees who share public transportation, live in the same towns, have children in the same schools, and use the same residential Internet and telephone providers. Pandemic plans should be shared and resources should be coordinated. Companies will not survive this type of event in a vacuum.

Pandemics are global; every supplier, vendor, contractor, and customer will be hit in a pandemic - regardless of its location. Transportation will be less available because transport companies have employees who will be sick or have to care for sick family members. No one will be immune. Collectively, surviving this type of event facilitates the best possible recovery for each company.

Address Legal Issues

A pandemic may sufficiently disrupt supply chain flow to force a company to renege on existing contracts. While many contracts have an "Act of God" provision, it would be up to the company to argue whether the event - a pandemic - was unforeseen. Given the publicity of the pandemic potential, unforeseeability could be a difficult position to take; adding a pandemic clause would eliminate this need. Other contractual issues may arise from canceling contracts due to late payment.

Companies should review contracts with their legal departments to determine how services and payments will continue if a customer, vendor, or supplier is unable to meet its obligations due to a pandemic and identify alternates for critical single-source suppliers in the event such suppliers are unable to meet their obligations.

Address Insurance Issues

Issues may arise with insurance policies, such as workers' compensation, general liability, and directors' and officers' liability regarding coverage and covered acts should a pandemic arise. Workers' compensation coverage may be in question for those employees alleging the virus was transmitted at work. Potential liability may exist if the virus is spread as the result of negligent acts. Ill-prepared companies that suffer a dramatic drop in stock price may face shareholder lawsuits over failure to adequately prepare for a pandemic. Companies should check with their insurers and brokers to determine how coverage will be determined in a pandemic.

Still Not Enough?

With significant absenteeism, even the most prepared company is going to suffer some disruption if a pandemic hits. Companies should know that their entire plan may not work as expected and their recovery might not be as timely as it would if the plan functioned correctly. In order to plan for such circumstances, the company should be prepared to devote resources to protect the truly essential functions, go without others for as long as possible, and establish an aggressive strategy to resume the less essential operations when each wave of the crisis is over.

To protect a company's reputation and overall survivability, the ability to manage a crisis is more important than the crisis itself. Protecting vital business operations is the best way to manage any crisis.

The Sky Is Falling? What If It Isn't?

"It's not if a pandemic will hit; but when" has been repeatedly quoted. But what happens if the pandemic does not happen? Will all of this planning be for nothing? No. A pandemic represents a new, emerging type of threat that requires organizations to consider different and more thorough recovery strategies. However, it is not just the "influenza virus" we are preparing for but any threat that reduces a significant percentage of the available labor pool, affects an entire region, or disrupts an entire supply chain. If we are prepared for a pandemic, which disrupts all of these, we are far better prepared for an event that disrupts only one. And in the end, companies will have a more robust contingency plan and resilient organization.

Michelle Cross, Senior Vice President, Risk Consulting, Wells Fargo Insurance Services contributed largely to this article. For additional information on pandemic or business continuity consulting services, please contact her at michelle_cross@wellsfargois.com or 617-204-2529. Additional references on pandemic can be found at the following websites: Centers for Disease Control and Prevention (CDC) http://www.cdc.gov, http://www.cdc.gov/swineflu, World Health Organization, http://www.who.int/csr/disease/swineflu/en/index.html and U.S. Department of Health and Human Services, http://www.pandemicflu.gov

Richard Dahm, Jr. is senior risk consultant for the National Hospitality Division of Wells Fargo Insurance Services, Clearwater, Florida. His expertise includes property, restaurant/hotel facilities, and risk management. He holds a BA in management from Eckerd College and an MBA from DeVry University. Richard is a member of the Florida Restaurant and Lodging Association. Mr. Dahm's knowledge, coupled with his professional staff of claims, safety, and marketing professionals enables him to provide hospitality executives with consultation that reduces insurance risks and premiums. Mr. Dahm can be contacted at 800-282-3343 Ext: 5436 or Richard.Dahm@wellsfargo.com Extended Bio...

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