Issue Archive: May/June 2009

Preparing for H1N1

Author: Brian Zawada

At press time, the 2009 H1N1 virus continued to spread worldwide, affecting 33 countries
with more than 6,000 confirmed cases. Thus far, 2009 H1N1 has a relatively low mortality
rate, with symptoms resembling seasonal flu. The World Health Organization (WHO) raised
its alert level to a Phase V, indicating “larger cluster(s) but human-to human spread still
localized, suggesting that the virus is becoming increasingly better adapted to humans, but
may not yet be fully transmissible (substantial pandemic risk)”. As a result, the 2009 H1N1
outbreak is not a pandemic, but it does offer some of the characteristics associated with
such an event.

From an epidemiology perspective, pandemics have a number of characteristics worth

remembering:
• Scope and Geography: A new global viral strain affecting the human population (with the
majority being susceptible), easily spread human to human on two or more continents;
pandemics affect everyone (including healthy adults), not just those normally with weaker
immune systems (i.e. the young and elderly)
• Duration: 18-24 months worldwide
• Waves: 2-3, with a single wave affecting a specific geography for approximately six weeks
• Absenteeism: Higher than normal seasonal flu, with estimates ranging from 10-40 percent
• Stability: Viruses leading to pandemics are often biologically unstable (their structures
change frequently), making it difficult to acquire immunity and manufacture effective
vaccines

So, was this in fact the first wave of a multi-wave public health event? If so, should
organizations around the world view it as a wake-up call, thus affording everyone an
opportunity to fine-tune their business continuity strategies and pandemic preparedness
efforts? Assuming this is the case, what should you focus on during these next few months,
leading up to the traditional seasonal flu season (when the next wave might occur)?

Why Care About Wave 2?

Public health experts (through the media) offered perspectives comparing the 1918
pandemic and the 2009 H1N1 outbreak. The similarities are somewhat remote, but they
include the following:
• A similar viral structure (H1N1), but as public health officials indicate, far different viral
markers influencing transmission and mortality (the 1918 pandemic was strictly avian in
nature)
• A mild, initial wave in the spring
• A proven capability to infect a relative high percentage of young and healthy adults that
come in contact with the disease
Known as the Spanish Flu, the 1918 pandemic killed between twenty and fifty million people
by the time it dissipated in 1919. What scares people the most is that the 1918 outbreak
had a mild spring outbreak (similar to the 2009 H1N1 influenza spring outbreak), then
returned in the fall in a severe second wave that led to millions of deaths worldwide. While
experts believe that this version of the virus is not likely to cause severe illness in the fall,
there is a possibility it may merge with another more virulent strain, resulting in a new virus
that can be easily spread person-to-person.

Although these similarities may spur executive managers to action, it’s important to note
that experts remain unsure how the 1918 virus formed. It’s also important to note that the
2009 H1N1 virus has demonstrated an ability to easily swap out genetic material with other
viruses (which is why it has four separate strains). This could possibly make it easier for it
to mix further with other viruses, which may possibly be more virulent. Overall, a significant
number of unknowns remain. Because the traditional seasonal flu season is imminent in the
southern hemisphere, experts are poised to closely monitor its impact (if any) and how it
might impact the northern hemisphere beginning as early as September.

Preparedness Recommendations

Let’s assume for a moment that the April/May outbreak of H1N1 will reappear later in the
fall as a more virulent strain. Or more generally, it surely can be assumed that a pandemic
will occur at some point in the future, as it has throughout history. Regardless, what should
organizations do to best prepare right now? Based on input from a number of leading
organizations, the following eight issues require management attention prior to the next
public health event.

1. Human Resources Policy Implications

Arguably the most discussed issue associated with 2009 H1N1 thus far is the
adequacy of human resources policies. Over the past few years, many organizations
that proactively planned for a pandemic evaluated their then current-state policies to
better understand the implications associated with prolonged absenteeism (and the
effect on continued employment, benefits and payroll), caring for sick family
members, travel restrictions, on-site quarantine and demanding employees stay
home (if they are sick or exposed to someone who is sick). Some of these
organizations made amendments to their policies, whereas others made policy
addendums but held them in reserve until an event triggered their need (one such
trigger being a World Health Organization move to a Phase IV or Phase V).

Human resources policy implications are a tough issue—but one that shouldn’t be
ignored due to complexity. Now that management isn’t under the gun to make a
decision in the middle of crisis, engage your leadership team in thinking through the
effects of a prolonged pandemic and the effect on the employee relationship. The
issues mentioned above should be viewed as key topics to engage your leadership
team, which may result in value-added discussions and possibly policy amendments.
In addition, proactively addressing these concerns will give your organization time to
consider any legal repercussions associated with any proposed strategies to ensure
these strategies are implemented appropriately.

2. Personnel Single Points of Failure Analysis

This recommendation may seem obvious, but many organizations haven’t taken the
time to identify critical roles and where single points of failure may exist (or maybe
 where only two or three people have the knowledge and experience to perform a
critical role). Taking this one step further, the 2009 H1N1 event taught many
planners to assess the impact of school or day care closures on critical roles, and if a
business continuity risk exists due to family priorities.

For organizational activities that must continue, carefully identify these roles that
must be staffed and the skill level/experience necessary to perform these activities.
Identify contingent staffing sources for roles with minimal day-to-day staffing
(internally or externally within the organization) or initiate cross-training.

3. Supply Chain Assessment

A common topic of discussion over the past few weeks amongst crisis management
was the adequacy of inventory levels during a pandemic, specifically if the
organization’s supply chain would be able to meet demand changes, and if key
suppliers were adequately prepared for a pandemic.

Consider engaging your key suppliers in a dialogue regarding preparedness,

expectations and capabilities. Try to avoid the mass questionnaire; instead, engage
in verbal dialogue to enable two-way expectations management and business
continuity capability improvement.

4. Stockpiling Resources

This issue may not apply to all organizations, but a good number of executive
managers made the decision to acquire antibacterial solutions, enhanced cleaning
products, masks, gloves and even antivirals, only to find they were unavailable or
back-ordered.

If these resources are important as a method of controlling fear or encouraging

employees to remain at work, consider carefully and prudently investing in resources
in advance of a Phase IV, V or VI declaration.

5. Product/Service Demand Preparations

In most organizations, the 2009 H1N1 incident may not have resulted in significant
changes in demand for your products or services. In the event of a pandemic with
significant societal disruption and fear, many organizations can expect to experience
shifts in demand—some less, some much more.

As part of your pandemic preparedness initiative, consider engaging the operational

elements of your organization, and assess the effect of a pandemic on demand. This
analysis will help focus staff scheduling on the most important elements of the
organization, as well as ensure those same organizational activities have the right
resources to meet realistic customer expectations.

6. Work From Home Viability Analysis

Some organizations made the assumption that many of their people could work from
home in the event of a pandemic, beginning when the WHO moved the alert level to
Phase V or VI. These same organizations began working to implement such
strategies, only to find designated employees did not have the resources or access to
perform essential tasks at home.
 If work from home is a part of your organization’s strategy, evaluate resource needs
and capacity constraints, in particular remote access availability. Exercise this
capability to ensure this is a strategy that management can rely on.

7. Prepare Leadership to Make Decisions

A common issue discussed amongst business continuity professionals is how their

crisis management teams were ill-prepared to address a public health event. These
teams were comfortable in dealing with a lost supplier or a facility issue, but they
disagreed and failed to fully understand the implications associated with a pandemic.

Consider delivering hands-on training to your crisis management team and other
executive managers, and offer a table-top session that enables participants to
explore the tough issues associated with absenteeism, supply chain disruption,
changes in product/service demand and communications.

8. Prepare to Communicate

Odds are, your organization experienced this - a customer called or emailed asking
for a 24-hour turnaround response regarding your pandemic preparedness status.
Through no fault of their own, the sales, operations and marketing organizations
each sent out various summaries of your organization’s capability. Unfortunately,
many were incomplete, inaccurate or introduced legal risk.

Take this opportunity to preplan internal and external communications in order to

create awareness amongst your employees, business partners and customers,
providing them assurance regarding the time and resources invested to mitigate the
threat of absenteeism. In addition, provide guidance internally to ensure crisis
communications messaging comes from one source, with statements authorized by
the Crisis Management Team.

The future impact associated with 2009 H1N1 is purely speculative. Waves, the total
number of cases, mortality rates, the availability of an effective vaccine, antiviral stock
and above all, population fear and government reaction are all unknown. Yes, the most
severe pandemic will cause significant societal breakdown, but public and private
organizations can take action to blunt some of the effects. Everyone has a responsibility
to perform activities deemed prudent and realistic, with the goal of offering as safe a
workplace as possible, thus continuing the delivery of essential products and services.
Overall, any business continuity practitioners offered an opportunity to improve business
continuity and pandemic preparedness strategies in preparation for “Wave Two” (if it
occurs) should consider the points raised here to improve their organization’s
preparedness for any widespread public health event.