Pandemic Flu: Critical Infrastructure Management

From experts to laypersons, no one knows whether the Avian (bird) Flu will be will be the next disaster. New reports consistently state it will be the next major worldwide health concern for the following decade. In my opinion, fire and EMS personnel are a force in place for any type of calamity, and we need to prepare ourselves to answer the call. This article will help give you some basic talking points on what to prepare for in the event of a pandemic flu. It will also offer some guidance to discuss critical infrastructure concerns to stakeholders in your community.

Introduction

The next pandemic flu would impact the world population because it will be a strain of flu which humans have not been exposed to. It may be the "bird flu," or some other strain that mutates from bird to human. Here is a quick review on how the current avian flu would mutate.

The virus is currently in parts of the bird population. The current virus exists primarily in birds in Asia, Europe, and Africa. The virus has been reported to occur in some mammals throughout these areas as well. It has mutated to infect certain mammals, including cases involving humans. However, the virus has not yet mutated to be transmitted from human to human. Once this occurs, the potential for a widespread pandemic flu would be very likely.

Since the human population will have no natural immunity to this virus, the disease will be able to rapidly spread. Conservative estimations feel that 15-40% of the population will become either ill, or unable to work. Those in Fire/EMS will be faced with unprecedented numbers of ill patients, and will be required to staff crews while facing the same rates of illness within their own organization.

What the experts are saying

Dr. Michael T. Osterholm of the Center for Infectious Disease Research and Policy:

"Recent clinical, epidemiological, and laboratory evidence suggests that the impact of a pandemic caused by the current H5N1 strain would be similar to that of the 1918--19 pandemic. More than half of the people killed in that pandemic were 18 to 40 years old and largely healthy. If 1918--19 mortality data are extrapolated to the current U.S. population, 1.7 million people could die, half of them between the ages of 18 and 40. Globally, those same estimates yield 180--360 million deaths, more than five times the cumulative number of documented AIDS deaths." - Foreign Affairs, July/August 2005

He is also famous for his utterance after a press conference when he described our fate if a pandemic were to occur this year: "We're screwed."

Dr. Shigeru Omi, WHO's regional director for the Western Pacific:

"As the new cases of human infection with the H5N1 virus in Turkey show, the situation is worsening with each passing month and the threat of an influenza pandemic is continuing to grow every day." - MSNBC News, January 12, 2006

Dr. Julie Gerberding, Director of the American Center for Disease Control:

"We've probably never been closer to a pandemic than the year in 1917. And so when we see the ominous signs of this very bad virus continuing to propagate there, we do need to take it seriously and solve some of the problems that would be in our way from effective response in the United States." - CBS News, 1 January 2006

Dr. David Nabarro, U.N. system coordinator for avian and human influenza:

"We expect the next influenza pandemic to come at any time now, and it's likely to be caused by a mutant of the virus that is currently causing bird flu in Asia." - Newsday, 28 September 2005

"There are some subtle changes in the genetic makeup of H5N1 which suggest that it is making some of the mutations that would enable it to have a higher likelihood of being able to become a human-to-human transmitted virus" CIDRAP news, Dec 16 2005

"So many people, when I talk to them about getting prepared, seem to imply that we've got months in which to get prepared but I say to them: It may not be months. It could be that we're going to get human-to-human transmission tomorrow so please act as though it's going to start tomorrow. Don't keep putting off the difficult issues." - TodayOnline, Jan 25 2006

Critical Infrastructure

It is important to understand what is meant by the term "Critical Infrastructure." Critical infrastructure are those sectors that provide the production of essential goods and services, interconnectedness and operability, public safety, and security that contribute to a strong national defense and thriving community. When the critical infrastructure is compromised, the welfare and standard of living is greatly impacted.

Some specific areas that make up critical infrastructure are:

• Emergency Services (police, fire, EMS)
• Banking and Financial Services
• Chemical & HazMat Agencies
• Defense
• Water and public works sectors
• Public Health & Healthcare
• Information Technology
• Energy
• Telecommunications
• Postal / Shipping
• Transportation
• Food and Agriculture

Impacts to Critical Infrastructures

One interesting point is that 85% of critical infrastructure resources reside in the private sector. However, private sectors generally lack plans for catastrophic health emergencies such as a pandemic flu. One of the major impacts to both private and public sectors making up critical infrastructures will be derived directly or indirectly from unprecedented rates of absenteeism. Estimated rates of absenteeism range from 15-40%. These rates will be due to sickness, quarantines, travel restrictions, family responsibilities, and fear of contracting disease. With rates of absenteeism across disciplines, there potentially will be a shortage of workers to provide the basic needs for communities.

The Wave Effect

Although it is uncertain exactly how a pandemic flu will manifest itself in the human population, there are some popular beliefs. The typical incubation period for such a flu will be about 2 days. Based on previous studies, on average, an infected person will spread disease to at least 2 other people. In densely populated areas, this would cause a rapid spread of the disease. Epidemics will last 6 to 8 weeks in affected communities, potently depleting reserves of medical supplies.

Multiple waves across the country are likely to occur with each wave lasting 2 to 3 months. These waves may be due to those not infected by the first outbreak becoming contaminated. These waves have been noted before in pandemic flu strains.

Planning

Fire and EMS are key players in preparing sectors of the critical infrastructure to meet the expected demands. Now is an excellent time to offer to speak to business groups on the potential problems they may face, and how to prepare now for such an event. Some recommendations from the Department of Homeland Security include:

• Establish a process for infection control, including offsite work options, and worker education.
• Establish surveillance protocols to monitor the health of employees and potential absentee rates.
• Develop pandemic specific operations plans to maintain critical services despite absenteeism. These could include cross-training of employees in other areas of the operation.
• Monitor international / national pan threat levels.
• Coordinate with officials to share plans, preparation, and response/recovery information.
• Establish partnerships with other members of the sector to provide mutual support and maintain of essential services.

Other Business Considerations

Along with planning, businesses will need to develop written plans for maintaining essential operations and services with 40% absenteeism or when other resources are not available. If they will need specific resources for their operation (i.e. fuel, raw material, chemicals) coordination should begin to develop contingency plans before a pandemic flu impacts those areas.

Dialogue and planning phases need to begin on how to maintain essential operations and services for those periods of 6-8 weeks between waves. Considerations would include ways to lessen the impact as well as how to quickly increase reserves between waves.

Bolstering the depth of reserves for essential workers at all levels will be a critical concern. Possibly developing a dialogue with similar companies or even competing services to share employees as a way to provide services and remain fiscally strong through the waves of illnesses.

Provide delegations of authority and orders of succession planning and workers. Develop, discuss, and test succession plans. These plans need to take into account the absentee rates of 40% and include that rate for senior management and the head of the organization.

Development of a Continuation of Operations Plan

It is important to plan for operations in the event of a pandemic flu. Interestingly, some of the same contingency issues would also be used for any other issue that would stress your system. Remember, your plan needs to prepare for a 40% decrease in your workforce.

Some of the key considerations that should be developed are:

• Identify essential and non-essential department functions and processes for your operation
• Identify positions required to complete essential functions
• Identify and assign key team leads and alternates.
• Document processes and tasks that may need to be altered
• Identify staff that can be crossed-trained to backfill critical functions
• Identify retirees, temporary employees or sub-contractors who could back up essential staff
• Identify critical functions that can be performed via telecommuting from home
• Establish shifts, longer hours of operations, alternate work days, etc
• If necessary, develop plan to isolate and house staff in place to ensure critical functions continue.
• Communications procedure in place to contact staff at home
• Identify methods to limit frequency and type of face-to-face contact (hand¬shaking, seating in meetings, shared workstations, office layout, etc.) among employees and between employees and customers.
• Personal Protective Equipment needs (masks, gloves, anti-bacterial soap)
• Do your supplies have plans in place for a pandemic flu

It is never too early to begin the planning for a pandemic flu. In fact, it is our job to prepare and develop contingency plans in the event a disaster occurs. In a world that can change daily, being a proactive organization is part of the job. Failing to plan when there is no pressure, will ultimately lead to critical failure when the pressure is increased.

Jim's Website Pick
Here is a website that is automatically searching 28,655 news sources worldwide every five minutes for the topic of Bird Flu. I learned of the outbreak in Moscow within 10 minutes of the event hitting the press. Just copy and paste into your web browser:

www.newsnow.co.uk/newsfeed/?name=Bird+Flu

For questions regarding this article or other topics, please contact Jim Sideras through his email address at: sideras@post.harvard.edu.

James Sideras (sa DARE us) is a Division Chief for Sioux Falls Fire Rescue. He is a 22-year veteran of SFFR and a registered nurse with a Masters of Science degree in nursing.

He received the Harvard University Fire Executive Fellowship and has also completed a Human Resources program at Cornell University. Currently in the National Fire Academy's Executive Fire Officer program, he has spoken at several national conferences on emergency medical topics.

Jim is a former intensive care burn nurse and a member of the National Association of EMS Physicians, Sigma Theta Tau International Honor Society of Nursing, the South Dakota Nurses Association and the South Dakota EMT Association.

He is also getting a Masters degree in Administration Studies through the University of South Dakota.