An Avian Flu Pandemic: Much ado about nothing?

October 9, 2006

It’s reasonable to assume that an avian flu pandemic could take flight in the near future, and companies need to prepare a response, according to Rick Casse, former director of business continuity planning for Gap Inc. Keeping that in mind, Casse, who was the keynote speaker at the Golden Gate Chapter of the Risk and Insurance Management Society meeting in September, discussed how to prepare for that threat.

Understanding Influenzas

According to Casse, the influenza that could become a human pandemic is H5N1, a bird flu strain. The concern occurs when the bird virus jumps from the bird population to the human population.

“There’s a big reservoir of viruses out there in the wild bird populations,” he said. “Sometimes when those viruses get from the wild bird population into domestic poultry, you see the die-offs that we’ve already seen … that’s been affecting the world.”

Of the 1,100 or so human pathogens that people are subject to, about 700 of those originated in animals, Casse added. “We’re part of a long chain where viruses start in this case in bird populations and then move into human populations.”

Viruses can change internally, he said, creating new strains against which humans have no immunity. If that happens, a worldwide pandemic could spread from person to person and cause much death.

Casse said there have been three major pandemics in the 20th century. The one most similar to today’s potential avian flu pandemic is the Spanish Flu of 1918, which killed an estimated 40 million to 50 million people based on World Health Organization statistics. For comparison, Casse said about 700 people died from the SARS outbreak in 2003.

Every year, approximately 36,000 people die from the seasonal flu, typically the elderly, infirm or very young. The concern, with an avian flu pandemic, however, is that people with weaker immune systems are not the ones dying from the disease, Casse said.

“Today’s H5N1 virus has been killing healthy people as opposed to the seasonal flu, which typically affects people with weakened immune systems,” he said. “Some theories … are that people’s immune systems are causing the fatalities because of an overreaction to the virus.”

Pandemic potential

The first outbreaks of human cases of H5N1 were in Hong Kong in 1997. “So why do we think it’s a threat and not just Y2K all over again?” Casse asked. It wasn’t until last year that the virus really got into the wild bird population and began spreading rapidly across the globe, he explained. “Now, we have increased the exposure of people to the existing virus and multiplied it multiple times.”

The virus now is widespread throughout wild and domestic bird populations in Southeast Asia, Europe and Africa, Casse said. Cases have not yet been confirmed in North or South America. However, the virus is spreading from birds to manuals, indicating that it is mutating. Last year, the entire cat population at the Bangkok Zoo died of H5N1, Casse said.

“It’s those potential mutations to the virus that make it more easily transmitted among people and create some of the risk of a pandemic,” Casse said.

Ten countries have confirmed cases in which humans have been infected with today’s version of H5N1 and people have died.

“To highlight why The Gap has taken this seriously, of those 10 countries, we do business in six of them,” Casse said. “So it became very high on our radar.”

Furthermore, there’s no H5N1 vaccine available. China has announced that it is ready to begin vaccine trials, but no one knows if that vaccine will be effective if and when the virus mutates into a human virus, he said.

“Every virologist that you talk to is very concerned,” Casse said.

Protecting businesses

Look at 1918 data, Casse said the Spanish Flu outbreak began in military camps in the United States. In less than four weeks, the virus was completely across the country — “and that was an era without air travel,” he noted.

“There’s a prediction that if [a pandemic] lands in San Francisco on Monday, it will be in New York by Friday. There is not going to be much warning. It will be worldwide … When it will peak is partially going to be determined by the public health response to it,” Casse said.

Health officials predict that a pandemic could make between 25 percent and 35 percent of the population ill at one time, and there will be waves of sick people. “How many folks are going to need care from one of their loved ones who may be unable to go to work? How many of them are going to be children who can’t go to school and are going to require some childcare? The business impact of that kind of absenteeism is significant,” Casse said.

Consequently, businesses need to create a plan that takes into account a severe illness that could go on for 12 to 18 months, he said, and could affect the worker population, customers and suppliers.

“The CDC said if 1918 happens again — a pandemic on that scale with today’s population — almost 10 million people will be looking for hospitalization. How many of you think our hospitals today can absorb another 10 million people?” Casse asked.

Thus, businesses’ and the public’s ability to stop the virus from spreading and to take care of themselves will play a big role in containing the pandemic. If a pandemic occurs, there will be social and economic disruption. People aren’t going to want to go shopping or to public gatherings. People also may be restricted by local health authorities’ requirements.

“I’ve heard one person state that it’s going to be worse than the Great Depression,” Casse said. “I’ve heard others say our economy is resilient.” The International Monetary Fund has a report that indicates the impact will be sharp and severe for a short period, and then the economy will recover relatively quickly.

The good news, Casse added, is that as the potential avian flu virus works its way through community immunity levels, the impact will begin to die down. “It will eventually evolve into what’s going to become our seasonal virus and go forward,” he said.

Halting an outbreak

Yet until that happens, it’s important for businesses and the public to create a pandemic preparedness plan.

So how do you reduce the risk?

“Respiratory etiquette is key,” Casse said.

The most common way we pick up respiratory diseases is hand to mouth, hand to nose, he said. The viral particles are typically carried in droplets, so they can stay on a surface if someone sneezes and remain alive for two to three days, depending on the surface.

With SARS, much of their precautionary actions were taken around identifying sick people, Casse said. But unlike SARS where one of the symptoms was high fever, with the flu, that’s not the case. “You may be infectious before you’re showing symptoms,” he said. “If nothing else, remember to wash your hands.”

Social distancing also can help. That could be as simple as spreading out in a room so that employees are more than three feet from each other. That also could mean not having face-to-face meetings or not shaking hands.

“SARS was a great lesson because [public health responses] worked,” Casse said. The outbreak occurred in Hong Kong and quickly went to Toronto, but health authorities were able to quickly squelch the outbreak, he said. “There was a localized impact to those areas and businesses, but it never got out of hand.”

Surgical masks and Lysol are good at preventing spread of the disease. “Surgical masks are cleary not effective in preventing infection, but they do have a barrier benefit,” Casse said. Hand sanitizers also help. However, Casse said gloves are not part of the Gap’s pandemic plan because the flu is not a blood borne pathogen.

With respect to business operations, Casse said to keep in mind that outbreaks will be a global event. Most plans are based on loss infrastructure; if you lose a facility you go to your alternate site. “That may not be applicable here,” he said. “This is a disaster that impacts your workplace, and potentially your customers and suppliers. The need for cash might be greatly increased,” he said.

“Most businesses would have a tough time accommodating an absenteeism rate of 50 percent,” he said. But he said scientists predict it will take six to 12 months for the first batches of a vaccine to get to market, and those will be rationed, so employees will not have access to vaccines right away. Additionally, public service agencies are going to be dealing with absenteeism as well.

“If a car runs into your power pole, what if they can’t repair it for a week?” he asked “There are lots of considerations that need to be put into your plan. Are you going to pay people for 12 months if they decide they can’t work because their child can’t go to school?”

When putting together a business plan, Casse said to consider whether the company’s infrastructure can support a work from home strategy? “Can the telephone and cable companies support the number of people who plan to work from home?” he asked.

He also suggested companies assess who are essential employees who will not be able to work from home, such as network administrators. “How do you provide support [for them] when there’s an impact of this extent?”

Businesses should consider whether there is a technology solution, such as video conferencing to minimize face-to-face contact, Casse said. Companies may need to allow people to work different shifts and strategize for each workplace. Communication is key, he said.

Finally, Casse noted, people need to know how to take care of themselves and their families. “Pandemics happen. What we don’t know is when it’s going to happen and how bad it’s going to be,” he said.

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Insurance Journal West October 9, 2006
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