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8/13/2007
Patterson - Business Continuity and Avian Flu 1
8/13/2007Patterson - Business Continuity
and Avian Flu 1
Pandemic Influenza - 2007 Business Preparation and Response Plans
David G. Patterson, CPP, PSP, CFE, CHS-III
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and Avian Flu 2
Definitions
• Epidemic: An increase in disease above what is normally expected
• Pandemic: A worldwide epidemic
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and Avian Flu 3
Pandemic History
• 1918-19: 500,000 -650,000 • Ten times as many
Americans died of flu than died in WW I
• 1957-58: 70,000• 1968-69: 40,000• Typical annual
influenza season: 36,000
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What Causes Pandemics?
• Fowl are natural reservoirs of influenza and can spread the virus to other birds
• All human influenza viruses arise from avian viruses
• Avian influenza viruses evolve into new strains capable of infecting humans
• A new avian-derived flu virus that can reproduce and spread in humans leads to a pandemic
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Facts About Pandemics• Influenza pandemics are inevitable:
naturally recur at more-or-less cyclical intervals
• Can cause:• High levels of sickness and death• Drastic disruption of critical services• Severe economic losses
• There can be little warning time between the onset of a pandemic and its arrival in the U.S.
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Facts About Pandemics (2)
• Outbreaks occur simultaneously in many areas
• Impacts will last for weeks to months• Pandemics can disproportionately affect
younger, working-age people• Current avian influenza outbreak in Asia
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Impact on Health Care System• Extreme staffing shortages
• Shortage of beds, facility space
• Shortage of key supplies (ventilators, drugs)
• Hospital morgues, Medical Examiner, and mortuary services overwhelmed
• Extreme demands on social and counseling services
• Demand will outpace supply for months
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Impact on Infrastructure
• Significant disruption of transportation, commerce, utilities, public safety, and communications
• Limited assistance from federal, state, and local governments due to nation-wide impact
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Impact on Businesses
• High absenteeism
• Challenges getting to/from worksite
• Psychological impacts on workforce will be extreme
• Social distancing efforts may dramatically change hours of operation or close businesses temporarily
• Economic losses – small businesses at greatest risk
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Pandemic Preparedness
• Proper organization and coordination
• Surveillance - Recognizing & reporting of cases
• Vaccine and antiviral drug management
• Managing patient care
• Maintaining essential services
• Implementing hygiene & social distancing measures
• Employee education and communication
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Current World Status
• Began in Fall 2003. • At least 319 confirmed
human cases, 192 deaths as of July 25, 2007
• No sustained person-to-person transmission
• Now in WHO Stage 3• Information from World
Health OrganizationAvian influenza
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Potential Impact of Pandemic Flu in the US
• Assumptions• Susceptibility to virus will be universal• Sustained person to person transmission• Attack rate 15% to 40% • Community outbreak will last 6 – 8 weeks• Possibly two waves • Many geographic areas affected at the same
time
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• Up to 200 million people infected
• 40 - 90 million people clinically ill
• 20 - 46 million outpatient medical visits
• 360,000 – 9,000,000 hospitalizations
• 104,000 – 2,000,000 deaths• US losses estimated at $71-
$166 billion
Estimated National Impact
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Treatment and Prevention: Vaccines
• Vaccine takes 6-8 months to produce • Supplies will be limited, if available at all
• Establish priority groups for use of limited vaccine
• 2nd dose after 30 days will likely be required• Need to monitor vaccine safety and efficacy
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Treatment & Prevention: Antiviral Drugs
• Antiviral agents• Effective in preventing illness• Can prevent severe complications • May not be effective against pandemic
virus
• Supplies will be limited• Establish priority groups for use of
available drug• Treatment over prevention
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Business Impact
• People will be seeking information – communication systems may fail
• Key personnel may be unavailable for lengthy periods (permanently in a worst case scenario) – apart from those falling to the disease, many people may choose to stay at home rather than risk exposure
• Offices may be voluntarily closed • Offices may be closed by health authorities • Transport systems may be disrupted • Movement of people may be restricted • Suppliers may be forced to close
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Business Impact (2)
• Customer base may decline as client organizations are forced to close, or people avoid populated environments such as shopping centers
• Panic-based evacuations may be attempted• Crime will increase and law and order will suffer• Litigation may result from claims centered
around air conditioning, duty of care, etc.• Authorities may not be able to cope if numbers
of sick and dying exceed expectations
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Federal Roles & Responsibilities
• Coordinate national Influenza Pandemic Response Planning (IPRP)
• Develop a national information database/exchange clearinghouse and surveillance
• Develop generic guidelines and information templates for modification of pandemic response planning, as needed
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Government’s Actions
• Strategic pillars• Preparedness and communication• Surveillance and detection• Response and containment
• Licensed a pre-pandemic vaccine• Stockpiling antiviral drugs (50 million)• Test exercises for state and local governments• Portable lab tests for speed and accuracy• Improved reporting of cases• Developed H5N1 human vaccine• Stockpiling PPE (Personal Protection Equipment)
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State Roles & Responsibilities
• Maintain surveillance and data management systems to implement the IPRP
• Incorporate the IPRP with the State Health Dept’s existing emergency response plans
• Review and exercise the IPRP on an annual basis
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State Roles & Responsibilities
• Develop and maintain legal documents for volunteer resources, quarantine, etc.
• Coordinate agreements with the state police• Develop a plan to close and reopen schools,
businesses, and other public places/events• Prepare to activate operations for a pandemic
appropriate for the occurring infectious disease
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Local Roles & Responsibilities
• Coordinate security provisions for vaccine, human resources, and clinic locations
• Identify local administrative and medical decision makers
• Develop local preparedness plans that correspond to statewide plans
• Identify local surveillance teams
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Local Roles & Responsibilities (2)
• Meet with local stakeholders and review major elements of local emergency response preparedness
• Modify local Points of Dispensing (POD’s) to account for target groups, projected vaccine supply, and available human resources
• Secure written agreements from hospitals and other community properties that will be utilized to keep & administer vaccines and antivirals
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Local Roles & Responsibilities (3)
• Obtain written commitments from agencies and institutions that will provide volunteers
• Maintain a current plan for local surveillance, medical and emergency response, vaccine & antiviral administration and communications
• Develop a plan utilizing communication templates, in languages common for the area, to educate the public
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Local Roles & Responsibilities (4)
• Communicate with schools, businesses, and other venue for potential closures
• Develop collaborations with adjoining counties, districts, and states
• Conduct local and county exercises and drills annually for an emergency influenza pandemic response.
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Business Role and Responsibilities• Business Preparation Plan
• Establish pandemic management group
• Establish policy• Prioritize business processes• Identify essential employees and
skills• Establish alternate work areas and
employees • Provide for cooperation with local
community• Establish a communication program• Train employees on flu, hygiene,
and prevention• Stock disinfectants, food, water,
gasoline, diesel, anti-virals, and PPE• Establish office disinfecting program
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Business Role and Responsibility
• Business Response Plan• Establish response actions for each organization at each
stage• Establish priorities and actions for each department• Establish actions for employees• Implement employee monitoring and quarantining • Plan must be revised periodically• Plans must be exercised
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Implement Effective Knowledge Management
• Complete a critical records analysis • Provide Standard Operating Procedures• Cross-train key employees• Ensure that skills are distributed across
geographically dispersed branch offices• Implement succession planning • Capture and manage critical information • Off-site storage of copies of all critical
information
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Business Communications
• Ensure that all contact lists are up to date and maintained
• Evaluate all communication options to keep personnel informed (mobile network, 800 number, radio, internet, intranet, etc.)
• Establish means to communicate with suppliers • Establish means to communicate with your customer
base • Establish an authorized and competent team to
communicate with key stakeholders and the media • Consider remotely hosted email and website options• Consider alternate telephone providers for redundant
systems
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Implement Flexible Work Practices
• Establish critical work functions in several offices
• Plan for work from home • Lease remote facilities in safe areas and
relocate personnel • Develop key requirements for each option• Establish secure housing for critical employees
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Transportation
• Restrict travel• Eliminate group
meetings• Contract with a
company to provide private transport for employees
• Establish car pool systems
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Suppliers• Review your supply chain and contact points• Arrange for multiple suppliers • Plan for geographic dispersion • Negotiate where you stand in the “pecking order”• Ensure that your suppliers have effective and
thoroughly tested business continuity plans• Develop receiving and delivery procedures to eliminate
contact
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Customers
• Review your customer base and other income producing opportunities
• Expand upon your existing customer base • Examine distribution and delivery options that reduce the
need for movement of people • Expand to global markets• Diversify your product set• Examine hedging opportunities to spread your risk• Arrange for alternate payment methods to avoid contact• Arrange for other service delivery methods to avoid contact
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Physical Security• Arrange to secure your facilities for short and long term
periods of vacancy• Ensure that your security provider will give you priority if
the security provider receives multiple demands for increased resources
• Consider plans for security of personnel at all times – in the office, traveling between home and office, security at homes
• Consider planning for secure provision of consumer staples: food, drink, essential household items. This could involve bulk purchasing arrangements, escorted shopping groups, etc.
• Identify contacts within the police and emergency services organizations and provide them with a named contact and alternate within your organization to make decisions
• Make sure you understand the plans and limitations of local police and emergency services
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Legal, Regulatory, Insurance
• Carefully examine all aspects of your insurance policies to ensure you are covered for all cases of business cessation including voluntary closure, mandatory closure (emergency services), etc.
• Ensure you are adequately covered for loss of income • Ensure you have liability coverage if employees contract the disease • Ensure that you regularly inspect air conditioning plant and all
shared washroom facilities to guarantee conformance to health standards
• Review OSHA and HIPAA requirements• Review requirements under the Family and Medical Leave Act • Develop backup plan for legal resources• Legal should develop policies and procedures to provide employee
and family death support
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Technology
• Use heat sensors to screen personnel
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Personal Protective Equipment
• Surgical mask or respirator• Disposable gloves • Protective eyewear (i.e.
goggles/visor/shield) • Long-sleeved cuffed gown • Cap (in high-risk situations
where there may be increased aerosols)
• Plastic apron (if splashing of blood, body fluids, excretions or secretions is anticipated)
N-95 Respirator
Surgical Mask
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Individual Employees
• Stay home when sick• Respiratory & hand
hygiene:• Cover your cough/sneezes• Wash hands and/or • Use alcohol hand gel• Avoid touching eyes, nose,
mouth
• Stay informed• Avoid crowds during an
outbreak
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Individual Employees (2)• Store a two week supply of
water and food • Arrange for continuous
supply of prescription drugs • Have supply of vitamins,
nonprescription drugs, and other health supplies
• Plan care for other family members
http://www.pandemicflu.gov/plan/pdf/individuals.pdf
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Conclusion
• Identify your mission critical activities, consider the risks, develop your plans, stock your supplies --- then exercise, exercise, exercise your plans
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More Information About Pandemic Influenza
• Websites• www.pandemicflu.gov – information and federal plan• www.health.state.pa.us – Pennsylvania state plan and
information• www.cdc.gov/flu/avian - Centers for Disease Control• www.aphis.usda.gov/vs/birdbiosecurity - USDA• www.who.int - World Health Organization
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David G. Patterson, CPP,PSP,CFE, CHS-III
The Steele Foundation
415-225-0914
Contact Information