Surviving the Waves: Critical Infrastructure and H1N1

Jeff Green and Sabrina Malkani, SRA International, Inc.

In April 2009, the world was introduced to a new influenza virus, now called 2009 H1N1 Influenza. Just a few weeks after the introduction, the H1N1 virus was in nearly every corner of the globe. And on June 11, 2009 the World Health Organization (WHO) raised the pandemic alert level to Phase 6, signaling that a global pandemic of 2009 H1N1 flu was underway. Even before the official confirmation of the pandemic, this new H1N1 virus was spreading quickly. While the effects from the first wave of the H1N1 flu this spring in Europe and the United States were, for the most part, moderate, businesses and organizations across the globe should be prepared for a third, and even fourth, wave whose effects could be dramatically more severe.

One key reason that critical infrastructure operators and businesses should be concerned about 2009 H1N1 influenza is that they have a limited ability to maintain operations successfully if a significant portion of their workforce is absent. In a national survey that examined business preparations for a widespread H1N1 influenza outbreak, Harvard School of Public Health researchers found that only one-third of businesses believe they could sustain their business without severe operational problems if half their workforce were absent for two weeks due to H1N1. Only one-fifth believe they could avoid such problems for one month with half their employees.

Since this influenza virus first emerged, critical infrastructure stakeholders in the government and private sector in Europe, the United States, and countries around the world have been working diligently to update their plans to ensure continued provision of services. In boardrooms on both sides of the Atlantic, many companies, especially those involving critical infrastructure, prepared themselves and their employees for just such an event. Now that we are seven months into this pandemic, businesses that developed and exercised plans in advance of a potential pandemic are revising those plans based on what we have learned from the initial wave of H1N1 in the spring and the early indicators gleaned from the first few weeks of this year’s flu season.

Background on 2009 H1N1 Influenza

H1N1 has infected more than 414,000 people worldwide, killing nearly 6,000 people in its wake since April 2009. More than 300 of the deaths have occurred in European Union (EU) and European Free Trade Association (EFTA) countries. After barely a month since the official start of the annual flu season in the Northern Hemisphere, these numbers continue to rise at a disturbing rate of speed. In the U.S, H1N1 has virtually blanketed the country from coast to coast, with 49 out of 50 states reporting cases. The same story is being repeated in Europe as well. Currently, all 27 EU and 4 EFTA countries are reporting cases of 2009 H1N1 influenza. Given that countries are no longer required to test and report individual cases, the number of cases reported understates the actual number of cases.

The official start of flu season in the U.S. was October 4, and the U.S. Centers for Disease Control and Prevention (CDC) is already reporting “unprecedented” flu activity, especially among young children. Similar sentiments are being echoed across Europe, as well. By some estimates, U.S. public health officials are reporting the number of cases in the first month of flu season as matching and exceeding the numbers of cases typically seen between October and February. More troubling, the CDC has called the increased mortality in infants, children, and teenagers “very sobering.” By any measure, this is going to be a long flu season in the U.S., Europe, and around the world.

Based on our experience with prior pandemics, there is a high likelihood it will get worse before it gets better. For example, during the second wave in the fall and winter of 1918, the pandemic was much worse than the first wave earlier that summer, and the third wave in the spring of 1919 was nearly as bad. In fact, the virus actually became more pathogenic as it progressed. Prior to H1N1 and since 1918, we have suffered through two much milder pandemics in the mid-twentieth century. We still have a great deal to learn from each of the three pandemic flu outbreaks of the previous century. Models based on the relatively mild 1957 and 1968 pandemics suggest that as much as one-third of Europe’s population will become ill during this current pandemic. Equally troubling, estimates indicate that up to 15 percent of European workers will be absent from the workplace at the pandemic’s peak. These estimates may be conservative. The European Centre for Disease Prevention and Control, for example, estimated that in the worst-case scenario, the virus would infect up to 30 percent of the EU population during the winter season.

Role of Businesses during a Pandemic

An estimated 25 percent of businesses never reopen in the wake of a major disaster, according to the Institute for Business and Home Safety. With that in mind, it is imperative that the public and private sectors continue preparing for and responding to this second wave of H1N1. They must also continue to prepare for a potentially more severe wave or other natural or man-made disaster in the future. As with any catastrophe, having a contingency and business continuity plan is essential. Businesses that fail to prepare for such a scenario may find themselves without the staff, equipment, or supplies necessary to continue providing essential services. Companies that provide critical infrastructure services, such as power and telecommunications, are especially important, and should plan for continued operations during such a crisis.

The H1N1 virus poses a serious risk to the United Kingdom’s economy and it could reduce the Gross Domestic Product of the U.K. by as much as 3 percent, a recent report from Ernst and Young’s influential ITEM Club found. The report also found that H1N1 could hit the U.K.’s already beleaguered economy hard by stifling demand for things such as travel, retail, and tourism coupled with higher-than-average rates of worker absenteeism. Moreover, the U.K. government has warned that worker absenteeism rates could spike during this second wave, potentially reaching as high as to 27 percent if schools close and employees stay home to look after their children. Worker absenteeism remains the central pandemic-related impact on businesses, which is why keeping healthy employees well and sick employees out of the office is imperative for all businesses. To maintain business continuity, and the operations of critical infrastructure, businesses must reduce the transmission of the H1N1 virus in the workplace.

With these challenges and realities in mind, critical infrastructure owners and operators must take the time to address (and in many cases re-address) pragmatic steps within their own operations. With no effective government-sponsored system to provide predictive information on pandemic influenza, planners in the U.S. and the EU should work together to create redundant capabilities at the local and corporate levels. This means, having the capability to perform critical functions at multiple locations to address jurisdictional variance in disease over time, as well as task-based redundancy within jurisdictions. Knowing that H1N1 is affecting the young adult communities in higher numbers than other populations, planners may want to consider secondary assignees for critical tasks from different age ranges. Planners should also work to monitor absentee rates in the workplace to take mitigating steps appropriately and in a timely fashion.

Public health professionals look at pandemic flu and see a public health emergency. Critical infrastructure protection professionals look at pandemic flu and see the potential for economic calamity. Both views are correct, but both sides must work together to ensure a company is adequately positioned to prepare for, respond to, and recover from the effects H1N1 could generate. In general, businesses and employers play a key role in protecting the health and safety of their employees and, in turn, their employees’ families. Moreover, they play a large role in limiting the negative impact of influenza outbreaks on the society and the economy. Most business planners agree that established mechanisms for tracking the pandemic are not especially useful for business planners interested in maintaining operations. Tracking geographic spread or death is less helpful than a metric of absentee rates. While the effectiveness of this more pragmatic metric is dampened due to regional and community variance in disease rates and severity, this statistic is key in alerting planners to potential disruptions in their operations.

The severity and amount of illness that the 2009 H1N1 virus will cause during the remainder of the 2009-2010 influenza season cannot be predicted with any degree of certainty. As we face the likelihood of a wider H1N1 influenza outbreak, we simply do not know how the virus will continue to evolve. Therefore, employers should develop flexible plans that will allow them to respond to varying levels of severity. Employers should also be prepared to adjust their plans if a potentially more serious outbreak of influenza evolves during the fall and winter months again next year.

Preparedness and Response Recommendations for Businesses and Critical Infrastructure Owners and Operators

For those businesses and organizations in the U.S. and across Europe that did not make pandemic preparedness a high priority, it is not too late. The recommendations below are actions that businesses can take now to protect the health of employees and ensure business continuity:

• Review or develop a flexible pandemic plan, and involve your employees in developing and reviewing your plan.
• Engage local health departments to establish channels of communication and methods for dissemination of local outbreak information.
• Review human resources policies to make sure they are consistent with public health recommendations as well as existing workplace laws.
• Identify essential business functions, essential roles, and critical elements within your supply chain required to maintain business operations. Plan for how your business will operate if there is increased levels of absenteeism or interruptions in the supply chain.
• Develop policies that encourage ill workers to stay home without fear of reprisals.
• Develop flexible policies that allow workers to telework and create leave policies that allow workers to stay home to care for sick family members or care for children if schools and/or childcare programs close.
• Share best practices with other businesses in your community (especially those within your supply chain) to improve response efforts.
• Encourage workers to obtain a seasonal influenza vaccine as well as the 2009 H1N1 vaccine.
• Plan to implement practices to minimize contact between workers through telecommuting and flexible work hours. Exercise your telework plans with your employees to make sure they work properly and are effective.
• Employers should test the effectiveness of their plans by conducting regular exercises.

One useful resource that SRA International developed for the U.S. Department of Homeland Security is The Pandemic Influenza Preparedness, Response, and Recovery Guide for Critical Infrastructure and Key Resources. While U.S.-centric, this guide serves as a practical tool developed for business owner-operators (around the world) and their contingency planners to enhance their pandemic plans. It also introduces a contingency planning process for the pandemic and provides business planners with numerous sector-specific and common pandemic influenza planning variables keyed to escalating disaster phases.

Protecting Employee Health

It is important for employers to educate and train their employees in proper hand-washing hygiene, cough etiquette, and social distancing techniques. Employers should review this list below and encourage employees to practice good health habits that will not only help them protect their own health, but also the health of those around them.

• Stay home if you are sick.
• Wash hands frequently with soap and water for 20 seconds or use an alcohol-based sanitizer.
• Avoid touching your nose, mouth and eyes.
• Cover your coughs and sneezes with a tissue or cough and sneeze into your upper sleeve.
• Wash your hands or use an alcohol-based sanitizer after coughing, sneezing or blowing your nose.
• Keep frequently touched common surfaces clean (e.g., telephones, computer equipment, etc.)
• Try not to use other workers’ phones, desks, offices or other work tools and equipment.
• Maintain a healthy lifestyle.

2009 H1N1 Planning Considerations

The majority of large businesses rely on a global network of essential material and support functions. Businesses should ensure that all essential business partners in the supply chain are equally well prepared for the pandemic. Business planners should also assess the diverse national and international legal and regulatory authorities, issues, and restraints that could affect their business, supply chain, transportation of goods and services, priority for municipal services, and workplace safety issues. Additionally, planners should fully assess the risks, impacts, and implications of pandemic-related disruptions to international production, supply chain, and goods and personnel movement.

Planning efforts need to assess systemic effects (e.g., supply chain impact, just-in-time delivery, warehousing, and logistics) and support the development of contingency plans to address lack of critical services and delivery of essential commodities.

In any pandemic, vaccination with a specific pandemic vaccine is considered one of the most effective countermeasures for protecting individuals. In the EU, the European Commission has granted authorization to three vaccines for 2009 H1N1 influenza, following the recommendation issued by the Committee for Medicinal Products for Human Use (CHMP) at the European Medicines Agency (EMEA). Recently, vaccine production capacity has increased which is a reassuring sign for Europe in terms of potentially having sufficient vaccine available to cover the needs of the population. Ultimately, the decision of who will get the vaccine is the responsibility of the Member States and individual doctors advising patients.

Lack of continuity planning can result in a cascade of failures as employers attempt to address challenges of an influenza outbreak with insufficient resources and workers. The survival of a business depends on the employer’s ability to re-establish critical functions and processes. Depending on the length and severity of an interruption, there may be significant consequences if a business is unable to continue its operations in a timely manner. An all-hazards contingency plan for pandemic influenza will be applicable to any disaster including fires, floods, earthquakes, hurricanes, terrorist attacks, and computer viruses, among other potential catastrophes.

Jeff Green is a Principal and Deputy Director of the Infrastructure Protection and Resiliency Practice at SRA International, Inc. Mr. Green has expertise in pandemic influenza preparedness, infrastructure protection analysis and policy development, communications and outreach strategy, and public-private partnership building.

Sabrina Malkani is a Project Manager within the Infrastructure Protection and Resiliency Practice at SRA International, Inc. Ms. Malkani has expertise in pandemic influenza preparedness, infrastructure protection, bioterrorism preparedness, and public-private partnership building.

Both Mr. Jeff Green and Ms. Sabrina Malkani have been key contributors to the pandemic influenza preparedness efforts of the U.S. Department of Homeland Security (DHS), Partnership and Outreach Division. Mr. Green led the development and writing of the Department's Pandemic Influenza Preparedness, Response, and Recovery Guide for Critical Infrastructure and Key Resources and follow-on Sector-Specific Planning Guidelines. Ms. Malkani has led the DHS H1N1 planning support team responsible for updating the Guide and Sector-Specific Planning Guidelines to account for the emergence of the 2009 H1N1 virus.

SRA International, Inc. provides strategic consulting to federal, state and local governments, as well as the private sector. Some of SRA's principal clients include the Department of Homeland Security and other federal agencies. SRA's strategic consulting services include the spectrum of infrastructure protection and resiliency issues: Preparedness, Vulnerability Reduction, Consequence Mitigation, Response, Recovery, and Reconstitution. This opinion is part of a monthly series pertaining to various experiences with the implementation of infrastructure protection strategies. For more information, please contact Craig Wilson at Craig_Wilson@SRA.com.
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1 European Center for Disease Prevention and Control. Influenza Pandemics: Known Facts and Known Unknowns. May 2009.