Business planning for flu pandemic

[Guest guest]

Planning for the Next Disaster: Pandemic by Doug Gale

The experts tell us that a pandemic is inevitable. The only question

is when it will happen. Is your organization ready? Can you keep

essential IT functions running? What can you do to be prepared?

In the 1918-1919 influenza pandemic, somewhere between 30 million and

50 million people died worldwide. In the United States, an estimated

675,000 died, and the mortality rate was 2.5 percent. Health services

were overwhelmed as people sought medical treatment. Absenteeism

surged, interrupting essential services, such as law enforcement,

transportation, and communications.

But that was then; this is now. Surely we are better prepared to deal

with a flu bug with all our modern medical technology--or maybe not.

The influenza virus spreads very rapidly by coughing or sneezing, and

infected people can share the virus before symptoms appear. Although

the migration from small family farms to cities had begun, in 1918

roughly one out of every two Americans still lived in a rural

location. Few Americans owned cars, and travel was relatively limited,

further slowing the spread of the virus.

Today's world is based on closely interrelated and interdependent

systems of trade and commerce. According to Ken McGee, Gartner Inc.

vice president and research fellow, 8 percent of the human race, about

500 million people, cross national borders every year. That translates

to a staggering 1.4 million people crossing a national border every

day! McGee further warns that if the pandemic spreads across the globe

as quickly as some experts predict, worldwide social and economic

disruptions will follow as governments across the globe enact

quarantines that could last one to 12 weeks.

A Pandemic Influenza Primer

Influenza is viral illness; it becomes pandemic when it is found in a

large part of the population and affects people in many different

countries. According to the World Health Organization, an influenza

pandemic can start when three conditions are met:

1. A new influenza virus subtype emerges for which the human immune

system has no pre-existing immunity;

2. The virus causes serious illness in humans; and

3. The new virus spreads easily between humans by coughing and

sneezing.

There have been at least three influenza pandemics in the last

century: the " Spanish influenza " in 1918, the " Asian influenza " in

1957, and the " Hong Kong influenza " in 1968.

Bird Flu

While the origins of these pandemics remains uncertain, at least two

are thought to have arisen either when an avian (bird) influenza virus

mutated or when avian and human viruses exchange genetic material.

Concern about a new influenza pandemic is based upon the emergence in

1996 of a new strain of avian influenza, H5N1, in Guangdong Province,

China. The virus quickly spread, and, to date, more than 200 million

domestic birds have died or been killed in an effort to halt the

disease. Fortunately, although there have been hundreds of documented

human infections with a 60 percent mortality rate, H5N1 is not easily

transmitted from human to human. So far human cases have been largely

confined to individuals who worked closely with infected poultry.

In short, H5N1 meets two of the World Health Organization's conditions

for a pandemic. All it lacks is the ability to spread easily between

humans.

How Probable Is an Influenza Pandemic?

After a surge of publicity in 2006, avian flu has largely dropped out

of the news. That does not mean, however, that the threat has gone

away. New avian flu outbreaks continue although the mutation that

would support human-to-human transmission has yet to occur. (See for

example, www.who.int/csr/don/2008_01_03/en/index.html.)

With the H5N1 virus now firmly entrenched throughout the world, the

probability of human cases has increased. Each additional human case

gives the virus an opportunity to improve its transmissibility in

humans and develop into a pandemic strain.

While they are careful to point out that the timing and severity of

the next pandemic cannot be predicted, many scientists believe it is a

matter of time until the next influenza pandemic occurs.

What Would a Pandemic Mean to My Institution?

During past pandemics, attack rates reached 25 percent to 35 percent

of the total population. Under the best circumstances, assuming that

the new virus causes mild disease, the world could still experience an

estimated 2 million to 7.4 million deaths based on data from the 1957

pandemic.

In short, a pandemic would mean many (if not most) employees would not

show up for work either because they are sick, are caring for sick

family members, or are staying at home to avoid infection.

What Can My Organization Do About It?

While drug companies push antiviral immunizations as the cornerstone

of a pandemic plan, the article " Strategies for mitigating an

influenza pandemic " which appeared in the scientific magazine Nature

(Nature 442, 448-452, 27 July 2006) argues that influenza prevention

and containment strategies can be considered under the broad

categories of antiviral, vaccine, and non-pharmaceutical (case

isolation, household quarantine, school or workplace closure,

restrictions on travel).

Unfortunately, although clinical trials are underway, vaccines

effective against a pandemic virus are not yet generally available.

Similarly, although several antiviral drugs that can reduce the

severity and duration of seasonal influenza may be effective in

treating pandemic influenza, they must be administered within 48 hours

of the onset of symptoms. Finally, virus specific vaccines and

antiviral drugs are difficult to develop, test, and stockpile until

after the new viral strain has emerged. And time won't be on our side.

That leaves us with non-pharmaceutical strategies--ones that my

mother, who was a rural health nurse in the 1930s, would recognize.

Based on extensive mathematical modeling using the United States and

Great Britain, the Nature article concluded:

* Border restrictions and/or internal travel restrictions are

unlikely to delay spread by more than two to three weeks unless more

than 99 percent effective;

* School closure during the peak of a pandemic can reduce peak

attack rates by up to 40 percent, but has little impact on overall

attack rates;

* Case isolation or household quarantine could have a significant

impact, if feasible;

* Treatment of clinical cases can reduce transmission, but only if

antivirals are given within a day of symptoms starting;

* Given enough drugs for 50 percent of the population,

household-based prophylaxis coupled with reactive school closure could

reduce clinical attack rates by 40 percent to 50 percent.

Whoa, hold it partner. Let's go back to that third bullet. The

Internet allows us to effectively work from home! The challenge to us

IT folks then becomes making sure that the network and mission

critical systems remain up and running--and that is something we know

how to do!

A Very Short Institutional Quiz

Does your institution have a business continuity plan and process that

specifically addresses a pandemic? According to Gartner's McGee,

business continuity plans that do not specifically address pandemics

will not be effective.

Does your IT organization have a business continuity plan and process

that specifically addresses a pandemic? One the most effective

strategies to prevent the spread of infection is working online from

home--and that is something IT can plan for. This can be done even if

your institution does not have an institution-wide plan.

Have you tested your plan? For example, in the case of working from

home, how about a planned surprise exercise in which all employees are

directed not to show up for work in their office but to work from home

for a day.

Where Can You Learn More?

Fortunately, there is a wealth of background material, planning

documents, guidelines, and white papers available to help in

developing an institutional or departmental strategy. Some of my

favorite government sites are:

* U.S. Department of Health & Human Services Pandemic Influenza Plan

* U.S. Government General Site includes background material and

planning checklists

* State of Pennsylvania Checklist

* World Health Organization Avian Flu Site

* WHO Ten Things You Should Know

Although you have to be careful to consider what they might be trying

to sell, a number of vendor sites are useful:

Some practical tips for remote access strategies

Roche (Maker of an Antiviral) Toolkit

Sun Microsystems

Finally, a number of higher education organizations have taken the

lead in planning for a pandemic. Be sure to check out:

* University of California Emergency Management and an

Emergency Management Case Study

* University of Minnesota

* Loyola University Chicago

* University of California San Marcos

* University of Nebraska Pandemic Planning Template

* Planning for Certain High Risk Security Incidents

About the author: Doug Gale is president of Information Technology

Associates LLC (http://www.itassociates.org), an IT consultancy

specializing in higher education. He has more than 30 years of

experience in higher education as a faculty member, CIO, and research

administrator. He can be reached at dgale@....

Cite this Site

Doug Gale, " Planning for the Next Disaster: Pandemic, " T.H.E. Journal,

1/7/2008, http://www.thejournal.com/articles/21788