Overview: The risk of a flu pandemic (Summary)

Four months ago, I wrote "Overview: The risk of a flu pandemic" - a long post to serve as a keystone. It was long by necessity, because a pandemic is complicated. You may not have spent the time to read that post. But I want you to get the message. So I've written this "executive summary" of the Overview. I hope it whets your appetite to read the original. You need the information.

 

There's broad consensus among infectious disease researchers that other flu pandemics will happen. One particular subtype of flu now widespread in birds is a prime candidate to develop a human strain. Here's why the experts are especially worried.

Human influenza pandemics are natural events which happen from time to time. A flu pandemic is a global outbreak - a worldwide epidemic - of a new strain of influenza.

Human influenza is caused by human flu viruses - viruses that make humans sick. These are variations of flu viruses found in birds, but they're not the same. "Bird flu" is a disease in birds caused by flu viruses that make birds sick. Since flu viruses mutate, a bird flu virus could develop a variation (strain) that easily passes among people. That new human flu virus - not the original bird flu virus - is what would cause a human flu pandemic. We would catch the flu from each other (not from birds).

Since this human virus would be a new strain, we have no immunity. Therefore, it will make many people sick -- more people sick at once than you've ever seen. (That's a very important point: the widespread scope of illness.)

On rare occasions, a bird flu virus itself can make a few humans sick.

 

Conditions for a Pandemic

For a human flu pandemic to occur, three conditions are required, according to the World Health Organization (WHO):

• A highly virulent flu virus (i.e., it has great ability to cause disease).
• A lack of human immunity to the virus.
• The emergence of a human strain of this new virus (i.e., a strain that's capable of easy, sustained transmission among people instead of among birds).

One particular flu virus - known as "Influenza A (H5N1)" - currently meets the first two pandemic requirements above, but not the third.

However, H5N1 is of great concern because (1) it's causing unprecedented disease in birds, (2) in limited instances, it has jumped the "species barrier" and infected humans, and (3) it could develop a human strain of flu. When a new human flu emerges, it probably cannot be contained and eradicated.

 

High risk characteristics

The next flu pandemic may be the biggest risk the world faces. The typical characteristics explain why:

• A pandemic attacks people, not property. Two corollaries:
1. The effects will be rooted in the impact on people, not in the impact on property. Many people will be removed from their normal roles - either sick, caring for the sick, caring for children during school closures, avoiding possible exposure to the virus, etc. Employee absenteeism, in particular, may cause significant supply problems and economic impacts.
2. Preparations should focus on protecting people. Sample tactics:
• Reduce person-to-person contact.
• Encourage thorough, frequent handwashing.
• Provide sanitizers and germicidals.
• Provide personal protective equipment (e.g., N95 respirators, latex gloves).
• Provide antiviral drugs (where available) to sick or exposed people.
• Provide vaccines (when available).
• Widespread illness - including a rapid surge in the number of cases.
• Pandemics are unpredictable in their severity. However, based upon past pandemics, the U.S. government assumes for planning purposes that 30% of people will get sick.
• Severe disease in age groups who are normally less susceptible - young adults, in particular.
• A large number of deaths.
• A pandemic is global and will rapidly spread to every part of the world. Today’s mobility may accelerate that spread.
• Prolonged duration - maybe a year or two - with possibly debilitating effects on business operations and public morale.
• Multiple waves of outbreaks - likely two or more waves, each lasting weeks.
• Overwhelming impact. By spreading globally in short order, the disease could stress many systems and services.
• In particular, a pandemic will cause a surge in the need for health care. However, our "surge capacity" is limited.
• Limited outside help - because there is no "outside." Unlike local disasters, a pandemic is global. With the same crisis happening everywhere at once, governments and non-government aid agencies will not have enough resources to help everyone.
• Therefore, MUCH depends upon individuals, communities, and businesses making their own preparations.

 

Direct & indirect impacts

During a pandemic, many normal activities may be disrupted by (1) the direct impact of widespread sickness, (2) the indirect impacts from having so many people sick at once, and (3) changes in our activities in order to avoid sickness.

Direct sickness-related impacts. Influenza is very infectious; many people will require medical care. (Therefore, many people will need to administer medical care, including within households.)

Indirect impacts ("ripple effects") resulting from (1) so many people displaced from their normal roles for extended periods and (2) interruptions/failures of "systems" due to inadequate pandemic preparation. Major indirect impacts will include:

• High employee absenteeism. Remember, a pandemic attacks people. Regular business continuity plans usually DO NOT address many of the unique challenges posed when a large number of people are "absent" from their normal roles, perhaps for an extended period. Employee absenteeism may cause disruptions in today's specialized, globalized, just-in-time supply chains ... in service-based businesses ... and in transportation services. These disruptions may, in turn, cause shortages.
• "Social distancing." To reduce the person-to-person contact that can spread a highly infectious disease, social distancing will be encouraged and/or imposed. This may include school closures, daycare center closures, and cancellation of public gatherings and events.

 

Reducing the impacts

How can we dampen the impacts?

Goal #1: Reduce illness

• Don't get sick or make others sick. (If you're sick, stay home!!)
• Businesses, consider ways to distribute or segregate your workforce; internal "social distancing." Include telecommuting.

Goal #2: Delay illness; Slow the spread.

• By slowing the rate of transmission, cases are distributed over a longer period ... which lowers and delays the peak ... which reduces the strain on healthcare and other systems ... and buys time for mitigating actions (e.g., vaccine development).

Goal #3: Be prepared - ready to treat the sick and cope with changes imposed on daily activities.

• How well we prepare will directly influence how well we cope and recover.
• Remember: the needs probably will far exceed government ability. So individual planning and preparation is EXTREMELY IMPORTANT.
• Consider both types of intervention - pharmaceutical and non-pharmaceutical:
• Pharmaceutical.
• There is no cure for influenza.
• While vaccines often can prevent infections, a well-matched flu vaccine can only be made after the pandemic strain is known. Even then, vaccine manufacturing capacity is limited. (Annual flu vaccine - used to prevent existing human flu viruses - will not protect against a new flu virus.)
• Antiviral drugs (e.g., Tamiflu, Relenza) can reduce the length and severity of the flu. Rapid delivery is important.
• Non-pharmaceutical.
• Germ barriers.
• Space; social distancing.
• Personal protective equipment: N95 respirators, latex or nitrile gloves, medical or lab gowns, medical eye protectors/goggles, face shields.
• Germ killers.
• Thorough handwashing.
• Hand sanitizers.
• Germicidal cleaning agents.
• Ultraviolet air sanitizers. [Explained]
• Supplies - Household. Stockpiling can help reduce the spread of a pandemic (by reducing the need to go to the store). [See "'Stockpiling' is not a dirty word."]
• Supplies - Business. Not just supplies for disease prevention among employees, but business operating supplies. Stockpile or pre-arrange reliable delivery of critical parts, ingredients, packaging, office supplies, etc.
• Logistics - Business.
• Forward-thinking companies are "treating a pandemic as a truly catastrophic event versus a 'manageable disruption'." (Marsh)
• REMEMBER: An infectious disease attacks your people, not your buildings and IT networks.
• Identify essential functions and who performs them. Cross-train for coverage.
• During the pandemic, temporarily scale back or discontinue non-critical functions.
• Protect employees from infection.
• Consult suppliers to forestall shortages.
• Consult transportation companies re: inbound/outbound shipping.
• Consider changes in demand for your goods/services that may occur during a pandemic.
• Expand online and self-service options for customers and business partners.
• Review your human resources policies in pertinent areas.
• Review your legal ramifications in pertinent areas.
• Review your business insurance in pertinent areas.
• Implement a communication plan - to all stakeholders; before, during, and after the event. (Start now!) Employees, customers, suppliers, shareholders, community, etc.
• [See also ideas from The Trust for America's Health.]

 

Probability & timing

A pandemic is a "low probability, high impact" event event. NOTE: "Low probability" means "not likely at any given time." It does NOT mean "never happens." (It has happened three times in the last century.) Influenza pandemics are natural, recurring events - but unpredictable in timing. It truly isn't a question of "if," but "when."

• Risk managers know that at some level of impact, the price for being unprepared becomes unacceptably high.

We don't know when the next flu pandemic will begin, how long it will last, how severe it will be, or which flu virus will cause it. We just know it's coming. So, what's your plan?



For more in-depth explanations of the pandemic risk and mitigating plans, read the original version of this post - which discusses:

• Why "bird flu" is not "pandemic flu."
• What it means to say a pandemic is a "low probability, high impact" event.
• More about the H5N1 flu subtype.
• Can a newly emerged human flu be contained?
• Avoiding simplistic assumptions.
• Indirect impacts of pandemics: Economic and daily living.
• Other complicating factors in a modern day pandemic.
• More about Non-pharmaceutical interventions.
• More about Business Logistics.