Pandemic planning: a business angle...Risk identification, assessment and control Education and...

2008 EPICC Forum, Richmond, B.C.

Andrew Wilson, WorkSafeBC. 1

Pandemic Planning: a business angleEPICC Forum 2008

Andrew Wilson, WorkSafeBC

2008-02-27: 2

WorkSafeBC - who are we?

BC’s statutory Workers’ Compensation agency.

Our mandate is to serve the workers and employers of BC by acting as both insurance company and OSH agency

We work to keep workers and workplaces safe and secure from injury, illness, and disease. Including our own.



2008-02-27: 3

Some 2006 numbers

Serve 188,000 employers, 2.2 million workers.

173,014 injuries reported 131,118 claims.

20,000+ phone calls per day.

15,000+ documents per day.

2.7 million days of work lost to injuries.

$1.125 billion paid out in claim costs.

2008-02-27: 4

Are we “due” an influenza pandemic?

Earliest documented influenza pandemic circa 1500s. Some indicators for 412BC.

They seem to occur about 3 per century.

18th Century: 1729, 1732, 1781.

19th Century: 1830, 1833, 1847?, 1888.

20th Century: 1918, 1957, 1968.

21st Century: ?



2008-02-27: 5

Prevalence 2003-2008As of 2008-02-06

2008-02-27: 6

H5N1 Country Infections (Current Outbreak)

0

20

40

60

80

100

120

140

160

180

Dec

-03.

Feb-

04.

Apr

-04.

Jun-

04.

Aug

-04.

Oct

-04.

Dec

-04.

Feb-

05.

Apr

-05.

Jun-

05.

Aug

-05.

Oct

-05.

Dec

-05.

Feb-

06.

Apr

-06.

Jun-

06.

Aug

-06.

Oct

-06.

Dec

-06.

Feb-

07.

Apr

-07.

Jun-

07.

Aug

-07.

Oct

-07.

Dec

-07.

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%Estimated country count Global population % in infected countries

As of 2008-01-28

Source: http://www.oie.int/eng/info_ev/en_AI_factoids_H5N1_Timeline.htm

Note: data drawn from OIE but is approximate due to delayed/missing outbreak status reports from counties.

6.6 billion



2008-02-27: 7

Quarterly cases: 2005 - present

0

5

10

15

20

25

30

35

40

45

50

Winter'05

Spring'05

Summer'05

Fall '05 Winter'06

Spring'06

Summer'06

Fall '06 Winter'07

Spring'07

Summer'07

Fall '07 Winter'08

0

5

10

15

20

25

30

35

40

45

50Died Recovered Cases

Note: data drawn from WHO but is approximate due to delays in laboratory confirmations.As of 2008-02-22

2008-02-27: 8

Why worry…

“Once a fully contagious virus emerges, its global spread is considered inevitable.”

“…a substantial percentage of the world’s population will require some form of medical care.”

Source: WHO, Ten things you need to know about pandemic influenza. Source link.



2008-02-27: 9

Why worry…

“More than a fifth of firms do not have sufficient working capital in place to enable them to survive an outbreak of avian 'flu lasting 12 weeks”

22% unable to operate if 30% - 40% staff unavailable.

40% unable to operate if 30% - 50% of staff unavailable.

Source: London Chamber of Commerce & Industry, April 2006. Source link.

2008-02-27: 10

Threats to business

Can I sell my “stuff”?

Can I get what I need?

Do I have staff?- Lean & Mean- SPOFs- Caregivers



2008-02-27: 11

Staffing levels

Unless mortality rate catastrophic, issue is nothow many people die.

Critical questions are:infection rateduration of recovery/quarantine periodworried welldependents factor

2008-02-27: 12

The “Willing & Able” to work

Difficult to assess.

A couple of recent studies in the health care field.

New York health care workers during 2005 by Qureshi et al.Maryland health departments during 2005 by Balicer et al



2008-02-27: 13

Willing to work? (Qureshi et al, 2005)

WillingNot sure

Not willing

62%

23%

15%

Smallpox

57%25%

18%

Radiation

48%30%

22%

SARS

6%9%

85%

MCI

2008-02-27: 14

More general study (Balicer et al, 2006)

Study of health department workers. i.e. both “clinical” and “technical and support” staff.

“…nearly half of workers likely not to report…”“…perception of the importance of one’s role…single most influential factor…[on] willingness to report”

almost 75% of technical/support workers don’t expect to be asked to work.



2008-02-27: 15

General public survey (Harvard, Oct. 2006)

60% of those families with child 0-17 would need one employed adult to remain home if school/day-care closed.

Expecting to have a serious money problem if had to miss work for:

7-10 days - 25%1 month - 57%3 months - 76%

Source: Harvard School of Public Health, Pandemic Influenza Survey, 2006

2008-02-27: 16

Lessons

Communicate!Workforce preparednessCrisis counsellingFamily preparedness

Expect “healthy absenteeism”.

Prepare to redeploy staff.



2008-02-27: 17

Organisation’s bottom line…

“It’s the people, stupid!”

What are your critical processes?

Who are your critical resources?

What are your dependencies?

Activity here is “A Good Thing” and will pay off in other areas.

2008-02-27: 18

WorkSafeBC, the employer…

Infection control

Communication

Staff policies

Environment scanning

Business Continuity Plans



2008-02-27: 19

WorkSafeBC, the regulator…

Liaison with external agenciese.g. BC CDC, BC Gov., Council of Canadian Academies

Creation & enforcement ofRegulations

Creation ofGuidelines

2008-02-27: 20

Statutory requirements

Workers Compensation Act: General Duties

§115(1): Every employer must ensure the health and safety of all workers working for that employer… and any other workers present…

§116(1): Every worker must take reasonable care to protect… [the worker and other persons]…



2008-02-27: 21

Regulatory requirements: ECP

§6.34 Biohazardous Materials: Exposure Control Plan

“The employer must develop and implement an Exposure Control Plan meeting the requirements of §5.54, if a worker has or may have occupational exposure to a bloodborne pathogen, or to other biohazardous material as specified by the Board.”

The virus that causes pandemic influenza would be specified by WorkSafeBC as a “biohazardous material” and employers will be required to implement Exposure Control Plans.

http://www2.worksafebc.com/publications/OHSRegulation/Part6.asp#SectionNumber:6.34

EFFECTIVE2008-02-01

2008-02-27: 22

Regulatory requirements: ECP

§5.54 Chemical and Biological Substances: Exposure Control Plan

Statement of purpose and responsibilitiesRisk identification, assessment and controlEducation and trainingWritten work procedures, when requiredHygiene facilities and decontamination procedures, when requiredHealth monitoring, when requiredDocumentation, when required

Plan must be reviewed at least annually, in consultation with the joint OHS committee or worker OHS representative.

http://www2.worksafebc.com/publications/OHSRegulation/Part5.asp#SectionNumber:5.54



2008-02-27: 23

OHS Guidelines

Not regulatory requirements.

Practice documents, associated with regulation, providing information, interpretive guidance, and WorkSafeBC decisions

Two guidelines of importance:G6.34-6 Exposure Control Plan – pandemic influenzaG8.33(2)-1 Approved respirators

2008-02-27: 24

Guideline G6.34-6: ECP – pandemic influenza

Addresses Pandemic, Seasonal and Avian influenza

The key Exposure Control Plan elementsStatement of purpose and responsibilitiesRisk identification and assessmentRisk controlEducation and trainingWritten work proceduresHygiene facilities and decontamination proceduresHealth monitoringDocumentation

Table 2: Personal protective measures

http://www2.worksafebc.com/Publications/OHSRegulation/GuidelinePart6.asp#SectionNumber:G6.34_6

Note: This was G6.34-2 but was revised and renumbered 2008-02-01.

REVISED

Re-issued: 2008-02-01

Renumbered: Was G6.34-2



2008-02-27: 25

Yes (minimum N95 respirator or equivalent)

Not required (unless likely to be exposed to coughing and sneezing)

Not required AirwayProtection -respirators

Yes in some cases- e.g. when working directly with pandemic influenza patients)

Not requiredNot required Eye protection -Goggles or Face shield

Yes in some cases- e.g. when working directly with pandemic influenza patients

Not requiredNot requiredApron, Gown, or similar body protection

Yes in some cases- e.g. when working directly with pandemic influenza patients.

Not required (unless handling contaminated objects on a regular basis)

Not required Disposablegloves

Yes (washing with plain or antimicrobial soap and water; or use of hand wipes that contain effective disinfectant)



Hand hygiene

High risk: Workers who may have contact with infected patients, or with infected persons in small, poorly ventilated workspaces4

Moderate risk: Workers who may be exposed to infected persons from time to time in relatively large, well ventilated workspaces3

Low risk: Workers who typically have no contact with pandemic influenza-infected persons2

Table 2: Personal protective measures for pandemic influenza

G6.34-6 ECP – Pandemic Influenza

http://www2.worksafebc.com/Publications/OHSRegulation/GuidelinePart6.asp#SectionNumber:G6.34_6

Note: This was G6.34-2 but was revised and renumbered 2008-02-01.

2008-02-27: 26

ECP - Risk identification and assessment

Routes of transmissionAirborne transmissionDroplet transmissionContact transmission – direct & indirect

Work methods

Work environment

Council of Canadian Academies, Dec/2007.

- “Inhalable particles” (<100μm)

- “Ballistic particles”



2008-02-27: 27

OSHA Occupational Risk pyramid

Very high

High

Medium

Lower risk (Caution)

e.g. Health Care employees (doctors, nurses)

e.g. Health Care support staff (EMTs, doctors, nurses)

Staff with high frequency of contact with general public

(high volume retail, schools)

Staff with minimal contact with public.

(many office workers)

OSHA 2007 Guidance on Preparing Workplaces for an Influenza Pandemic.

2008-02-27: 29

Hierarchy of Controls

PPE

Work Practices

Administrative Practices

Engineering Controls e.g. barriers protecting receptionists, security guards.

e.g. no-touch washrooms, communications, cough/sneeze etiquette.

e.g. HR/LR policies encouraging ill people to stay away, enabling telework, reduced face-face work.

OSHA 2007 Guidance on Preparing Workplaces for an Influenza Pandemic.



2008-02-27: 32

Respiratory protection

Three questions:

Is airborne particulate spread by coughs, sneezes and medical procedures?

Do approved respirators provide better protection against airborne particles than surgical masks?

Can infection occur by airborne transmission in enclosed spaces?

Yes.

Yes.

Yes. CCA concluded that evidence sufficient to support airborne infection as primaryroute of influenza infection.

http://www.scienceadvice.ca/influenza.html

2008-02-27: 33

What next?



2008-02-27: 34

Some final thoughts…

During the last two decades of the 20th

century, there was roughly one new (or newly identified) human pathogen per year. A similar situation applies to animal pathogens*.

e.g. HIV, Lyme Disease, E.Coli 0:157, BSE

SARS and H5N1 suggest that things haven’t changed much.

As of 2000, there were an estimated 1,415 pathogens. 175 are considered “emerging”**.

Sources: *Woolhouse MEJ, Dye C, 2000, ** Taylor LH, Latham SM, Woolhouse MEJ, 2000

2008-02-27: 35

2003-2006 Public Health “events”

288

10889 81 78

41

0

50

100

150

200

250

300

Africa Western Pacific EasternMediterranean

South-East Asia Europe Americas

EventsEvents of potential international concern by WHO region

Source: WHO World Health Report 2007

n = 685



2008-02-27: 36

Corporate bottom line…

Any analysis, planning and communications will benefit you in terms of your Business Continuity.

Any infection control enhancements will benefit you in terms of overall staff illness levels.

The benefits extend far beyond “pandemic planning”.

Keep monitoring your environment.

2008-02-27: 37

Individual’s bottom line…

Personal PreparednessWash your handsWash your handsWash your hands

Learn

Stay current

Beware the hype



2008-02-27: 38

Our backup plan…

Thank you!



Additional information

2008-02-27: 41

References (continued)

Blendon R.J., Benson J.M., Weldon K.J. & Herrman M.J. (2006). Pandemic Influenza and the public: survey findings. Retrieved February 2, 2008, from http://www.hsph.harvard.edu/panflu/IOM_Avian_flu.pptCampbell A. (2006). The SARS Commission Executive Summary, ISBN 1-4249-2821-4, p.24. Retrieved February 2, 2008, from http://www.sarscommission.ca/Balicer RD, Omer SB, Barnett DJ & Everly GS. (2006). Local public health workers’ perceptions toward responding to an influenza pandemic. BMC Public Health, 6(99). Retrieved Febrary 2, 2008, from http://www.biomedcentral.com/1471-2458/6/99Kilpatrick AM, Chmura AA, Gibbons AW, Fleischer RC, Marra PP & Daszak P. (2006). Predicting the global spread of H5N1 avian influenza. PNAS, 103, 19368-19373. Retrieved February 2, 2008, from http://www.pathobiologics.org/ivphc/ref/ArtAIspreadKillpatrick06.pdfLee VJ, Chen MI. (2007). Effectiveness of neuraminidase inhibitors for preventing staff absenteeism during pandemic influenza. Emerging Infectious Diseases, 13(3). Retrieved February 2, 2008, from http://www.cdc.gov/EID/content/13/3/449.htmOIE. (2008). Facts & Figures: H5N1 Timeline. Retrieved February 2, 2008, from http://www.oie.int/eng/info_ev/en_AI_factoids_H5N1_Ti`meline.htmQureshi K, Gershon RRM, Sherman MF, Straub T, Gebbie E, McCollum M, Erwin MJ & Morse SS. (2005). Health Care Workers’ Ability and Willingness to report to duty during catastrophic disasters. Journal of Urban Health, 82(3), 378-388.



2008-02-27: 42

References

Taylor LH, Latham SM, Woolhouse MEJ. (2000). Risk factors for human disease emergence. Philosophical Transactions of the Royal Society B: Biological Sciences, 356(1411), 983-989. Retrieved February 4, 2008, from http://dx.doi.org/10.1098/rstb.2001.0888

Webster RG, Govorkova EA. (2006). H5N1 influenza – continuing evolution and spread. New England Journal of Medicine, 355(21), 2174-2177. Retrieved February 2, 2008, from http://content.nejm.org/cgi/content/full/355/21/2174

WHO. (2004). Laboratory Biosafety Manual (3rd Edition). Web link.

Woolhouse MEJ & Dye C. (2000). Preface. Philosophical Transactions of the Royal Society B: Biological Sciences, 356(1411), 981-982. Retrieved February 4, 2008, from http://journals.royalsociety.org/content/qy0leb2h83mcgju4/fulltext.pdf

WorkSafeBC: Exposure Control Plan – Pandemic Influenza. Web link.

Pandemic Planning: a business angleEPICC Forum 2008

Richmond, British Columbia

Andrew Wilson, WorkSafeBC

604-232-5814, [email protected]

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