Reasons for Concern, Reasons for Preparedness

1. Pandemic Influenza: Threat versus Preparedness Scott A. Mugno Managing Director Corporate Safety, Health and Fire Protection FedEx Express Reasons for Concern,Reasons for Preparedness

2. QUOTE • “ The worst could be happening and you may not know it for days – • weeks. Under-responding now may doom any full-scale response you • may hope to take later.” (…) “In responding to a potential pandemic, you • have to assume the worst – guilty until innocent – and react accordingly.” • Marc Lipsitch • Associate Professor of Epidemiology • Harvard School of Public Health

3. Why Be Concerned About a Pandemic? • A pandemic is a Global Disease outbreak • Flu Pandemic is new influenza virus which people have little or no immunity and there is no vaccine • It spreads easily person-to-person, causing serious illness/death • Can sweep across the country/world in a very short time • Difficult to predict when it will occur or how severe it will be • When it starts, all around the world will be at risk

4. Why Be Concerned About a Pandemic? (continued) • Experts concerned about spread of highly pathogenic avian H5N1 virus • Influenza A (H5N1) virus raised concerns about a potential human pandemic because it is especially virulent: • It is being spread by migratory birds • It can be transmitted from birds to mammals and in limited circumstances to humans • Like other influenza viruses, it continues to evolve (mutate)

5. Why Be Concerned About a Pandemic? (continued) • H5N1 virus does not usually infect people • But infections have occurred in humans • Most of these result from direct or close contact w/H5N1 infected poultry or surfaces • When species barrier crossed, H5N1 causes largest number of severe disease and death • So, right now this is still an avian (bird) flu, not a human flu

6. Pandemic History • Pandemics are inevitable – occur throughout history at regular intervals • 1918 Spanish Flu – 40 to 50 million deaths; 675,000+ U.S. deaths • 1957 Asian Flu – 1 to 4 million deaths; 70,000 U.S. deaths • 1968 Hong Kong Flu – 1 to 4 million deaths ; 34,000 U.S. deaths

7. Pandemic History (continued) • 1918 “Spanish Flu” Influenza Pandemic • Name is misnomer; started in Fort Riley, Kansas • Swift! – Morning, well; sick by Noon; dead by Nightfall • Spread across the globe in 4 - 6 months; lasted 18-20 months • One quarter Americans believed to have contracted this • At least 40 - 50 million people died worldwide; 650k in US • Death rate 25 times higher than previous epidemics • Pandemic affected and killed younger, healthy people

8. The Situation Today (November 5, 2007) • Phase 3 of 6; a new influenza virus subtype is causing disease in humans, but is not yet spreading efficiently and sustainably among humans. • 60 Countries have confirmed cases of birds infected w/H5N1 • 12 Countries have confirmed cases of humans infected w/H5N1 • Human Cases 2007: 72 cases/48 deaths (66% fatality rate) • Human Cases 2003-2007: 335 cases/206 deaths (61% fatality rate) • No travel restrictions recommended byWHO nor CDC

9. The Only Constant is Change • H5N1 strain may not be the Pandemic Flu • Don’t know when it will/won’t be the Pandemic Flu • May or may not have a vaccine • Antivirals may or may not work • Quarantine/Don’t Quarantine • Use masks/Don’t use masks Solution: Stay informed/Updated

10. What to Watch For • H5N1 virus evolves or mutates • Doctors or nurses becoming infected • Clusters of infections • Outbreaks in under developed areas or countries • Quarantines • Smuggling of birds • Under reporting of H5N1 cases

11. Why Prepare/Plan Now? • This is NOT a Drill (or Y2K) • Yes, many uncertainties; but waiting is too late • Can’t prepare afterit is confirmed • The SPEED of a pandemic is unpredictable • The MAGNITUDE may be like nothing before • Preparedness is NOT just about H5N1 Avian Flu • Much of what is required here applies to all your other contingency/continuity incident planning

12. Pandemic Flu and Potential for U.S. Economic Recession • March 2007 ‘Trust for America’s Health Analysis’ • U.S. economy could lose an estimated $683 billion • This is roughly a 5.5 percent decline in annual GDP • Nevada would face the highest (8.08% or $9 billion) • California the largest economy could lose $87 billion • Vermont the smallest economy could lose $1.3 billion • Previous estimates range from 4.25% to 6.00% GDP loss

13. Status of U.S. Pandemic Preparedness • Key Progress • Federal investment of $7 billion for preparedness; mostly for vaccine development • National Strategy for pandemic preparedness and implementation plan • Mostly successful execution of 6 month benchmarks • Release of initial community guidance • All states have at least a draft pandemic plan

14. Status of U.S. Pandemic Preparedness (continued) • Key Concerns • Lack of vaccine & vaccine production capability • Inadequate capabilities to distribute vaccine & medical equipment • Insufficient stockpile of anti virals & other medical equipment/PPE • Gaps in hospital & health care provider capacity to manage surge • Shortage in health care providers • Health Insurance, Worker’s Comp, funding issues

15. Likely Community Pandemic Activities • Issue isolation and quarantine guidelines/requirements • Cancel public events and schools • Limit non essential work activities • Coordinate area treatment centers • Coordinate delivery of vaccines and or anti virals • Oversee anti viral allocation • Prioritize groups to receive vaccine and administer if available • Expand on going surveillance to include: • Deaths and hospitalizations • Vaccine effectiveness • Anti viral resistance

16. Business/Infrastructure Continuity Planning Elements Overview • Human Resource Issues • Deciding whether a workplace should stay open or close • Any risks to employees and others must be reasonable • Keep Communication Open and Frequent • Influenza Manager • Medical Advisor • Activation of the Plan • Communication with Staff • Maintaining Essential Business Activities • Identifying Core People/Skills • Planning for Absence • Knowledge Management • Communications

17. Business/Infrastructure Continuity Planning Elements Overview (continued) • How might shortages of supplies affect business operations? • How will staff and visitors be protected from becoming ill? • Restrict Entry of People with Symptoms • Personal Hygiene • Workplace Cleaning • Air Conditioning • Increase Social Distancing • Managing Staff Who Become Ill at Work • Staff Travel • Personal Protection Equipment

18. An Overview of the FedEx Express Pandemic Preparedness Plan • Pandemic Planning Structure • Communications • Business Continuity • Optimizing Employee Health • Reduction of Infection Risk • Management of Infected / Potentially Infected Staff • Attendance • Pay Administrations

19. An Overview of the FedEx Express Pandemic Preparedness Plan (continued) • Training • Employee Services • Workplace Practices • Management of Expatriates • Management of Travelling Staff • Antiviral Medications • Management of the Deceased

20. Pandemic Planning Structure • Resourcing Pandemic Planning • Pandemic Preparedness Team • Development and Maintenance of a Pandemic Plan

21. Communications • Keeping Management Informed • Keeping Staff Informed • External Communications

22. Business Continuity • Pandemic Preparedness Plan in Relation to Policies and Plans • Influenza Management • Product Not to be Contaminated

23. Optimizing Employee Health • Optimizing Employee Health • Seasonal Influenza Vaccination

24. Reduction of Risk Infection • Reduce Risk of Employees becoming Infected Outside Facilities • Reduce Risk of the Introduction of Virus into Facilities • Reduce Risk of Virus Transmission in Facilities

25. Management of Infected/Potentially Infected Staff • Employees Declaring Illness Not To Be Disadvantaged • Treatment of Staff Suffering Pandemic Influenza • Contact Tracing • Antiviral Medications

26. Attendance • Medical Absence Pay • Leave of Absence • Alternate Work Arrangements • Attendance • Business Closings

27. Harvard School of Public Health Project on the Public and Biological Security Survey • A survey conducted of a representative national sample of 1,697 adults age 18 and over, including 821 who had children under age 18 in the household; Released last week at IOM meeting. • The margin of error for the total sample was plus or minus 2.4 % points • “Now I want to ask you some questions about a possible outbreak in the U.S. of pandemic flu, a new type of flu that spreads rapidly among humans and causes severe illness. Currently there have not been any cases of pandemic flu in the U.S. However, imagine that there was a severe outbreak in the U.S. and possibly in your community and a lot of people were getting very sick from the flu and the flu was spreading rapidly from person to person.”

28. Harvard School of Public Health Project Survey (Continued) • Survey asked employed Americans about problems they might have if asked to stay out of work for 7-10 days, 30 days, and 90 days • The longer people are out of work, the greater the number people who face financial problems • “These findings are a wake-up call for business, that employees have serious financial concerns and are unclear about the workplace plans and policies for dealing with pandemic flu.”

29. Harvard School of Public Health Project Survey (Continued) • 74% believe they can miss 7-10 days of work without serious financial problems (25% would face problems) • 57% think they’ll have serious financial problems if they had to miss work for 30 days • 76% think they’ll have serious financial problems if they had to miss work for 90 days • 29% say if they had to stay away from work for a month they would be able to work from home that long

30. Harvard School of Public Health Project Survey (Continued) • 19% (employed) are aware of a plan at their workplace to respond to a serious outbreak of pandemic flu • 22% are very or somewhat worried that their employer would make them go to work even if sick • 50% believe their workplace would stay open if public health officials recommended that some businesses in their community should shut down • 35% think if they stayed home from work, they would still get paid; 42% think they won’t get paid; 22% don’t know

31. Pay Administration • Overtime Pay • Hourly Pay Administration • Exempt Pay Administration • Non-Exempt Pay Administration • Emergency Recall • Funeral (Bereavement) Pay • Incentive Pay • Time Cards

32. Still Under Development • Training • Employee Services • Workplace Practices • Emergency Work Rules • Workplace Practices • Management of Expatriates • Management of Travelling Staff

33. Personal Protection Equipment (PPE) & Other Tools • Cold/Seasonal Flu Etiquette • Communication, Communication, Communication • Masks* • Gloves* • Hand Sanitizer* • Disinfectant* • Antivirals* (*Stockpile?)

34. Misconceptions about the need for hasty disposal of bodies Infection control procedures Pronouncement and certification of death Need for autopsies Identifying and tagging bodies Social and religious considerations Funeral homes Cremation vs. burial Mass burials Temporary mortuaries Body storage and delayed burial Isolated communities and remote sites Planning for Mass Fatalities Management of the Deceased

35. Closing Thoughts – Minimizing Risks • A pandemic will affect your business, staff and customers • How much will depend on the severity of the pandemic and how well prepared you are • Steps to cover include pre pandemic, pandemic and recovery phase • No one, single response; respond flexibly, depending on the situation • Remember, preparing for a pandemic is worthwhile for other crises as well • Good communications between all is critical; Keep yourself informed • Recognize the human dimension to a pandemic

36. Closing Thoughts – Minimizing Risks (cont.) • Eliminate the risk of possible infection; consider: • Work from home • Use the internet for other service options • Work varied shift patterns; extended/flexible hours • Avoid ‘presenteeism” • Isolate the risk of possible infection; consider • Install screens • Use ‘night service’ windows where applicable

37. Closing Thoughts – Minimizing Risks (cont.) • Minimize the risk of possible infection; consider: • Provide and use Personal Protective Equipment • Provide training and improve facilities to maximize personal hygiene • Provide training and facilities to enable people to maintain social distancing

38. QUOTE • “ Plans are nothing, planning is everything.” • Dwight D. Eisenhower • “No plan survives contact with the enemy” • Helmuth von Moltke

39. SOME RESOURCES • http://www.moh.govt.nz/pandemicinfluenza • http://www.flu.gov.sg/ • http://www.pandemicflu.gov/ • http://www.continuitycentral.com/feature0251.htm • http://www.cidrap.umn.edu • http://www.osha.gov/pandemic • http://www.who.int

40. Reasons for Concern,Reasons to Preparedness Executive summary: Prepare … Now Resist “Pandemic Fatigue”

41. Reasons for Concern,Reasons to Preparedness Questions and Answers Thank you for listening (Did I mention Prepare … Now?)