Pandemics Through History: Lessons Learned and Business Impacts Today

1. Pandemics :A State of ReadinessCPBI 2007 National Conference Rodney Nelson, MA Medical Anthropologist Senior Manager, Executive NetworksThe Conference Board of Canada

2. Session Objectives Provide prospective members with: • The history of pandemics • Pandemic Today • What businesses need to consider

3. Is Pandemic the next Y2K? Edvard Munch, 1893 “Pandemic" is the seventh most frequently searched word in online dictionaries this year

4. History of Influenza

5. History of Influenza • Since the first well-described pandemic of influenza-like disease occurred in 1580, 31 influenza pandemics have been documented. • 1729-1730, 1732-1733, 1781-1782, 1889-1890 and in 1900 • 1918 “Spanish flu” (H1N1?)- 20-100 million worldwide died • 1957/58 “Asian flu” (H2N2) - One million died • 1968 “Hong Kong flu” (H3N2) – One or two million died • 1976/77 “Russian flu”(H1N1) – (anyone born after 1957) Influenza A Type - HA antigen – mutation H5N1/ H7N7/ H7N2/ H9N2/ H7N3/ H10N7

6. 1485 “Sweating Sickness" • Flu like symptoms recorded • Two to three hundred thousand sick in Britain • Extremely high mortality rate • The Lord Mayor of London, his successor, and six aldermen died • Royal Navy could not leave port due to illnesses • Doctors remedies • Tobacco juice • Lime juice • Laxatives • Bleeding/ leeching

7. 1918 “Spanish Flu”

8. 1918 “Spanish Flu” • Commonly believed to be an avian or swine mutation • Similarities to H5N1 • Mortality rate of up to 50 million people (2.9%) • 25 % of the population affected • Hit adults in their prime (ages 19-40) • 500,000 cases in Quebec • 2 waves • February - April (recorded in New York City) • September - October • Death was very quick • 1200 deaths in Toronto in three weeks

9. 1918 Impacts • Half the population infected • Closure of industries • Stores, churches, government ministries, schools • Psychological impact • Bereavement, fear, anxiety, refusal to work, mass graves • Strain on industry resources • Private industry appropriated • Buildings taken over for make shift hospitals • Trolley cars to move caskets • Arenas to house bodies

10. Essential Services Were Limited

11. 1918 Business Loss • Losses to businesses were staggering • Pool halls, restaurants, and theatres suffered heavy losses • Insurance industry paid out major claims • Supply chains collapsed • Small and medium businesses closed for good (Duncan 2003 and 2006)

12. Prudential Assurance paid out two times as much in flu claims in 1918 as it did in all world war claims (Duncan 2003 and 2006)

13. Severe Acute Respiratory Syndrome (SARS)

14. Severe Acute Respiratory Syndrome (SARS) • 8,240 cumulative cases worldwide (WHO) • 140 in Canada (majority in Toronto) • 31 deaths reported by Health Canada • Canada has highest SARS mortality rate in the world • Toronto SARS • Travel restrictions in and out • WHO travel warning list • Home quarantine in place • Hospitals overrun • York Region Health Connection calls -13,399 total calls received

15. Severe Acute Respiratory Syndrome (SARS) • Healthcare workers were uninformed (communication) • Fear, anxiety, overworked • Health sector was not prepared (planning) • Equipment, diagnostic techniques, coordination • Business loss • $1.5 billion loss in Canada (est. to date CBOC) • $950 million loss in Toronto (est. to date CBOC) • $190 million lost in tourism industry alone in 2003 (Canadian Tourism Commission ) • Tourism down 75% to 85% in 2003 (Canadian Tourism Commission )

16. SARS Lessons Learned • Precautionary Principle – Act before it is too late • Effective communications in a crisis • Protect Employees • Surveillance • Lines of authority and responsibility need to be clear • Human resources must prepare • Anticipate Loss of work force and clients • Family response and dependant care needed • Early resumption of business • Resumption plan including marketing (Time for Toronto, SARSstock)

17. H5N1

20. Cumulative Number of Confirmed Human Cases of Avian Influenza A/(H5N1) Reported to WHO 267 161 Total number of cases includes number of deaths. Total number of cases includes number of deaths.WHO reports only laboratory-confirmed cases. Total Cases: Total Deaths: 15 January2007

21. Pandemic Today

22. The flu shot will protect me Surgical masks will protect against influenza strains Vaccines will be available Survival means immunity Tamiflu will be effective Canada is safe Who will disinfect workstations of those infected? Sneezing into my sleeve will help protect others Airborne particles have only a three foot radius I am too healthy to catch it This is an “Asian” disease Only birds can transmit it Myths

23. A vaccine will take time (4-6 months) Development Manufacturing Distribution N-95 masks often fail with improper use There may be more then one wave Opportunists will take advantage of the situation Many businesses will not survive HR, Legal, Financial, Supply, IT, Facilities all need to be involved BCP needs a recovery plan Working from home is not the answer Your business may be deemed non-essential by essential services Reality

24. 1st Wave • May last for 2-3 months • Hospitals are planning for 8 week peak • School and day care closures • House quarantines • Social gathering places closed • Shopping malls, stores, movie theaters, restaurants

25. 1st Wave • Essential services will be limited • Power, water, mail, tel-com, police, ambulance, sewage, garbage • Government action in place • Secondment possibilities • Limited services • Heath care priorities

26. 2nd or 3rd Wave • Can be more devastating than the first wave • Antivirals may or may not be effective • Vaccine production limitations • Limited resources • Hospitals, businesses, food, essential services • Civil threats • Small towns, resource fighting, looting • Limited food distribution • Canadian Grocer Association, Loeb, Loblaws

27. Business Considerations

28. Emergency Management and Civil Protection Act • Outlines process for declaring and management emergencies “State of Emergency” • 72 hours (Premier, then verified by Lieutenant Governor in Council) • 14 days (LGIC) • +14 days (LGIC) • + 28 days at a time (by Assembly)

29. Emergency Management and Civil Protection Act • Powers – section 7.0.2.(4) • Implementing emergency plans, evacuation • Restricting travel to certain areas • Establishing facilities for safety, shelter, care • Fixing prices • Procuring necessary goods, services, and resources • Collect, use, and disclose information

30. Emergency Management and Civil Protection Act s.7.0.2.(4) “12. Authorizing, but not requiring, any person, or any class of persons, to render services of a type that that person, or a person of that class, is reasonably qualified to provide.” ________________________________________________ Emergencies Act (federal) s.8(1)(d) “(d) the authorization of or direction to any person, or any person of a class of persons, to render essential services of a type that that person, or a person of that class, is competent to provide and the provision of reasonable compensation in respect of services so rendered;”

31. The SARS Commission – Campbell J.Precautionary Principle“Where there is reasonable evidence of an impending threat to public health, it is inappropriate to require proof of causation beyond a reasonable doubt before taking steps to aver the threat” -The Krever Report Good Governance and Duty to Care

32. Good Governance and Duty to Care • SARS tort law cases - Findings • 8 individual cases and one class action • A “new” standard of care • Have pandemic plans and preparations that meet a reasonable standard

33. Good Governance and Duty to Care Organizations must show a “duty to care” in good governance by protecting the health and safety of their employees. David Cameron, MD, LLP Cassels Brock & Blackwell

34. Don’t Panic - its in the BCP! • Much of what you plan is also applicable in other situations: • Prolonged strikes • Prolonged blackouts • Natural disasters • Security/Terrorism events • Bio Threats • Contaminations • Consultation • Policies • Business Continuity Plan • Communication • Implementation • TEST TEST TEST your BCP (Training)

35. Consultation • Senior Management • Business Continuity Specialists • Risk Management Specialists • Human Resources Officers • Occupational Health & Safety Officers • Legal • Employees • Unions • Associations • Suppliers • Government (Municipal, Provincial, Federal) and…… Policy Wonks……

36. Policy Considerations • Fitness-to-Work Policy • Contact and Monitoring Policy • Restricted Access Policy • Healthy Workplace Policy • Emergency Leave Policy • Work from Home Policy • Crisis Support Policy • “Hazardous-Duty” Pay • Travel Policy • Dispute Resolution • Workplace Harassment • Conduct and Behaviour • Health and Safety • Facilities

37. Compensation & Benefits Policies Policy Considerations • Vacation and Vacation Pay • Personal Leaves • Bereavement Leave • Benefits Related to Part-Time Employment • Emergency Leave • Sick Pay Leave • Absenteeism • Call-In Pay • Job Evaluation and Job Performance • Overtime • Shift Premiums • Retirement • Automobile Expenses

38. BCP Must Haves • Monitoring – When it happens • Testing – Will it work? • Preparedness Plan – Everything in place • Response Plan – How to act • Continuity Plan – How to keep business operating • Recovery Plan – How to return to business as usual • Lessons Learned – To better plan

39. Supply Chain What can organizations do to ensure supply chain effectiveness? • Identify critical suppliers • Ensure contracting procedures for alternative suppliers • Link with your suppliers business continuity plans • Ensure contracts with essential services • Stockpiles of essential items • Explore sharing of resources

40. Communication • Stakeholders • Public, Employees, Business Partners, Public authorities • It’s a dialogue over an extended time • Build Trust • Combat fear • Acknowledge uncertainty • Make good decisions – best method to build trust • Communicate early • Try to predict stakeholders’ responses • Be transparent and truthful • Respect and publish privacy guidelines • Plan your messages – adapt to the medium • Monitor the media

41. What is not in the BCP • During a pandemic external resources will be limited or nonexistent • Not an isolated event - it will be world wide • More than one event may take place • Long time frame of event horizon • Gradual not immediate • Long term health issues • Population decrease of targeted age group

42. Business Assumptions • 1/3 of your staff will be ill or unable to report to work • Not all at once • Expect mortality • 20% - 30% absenteeism rate is expected during peek • Daycare and school closures • Family related • Fear, bereavement, depression • Government intervention • Secondment of medical staff or supplies • Volunteer requests • Facility requests

43. Business Assumptions • Supply chain may fail • Stock pile of resources • Sharing of resources • Travel disruptions (local, national and international) • Buses, taxis, subway • Planes, trains, trucks and ships • Limited social and essential services available • Power brownouts, blackouts, generators • Tele communication disruptions • Oil, gas, propane • Police, ambulance, fire, garbage

44. Business Health Strategies • Assessment tools • Self assessment • Monitoring staff and visitors • Front door check policy • Contact tracing • Medical network • Who has training? • Who is taking the lead? • External medical resources? • Precautions • Hygiene practices (office disinfectants, sanitary stations, clean rooms) • Social Distancing

45. Plans in Place • World Health Organization • Health Canada • Public Health Agency of Canada • Canadian Food inspection Agency • Public Safety and Emergency Preparedness Canada • Alberta Health and Wellness • Ontario Ministry of Health and Long-Term Care • City of Calgary, Ottawa, Toronto, Montreal, Brampton, Vancouver and other cities • Various businesses and essential services

46. Final Thoughts WHO decimated bird population after H5N1 discovered Even the best plans fail. But it is better to fail gracefully then not. Ugandan outbreak

47. Resources www.phac-aspc.gc.ca/new_e.html Health Canada www.influenza.gc.ca/ Government of Canada www.who.int/csr/disease/avian_influenza World Health Organization www.pandemicflu.gov USA Government www.cdc.gov/flu/avian Centres for Disease Control www.sarscommission.ca SARS Commission www.phac-aspc.gc.ca/cpip-pclcpi/hl-ps/index.html Highlights from the Canadian Pandemic Influenza Plan for the Health Sector,2006 www.hrpao.org/HRPAO/Events/Whitepaper.htm Pandemic Planning: A Guide for HR Professionals www.theconferenceboard.ca/PPWG The Conference Board of Canada, Pandemic Preparedness Working Group

48. (613) 526-3090 ext 445 nelson@conferenceboad.ca Thank You Please feel free to contact me at: Rodney Nelson, MA Medical Anthropologist Senior Manager, Executive Networks The Conference Board of Canada 255 Smyth Rd., Ottawa, Ontario, Canada