EPIDEMIC AND PANDEMIC PREPAREDNESS

1. EPIDEMICANDPANDEMICPREPAREDNESS - 17 July 2006 - AIPC

2. What It Is & What It Isn’t • Why Is There Concern • Where Are We • SARS : A Recent Model • What Can We Do

3. “It is not a matter of whether there will be another influenza pandemic but rather a question of when. It is 36 years since the last pandemic; with 39 years being the longest known previous interval between pandemics, the next pandemic is arguably overdue.” MacMahonJournal of Antimicrobial Chemotherapy (2005)55, Suppl. S1, i5-i21

4. Pandemic Influenza History • Spanish Flu - 1918 (40 million deaths) • Asian Flu - 1957 (2 million deaths) • Hong Kong Flu - 1968 (1 million deaths)

5. Overview • Seasonal influenza • Avian influenza • Pandemic influenza • Preparedness - government, partners, individuals

6. Influenza

7. Influenza • Respiratory infection • Spread through coughing, sneezing • 1 to 5 days from exposure to onset of symptoms • Spread 1 day before illness up to 7 days after • Seasonal influenza traditionally occurs October through April

8. Influenza Symptoms • Rapid onset of: • Fever • Chills • Body aches • Sore throat • Non-productive cough • Runny nose • Headache

9. Seasonal Influenza • 36,000 deaths nationally every year • Vaccine available • High risk for complications include: • Very young • Very old • Fragile immune systems • Pregnant women

10. AVIAN INFLUENZA

11. Avian Influenza (“Bird Flu”) • Birds of all species thought to be susceptible • Two forms • Mild • Severe • Signs and Symptoms • Mild: ruffled feathers, reduced egg production; significant to poultry producers • Severe: extremely contagious between birds, rapidly fatal, about 100% of birds infected die.

12. Avian Influenza - H5N1 Infection in Humans • Virus remains an avian flu strain • Human infection - occurred when living quarters are close to animals • Transmission • Contact with manure • Handling chickens • Eating sick, undercooked chickens

13. Avian Influenza - H5N1Why do we care? • Spreading among birds quickly and across countries • Jumping hosts (across animal groups) • Large percentage of deaths in those infected (228 documented cases, 130 deaths) as of June 20, 2006 • Has potential to mutate into a human strain

14. Pandemic • Epidemic • More than the expected number of cases within a certain period of time • Pandemic • Geographically widespread epidemic of disease

15. Influenza Virus Attaining Pandemic Status • A “new” virus transmitted to humans (no immunity within the community) • Must be able to cause illness in humans • Must be able to pass easily from human to human

16. WHO Stages of Pandemic Alert

17. An infection caused by influenza viruses carried and spread among humans. A disease caused by influenza viruses carried and spread among birds. • A new strain of influenza virus that spreads worldwide. • It is carried and spread among humans; and • Humans have little or no immunity against it. • Breathing droplets that have been sneezed or coughed into the air by someone with the flu, or having the droplets land on the surface of your eye. • Shaking hands with an infected person or touching a contaminated surface, and then touching your own eyes, nose or mouth. • Wild birds are the main carriers. • Domestic birds (like chickens & turkeys) get the virus from wild birds and may become seriously ill. • Humans do not easily contract bird flu viruses. • Humans can only get bird flu by handling infected birds or coming into contact with contaminated faeces. • There is no evidence that bird flu is passed by eating cooked poultry products. • Spread the same way as seasonal flu. What is the connection between human flu, bird flu and pandemic flu? Human flu + Bird flu can = Pandemic flu One way pandemic flu can occur is if bird flu mixes with human flu and creates a new strain of flu virus that can spread easily from human to human.

18. SARS 2003

19. The Problem Uncertainty about SARS created a cycle of fear • A highly mysterious, world travelling virus • Little known about contact or transmission • Super spreaders infecting 100’s people each • Fatality rates of 15% • Cover ups, secrecy and conspiracy in China • Speculation • Intrigue • Rumour • Fear • Panic Creating

20. The Result Public Perception fuelled by sensationalised speculation “SARS Ate My Earnings”eraider.com, 11 june 2003 Chinese try smoking and drinking to stave off Sars Irish Independent, 6 May 2003 SARS virus spread by African wild cat  PRAVDA.RU, 23 May 2003 Did SARS come from Outer Space? MEDSERV/ May 26, 2003 Eating Cats Causes SARS THE SUN/ May 23, 2003 CIA Behind SARS Virus National Enquirer/ April 29, 2003

21. The Immediate Impact Within the Travel, Tourism and Meetings Industry alone: • Visitor arrivals to Singapore decline 70% by May • 23 SIA planes grounded at Changi Airport • Hotel occupancy as low as 7% in some 5-star hotels • Over 25 concerts, conventions and exhibitions cancelled or postponed • Loss of over $38m for the industry • Loss of $200m to the local economy • Loss of income, loss of jobs, failed businesses

22. The Effect Visitor Arrivals to Singapore 2002 vs 2003 800k 2002 600k 400k 2003 200k 0 Jan Feb Mar Apr May Jun Jul Aug Sep

23. SARS Company Procedures • Appointment of SARS Prevention Manager • Temperature Checks • Each staff member issued oral thermometer • Temp. checks conducted twice daily • Recorded by partner • Staff issued “Cool” badges • Temp. reading over 36 degrees sent to clinic • Surgical masks issued to all staff

24. SARS Company Procedures • Travel • Reduction overall • Overseas travel declaration • Mandatory 10 day quarantine from SARS country • Company purchased 12 thermal scanners • Used to check vendors • All event attendees screened • Daily disinfecting of all common areas • Close liaison with Ministry of Health

25. Why Plan ? • F U D - Fear - Uncertainty - Doubt • Protect Employees / Public • Communication • Business Loss • Absenteeism • Travel Restrictions • Work From Home • Prevent Spread

26. Business ContinuityGuide

27. Alert : Green What it means: • Isolated overseas or local cases of animal-to-human transmission. Threat of human-to-human remains low Possible scenarios: • Heightened awareness amongst members of the public Recommended Actions: Employees • Set up a team to oversee business continuity planning • Update contact details of staff • Update staff policies on: - Overseas travel - Absenteeism and extended medical leave - Recall of staff based in affected areas • Stock up on thermometers, disposal gloves and N-95 face masks • Increase personal hygiene awareness

28. Alert : Green Process and Business Functions • Identify critical functions that may be affected due to absence of staff, e.g. production, sales etc • Plan for an absenteeism rate of up to 25% during Alerts Orange and Red • Consider cross-training of staff in critical functions • Identify functions that can be done off-site or from home Business Infrastructure (Equipment and Facilities) • Prepare telecommunications access for employees working from home • Plan for increased use of telecommunication systems and call-centres

29. Alert : Green Stakeholders (Suppliers/Customers) • Update contact of key suppliers and customers • Identify customers, suppliers and shareholders who are likely to be affected by the pandemic • Identify alternate suppliers of key services, components and/or goods • Co-ordinate business continuity plan with suppliers and customers Internal and External Communications • Create general awareness of flu and preventive measures among staff. Consider various communications channels such as briefings, newsletters, intranet or email • Include sources of flu information such as websites of the Ministry of Health and SPRING Singapore • Develop an external communications plan for various alert levels aimed at customers, suppliers and shareholders

30. Alert : Yellow What it means: • Slight human-to-human transmission Possible scenarios: • Travelling to and from affected areas may be restricted • Companies to start briefing staff on business continuity plan Recommended Actions: Employees • Appoint a Flu Manager • Implement screening and isolation procedures for staff and visitors • Implement policy on overseas travel • Screen staff who visited affected areas in preceding 14 days • Follow any vaccines and medication advisories issued by MOH at that time • Issue thermometers, disposal gloves and N-95 face masks • Consider succession planning for key staff

31. Alert : Yellow Processes and Business Functions • Update plan on how/when to activate (a) Alternative suppliers (b) Alternative delivery means to customers Business Infrastructure (Equipment and Facilities) • Activate equipment for remote communications access to affected areas, e.g. video-conferencing • Disinfect common areas within your workplace • Check the websites of the Ministry of Health or National Environment Agency for guidelines on disinfecting workplace areas

32. Alert : Yellow Stakeholders (Suppliers/Customers) • If necessary, activate plan for alternative suppliers • Establish alternative delivery means or delivery sites • Consider alternative sales/service channels that do not require face to face contact, e.g. e-commerce, mail order purchase Internal and External Communications • Reassure staff by briefing them on your company’s business continuity plan and what to do in the event of higher alert levels (Orange, Red and Black) • Brief staff on external communications plan, e.g. what to say, when and to whom • Inform customers and suppliers about your company’s business continuity plan

33. Alert : Orange What it means: • Evolves into human disease. WHO confirms several outbreaks in one country, spreading to other countries • Death expected Possible scenarios: • The public starts to avoid crowded areas • Business travellers and tourists to Singapore decrease • Companies start temperature taking • Our airport and points of entry start temperature screening of overseas visitors Recommended Actions: Employees • Update staff regularly on health advisories • Encourage staff to stay home if unwell and monitor status

34. Alert : Orange Processes and Business Functions • Pre-qualify alternative suppliers from unaffected areas • Activate process and systems to support remote access for staff Business Infrastructure (Equipment and Facilities) • Clean and disinfect common areas more frequently • Activate agreements with cleaning/decontamination contractors

35. Alert : Orange Stakeholders (Suppliers/Customers) • Institute temperature taking and contact tracing for visitors • Prevent visitors with flu-link symptoms from entering workplace • Activate alternative delivery arrangements with suppliers and customers Internal and External Communications • Inform external parties of restriction on visits to company’s premises • Update relevant customers/suppliers in the continuity of your business • Inform suppliers and customers of alternative procedures for pick up/deliveries

36. Alert : Red What it means: • Widespread infection. Increase in deaths • Healthcare system likely to be overwhelmed • Essential services need added protection to ensure full operational capacity Possible scenarios: • Certain countries may impose border closures • High absenteeism from work may occur Recommended Actions: Employees • Non-critical staff to work from home • Activate succession plan if necessary • Make arrangements for counselling support

37. Alert : Red Processes and Business Functions • Monitor/maintain contact with suppliers and customers through remote access Business Infrastructure (Equipment and Facilities) • Monitor inventory levels Stakeholders (Suppliers/Customers) • Activate partnership agreements for reciprocal shipments of finished goods to customers Internal and External Communications • Regularly update staff and stakeholders of actions taken to instil confidence

38. Alert : Black What it means: • High death rates reported • Economic activities are severely disrupted, as panic sweeps through the community Possible scenario: • Economic activity may slow down to a standstill as the public focuses on survival Recommended Actions: • Stop economic activities • Abide by health advisories from the Ministry of Health

39. Resources • Basic Preparedness Plan www.ready.gov/business • World Health Organization www.who.int • Europe http://ec.europa.eu/comm/world/avian_influenza/index.htm

40. EPIDEMICANDPANDEMICPREPAREDNESS - 17 July 2006 - AIPC