H1N1 INFLUENZA (Swine Flu): What employers and employees need to know

1. H1N1 INFLUENZA (Swine Flu):What employers and employees need to know

2. What is H1N1 Influenza? • H1N1 Influenza is the new name for the 2009 Swine Flu. • Started in Mexico, and now is worldwide – • 40 countries • 9,830 cases • 79 deaths As of May 19, 2009

3. U.S. • 48 states, including Hawai`i • 5,469 cases • 6 deaths • HAWAI`I • 26 cases In United States - As of 5/19/09

4. World Health Organization (WHO) Bird Flu H1N1 Flu WHO declared Phase 5 status on 4/29/09

5. H1N1 does not appear to be as virulent as • Avian Flu (H5N1) • Similar to Spanish Influenza of 1918 – affected healthy young adults • SARS – Toronto – affected healthy health care workers • As of 5/19/09, with 5,469 confirmed & probable cases in the U.S., only 6 deaths There is no need to panic

6. H1N1 Influenza Severity rate On May 1, Mexico’s fatality rate was 6-7%

8. Kills ~ 36,000 Hospitalizations ~ 200,000 Infection Rate: 5 – 20% of population (15 – 61 million people each year) Fatality Rate: ~ 0.09% on average Severity Rate: ~ 0.5% on average Seasonal flu

9. Severe Acute Respiratory Syndrome November 2002 – July 2003 8,096 cases worldwide 774 deaths In Canada – mostly healthcare workers (healthy young adults) Fatality rate: 9.6% More than 100x more fatal than Seasonal Flu SARS

10. H5N1 2005 – 2006 mostly Similar to Spanish Influenza of 1918 – healthy young adults Confirmed cases: 208 No. of Deaths: 115 Fatality Rate: 55% More than 5x more virulent than SARS, 500x more virulent than seasonal flu Avian Flu

11. H5N1 Avian Influenza Situation Update Humans 55%!

12. H1N1 Flu Versus other flus In U.S. appears to be similar in severity to seasonal flu But it’s not the same as seasonal flu!

13. Never-before seen combination of human, swine, and avian influenza viruses. • Most affected are healthy, young adults • More contagious than seasonal flu • 22-33% versus 5-15% for seasonal • Virus may continue to evolve • No human immunity • May become more virulent • Major impact on society “NOVEL” Virus

14. So why the concern? • Viruses mutate quickly • The 1918 Spanish influenza was originally a mild flu in the spring • Came back in November as a killer • Different from seasonal flu in viral composition • Leads to uncertainty

15. OSHA Hawai`i Workshop 05/20/2009 15

16. Credit: US National Museum of Health and Medicine Influenza Pandemicsof the 20th Century 1918: “Spanish Influenza” 1957: “Asian Flu” 1968: “Hong Kong Flu” A(H1N1) A(H2N2) A(H3N2) 20-40 m deaths 675,000 US deaths 1-4 m deaths 70,000 US deaths 1-4 m deaths 34,000 US deaths

17. Past history – last 4 pandemics 1889, 1918, 1957, 1968 • First wave in spring was mild • Second wave in fall – much more virulent. Time to Prepare -- 3 months!

18. This is a MUST for all businesses!!!! Pandemic flu plan

19. Continuity of Operations (COOP) Worker Protection - OSHA/HIOSH Law “Every employer shall furnish to each of the employer’s employees employment and a place of employment which are safe as well as free from recognized hazards.” Section 6(a) of the Hawai`i Occupational Safety and Health Law, Chapter 396, Hawai`i Revised Statutes Pandemic Flu Plan

20. Common knowledge to the industry Employer genuinely desirous of protecting workers. Recognized Hazard

21. Occupational Risk pyramid for pandemic influenza Risk Level depends on whether or not jobs require: • Close Proximity • Repeated or Extended Contact To people: • Potentially infected, or • Known or suspected sources http://www.osha.gov/Publications/influenza_pandemic.html

22. Very High Exposure Risk • Healthcare workers performing aerosol generating procedures on known or suspected patients • Cough Induction procedures • Bronchoscopies • Some Dental procedures • Invasive specimen collection

23. High exposure risk • Healthcare and delivery support staff • Doctors, nurses, others that must enter patients rooms • Medical Transport • EMTs • Autopsy • Morgue and mortuary employees

24. Medium exposure risk • High frequency contact with general population • Schools • High population density work • High volume retail

25. Low exposure risk (Caution) • Employees with minimal contact with the general public and other coworkers • Office employees

26. For workers exposed to hazards for which respiratory protection is required • Only NIOSH approved N95 or higher • Full program – no waivers for medical evaluations or fit testing. • Where hazard assessments have determined that respirators are NOT required - • Voluntary filtering face-pieces – Training as per Appendix D. respirators

27. Guidance on Preparing Workplaces for an Influenza Pandemic (OSHA Publication 3327-02N)(2007) (http://www.osha.gov/Publications/influenza_pandemic.html) Pandemic Influenza Preparedness and Response Guidance for Healthcare Workers and Healthcare Employers. (OSHA Publication 3328-05 (2007). (http://www.osha.gov/Publications/3328-05-2007-English.html) Documents

28. Frequently Asked Questions on Pandemic Influenza Preparedness and Response Guidance for Healthcare Workers and Healthcare Employers. OSHA, Office of Occupational Health Nursing (OOHN). (http://www.osha.gov/SLTC/pandemicinfluenza/pandemic_health.html) • Proposed Guidance on Workplace Stockpiling of Respirators and Facemasks for Pandemic Influenza. OSHA. (http://www.osha.gov/dsg/guidance/stockpiling-facemasks-respirators.html) • Workplace Preparation. PandemicFlu.gov. (http://pandemicflu.gov/news/panflu_webinar4.html) Other Documents

29. Lead State Agency is the Hawai`i State Department of Health (HDOH) • Issue advisories, warnings to public • Recommends actions • Can require quarantine and isolation • Governor can issue Emergency Declarations What is the State doing?

30. Infection Control for Employers • Training – • Cough Etiquette • Hand Washing • Posters in Public Areas • Hand Sanitizers • Sick leave policy

31. How is Influenza spread ? • Tiny droplets from coughing or sneezing • Spreads 3 – 6 feet • Can survive on surfaces up to 1-2 days • Transferred from hands to mouth, nose, eyes.

32. Infection Control • Cover your cough/sneeze • Wash hands (Use waterless/ alcohol-based hand cleaners if water/soap not available)

33. Infection Control • Stay Home When Sick • Keep Self and Family Healthy • Sanitize Work Stations of Co-Workers Who Become Ill

34. NO H1N1 (Swine Flu) is not spread by food. You cannot get H1N1 by eating pork or pork products. Eating properly handled and cooked pork products is safe. Reason for change in name is to separate pigs from the human H1N1 flu. Can people catch H1N1 (swine flu) from eating pork?

35. Hygiene and Distancing are more effective Purpose is to prevent the transmission of droplets and fomites from the ill person. Limited protection for the non-ill person trying to avoid getting sick In the workplace, when respirators are necessary for the type of work, only NIOSH approved N95 respirators are allowed. What about those masks?

36. There is NO vaccine for H1N1 yet. Earliest would be fall of 2009. CDC has NOT recommended that the general public take anti-viral drugs such as Tamiflu or A viruses. They are most effective if taken 48 hours after exposure. What about vaccines or tamiflu?

37. Hawai`i State Department of Health website: http://hawaii.gov/health H1N1 Flu Information Hot Line (Hawai`i State Department of Health) (866) 767-5044 Hawai`i Preparedness

38. Centers for Disease Control: http://www.pandemicflu.gov/ • World Health Organization (WHO) http://www.who.int/csr/disease/swineflu/en/index.html • OSHA www.osha.gov Other Sources of Info

39. What can you do ? Don’t Panic! • Implement good hygiene and infection control practices. • Stay healthy (Keep your family healthy) • Wash your hands frequently – soap and water or alcohol based hand sanitizer • Cover your mouth and nose when coughing or sneezing • Go to your doctor if you suspect you have the flu! (Don’t wait)