Pandemic Influenza Planning
It’s inevitable. And it’s imminent. So say the World Health Organization (WHO) and the Public Health Agency of Canada (PHAC).They are talking about the likelihood of a worldwide influenza pandemic.
“We are long overdue for another pandemic,” agrees Dr. Donald Low, Microbiologist-in-Chief, Mount Sinai Hospital Toronto. An internationally recognized authority in microbiology and infectious diseases, Dr. Low adds, “It is not a question of if a pandemic will occur, but when, and how severe.”
Next year will mark the 90th anniversary of the great influenza pandemic of 1918 and 1919. Known as the “Spanish flu” it was an event widely considered to be one of the greatest natural disasters in human history. Historians and scientists estimate approximately 50 million people worldwide died from this deadly disease.
Since 1918, there have been two other influenza pandemics—the “Asian Flu” and the “Hong Kong flu”. Together these two pandemics resulted in approximately three million deaths worldwide.
Unfortunately, as Dr. Low suggests, infectious disease experts can’t predict exactly when or where in the world this deadly flu will strike. They can tell us though, around a quarter of the Canadian population will be affected, with an estimated 11,000 to 58,000 deaths expected. The ultimate number of fatalities will depend on how severe the illness is, how different age groups are affected, and how well we respond.
Since the SARS crisis of 2003, there has been much concern and discussion over our ability to handle another pandemic. The SARS Commission report outlined systemic failures in communication, infection control and occupational health and safety that compromised workers’ health and left workplaces throughout the province ill-prepared for the outbreak.
Learning from past mistakes, our national, provincial and local levels of government, in conjunction with international partners such as the WHO, have developed and are continually fine-tuning pandemic influenza plans.
With feedback from Ontario Public Service Employees Union (OPSEU) the Ontario government (through the Ministry of Government and Consumer Services) recently developed a user-friendly pandemic planning guide to act as a resource for all of Ontario’s government ministries. “We have an obligation to the public to ensure essential government services remain open during a pandemic. At the same time, we must protect the health and well-being of our workers. This guide will help individual ministries to make informed decisions on how to achieve these goals,” says Malcolm Smeaton, director, Emergency Management and Security Branch, Government and Consumer Services.
For the last four years representatives from Ontario Nurses’ Association (ONA) and OPSEU participated on the Ontario Health Plan for Influenza Planning Steering Committee advising the provincial government on development of their pandemic influenza plan for health care workers.
These labour representatives fought for and won adoption of the precautionary principle (a SARS Commission recommendation), a separate chapter on occupational health and safety measures and a requirement for the use of N95 respirators to protect health care workers from the possibility of short distance, fine droplet aerosol transmission of the influenza virus. What they want next is recognition the influenza virus may be an airborne disease and therefore workers should wear N95 respirators even if they are more than two metres away from an infected patient.
“We have come a long way and there are some good provisions contained in the Ontario Health Pandemic Influenza Plan (OHPIP). However, there is still room for improvement,” says Lisa McCaskell, OPSEU senior health and safety officer and member of the steering committee. Unlike the public service guide the language of this plan needs to be written more clearly, says McCaskell. She adds, “Our individual employers now need to step up to the plate and enlist the help of their workers to develop and implement their own pandemic plans.” To help their members make recommendations both OPSEU and ONA have developed informational materials on pandemic planning.
But public service and health care workers aren’t the only ones making plans. Workplaces from many sectors have started to put plans in place.
One of them is the General Motors truck plant in Oshawa. “After the SARS experience, we know the importance of planning sooner rather than later,” says management safety supervisor, John Stroyan. Together with other members of the joint health and safety committee (JHSC), Stroyan and worker co-chair Rick Borg, CAW Local 222, developed a comprehensive plan which they vetted through the medical doctor on staff and the local public health unit.
“We are treating pandemic influenza as we would any other health and safety issue,” says Borg. They have placed hand sanitizers at plant gates and are encouraging workers entering or exiting the workplace to make use of them. Cleaning staff are being trained to regularly clean hard surfaces such as desks, tabletops, door handles, tools and other equipment. During a pandemic additional outside cleaners will be used to help disinfect and clean workstations and work areas of employees who fall ill. As a last resort the company has stockpiled personal protective equipment such as N95 respirators, and gloves. Both will be available upon request.
The pandemic plan is communicated to workers through notices on health and safety bulletin boards and through workplace newsletters. Workers are trained on emergency procedures every year. Posters and booklets on proper handwashing procedures are also widely available.
As with any health and safety program the JHSC annually reviews the pandemic plan. Recently they tested its effectiveness through a role-playing exercise in which the joint committee and others pretend an influenza pandemic had emerged. Seated around a table they describe how each department would respond. Firefighters, police, and ambulance workers also participated. According to Stroyan and Borg many lessons were learned from the exercise and improvements were made to the plan as a result.
Working with their JHSC, Bell Canada, Nortel, Rogers Communications, CN Rail, and Air Canada either have plans in place or are in the process of finalizing their plans. CAW director health, safety and environment Sari Sairanen says they are pleased larger employers are on board and involving workers in developing their pandemic plans. However, the challenge is to convince mid-size and smaller companies to follow suit.
Other unions such as Canadian Union of Public Employees (CUPE), Elementary Teachers’ Federation of Ontario (ETFO), and Communications, Energy and Paperworkers Union (CEP) have issued pandemic planning guidelines to their members.
“Given pandemic influenza is an occupational health and safety hazard as well as a public health issue, the employer still has a legal duty to take every precaution reasonable to reduce worker exposure to the virus. This includes providing them with good air quality, awareness training and education, and as a last resort, the highest level of personal protective equipment available,” says Keith McMillan, CEP national representative, health and safety, Ontario Region.
United Food and Commercial Workers Union (UFCW) Local 1000 A has begun to train staff members on pandemic influenza. “This is just the beginning,” says their executive vice president, Pearl Sawyer, “More training for our members is planned for the spring. Meantime, workers can incorporate simple precautions into their daily routine such as proper handwashing, coughing etiquette or staying home when ill.”
According to Nancy Hutchison, health and safety coordinator for United Steelworkers Union (USW) District 6 pandemic planning is high on the agenda of their upcoming National Health and Safety Conference. “We understand it’s time to get ready. We are in the process of developing awareness materials for our members and are determined to get our workplace pandemic plans up and running.”
WHSC recently updated its Emergency Preparedness and Response Program to include pandemic planning. For more information contact a WHSC training representative at an office near you or visit our web site at www.whsc.on.ca
Pandemic Influenza Planning
Frequently Asked Questions
1. What is “seasonal” influenza?
Seasonal influenza or “flu” is a highly infectious respiratory illness caused by one of three viruses, influenza A, B or C. The virus is easily transmitted when someone with the flu coughs, sneezes, or talks in close proximity to another person and droplets containing the virus come into contact with the mucous membranes of the other person’s eyes, nose, or mouth causing infection.
The flu is also spread indirectly when a person comes in contact with contaminated objects, surfaces, or skin (hands) and then touches their eyes, nose or mouth. A flu virus can survive for several minutes on the hands and for one or two days on hard surfaces like counters or desks.
2. What are the symptoms of the flu?
Symptoms of the flu typically include: headache, chills, coughing, fever, loss of appetite, muscle aches and fatigue, runny nose, sneezing, watery eyes and sore throat. The flu can be contagious for 24 to 48 hours before any symptoms arise and for five days after the onset of symptoms.
3. What is pandemic influenza?
Pandemic influenza is a global outbreak of a new strain of the influenza A virus that is easily spread from person to person and from country to country around the world in a short period of time. It can cause severe illness and death because the population has little or no immunity to the new virus.
4. What causes pandemic influenza?
A pandemic flu virus can emerge if an avian influenza (bird flu) virus mixes with a human flu virus or if an existing avian flu virus mutates, creating a new strain that can infect humans. Since people have no immunity against the new strain, it can spread rapidly around the world from person-to-person, causing a pandemic.
5. Why worry about avian influenza or “bird flu”?
Evidence suggests recent influenza pandemics were caused by different types of avian influenza A (“bird flu”) viruses. Presently, the WHO is concerned about the H5N1 avian influenza A virus that spread from South Asia, to countries in Europe and Africa. Highly infectious, the H5N1 avian influenza virus causes mild illness in some migratory waterfowl, but is quickly fatal in chickens. Millions of birds have been culled (killed) in an effort to prevent the spread of the virus.
Although the H5N1 strain of avian influenza is not easily transmitted to humans, 18 people contracted the virus and six people died in Hong Kong in 1997.
6. How does avian influenza spread?
There is no evidence that H5N1 avian influenza can spread easily from person to person. If it does come to Canada, it would most likely appear via the migration of infected wild birds. Through respiratory secretions and contaminated feces (droppings) these wild birds can spread the virus among chickens. People have become infected through close contact with infected chickens or their droppings which can survive on their clothing or shoes.
Health care and laboratory workers are equally at risk of contracting the H5N1 influenza virus through direct and indirect contact while caring for influenza patients.
7. What should be considered in a pandemic plan?
If your workplace does not already have a pandemic plan in place, you may want to consider putting pandemic influenza planning and prevention on the agenda of the next joint health and safety committee meeting. Don’t know where to start? The following is a list of things to consider when developing or reviewing a pandemic influenza plan. This list is by no means exhaustive, but it should get the discussion going.
The main goal of a pandemic plan is to eliminate worker exposure to the infectious virus by containing the spread of the virus throughout the workplace.
The plan should include the precautionary principle as per the recommendation of the late Justice Archie Campbell in the SARS report.
Methods of control should follow the usual hierarchy of controls: At the Source, Along the Path and as a last resort At the Worker (e.g. through engineering controls, administrative controls, work design/organization and personal protective equipment).
To ensure workers have the knowledge and skills to reduce influenza transmission, employers must provide appropriate education and training. All training programs must be developed in consultation with and reviewed by the JHSC or health and safety representative.
There should be provisions for communicating the plan in a clear and timely manner to all workers prior to and during the pandemic. Stay in contact with employees who are sick at home.
If protective equipment is deemed necessary for your workplace there should be a provision in the plan for the stockpiling of proper PPE and other protective equipment. Protective equipment should be of the highest level of protection (for example, N95 NIOSH-approved respirators, instead of surgical masks). Training should be provided on use, care and removal of N95 respirators.
Consider social distancing during a pandemic. Cancel the gathering of large amounts of people into one area. Explore the option of eliminating or reducing travel during a pandemic. In place of having face-to-face meetings schedule teleconferences, communicate by email and so on.
Workers advised to work from home should be properly equipped with consideration for their health and safety.
In health care settings use isolation and negative pressure rooms to reduce exposure if appropriate. Segregate those with pandemic influenza in a self-contained area.
Implement testing exercises or emergency drills to identify weak planning or areas that need to be changed in the plan.
The most important defense against the influenza virus is proper handwashing. Provide access to hygiene products such as sanitizers, soap, tissues and handwashing facilities and hot water.
Provide psychosocial support (through an Employee Assistance Program) to workers during and after a pandemic to relieve stress and anxiety.
Provide a list of resources workers can use to get more information on how to protect themselves and their families at home during a pandemic.