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It is a question of when and not if for health experts who are bracing for a pandemic of influenza to strike. How can U.S. businesses prepare for such a health emergency that has struck at least three times in the last century?

Masks were part of the policemen's uniform during the 1918 influenza.

Many businesses that plan for a pandemic of influenza do not even begin to comprehend the magnitude of such a potential outbreak. Thus, their plans are likely to be inadequate. Sure enough, it will not hurt to have some hand sanitizers and masks around. But those might only be adequate for a time when staff members have colds. The particular type of mask that may be required to protect against acquisition of influenza is still under consideration. It may turn out that only sophisticated respirators will be considered valid, and those will require fit testing and repeated fit checking. Having anything less under the guise of providing safety to your staff members may give your risk managers pause. Perhaps the real question is, "Just what will your employees be doing at work anyway?"

Learning from a Dire Past
Looking back at the pandemic of 1918 is instructive. In September, the death rate was under 20 per 1000, but by October it had swollen to over 50 per 1000. Over the period of the 1918 outbreak, there was incomplete information available and a shortage of staff to accurately count the total deaths. Worldwide there are widely varying estimates of total deaths, but they cluster about the 20- to 50-million range.

Given the larger population and greater movement of our people, we can expect more deaths if a pandemic should occur now. Estimates in the range of several hundred million deaths worldwide are frequently predicted. And for every death, there will be many ill people who will survive but are sick, unable to work. Those who are well will need to assist wherever they can to provide essential services.

Vaccines for pandemic strains are unlikely to be available soon enough to protect all U.S. citizens.

Vaccines are unlikely to be widely available in time to stem the course of an outbreak. Anti-virals, though stockpiled, will be challenging to administer and distribute. At present, rapid testing is the only logical course of action to direct the distribution of this limited resource. And the University Hygienic Laboratory, Iowa's public health and environmental lab, is under-resourced to perform this function. When the stockpile of anti-virals is available, science-based decision-making may be crippled unless more capacity is available through funding of the UHL's Iowa Vanguard* initiative.

Offshore Reliance
Even if vaccines and anti-virals were suitably resourced in this country, a miracle of sorts, there would still be a problem of major proportions that businesses would need to plan around. That problem stems from the fact that globalization has changed the way we do business. It has created reliance on offshore manufacturing companies that supply businesses with just-in-time inventories. And technology has cinched the deal with computer-driven inventory and procurement systems. When a pandemic arrives, just-in-time inventories will likely fall short of need.

Our reliance on the functioning of other countries has never been greater but those other countries would not be able to fulfill our expectations. Many other countries would not have sufficient vaccine and anti-viral resources, if any. Thus, their people would be suffering as great or greater morbidity and mortality. Therefore their workers would be home, struggling to sustain life and deal with death.

Forget about promised delivery dates of raw materials and assembly parts. Those already assembled would languish in warehouses for want of transportation. Perishable goods might rot in fields not harvested or in crates not shipped. Critical lifesaving drugs, insulin for example, might be severely limited in supply. Businesses in the U.S. would not have stocks of assembly parts or retail goods. Perhaps this would not be all that bad because they would not have many well customers on a local basis or transportation workers available for remote deliveries. So what should businesses plan for when they begin to develop a pandemic flu plan?

Adequate protection from acquiring influenza may require a respirator instead of a simple mask.

Who Decides to Turn Off the Lights?
During a pandemic, essential services such as hospitals can expect to be overwhelmed with ill individuals, too few respirators and too few healthy workers. Their plans would include cancelling all elective surgeries and postponing noncritical surgeries that could be delayed. And they may need many volunteers to help transport ill patients. Grocery stores that still have inventory may elect to deliver groceries to those too ill to drive, or they may deliver to all customers to limit spread of disease. A bag of groceries left on the front porch presents a lesser risk of disease transmission than does an in-store transaction. But grocery stores may need volunteers to transport foods.

Businesses that provide retail goods may find themselves without customers even if they have inventory. Businesses that manufacture goods may have no raw materials, no laborers, no demand or no warehouse space for their inventory or some combination of the above. A business plan should include considerations as far reaching as these.

Its not possible to predict the exact circumstance, but there should be a plan for decisions about when to shut off the lights and what to do with the employees who can work. Could some of them be paid by the company to volunteer? Volunteer drivers could deliver essential goods to ill persons. Computer operators and telephone duty personnel could oversee the needs and identify the resources and communicate the requests to the drivers. Nurturers could assist staff in hospitals. If such a plan were feasible, who would be the key personnel to oversee the decision to go to such a plan? Will the decision-makers be healthy?

Planning is Paramount
The plan is not as important as the planning; Ike said that. Getting staff members together to identify some key strategies is important. Having lists of telephone numbers for off-duty staff members is also important. Knowing what radio stations to tune into for guidance and what websites to bookmark are also important. Planning means that the group knows where to go for resources and how to adapt the plan to the circumstances.

Unlike any other time in human history, Iowans today can prepare for the potential of a pandemic.

The federal government has laid the responsibility in the hands of the locals, citing its inability to adequately manage an outbreak of great magnitude. It is imperative that local businesses know how to access their local health departments and emergency operations center communications. Have representatives from these agencies come to your business to guide your planning, and have them bring their partners from EMS and other units that may be invaluable to your operation in the event of an emergency.

There are courses available to provide greater insight. At the Center for Infectious Diseases Research and Policy (CIDRAP) in the Twin Cities, such courses are offered. There also is a great deal of information on the CIDRAP website (www.cidrap.umn.edu) about influenza and its potential to cause a major pandemic in the future. While a pandemic may not be as far reaching as CIDRAP warns, their prescience is invaluable in pushing us to recognize the breadth of possibilities that we face.

Pandemics like the 1918 influenza rob businesses of their workforce and nations of their citizens.

At this point, there may be no foolproof means of ensuring that a pandemic does not devastate the U.S. workforce or completely cut off access to vital inventories. And inevitably, mistakes will be made when such an emergency does arise. The first and potentially the largest mistake, however, may be the failure to plan at all.

More information about preparing for an outbreak of influenza is available on the following website: www.pandemicflu.gov/plan/tab4.html

*Iowa Vanguard is a proposal of the UHL to protect Iowans by detecting outbreaks about to happen and stopping them in their tracks. If adequately funded, Iowa Vanguard will enable resources to be deployed where disease is actually present. This will maximize effective use of limited resources and optimize outcomes for Iowa citizens.