http://www.loma.org/res-04-06-AvianFlu.asp
Special Report:
Part 1: Is Your Company Prepared?
Part 2: Conversation with a Medical Director
Avian Flu: Is Your Company Prepared?
With the rapid spread of the deadly H5N1 strain of avian (bird) flu from Asia to Europe in the last few months, governments and businesses around the globe have begun devising contingency plans so that their business could continue to function if the virus were to cause a pandemic. Five insurers recently participated in a LOMA survey that asked them to explain the status of their contingency plans and what steps they’re taking to prepare for the worst. Here’s what they had to say.
By Stephen Hall
If the avian (bird) flu becomes a pandemic, is your company prepared? The last major pandemic occurred in 1918, when an influenza strain known as “Spanish flu” killed somewhere between 20 million and 40 million people. According to science, pandemics occur every 10 to 50 years, and the world is long overdue for its next one. Many scientists say that H5N1, a deadly strain of avian (bird) flu that first appeared in Hong Kong in 1997, will likely trigger the next pandemic. In the last few months, it has spread from Asia across Europe and into Africa at an alarming rate, primarily through bird migratory routes.
Scientists say human infection is currently possible only when people come in close contact with infected chickens or wild birds. But scientists are concerned that H5N1 could mutate into a form that is easily transmitted among people and set off a pandemic that could kill anywhere from 25 to 165 million people worldwide, according to the World Health Organization’s (WHO) projections.
As for the potential economic impact, the World Bank estimates that such a pandemic could cost as much as $800 billion worldwide. In addition, the Insurance Information Institute (III) estimates that such a pandemic could result in $133 billion more in death claims for life insurers than would be expected in the absence of a pandemic—a figure that doesn’t even include claims from other insurance products, such as health care.
In January, LOMA sent out an informal “Quickie Question” (QQ) Survey to 22 of its larger member companies (organizations with total assets of $30 billion or greater) that included the following four questions:
1) Is your company reviewing policies, pay practices and business continuity plans in case the avian flu becomes a pandemic event? If so, what additions and/or changes are you making in the event of a pandemic?
2) Do you feel your current policies, pay practices and business continuity plans adequately address an event such as this, or do you expect that some changes, exceptions and/or new policies will be made, such as travel restrictions, restricted access to company property, sick pay, work at home schedules, and screening of employees and visitors?
3) Do you have expatriate employees on assignment in or near an affected area? If so, what actions have you taken or may be considering for their safety (i.e., evacuation back to the U.S. or another “safe” location, early/additional home leave visits)?
4) If an expatriate employee asks to leave their assignment, contrary to company-initiated action, how would their request be handled (i.e., transfer, repatriation, termination of the assignment)? Also, would expenses associated with the relocation be at the company or employee’s expense?
Five of the 22 companies who received the survey agreed to participate, and of those five, four consented for their survey responses to be reprinted for this story: Manulife Financial Corp., Nationwide Financial Services Inc., and two companies that did not wish to be named (and will be referred to here as “Company X” and “Company Y”). In addition, the chief medical officer of Nationwide consented to a separate phone interview with Resource in which he discussed his thoughts on avian (bird) flu and the measures that Nationwide is taking to be prepared in case a pandemic occurs. (To read his comments, please see “Pandemic Preparations at Nationwide: A Conversation with Dr. Michael Moore” following this article.)
Manulife Financial Corp.
In her response to the LOMA survey’s question about possible changes in company policy, pay practices and/or business continuity plans if a pandemic occurs, a representative for Manulife wrote: “Active planning efforts are under way. Broadly speaking, we are bolstering existing plans and policies. We are creating new documentation to help us assess the severity of the impact to our business and aligning this with the WHO model. Business units are specifically addressing the need to keep key business functions operational with a potentially severely reduced staff. Policies and pay practices were updated to address health concerns during the SARS epidemic [in 2002] and are presently considered adequate for an avian flu pandemic.”
According to the Manulife representative, work from home would be a major component of their response to an avian (bird) flu outbreak. “A move to that strategy is not considered a policy change so much as the implementation of an existing planned response,” she wrote. “Many of the items mentioned are already planned responses, and implementation will remain fluid to meet a presently unknown impact of the situation.”
Addressing the survey question about expatriate employees on assignment in or near an affected area, the Manulife representative wrote: “The safety of all employees, including expatriates, is of extreme importance to the company. The action taken to protect those in affected areas will be gauged to the threat. The suggestions listed above are all options for how to deal with the crisis and will be used according to a judgment about their effectiveness.” If an expatriate employee asked for permission to leave their assignment due to a potential threat of infection, then according to the Manulife representative, “In a bona fide crisis, either the employee or the company may initiate a request to leave an assignment to protect the employee’s well-being. The company would pay the cost. As in the other responses, the exact nature (transfer, repatriation, etc.) will be dictated by the assignment and severity of the threat.”
Nationwide
Dr. Michael Moore, M.D., FACP, vice president—chief medical director for Nationwide, completed the survey on Nationwide’s behalf. In his response to the first question, he wrote that Nationwide has actively reviewed all of its disaster planning and is in the process of addressing staffing shortfalls that could occur as the result of a pandemic and how the company would deal with such an issue. “We have modified our attendance policy to allow supervisors (with nurse consultation) to send sick employees home,” he wrote. “We have ordered N95 masks for all of our occupational nurses, met with state and local health officials to review our plans, and have created the Avian Flu Working Group, an internal task force made up of members from health, business recovery, employee safety and HR to oversee preparations.”
Regarding whether current policies, pay practices and business continuity plans are adequate, Moore wrote: “We are trying to anticipate what might happen, but will likely need to adjust to situations on the fly. Travel restrictions are likely with regard to affected areas if person-to-person transmission arrives.” There are currently no expatriate employees of Nationwide on assignment in or near an affected area, according to Moore, but if a situation arose in which an expatriate employee was working near an affected area and a pandemic were to start, “we would likely approve either work from home, temporary transfer to a ‘safe’ location, or return them to the U.S., likely at company expense,” he wrote.
“Company X”
“Company X” indicated that it is actively reviewing policies, pay practices and business continuity plans in case the avian (bird) flu becomes a pandemic event, “but this work has just started so we can’t provide an all-inclusive list of additions and changes.” On the question of whether it considers its current policies, pay practices and business continuity plans to be adequate in addressing a pandemic scenario, it wrote: “No, we are reviewing our business plans and all appropriate policies and pay practices, including topics noted in the question.” The possibility of imposing travel restrictions in the event of a pandemic has been put on the table for further discussion, they said. Finally, they noted that the possibility of expatriate employees requesting to leave an assignment in order to avoid infection is a matter that has not yet been addressed, but will be as part of the company’s overall review of its pandemic preparedness plan.
“Company Y”
“Company Y” wrote that it is “actively working on a plan and considering several changes to policies, such as increasing the number of paid sick days, implementing additional telecommuting, providing hand sanitizers, masks and gloves, limiting travel, and providing information and tips for how to prevent the spread of the virus, et cetera.” They said they “expect some changes” to their current policies, pay practices and business continuity plans to adequately address a pandemic event. In addition, they noted that a scenario in which expatriate employees would be on working in or near an affected area “does not apply” to them. Finally, with regard to an expatriate employee requesting removal from an assignment due to a pandemic threat, “Company Y” wrote: “We don’t have policy wording yet.” ■
[sidebar]
[head:] Planning for a Pandemic: Where Should You Start?
As the industry begins moving to address the threat of a potential flu pandemic and the alarming costs that could result from such an event, there is probably some confusion about where to begin. Dan Murphy, vice president of enterprise continuity at MassMutual, has a few suggestions:
■ “A great starting place would be the Business Pandemic Influenza Planning Checklist that was developed by the Department of Health and Human Services (HHS) and the Centers for Disease Control and Prevention (CDC),” he said. This checklist can be found at
http://www.cdc.gov/business.
■ Murphy also suggests working with city and state public health agencies and emergency preparedness organizations.
■ “Each company should perform an internal risk assessment to identify the unique issues that they would face, given the impact caused by high absenteeism rates for an extended period,” Murphy said. “The projected impact of a pandemic does present a situation that will require a review of various policies as well as a review of existing business continuity plans.”
■ Finally, as with any emergency planning activity, “Having discussions and plans developed in advance of the situation allows a more thoughtful response when an event occurs,” Murphy said.
For additional planning resources, please visit the following Web sites:
■
www.cdc.gov
■
www.healthyamericans.org
■
www.pandemicflu.gov
Part 2:
Pandemic Preparations at Nationwide: A Conversation with Dr. Michael Moore
The vice president and chief medical director for Nationwide discusses what his organization is doing to prepare for a possible flu pandemic, and what he suggests for the rest of the industry.
By Stephen Hall
With the Insurance Information Institute’s (III) recent estimate that a flu pandemic could cost the insurance industry as much as $133 billion in death claims, many in the industry are scratching their heads and wondering what they can do to prepare their organizations for such a possibility. But at Nationwide, work has already begun in earnest.
For starters, a task force called the Avian Flu Working Group has been assembled to help assess the ways a pandemic could affect Nationwide’s business functions and to help create and implement contingency plans that would help Nationwide continue to function in the face of such an event. The company has also created a “green-yellow-red” worksheet—a device similar to the U.S. Department of Homeland Security’s color-coded advisory system—that specifies a series of actions and protocols that would go into effect as certain conditions pertaining to avian (bird) flu arose. The Columbus, Ohio-based company has also been in regular communication with federal, state, and local health agencies in order to develop good working relationships between the agencies and Nationwide in anticipation of a pandemic scenario, in which time would likely be a critical factor.
Dr. Michael Moore, M.D., FACP, vice president—chief medical director for Nationwide, spoke with Resource about these and other steps his company is taking to prepare itself for the conditions that could arise if the deadly H5N1 strain of avian (bird) flu, which has been spreading rapidly from Asia across Europe and into Africa in recent months, triggers a pandemic that could threaten the lives of millions around the globe. His comments are below.
Q: Can you elaborate on the Avian Flu Working Group that’s been created at Nationwide?
MOORE : In creating the Avian Flu Working Group, we tried to recruit employees who were representative of the areas of the company that would be affected if a pandemic occurred. I was involved in starting it up, and then we brought in our HR group, who deals with employee affairs, regulations and so forth. And then it expanded to address business recovery for those employees who might be affected.
We have a lot of business recovery plans if, for example, a hurricane hits Tampa or an earthquake hits San Francisco . We’ve never dealt with anything before that would hit every company or every outlet at the same time. The public officials we’ve met with have told us to prepare for a 40 percent absence rate for at least a couple of months, if indeed a worst-case scenario occurred. And as our conversations started to occur, we realized that we really didn’t have a lot of the things we thought we had. For example, we always assumed we had the right to send a sick employee home. So we pulled out our employee handbook and looked for a sentence or passage that states that. It wasn’t there. And so we modified our internal regulations to say that if a person reports to work and exhibits such symptoms as coughing, fever and vomiting, then in consultation with a nurse, a manager can send that person home.
We’ve tried to model our working plan after what the federal government has done. And I use a mnemonic device called “PMIT,” which stands for “prepare, monitor, isolate and treat.” One of the things the federal government is telling people is that if you have a vital substance that is the lifeblood of your company, then you should make sure you have a supply of it that will last from two to four weeks, because your supply chain may not be reliable. Suppliers are going to have 40 percent absence rates, just like everybody else. So we want to raise awareness of that reality. We also want to get word out to our employees and say, “Make sure you have a survival kit at home.” So we’re going to include a post on our internal Web site that specifies what a survival kit should include, such as how much water per individual per day, and for how many days. We will advise them to make sure they have enough of the medicine that they would normally take during a two- to four-week period, because their drugstore may not be open. We will advise them to make sure they have enough food, flashlights and other necessities. We’re also working on putting together a plan, which we’ll send out to all of our offices, that covers issues like monitoring and isolation. I’ve been monitoring information from the CDC and the WHO and forwarding that information to our Avian Flu Working Group. If the situation with bird flu starts to heat up, what we would probably do is start sending that information out to supervisors, managers, and anyone else who needs it.
Q: Explain the “green-yellow-red” worksheet that Nationwide’s Avian Flu Working Group has devised.
MOORE : Here’s how it works: If situation X happens, we’re in Condition Green; if situation Y happens, we’re in Condition Yellow; and if situation Z happens, we’re in Condition Red. We’re in Condition Green right now, because there’s been no person-to-person transmission and nothing here in North America yet. We would go to Condition Yellow if person-to-person transmission developed outside of the U.S. , or if a case of avian flu is reported in North America . Finally, we would go to Condition Red if person-to-person transmission were to hit North America . And each one of those events triggers a certain level of action on our part.
For example, Condition Green is basically preparation; it’s about making sure you have cleaning supplies. A lot of the things that the government is recommending are very simple steps: Make sure you have cleaning supplies with antibacterial agents that you can use to clean common touch areas, such as doorknobs, stair railings and elevator buttons. Make sure you have gloves available so that if you find something that’s been exposed, you don’t inadvertently expose more people while trying to clean it up. Make sure you have hand cleaner available for people so that they can frequently sanitize their hands.
If we were to ever go to Condition Yellow, only the most essential business travel would be permitted. We would certainly minimize, if not outright ban, travel to any place in which there is person-to-person transmission. We would begin to look at alternative work environments so that people can work from home. A lot of what we do can be done on a computer. Approximately half of our people have VPN (virtual private network) access, so they can get into our systems to do what they need to do to properly do their job from an alternative location. VPN is what our systems people do so that employees can safely get into our systems and still have a secure environment. The idea is that we try to keep the people who are healthy away from the people who are sick, and keep the people who are sick at home and out of the office.
Condition Red would take effect if person-to-person transmission were to occur in North America . In that situation, we would be utilizing what we call “social distancing,” or keeping people from congregating. For example, instead of having a meeting, you would have a teleconference. You wouldn’t shake hands with people. Instead of me walking over to the other side of the building to tell somebody something, I would call them. People who would normally be going to conferences or meetings would dial in instead. We would try to keep people that are able to work out of the office, out of the office so that they are not exposed and are not exposing people to different elements.
Q: Has Nationwide had any discussions with federal, state and/or local agencies in formulating its contingency plans?
MOORE : We’ve met with both the state of Ohio and the Columbus city health departments to get a sense of how they would react if a pandemic were to start. That way, we would know what they plan to do, and we wanted them to know what we had planned as well. We actually let them review our plan and see what they thought, and we took their suggestions to heart. Those meetings also provided us with contact information; now we know who to call in each of those two organizations and how to reach them. Similarly, they know who to call in our organization and how to reach them. And that’s already been paying dividends. We’ve had a couple of instances where they have been sending us information—not about avian flu, but just about seasonal flu. So we’re able to monitor that here in the county that we’re located in. I recently gave a presentation to the ACLI’s 2006 Executive Roundtable, and one of my recommendations was to meet with local health officials where your business is located, because they are really going to be your entrance into the government treatment system.
If there is a pandemic, the two elements that I hope are going to happen are vaccinations and treatment with Tamiflu. The federal government is not going to be the distributor of those resources. They will hold a stockpile, but they will then give that to local health departments, who will in turn determine how it gets distributed. So it would be very useful for them to know how to get into your organization and who the right people to talk to are. Similarly, it would be nice for you to know who the appropriate contacts are in your local health department. When we met with both the state of Ohio and the Columbus city health departments, we asked them, “How are you going to function if you have 40 percent of your nursing staff out with the flu?” They hadn’t thought about that. So we said, “Well, we have an occupational nursing service. We have a number of nurses here in Columbus and around the country. Perhaps we could help bolster your distribution efforts, if indeed it comes down to a question of manpower, in terms of trying to get medicine out to the right people.”
So here’s where we are on our planning timetable: We’ve designed the plan, we’re putting the finishing touches on it, and our next step is to meet with senior management and say, “This is what we’ve got planned, and this is how we are planning to handle this.” We think it’s a fairly non-controversial plan, because it’s following basically the same guidelines that are part of the federal government’s plan. It’s fiscally responsible, because the most that we’re really asking people to do is stock up on some cleaning supplies. So if the pandemic does not hit—and frankly, the odds are that it won’t—they haven’t invested in anything more than some cleaning supplies, which they’re going to use anyway. It’s a plan in which we are following all the guidelines that the federal government is suggesting.
In other words, we’re not recommending that people stockpile Tamiflu. We held that discussion for about a minute-and-a-half and said, “Is this something that we want to even look into, even if we could get it?” And the general conclusion was that stockpiling Tamiflu would not constitute the behavior of a good corporate citizen, because in stockpiling Tamiflu, you’re potentially keeping it from people who really do need it. So we’re not going to stockpile it. We’re just working with the local health department and following their guidelines.
Q: Overall, what kind of grade would you give the industry, as far as their development of contingency plans in the event of a flu pandemic?
MOORE : I think they’re probably a grade C, and on their way up to a B. Ever since I gave my presentation on pandemic flu to the ACLI’s Executive Roundtable, I’ve had half a dozen organizations call me and ask for reprints of the handout that accompanied my presentation. I talked to the ACLI a week or so ago, and they said my handout has been the most requested piece of literature that they’ve had in at least the past several months. So the word is getting out that this is something that needs attention and is potentially very serious on two levels: for us as employers, and for us as life insurers. I think the Insurance Information Institute’s (III) recent estimate that a pandemic could cost the industry $133 billion got everybody’s attention as well. If my words of warning weren’t enough, that certainly got the attention of the CFOs.
Q: Are there any particular stages or aspects of preparation that you think are being overlooked by many companies?
MOORE : At this point, I think that if anything, people are not giving it the attention it deserves. The reaction I received after talking with some of the CEOs at the ACLI Executive Roundtable was, “Well, I heard about this, and I knew it could be a problem—but I never knew it could be that big a problem.” I think many people are thinking of it in terms of localized, weather-related disasters that we’ve dealt with in the past and saying, “Well, we did fine with the hurricane.” Well, a flu pandemic is not like a hurricane. True, it’s not going to knock down buildings, but when you start talking about a 50 percent mortality rate among people who have tested positive for bird flu, you realize this is a different scenario. Also, most people think of flu as affecting just the very young and the very old, but among those who have contracted bird flu, the people who are having the highest mortality rate are ages 15 to 40. That always surprises people. Most people who remember the Hong Kong flu outbreak look back on it and say, “Yeah, that was that funny disease back in 1968.” But most people don’t realize that Hong Kong flu had 10 times the lethality of normal seasonal flu. About 30,000 Americans die from flu each year; 300,000 died from Hong Kong flu. So while there was an upward blip on the mortality chart, it really didn’t get a lot of people’s attention. But even if that scenario arose again, a flu strain that has 10 times the lethality of seasonal flu is not an insignificant problem.
Q: What advice would you have for a company that wants to start working on contingency plans for a potential pandemic, but doesn’t know where to begin?
MOORE : There are two Web sites that I advise people to go to. One is pandemicflu.gov; that’s the official federal government Web site for that. There’s another one called healthyamericans.org, which has a pamphlet titled “It’s Not Flu as Usual.” It has a lot of useful advice, including how you can tell annual flu from pandemic flu, what to do in the event of an outbreak, and 10 steps your businesses can take. And I think it is probably one of the best things I’ve seen in a very compact brochure.
The other thing I would tell people is, begin now. If you wait until we start to see person-to-person transmission, even in Europe , you’re going to be so far behind, you’ll never catch up. There is a possibility that a pandemic won’t occur, and a few years from now, we may look back and say, “Boy, what were we all worried about?” But this is a disaster for the poultry industry overseas. They’re reporting that about 200 million chickens have been killed in an attempt to stamp out bird flu. The other news item that broke recently is a reported case of H5N1 in Iraq . And one of the main vehicles by which the Spanish flu spread back in 1918 was GIs returning from World War I. So when I read about the H5N1 case in Iraq , that sent a chill up my spine, because we’ve got hundreds of thousands of American soldiers over there who are rotating back after their tours of duty, not to mention all the private construction people and other expatriates over there who keep returning to the U.S. That sounds eerily similar to what happened in 1918.
I think that we at Nationwide are probably ahead of the curve, in terms of being prepared. But even then, at times it feels like we’re playing catch-up. So if you haven’t begun to think about this, it’s time to put this on the fast track. ■
Seems like all preparations must be done in advance.