Contingency Planning

They’ve Asked Me to Write an H1N1 Flu Plan, Now What?

By Ashley Pearson B.S., MPA October 13, 2009

Since the attacks of 9/11, lessons learned from Hurricane Katrina and H5N1 (the Avian flu), preparedness, planning and response have received renewed attention within health and human services agencies. Many states have experienced major emergency and disaster incidents of varying intensities over the years, but it can be argued that these three have had the greatest recent impact on agency preparedness. Many of us nationwide, working within both large and small organizations, have had the extra duty of “emergency planner”, “emergency director” or “disaster coordinator” added to our job descriptions as a result of their impact. H1N1 is newest threat and this article seeks to point you in the right direction to taking on this daunting role. As we face the second wave of H1N1 here in North America this fall and winter, now may be a good time to dust off your All-hazards emergency, Continuity of Operations (COOP), Joint Commission-EOC or emergency operations plan. Whether you are a new or experienced planner, this article should be helpful in providing you with a 1) basic overview of the key points to address this event, 2) building upon the strengths you may already, 3) the three plans you need to have and 4) provide tips on next steps you can implement into a plan right now.

H1N1 Overview

You may be asking, why are we worrying about this influenza? So far, it seems to be fairly mild and only causing a few deaths nationwide. If you are working in public health, you are probably not asking this, you already deep into the planning stage! First, I am not a medical professional, but have pulled the following from the federal Centers for Disease Control (CDC) and other credible sources. I am not going to spend time in this section on the epidemiology and etiology of the virus as the information put out by our national public health, scientific and medical experts is already voluminous. Here are key points for planners:

1. New Virus Strain: This flu, labeled H1N1 by the experts, is a novel influenza virus in the human population. This means it is a flu virus our bodies have not been exposed to previously. Due to this, our bodies have no built-up immunity, experience fighting it off and there is not a vaccine readily available. This being the case, our scientific and medical community, lead by the World Health Organization (WHO) globally, are concerned about its potential virulence and ability it has to harm many more of us than during the average flu season from October through March each year. Typically, the U.S. sees about 36, 000* deaths, most often in our elders or those with pre-existing conditions that are exasperated by contracting influenza. For more information on this, go to: http://www.flu.gov/individualfamily/about/seasonalflu/.
2. Impact Group: As stated above, the elderly and those already at risk are most negatively impacted by flu strains. The difference with this influenza is that, so far, it appears to be affecting more youth and flu usually impacts the elderly over 65, children under 2 years of age and those with chronic medical conditions. According to the CDC’s web site: “About 70 percent of people who have been hospitalized with H1N1 (Swine) flu have had one or more medical conditions that placed them in the “high risk” category for serious seasonal flu-related complications. These include pregnancy, diabetes, heart disease, asthma and kidney disease” (October 5, 2009).
3. First to Get Vaccine: Currently, the “CDC’s Advisory Committee on Immunization Practices (ACIP) has recommended that certain groups of the population receive the 2009 H1N1 vaccine when it first becomes available. These target groups include pregnant women, people who live with or care for children younger than 6 months of age, healthcare and emergency medical services personnel, persons between the ages of 6 months and 24 years old, and people ages of 25 through 64 years of age who are at higher risk for 2009 H1N1 because of chronic health disorders or compromised immune systems (CDC guidance as of October 5, 2009, www.cdc.gov). However, with the approval of the need for only 1 dose of vaccine for adults, it is expected that there will be more vaccine available faster than originally expected.
4. Why We Care: The virus has spent the summer running through the Southern Hemisphere. This is significant because since its discovery in Mexico in the spring, it has been spreading from Southern American and across the globe to Australia, during their traditional flu season. This has potentially allowed the flu to come into contact with a greater number of people in the human population. Experts tell us that this also gives the virus more opportunities to mutate and become resistant to potential preventive measures we develop to combat it.
5. Cause for Concern: So why be concerned here in America? As we enter flu season, H1N1 gets the chance to infect more of us and, in reality, it has never gone away. H1N1 has been with us since it was discovered in our population last spring. As reported throughout the summer and the start of the new school year, H1N1 has already done a good job of remaining active. It appears to have been successful in making children ill who congregated in summer camps and is spreading in colleges and universities as students return to campuses. It also continues to impact those in the other high-risk groups. Although the overall numbers remain small, our medical community remains vigilant to a potential for increase in impact and severity through use of surveillance measures in communities throughout the nation. A note to remember is that although the number of confirmed cases appear small, experts tell us that due to surveillance protocol practices in place, where most people are not officially tested to determine if their illness is H1N1, estimates are that the number of people who have it is likely greater than reported.
6. No Vaccine and No Guarantee: Part of the intense response to H1N1, besides the specter of the 1918 flu season in the memories of public health, is that there was no vaccine developed for this influenza. This is because our medical community commits its recourses to develop a seasonal flu vaccine based upon what they determine is likely to be the most widespread and impactful strains for the upcoming flu season. The Season flu shot this year addresses three targeted strains. With H1N1 being a new virus strain, a great deal of resources have been invested to create vaccine. Although now approved for children and adults, we are implementing these measures in reaction, not prior to, the onset of this pandemic. As such, the combination of vaccines, mobilization of appropriate community efforts to respond and effectively educate the population to their risks and responsibilities to mitigate H1N1 is no small task. Our greatest tool for limiting the risk of catching the virus remains infection prevention and getting the vaccine. In a time when attention is galvanized in the country on economic and political concerns, gaining the nation’s attention to bay attention to this pandemic also hard. In the area of planning, we can help by assisting our agencies and the populations we serve to prepare for an uncertain outcome. We all need to be prepared if this influenza mutates and it renders current vaccines ineffective. The likelihood of this is unknown, but we need to plan for a worst case scenario. Our overall goal is to foster preparedness, not panic in a culture that devalues prevention.

H1N1-Planning Strengths

As a strengths-oriented person, I would like to first list elements and areas that are pluses for those of us active in the health and human-services field. The old phrase “accentuate the positive” comes to mind and, there are things we can bring to the table that come directly from our daily work:

1. Natural Resilience: This can also be called doing more with less. Unfortunately, we are used to it and yes, it is actually a positive. In this sense, I am referring to the fact that those who work within our systems of care are already used to the fact that we are often asked to create something from nothing, or next to it. In relations to planning this means that we build upon pre-existing networks and have systems in place to educate clients to help themselves prepare for H1N1, including helping them accessing vaccine. The examples in the box below provide some ideas for this:

Things you can do and places to go for planning help:

• If you already offer Seasonal Flu Clinics on-site, build upon this model, modifying elements that are unique to H1N1 (for example, the age groups of those impacted)
• If you don’t offer flu clinics on-site you should work with sister organizations to get the message to your clients about where they can access public & private points of vaccine clinics. You may also look into partnering together to hold a clinic and combine resources.
• If you do not have a Continuity of Operations Plan (COOP) in place, it is time to develop a response plan
• Develop or build upon existing infection prevention planning
• Revise or create HR policy that addresses the key points of pandemic planning
• Gain buy-in from your executive leadership
• Network and share with colleagues. It is often difficult to implement these measures or develop guidance on your own. Luckily there are many people willing to help. A good source for human services and health care organizations are:

Guidance for Businesses and Employers to Plan and Respond to the 2009 – 2010 Influenza Season: http://www.flu.gov/professional/business/guidance.html

State & Local Government: http://www.flu.gov/professional/states/index.html

Hospital Pandemic Influenza Planning Checklist: http://www.flu.gov/professional/hospital/hospitalchecklist.html

Long-Term Care and Other Residential Facilities Pandemic Influenza Planning Checklist: http://www.flu.gov/professional/hospital/longtermcarechecklist.html

Health Insurer Pandemic Influenza Planning Checklist: http://www.flu.gov/professional/business/healthinsurer.html

CDC Guidance on Helping Child Care and Early Childhood Programs Respond to Influenza during the 2009–2010 Influenza Season: http://www.flu.gov/professional/school/childguidance.html

Faith-Based & Community Organizations Pandemic Influenza Preparedness Checklist: http://www.flu.gov/professional/community/faithcomchecklist.html

Planning for 2009 H1N1 Influenza: A Preparedness Guide for Small Business: http://www.flu.gov/professional/business/smallbiz.html

Business Continuity Planning Workgroup for Healthcare Organizations: http://www.bcpwho.org/

Wakefield Brunswick Management Consulting, MedPrep Consulting Group, LLC-Hospital Business Continuity Plan (guidance template): http://www.wakefieldbrunswick.com/downloads/Business%20Continuity%20Template%20Hospital.pdf

• Community Connections: In the human service and health care world, we are naturally partners in our communities. This is time to use these relationships to your advantage. If you conduct your risk or hazard analysis for this event and determine the are large holes in your plan, you may be able to fill them in my calling upon your community partners to help you and this also builds good will. For example, helping your local public health officer in spreading the word about where the local flu clinics are, can serve two purposes: 1) it helps with Seasonal flu shot distribution and H1N1 vaccination messaging while supporting their goal of proving citizens with access and 2) Your clients and staff benefit from the risk messaging and information.
• Do the Right Thing: Creating a plan, implementing it and getting risk messaging out are the best actions to take to support your community and service system in preparing for this pandemic event.

The Three Types of Plans

To survive a crisis, I recommend that you develop the following three types of plans suggested by Gerard Braud in his Crafting a Crisis Communication Plan article (2007):

An emergency operations plan

Often labeled as a "crisis plan," it includes steps for coordinating police, fire, EMS and rescue workers. Most do not contain any instructions for communicating with employees, media and other critical audiences.

A crisis communication plan

This plan tells you what to say, when to say it and what tools to use. This plan must be thorough, yet simple enough that anyone can execute it. It should direct you to do what is on page one, have you check it off, then move to page two and so on.

A business continuity plan

This plan should direct you on how to get the business up and running again after a crisis. It keeps the money coming in.

Ten H1N1 Planning Elements

As you work to develop a plan, here are some of the key areas to address. To simplify things I have limited them to ten fundamentals:

1. Plan Now: As stated earlier, if your organization does not have an emergency plan, such as an All-hazards, COOP or Business Continuity Plan, now is the time to develop one. The web sites listed above can help you to get started. Work to address areas germane to H1N1.
2. Dust off that COOP: If you already have a plan, now is the time to make sure you have a Pandemic H1N1 plan or checklist as part of it. There should be no need to reinvent the wheel here, but build or modify what you already have in place.
3. Communication Plan: A key part of any good planning for emergencies is having a communication protocol for this event. I would suggest it include: 1) a plan for responding to your constituencies externally, 2) an internal plan for how management and key staff communicate about the event, 3) a plan for how all staff will be communicated with (this should be created with your Communications department).
4. Staffing plan: Prepare for how you will deal with things if 30-40% of your staff are out at any one time. This is a key part of planning for H1N1 and pandemic.
5. Infection Prevention plan: If you have clinical staff on-board your organization, work with them to develop a plan for infection prevention and control that is clear, easily understood and addresses vaccination distribution (if you are offering it on-site).
6. Action Plan: Work with your leadership to develop a plan for critical actions you need to take within your organization and continue to provide core services.
7. Stay Informed: This is a fluctuating and changeable event, thing are changing on a daily basis. Find few, trusted sources and keep yourself updated.
8. Human Resources and Employee Issues: If you do not work within your agency to address these, they could have a crippling effect on your provision of services at worst or become an internal relations challenge, fostering ill-will among staff that are likely already feeling the negative impact of the down economy.
9. Be Prepared for the Long Haul: Part of the importance of planning for H1N1 is that we do not yet know how long it will last. As we enter the second wave, we may be facing a six to eight month term of impact, with dips and valleys in how it could impact your organization from day-to-day. It is also unclear if the virus will remain relatively mild for most people or if an increase in severity will cause us to ramp up in the response required. Be prepared to be flexible and to change plans if the situation demands it. Create a plan for if the flu becomes severe and has a greater impact than right now. Prepare yourself for this possibility and practice good health habits to keep yourself well.
10. Trigger points: Create a decision-making protocol for how and when you will ramp up your response, if needed. If you have limited resources to develop a formal protocol for the decision making process, you can develop a 2-3 page H1N1 response plan as an annex to your existing emergency plan to address key areas. This will also help ensure that executive staff known what their roles are and encourage clarity across all business units.

Whether you are a veteran planner or new to developing them, now is the time to have an H1N1 plan. Even in a world with many completing proprieties, with the arrival of vaccine in our states and local communities, now is the time to address this Pandemic. Recent media articles suggest that 80% of business have no emergency planning. It is the hope of many that this influenza will have a limited negative impact on functioning, but even one severe illness or death within your organization is one too many, especially if basic safety precautions could have assisted in mitigating the event. Having a solid and adaptable plan is necessary to successfully preparing to respond to H1N1’s impact on your agency. It’s not a question of if there will be an effect, but when. No one will fault you for a plan that you never need, but everyone will question you the moment it is needed and you never created one.

About the author

Ashley Pearson B.S., MPA
Ashley Pearson is the director of emergency management services for the Massachusetts Department of Mental Health-CO. She can be reached at Ashley.Pearson@state.ma.us.