Emergency Preparedness
Planning for the Next Disaster: Pandemic
Last month I wrote about a rather exotic low-probability but high-damage event that would have impact on a national scale: an electromagnetic pulse generated by a high altitude nuclear explosion. Such an event would damage things, things like computers that are at the heart of our complex information economy. But what about an event that leaves physical things such as routers undamaged but attacks the human element of our infrastructure on a global scale. Specifically, what happens if a lot of people around the world get sick at the same time?
In the 1918-1919 influenza pandemic, somewhere between 30 million and 50 million people died worldwide. In the United States, an estimated 675,000 died, and the mortality rate was 2.5 percent. Health services were overwhelmed as people sought medical treatment. Absenteeism surged, interrupting essential services, such as law enforcement, transportation, and communications.
But that was then; this is now. Surely we are better prepared to deal with a flu bug with all our modern medical technology--or maybe not. The influenza virus spreads very rapidly by coughing or sneezing, and infected people can share the virus before symptoms appear. Although the migration from small family farms to cities had begun, in 1918 roughly one out of every two Americans still lived in a rural location. Few Americans owned cars, and travel was relatively limited, further slowing the spread of the virus.
Today’s world is based on closely interrelated and interdependent systems of trade and commerce. According to Ken McGee, Gartner Inc. vice president and research fellow, 8 percent of the human race, about 500 million people, cross national borders every year. That translates to a staggering 1.4 million people crossing a national border every day! McGee further warns that if the pandemic spreads across the globe as quickly as some experts predict, worldwide social and economic disruptions will follow as governments across the globe enact quarantines that could last one to 12 weeks.
A Pandemic Influenza Primer
Influenza is viral illness; it becomes pandemic when it is found in a large part of the population and affects people in many different countries. According to the World Health Organization, an influenza pandemic can start when three conditions are met:
- A new influenza virus subtype emerges for which the human immune system has no pre-existing immunity;
- The virus causes serious illness in humans; and
- The new virus spreads easily between humans by coughing and sneezing.
There have been at least three influenza pandemics in the last century: the “Spanish influenza” in 1918, the “Asian influenza” in 1957, and the “Hong Kong influenza” in 1968.
Bird Flu
While the origins of these pandemics remains uncertain, at least two are thought to have arisen either when an avian (bird) influenza virus mutated or when avian and human viruses exchange genetic material.
Concern about a new influenza pandemic is based upon the emergence in 1996 of a new strain of avian influenza, H5N1, in Guangdong Province, China. The virus quickly spread, and, to date, more than 200 million domestic birds have died or been killed in an effort to halt the disease. Fortunately, although there have been hundreds of documented human infections with a 60 percent mortality rate, H5N1 is not easily transmitted from human to human. So far human cases have been largely confined to individuals who worked closely with infected poultry.
In short, H5N1 meets two of the World Health Organization’s conditions for a pandemic. All it lacks is the ability to spread easily between humans.
How Probable Is an Influenza Pandemic?
After a surge of publicity in 2006, avian flu has largely dropped out of the news. That does not mean, however, that the threat has gone away. New avian flu outbreaks continue although the mutation that would support human-to-human transmission has yet to occur. (See for example, www.who.int/csr/don/2008_01_03/en/index.html.)
With the H5N1 virus now firmly entrenched throughout the world, the probability of human cases has increased. Each additional human case gives the virus an opportunity to improve its transmissibility in humans and develop into a pandemic strain.
While they are careful to point out that the timing and severity of the next pandemic cannot be predicted, many scientists believe it is a matter of time until the next influenza pandemic occurs.
What Would a Pandemic Mean to My Institution?
During past pandemics, attack rates reached 25 percent to 35 percent of the total population. Under the best circumstances, assuming that the new virus causes mild disease, the world could still experience an estimated 2 million to 7.4 million deaths based on data from the 1957 pandemic.
In short, a pandemic would mean many (if not most) employees would not show up for work either because they are sick, are caring for sick family members, or are staying at home to avoid infection.
What Can My Organization Do About It?
While drug companies push antiviral immunizations as the cornerstone of a pandemic plan, the article “Strategies for mitigating an influenza pandemic” which appeared in the scientific magazine Nature (Nature 442, 448-452, 27 July 2006) argues that influenza prevention and containment strategies can be considered under the broad categories of antiviral, vaccine, and non-pharmaceutical (case isolation, household quarantine, school or workplace closure, restrictions on travel).
Unfortunately, although clinical trials are underway, vaccines effective against a pandemic virus are not yet generally available. Similarly, although several antiviral drugs that can reduce the severity and duration of seasonal influenza may be effective in treating pandemic influenza, they must be administered within 48 hours of the onset of symptoms. Finally, virus specific vaccines and antiviral drugs are difficult to develop, test, and stockpile until after the new viral strain has emerged. And time won’t be on our side.
That leaves us with non-pharmaceutical strategies--ones that my mother, who was a rural health nurse in the 1930s, would recognize. Based on extensive mathematical modeling using the United States and Great Britain, the Nature article concluded:
- Border restrictions and/or internal travel restrictions are unlikely to delay spread by more than two to three weeks unless more than 99 percent effective;
- School closure during the peak of a pandemic can reduce peak attack rates by up to 40 percent, but has little impact on overall attack rates;
- Case isolation or household quarantine could have a significant impact, if feasible;
- Treatment of clinical cases can reduce transmission, but only if antivirals are given within a day of symptoms starting;
- Given enough drugs for 50 percent of the population, household-based prophylaxis coupled with reactive school closure could reduce clinical attack rates by 40 percent to 50 percent.
Whoa, hold it partner. Let’s go back to that third bullet. The Internet allows us to effectively work from home! The challenge to us IT folks then becomes making sure that the network and mission critical systems remain up and running--and that is something we know how to do!
A Very Short Institutional Quiz
Does your institution have a business continuity plan and process that specifically addresses a pandemic? According to Gartner’s McGee, business continuity plans that do not specifically address pandemics will not be effective.
Does your IT organization have a business continuity plan and process that specifically addresses a pandemic? One the most effective strategies to prevent the spread of infection is working online from home--and that is something IT can plan for. This can be done even if your institution does not have an institution-wide plan.
Have you tested your plan? For example, in the case of working from home, how about a planned surprise exercise in which all employees are directed not to show up for work in their office but to work from home for a day.
Where Can You Learn More?
Fortunately, there is a wealth of background material, planning documents, guidelines, and white papers available to help in developing an institutional or departmental strategy. Some of my favorite government sites are:
Although you have to be careful to consider what they might be trying to sell, a number of vendor sites are useful:
Some practical tips for remote access strategies
Roche (Maker of an Antiviral) Toolkit
Sun Microsystems
Finally, a number of higher education organizations have taken the lead in planning for a pandemic. Be sure to check out:
