Healthcare

Public Health Answers for Non-Public Health Organizations

by Charles (Chas) Eby

Private companies and public agencies conduct business as usual most days, but emergency planners at these organizations should be acutely aware not only of the company’s vulnerabilities but also of any external threats to operations that might cause major problems. Cyber attacks, earthquakes, and/or a pandemic flu – to cite but three examples – could jeopardize the business infrastructure, physical facility, and workforce capacity.

To cope with these and other threats, contingency planners have been developing and exercising continuity of operations (COOP) and continuity of government (COG) plans for many years. The COOP programs reduce the overall risk associated with disasters and incidents that could quickly disrupt the business processes and essential functions of any organization.

Those essential functions usually are aligned with the primary goals and operations of each organization. Public health agencies typically espouse objectives that help improve the health status of local residents, a category that includes their own staff. Other types of organizations focus on core objectives related to their specific disciplines. However, there is an opportunity for these groups to include the primary objectives of public health preparedness planning within their COOP plans and everyday operations. By incorporating health preparedness tips, many organizations not only augment and upgrade their planning efforts, but also help ensure that the multidisciplinary response to a health emergency is comprehensive and effective.

Emerging Health Threats & Business Continuity A number of currently active public health threats affirm the need to include health preparedness in contingency planning as well as normal operations. In 2012, for example, Saudi Arabia reported the first case of the Middle East Respiratory Syndrome Coronavirus (MERS-CoV), a new lethal strain of respiratory virus. There have been more than 100 confirmed cases of MERS-CoV in eight countries since the initial outbreak, and almost half of the victims in those confirmed cases have died. Although there have been no casesentified in the United States – and all cases, in fact, can be linked to the Arabian Peninsula – both international and U.S. public health agencies are seriously concerned about this virus. Three reasons for concern are: its novel structure; the high mortality rate already recorded; and the current lack of vaccines and medications needed to mitigate the virus.

Another recent threat is a new strain of the avian influenza A (H7N9) virus reported earlier this year in China – beginning in April 2013, when an outbreak of that virus caused at least 130 people to become ill. Many of those infected had come into direct contact with poultry, but recent studies have shown that there has been some human-to-human transmission as well. Most cases of H7N9 have caused severe illness, which also was the case with the MERS-CoV outbreak.

So far, fortunately, the number of infections caused by both of these novel viruses has declined in recent months. This does not, however, eliminate a continuing concern that either or both viruses could mutate into a widespread outbreak or pandemic at any time. If nothing else, the MERS-CoV and H7N9 outbreaks serve as much needed reminders that healthcare organizations and agencies throughout the world should continue to develop the action plans needed to mitigate the short- and long-range effects of infectious diseases. In other words, the time for public health contingency planning is and always should be now, with the preparedness communities of all nations leading that long-range, continuing effort.

A “Top 10” Preparedness List for Non-Public Health Organizations Federal, state, and local health departments throughout the United States are already actively planning to cope with the still emerging MERS-CoV, H7N9, and other short- and long-range emerging public health threats. Many of these same agencies even include specific actions related to health preparedness in their COOP plans. In May 2013, to help guide those efforts, the U.S. Centers for Disease Control and Prevention (CDC) released a comprehensive report – the “Top 10 Influenza Pandemic Response Planning Tips for H7N9 Virus” – intended for a public health and healthcare audience. Also included in the report is an abundance of helpful information on such related topics as epidemiological surveillance, pandemic planning, laboratory testing, and mass vaccination programs.

The CDC’s report also discusses several essential “preparedness areas” for health departments, but many of the items on that list are too specific for other disciplines. However, the following 10 recommendations for action could help strengthen COOP plans and operations spanning the entire national spectrum of private and public sector organizations long before a major health emergency does occur:

1. Identify and assign an employee to serve as the organization’s emergency preparedness and public health liaison. Any employee so designated should establish contact with state and local health departments. A direct contact often proves to be invaluable for planning, particularly during an acute public health emergency.

2. Regularly monitor the CDC’s website and related surveillance information. Federal health departments, and most of their state-level counterparts, provide an abundance of helpful information and guidelines on emerging diseases for employers, travelers, state and local health departments, and the nation’s healthcare systems in general.

3. Endorse a healthy lifestyle within local organizations and promote seasonal influenza vaccinations. Numerous studies have demonstrated that employee vaccinations not only reduce absenteeism during flu season, but also may increase productivity. Additionally, employers canentify nearby health clinics, facilities, and pharmacies where staff may receive vaccinations and/or obtain medications on a regular basis as well as during health emergencies.

4. Develop and implement a detailed plan for rapidly notifying employees when a health emergency is declared. By working with local health departments, most organizations can script messages and recommendations ahead of time to quickly disseminate information to employees.

5. Develop worker safety guidelines and recommend that individual staff members develop family preparedness plans. Studies have shown that staff members are more likely to report to work during a public health incident if they believe that their families are safe and adequately prepared during an outbreak.

6. Create telework and proactive sick leave policies that staff members can quickly implement during a disease outbreak. Social distancing is a public health tactic that helps reduce the transmission of contagious diseases. Telework allows employees to perform many of their duties at home without facing the risk of contracting or spreading disease.

7. Ensure that various health issues related to overtime employee compensation are properly vetted, discussed, and agreed upon before an emergency occurs. Public health incidents can drastically reduce the size and effectiveness of any organization’s work force – a major problem that, of course, imposes an extra burden on other employees and often requires them to work overtime. Resolving these and similar issues with an organization’s human resources department would help ensure that overtime work is approved and performed as needed, and that all essential functions will continue without serious interruption.

8. Ensure that multiple communications modalities are available to keep staff fully informed on a continuing basis. Not all employees are likely to be onsite during or immediately after a widespread public health emergency develops. Coordinated communications planning and periodic testing would keep staff employees fully informed.

9. Enact policies or procedures that facilitate the rapid procurement of any additional services and/or material resources needed. Previous public health emergencies have demanded federal, state, and local interventions – as well as the dispersal of additional funds. Pre-drafted policies for receiving funds and/or other material resources to implement the programs can ease this process during an emergency.

10. Update an agency COOP plan. These plans spell out, in considerable detail, not only the organization’s essential functions and processes but also the various ways to ensure satisfactory continuation of those functions and completion of processes during an unforeseen emergency.

The current threats to public health are a timely reminder that many dangerous diseases can rapidly evolve – and, by doing so, affect the local preparedness community and the private sector. All organizations potentially involved, therefore, should at least consider including the health preparedness tips and guidelines mentioned above in their contingency plans to augment their own COOP programs.

There would be a helpful consequence for such actions – namely, improved and effective working relationships between public health and non-public health organizations. For that reason alone, state and local health departments, emergency management agencies, and the U.S. national responder community as a whole should consider issuing these recommendations, and/or similar guidelines, to public and private organizations within their jurisdictions.

________________________ Charles (Chas) Eby, MA, is the chief planner for emergency preparedness at the Maryland Department of Health and Mental Hygiene. His responsibilities have included: (a) leading the state’s overall planning efforts for medical-surge and fatality-management situations; (b) pandemic planning during the 2009 H1N1 influenza crisis; and (c) the agency’s continuity of operations plan. A graduate of Boston College and a current fellow in the Emerging Leaders in Biosecurity Initiative at the UPMC Center for Health Security, he received a Master of Arts degree from the Center for Homeland Defense and Security at the Naval Postgraduate School and can be contacted on Twitter @chas_eby.