Planning for 2009 H1N1 Influenza: A Preparedness Guide for Small Business

September 16, 2009, 2:00 PM ET

Planning for 2009 H1N1 Influenza: A Preparedness Guide for Small Business

Foreword

As a small business leader, you are a valuable partner in our nation’s defense against natural and man-made threats. Preparedness is the best method to defend against the impacts of all threats and all hazards, including public health threats.

As we face the possibility of a wider H1N1 influenza outbreak, it is difficult to predict how the virus may or may not change. However, we know the nation must be prepared to respond appropriately. The Department of Homeland Security is working to ensure you have the necessary tools and information to be prepared as well. The severity of illness that 2009 H1N1 influenza flu will cause (including hospitalizations and deaths) or the amount of illness that may occur as a result of seasonal influenza during the 2009–2010 influenza season cannot be predicted with a high degree of certainty. Therefore, small businesses should plan to be able to respond in a flexible way to varying levels of severity and be prepared to take additional steps if a potentially more serious outbreak of influenza evolves during the fall and winter.

Small businesses are often the backbone of private sector industries and their local communities. With this in mind, we must partner to ensure the wheels of the nation’s economy continue to turn, even if faced with absenteeism, restricted services, and supply chain disruptions. If prepared, small businesses can keep their doors open and our nation’s economic health and security resilient.

The most important thing you can do to prepare your business is to have a written plan.

This guide is intended to help you write your plan and help spread the message of preparedness. Also, encourage your employees to prepare their own homes and families, which includes having a plan to care for sick family members and storing a two-week supply of food and medical supplies. More information is available at Flu.gov. With your help, we can help keep our economy and our communities healthy and safe.

Yours truly,

Janet Napolitano
Secretary of Homeland Security
September 2009

Introduction

Small businesses play a key role in protecting employees’ health and safety as well as limiting the impact to the economy and society during an influenza pandemic. Advance planning for pandemic influenza, a novel infectious disease that could occur in varying levels of severity, is critical. Companies that provide critical services, such as power and telecommunications, have a special responsibility to their community to plan for continued operations in a pandemic and should plan accordingly.

A new influenza virus, now called 2009 H1N1 influenza, or 2009 H1N1 flu, first caused illness in Mexico and the United States in March and April, 2009. On June 11, 2009, the World Health Organization (WHO) signaled that a global pandemic of 2009 H1N1 flu was underway by raising the worldwide pandemic alert level to Phase 6. This action was a reflection of the spread of the new 2009 H1N1 flu virus across the globe, not the severity of illness caused by the virus. At the time, more than 70 countries had reported cases of 2009 H1N1 flu infection and there were ongoing community level outbreaks of 2009 H1N1 flu in multiple parts of the world. Since June, this new H1N1 virus has continued to spread. The Centers for Disease Control and Prevention (CDC) anticipates additional cases, hospitalizations and deaths associated with this pandemic in the United States during the U.S. 2009–2010 influenza season.

Community strategies that delay or reduce the impact of a pandemic (also called nonpharmaceutical interventions) may help reduce the spread of disease until a vaccine is available. Over the past several years, the Department of Health and Human Services (HHS), the CDC, and the Occupational Safety and Health Administration have developed guidelines, including checklists, to assist businesses, industries, and other employers in planning for a pandemic outbreak as well as for other potential disasters.

The Department of Homeland Security, the CDC, and the Small Business Administration have developed this booklet to help small businesses understand what impact a new influenza virus, like 2009 H1N1 flu, might have on their operations, and how important it is to have a written plan for guiding your business through a possible pandemic.

How to Write Your Plan

As a small business owner or employee, you do not want to be caught unprepared when the flu season hits. Regardless of the size or type of your business, a bit of planning now can put strategies into place that will help protect the business and its employees, when 2009 H1N1 flu hits. Plan now for the return of 2009 H1N1 to your community and for the potential for a more severe outbreak. It is important that the following list of recommendations be reviewed carefully and applied in the most appropriate way to your small business.

Identify a workplace coordinator who will be respon¬sible for dealing with 2009 H1N1 flu issues and their impact at the workplace, including contacting local health department and health care providers in advance and developing and implementing protocols for response to ill individuals. The coordinator should not wait for flu season to start in order to establish those contacts and relation¬ships, and check online resources of local public health officials immediately to learn what you should be doing.

Examine policies for leave, telework, and employee compensation and review with all employees so they are up-to-date on sick leave policies and employee assistance services that are covered under any of your employee-sponsored health plans. Leave policies should be flexible, non-punitive, and well-communicated. They should allow workers who have the flu to stay home and away from co-workers. Also, plan to have workers stay home if they have to care for sick family members. Be pre¬pared, in the event that there are school closures, to allow workers flexible schedules or other accommodations so they can mind their children and keep them safe at home. Explore the possibility of some of your workers working from home with appropriate infrastructure support.

Determine who will be responsible for assisting ill individuals in the workplace, and make sure at least one person can serve as the “go to” person if a worker becomes sick at the workplace.

Identify essential employees, essential busi¬ness functions, and other critical inputs (e.g. raw materials, suppliers, subcontractor services/products, and logistics) required to maintain business operations should there be disruptions during the 2009 H1N1 flu outbreak – and make plans on how to communicate with people that perform essential tasks to provide them assignments and work direction. Explore other ways you can continue business operations if there are supply chain or other disruptions.

Share your pandemic plans with employees and clearly communicate expectations. It is important to let your employees know your plans and expectations when 2009 H1N1 flu outbreaks occur in communities where you have a workplace. Consider ways to communi¬cate with employees who do not speak English or those with disabilities.

Prepare business continuity plans so that if there is significant absenteeism or changes in the way you need to conduct business in the workplace during this outbreak you can maintain operations. School dismissals and childcare provider closures may increase absenteeism in the workplace. Health officials may also advise that workplaces take multiple steps to increase the space between people and decrease the frequency of contact among people, also known as “social distancing” to reduce the spread of illness during a more severe outbreak.

Establish an emergency communications plan. This plan includes identification of key contacts (with back-ups), chain of communications (including suppliers and customers), and processes for tracking and com¬municating business and employee status.

Keeping Healthy: 10 Tips for Businesses

Employees are a crucial resource at any business, and especially small businesses. There are steps you can take now, and during the flu season, to help protect the health of your employees.

1. Develop policies that encourage ill workers to stay at home without fear of any reprisals.
   
2. Develop other flexible policies to allow workers to telework (if feasible) and create other leave policies to allow workers to stay home to care for sick family members or care for children if schools close.
   
3. Provide resources and a work environment that promotes personal hygiene. For example, provide tissues, no-touch trash cans, hand soap, hand sanitizer, disinfectants and disposable towels for workers to clean their work surfaces.
   
4. Provide education and training materials in an easy to understand format and in the appropriate language and literacy level for all employees. See the CDC website for H1N1 guidance for businesses.
   
5. Instruct employees who are well but who have an ill family member at home with the flu that they can go to work as usual. These employees should monitor their health every day, and notify their supervisor and stay home if they become ill. Employees who have a certain underlying medical condition or who are pregnant should promptly call their health care provider for advice if they become ill.
   
6. Encourage workers to obtain a seasonal influenza vaccine, if it is appropriate for them according to CDC recommendations. This helps to prevent illness from seasonal influenza strains that may circulate at the same time as the 2009 H1N1 flu.
   
7. Encourage employees to get the 2009 H1N1 vaccine when it becomes available if they are in a priority group according to CDC recommendations. For information on groups recommended for seasonal and H1N1 vaccines, please see Flu.gov. Consider granting employees time off from work to get vaccinated when the vaccine is available in your community.
   
8. Provide workers with up-to-date information on influenza risk factors, protective behaviors, and instruction on proper behaviors (for example, cough etiquette; avoid touching eyes, nose and mouth; and hand hygiene).
   
9. Plan to implement practices to minimize face-to-face contact between workers if advised by the local health department. Consider the use of such strategies as extended use of e-mail, websites and teleconferences, encouraging flexible work arrangements (for example, telecommuting or flexible work hours) to reduce the number of workers who must be at the work site at the same time or in one specific location.
   
10. If an employee does become sick while at work, place the employee in a separate room or area until they can go home, away from other workers. If the employee needs to go into a common area prior to leaving, he or she should cover coughs/sneezes with a tissue or wear a facemask if available and tolerable. Ask the employee to go home as soon as possible.

Keeping Healthy: 8 Tips for Individuals

In addition to the actions a small business employer can take to help protect the health of their employees, there are actions which employees may take to protect their own health, and that of those around them. Employers should review this list and encourage employees to read it and practice good health habits.

1. Stay home if you are sick with influenza-like illness for example, fever or chills AND cough or sore throat. In addition, symptoms of flu can include runny nose, body aches, headache, tiredness, diarrhea, or vomiting. CDC recommends that sick workers stay home if they are ill with influenza-like illness until at least 24 hours after they are free of fever (100° F [37.8° C] or greater) or signs of a fever without the use of fever-reducing medications. This would require employees to stay home for 3 to 5 days in most cases. CDC recommends this time period away from work regardless of whether or not antiviral medications are used.
   
2. Wash your hands frequently with soap and water for 20 seconds or use an alcohol-based hand sanitizer if soap and water are not available.
   
3. Avoid touching your nose, mouth and eyes.
   
4. Cover your coughs and sneezes with a tissue, or cough and sneeze into your upper sleeve. Dispose of tissues in no-touch trash receptacles.
   
5. Wash your hands or use an alcohol-based hand sanitizer after coughing, sneezing, or blowing your nose.
   
6. Keep frequently touched common surfaces clean. For example, telephones, computer equipment, etc.
   
7. Try not to use other workers’ phones, desks, offices, or other work tools and equipment. If necessary, consider cleaning them first with a disinfectant.
   
8. Maintain a healthy lifestyle; attention to rest, diet, exercise, and relaxation helps maintain physical and emotional health.

Frequently Asked Questions

What is 2009 H1N1 flu?

2009 H1N1 flu is a new influenza virus causing illness in people. Most people do not have immunity to this virus, so it spreads quickly.

People with the flu spread the virus through coughing or sneez¬ing near others. Sometimes people may become infected by touching something with flu viruses on it and then touching their eyes, mouth, or nose.

Those currently at higher risk of serious flu-related complica¬tions from 2009 H1N1 flu include children younger than five years old, pregnant women, people of any age with certain chronic medical conditions (such as asthma, diabetes, heart disease), adults and children who have a weak immune system, residents of nursing homes and other chronic-care facilities and persons aged 65 years or older. See CDC's information on high risk groups.

What are the signs and symptoms of 2009 H1N1 flu in people?

The symptoms of seasonal and 2009 H1N1 flu virus in people include fever or chills AND cough or sore throat. In addition, symptoms of flu can include runny nose, body aches, headache, tiredness, diarrhea, or vomiting. Like seasonal flu, 2009 H1N1 flu may cause a worsening of underlying chronic medical conditions.

In adults, emergency warning signs that need urgent medical attention include:

• Difficulty breathing or shortness of breath
• Pain or pressure in the chest or abdomen
• Sudden dizziness
• Confusion
• Severe or persistent vomiting
• Flu-like symptoms improve but then return with fever and worse cough

In children, emergency warning signs that need urgent medical attention include:

• Fast breathing or trouble breathing
• Bluish or gray skin color
• Not drinking enough fluids
• Severe or persistent vomiting
• Not waking up or not interacting
• Being so irritable that the child does not want to be held
• Flu-like symptoms improve but then return with fever and worse cough>

Severe illness (pneumonia and respiratory failure) and deaths have been reported with 2009 H1N1 flu infection in some people.

How long should a person stay out of work if they have an influenza-like illness?

Workers who have symptoms of influenza-like illness (see above) should stay home and not come to work until at least 24 hours after their fever has resolved. You should plan now to allow and encourage sick workers to stay home.

When will it hit my community and how serious will it be?

The 2009 H1N1 flu influenza virus may affect different communities at different times and in different ways. The flu may make many more people sick then usual, or it may not. We will likely see a re-emergence or continued outbreak in communities as the regular 2009–2010 flu season begins this fall.

Why should small business owners plan for 2009 H1N1 flu?

Small businesses are especially susceptible to the negative economic impacts of a flu pandemic. An estimated 25 percent of businesses do not reopen following a major disaster, according to the Institute for Business and Home Safety. Planning from the outset can help offset business losses, and protect your business and your employees when this flu hits. Benefits of planning are:

• Minimize disruption to business activities
• Protect employees’ health and safety
• Limit the negative impact to the community, economy and society

What steps should you be prepared to take when the H1N1 flu hits your community?

CDC recommends that sick people stay home and away from the workplace. The best way to slow the spread of the disease is to keep sick people away from well people, given that the 2009 H1N1 flu virus is a new virus and most people will not have prior immunity to protect them from acquiring infection. If sick people come to work, they may infect other workers, and this has the potential to lead to a high rate of absenteeism in the workplace.

Your business’s actions should be tied to the extent and severity in your local area. Choose someone to be responsible for flu issues at the workplace. They should contact the local heath department for guidance and monitor the level and severity of 2009 H1N1 flu illness in your business’ community and region, and sign up for CDC e-mail updates.

Where can I go for more resources?

Additional website links can be found on the last page of this guide. More resources can be found online at Flu.gov, a one-stop access to U.S. Government 2009 H1N1 flu, avian and pandemic flu information. See the U.S. Government website for help on preparing a business continuity plan.