Why a Flu Pandemic Is Disruptive

As we have said in an earlier post, an influenza pandemic has the potential for disrupting the critical infrastructure of our society, such as health care, utilities, and public safety. Any disruption to these essential services can make everyday life more difficult, disrupt our businesses, create additional health risks, and reinforce the economic downturn.

Why would critical infrastructure be threatened? A pandemic could potentially be disruptive because it has the potential to sicken so many of the essential personnel responsible for our critical infrastructure -- as well as the rest of us. The Homeland Security Council has made it very plain that the effect on workplace absenteeism could be severe throughout society:

There will be up to 40% workplace absenteeism at the peak of the pandemic in any given community -- National Strategy for Pandemic Influenza

In our highly interconnected world, many factors will combine to keep people out of the workplace:

1. Up to 1/3 of the workforce can be expected to be sick over the course of the pandemic (which will come in waves); some will die


2. Some who are well will stay home to care for sick family members (most healthcare will be supportive care)


3. Government and workplace policies to control the spread of the disease will keep others home


4. As the pandemic worsens, fear will keep others home


5. Persons exposed to the disease may be quarantined, even if they are not sick


6. If schools are closed, some will stay home to care for children


7. Official disease containment measures could limit commerce further: Non-essential businesses may be closed, and non-essential workers furloughed


8. Border crossings could be limited, thus limiting the availability of parts and materials needed by industry, as well as limiting access to customers in other countries


9. Effects will multiply as supply chains are disrupted. One business's closure will have a domino effect on its customers, its customers' customers, etc.

In today's highly interconnected world, a worsening in any of these factors will act on other parts of society to create even greater friction to the normal working of society. With all these interactions, perhaps it is plausible that the cumulative effect could reach the 40% absenteeism estimated in the National Strategy for Pandemic Influenza. If that happens, we will all need to be very well prepared.

WHO Says Pandemic Is Imminent -- Prepare Now

As I noted in an earlier post, a severe influenza pandemic can potentially do more than make us sick; it can have such a pervasive effect on our society that everyday commerce and public services are disrupted to some extent. A severe disruption in some services (utilities, medical care, etc.) could further endanger lives. A severe disruption to commerce could stifle economic activity -- just when there is a glimmer of possible recovery from a severe economic downturn.

Today, the WHO has raised its alert from Phase 4 to Phase 5. Phase 5 is only one step removed from the global pandemic phase. On its web site, the WHO defines Phase 5 like this:

Phase 5 is characterized by human-to-human spread of the virus into at least two countries in one WHO region. While most countries will not be affected at this stage, the declaration of Phase 5 is a strong signal that a pandemic is imminent and that the time to finalize the organization, communication, and implementation of the planned mitigation measures is short.

So, the WHO says that a pandemic is imminent, and there is little time to finish implementing whatever actions you need to mitigate the effects of the pandemic. It's time to take pandemic preparations seriously for your family, business, and community. If you, your business, or your community has not planned any mitigation measures, then you are far behind the curve. The time to act is now, but you still need to figure out what to do before you can make preparations.

What to do? The US Government has provided planning guidelines and placed links to them on the home page of PandemicFlu.gov. There are separate links on that page to planning guidelines for families, businesses, hospitals, and communities. Take a look.

As the WHO said in its Phase 5 announcement, "Influenza pandemics must be taken seriously precisely because of their capacity to spread rapidly to every country in the world." A pandemic is not a sure thing, but when there is a real and rising risk of a catastrophic outcome, we need to take it seriously. We all know what happened to our financial system when catastrophic downside risks were ignored for far too long.

Flu Could Bring US to a Standstill

Just when some observers think that they see a glimmer of hope for recovery of the world economy, along comes the swine flu. Now the worry is that a disease of pandemic proportions could bring suppress economic activity even further and throw the world into an even deeper depression.

How bad could things get for the economy, really? The US government prepared a strategy for how to respond to a possible influenza pandemic, and we can turn to the report for an estimate.

The US government's Homeland Security Council published the National Strategy for Pandemic Influenza in 2005, and their Implementation Plan seriously considers the disruptive effects that a disease of pandemic proportions could have on health, commerce, and the overall functioning of our society.

How bad does the government think it could get? The Nationsl Strategy warns that the pandemic “will ultimately threaten all critical infrastructure by removing essential personnel from the workplace for weeks or months”.

Critical infrastructure refers not only to the hospitals, clinics, etc. needed to care for the ill, but also to the things that make our society run normally -- transportation, energy, telecommunications, finance, etc. Essential personnel include people who keep the systems running for our water, electricity, medical care, food, and other essentials of life.

A national strategy is fine, but how well will it be implemented if an influenza pandemic actually strikes? An effective response needs to reach down to see that life continues for each and ever one of us.

A lot depends on how well states, local communities, and industry have prepared for the emergency, and on how well they all coordinate. How prepared are your business and your community?

US Government Estimates for Influenza Pandemic

Now that everyone is thinking about the possibility of a swine flue pandemic, how bad could it get?

For educated estimates of the morbidity and mortality that the US could experience during an influenza pandemic, we can turn to the HHS Pandemic Influenza Plan, November 2005. This government plan was specifically avian influenza (H5N1) and not the swine flu virus (H1N1), but of course avian influenza remains a threat too, and the characteristics of a new virus are not predictable. The HHS plan provides the following estimates and bounds for the US, based on the statistics of three 20th century pandemics:

• Number of ill: 90 million (30% of population)
  
• Number requiring outpatient medical care: 45 million (45%-50% of the ill)
  
• Number hospitalized: 0.865 million - 9.9 million
  
• Number of deaths: 209,000 - 1,903,000

Estimates vary with the assumed severity of the disease, with the lesser numbers corresponding to a disease like the influenza pandemics of 1956 and 1968, and with the larger numbers corrresponding to the influenza pandemic of 1918.

Either way, a pandemic of these proportions would have a greatly crippling effect on society in several ways -- the proportion of the population ill and off work, the number of people demanding health care, and the number of deaths. US society is unaccustomed to coping with disruptions of this magnitude, and the consequences for our economy and security are worryingly difficult to estimate.

Swine Flu Pandemic Potential

The swine flu outbreak that started in Mexico has spread to several parts of the United States and may also have spread overseas. Swine flu is caused by the H1N1 influenza virus, a mixture of swine, avian, and human viruses. A report from Reuters cited experts saying that the outbreak is probably already widespread and impossible to contain, for these reasons:

1. This new strain of influenza has shown it can spread easily from person to person.
2. It has been found in several places and among people who had no known contact, which suggests there is an unseen chain of infection.
3. This can happen because (a) respiratory illnesses are so common that doctors rarely test patients for flu, and (b) people could have had the swine virus and never known it.
4. Another factor suggesting that the disease is spreading undetected is that in the United States it has so far only been found in people who had mild illness.
5. World Health Organization director Dr. Margaret Chan has said the new strain of H1N1 has the potential to become a pandemic strain because it does spread easily and does cause serious disease.
6. CDC experts note that while it is possible to contain an outbreak of disease that is in one limited area, once it is reported in widespread locations, the spread is impossible to control.