Ready or Not?
Len Pagano, president and CEO of the Marietta-based SafeAmerica Foundation, says businesses have no benchmark when it comes to pandemic planning
In offices all over Georgia, managers are quietly playing a game of "Let's Pretend."
Let's pretend that two out of every five workers abruptly call in sick.
Let's pretend that my Asian suppliers all shut down at once.
Let's pretend that our foreign markets stop accepting shipments.
Let's pretend that all those things happen on the same day.
Let's pretend that day turns out to be eight weeks long.
The businesspeople contemplating those unnerving questions aren't speculating for amusement, or trying to frighten themselves for fun.
Instead, they — and hundreds of managers like them nationwide — are engaged in an urgent real-world calculation: If an influenza pandemic — the technical term for an outbreak that moves rapidly across national borders, causing unusually high rates of severe illness and early death — hits the United States, how will their companies be affected? What will it take to keep their employees safe — and their businesses alive?
The possibility of pandemic flu is a new thought for most executives. Until recently, the concept of an epidemic that could deal death and economic disruption around the world seemed like a dark fairy tale — or, for a few, like a dim family story dredged from the memories of grandparents who survived the Spanish Flu of 1918.
But then came SARS, the novel respiratory illness that broke out of south China in 2003 and circled the planet in weeks, sickening 8,096 people in 27 countries and killing 774. After SARS came Hurricane Katrina and the discovery that the United States could fumble the response to a major disaster. In the background, the rapidly evolving pathogen known as the Asian avian flu — a strain that had never before attacked humans but has now killed more than 130 — spread stealthily across the map, moving in three years from Southeast Asia to the western edge of Europe.
Suddenly, the possibility that a disease could swamp the world — and spark a secondary epidemic of social and financial havoc — seems very real.
"Pandemic influenza is definitely on our horizon," says Dr. J. Patrick O'Neal, medical director for emergency preparedness efforts at the Georgia Division of Public Health. "We don't know exactly when it is coming. But we do know that it is coming."
Businesses in Georgia and elsewhere are just beginning to grapple with the potential complexities of a disaster that, if it occurred, would be like nothing else in living memory.
"This is outside the box; it is overwhelming," says Len Pagano, president and CEO of the Marietta-based SafeAmerica Foundation, which is running pandemic-planning summits around the country. "Businesses have no parallel for this."
In the time that historical records of outbreaks have been detailed enough to rely on — about 300 years — there have been 10 influenza pandemics. But the one people remember, and health authorities recall with dread, is the misnamed Spanish Influenza — the Great Influenza — of 1918.
That novel strain of flu is believed to have arisen in Kansas in early 1918. It was carried to Europe by American troops, and cut a wide swath of illness across World War I's last battlefields; it earned the sobriquet "Spanish" because Spain's newspapers, among the few not under wartime censorship, discussed it freely. The infection — for unknown reasons grown yet more deadly — returned to the United States in September 1918. It made landfall in Boston; in little more than a month, it reached San Francisco. Before it faded in early 1919, it killed 675,000 Americans and at least 50 million people around the world.
Much has changed since then, of course. In 1918, the organism that causes flu had not yet been identified. Now it's one of the world's most-studied viruses, and vaccines and antiviral drugs exist to prevent or mitigate infection. Yet health planners concede that, if a pandemic began again, those long-standing innovations might be of little use.
Flu vaccine must be closely tuned to the strain it is aimed at — making it impossible to produce in advance of a pandemic's start — and takes six months or more to manufacture in bulk. Antivirals must be given as soon as an outbreak is recognized, but using them to slow a pandemic would require quantities that pharmaceutical manufacturing capacity cannot currently support and few countries could afford.
Against those limited interventions, planners place a modern reality. Influenza outruns most control efforts because it is one of a few diseases that pass from person to person before the infected know they are sick. In 1918, when the fastest modes of transport were steam ships and railroads, the flu circled the globe in 11 months. It would move far faster today.
But it could be equally deadly. Federal planning documents released last fall and this spring predict that a new pandemic would sicken 90 million Americans, require the hospitalization of between 865,000 and 9.9 million depending on the flu strain's severity, and kill between 209,000 and 1.9 million.
The economic impact, the documents suggest, could equal 5 percent of the gross national product: about $600 billion.
The First Hurdle
For Georgia businesses, the first hurdle of flu planning is believing that a pandemic is possible — a philosophical and emotional challenge rather than a fiduciary one.
"Six months ago I approached a Fortune 100 company," says Pagano, whose foundation is helping link businesses with government and private sector experts. "You would have thought I was trying to sell them on believing in UFOs. But within 60 days, they called back and said: You've convinced us; we want you in here."
The major federal planning documents — the Department of Health and Human Services Pandemic Plan, and the National Strategy for Pandemic Influenza Implementation Plan, both available at pandemicflu.gov — caution businesses to attend to three things: their employees, communications and physical infrastructure. They also warn businesses not to rely too heavily on the detailed disaster plans that many Fortune 500 companies developed after the 9/11 terrorist attacks, and refined after Hurricane Katrina, in hopes of handling either a natural or manmade disaster.
Why? Because based on past history and current computer models, a pandemic occurs not in one place, but everywhere at once — and not over a single day or week, but in rolling waves of outbreaks that could linger from eight to 12 weeks. And in any single wave, from 20 percent to 40 percent of the workforce might call in sick.
"Pandemic flu is mainly a workforce issue," says Dr. Mark Smolinski, director of Washington, D.C.'s Global Health and Security Initiative, part of the Nuclear Threat Initiative (NTI) founded by Ted Turner and former Georgia Sen. Sam Nunn. "How do you continue to function if you have huge absenteeism in your population — not just sick people, but people staying at home to take care of sick people, staying at home to watch kids if schools are closed?"
To the businesses that have begun pandemic planning, people are the first priority.
"We have asked: How do you in the first place keep your employees healthy? What are the things you can tell them to do?" says Charles Lathram, vice president of security and business controls at BellSouth Corp., who spoke at a business roundtable NTI held in Atlanta last spring. "The number one step is to minimize the chance folks will get sick in the first place."
Major businesses consulted for this story have begun building educational campaigns — using information from the Centers for Disease Control and Prevention and World Health Organization, or from nonprofits and private consultants — that will give employees information on pandemic flu and coach them in basic protective techniques: Cover a cough or sneeze. Dispose of tissues. Don't touch your eyes or nose. Most especially, wash your hands; CDC research has found up to 25 percent of colds and flu can be prevented by regular handwashing.
The challenge, companies say, is knowing when to launch those information campaigns: not too far in advance, or the advice will seem trivial; not too close to the crisis, or it won't be absorbed.
"Health is a sensitive issue, and people process information differently," says Shirley Powell, senior vice president for corporate communications with Turner Broadcasting Systems, Inc., which comprises CNN, TNT, TBS, the Cartoon Network, Turner Classic Movies and the Atlanta Braves. "What is regarded by some as routine precautions might cause unnecessary concern among others."
If good hygiene can't keep out the flu, the next challenge becomes minimizing its spread. In the absence of vaccines and antiviral drugs, the CDC recommends a technique the agency calls "social distancing." Translated from health-speak, that means employing milder forms of disease control than isolation and quarantine — something like moving work stations three feet apart (farther than a sneeze can travel) or sending people home to telecommute.
As a tech company, BellSouth is accustomed to having managers work remotely, Lathram says; it has designed a network to allow dial-in even by households that lack broadband. Now, he says, the company is assessing its workforce to decide how much home connection capacity employees already have, and which jobs can be done by telecommuting. Similarly, large amounts of work at Turner can be done over remote connections, Powell says — in fact, many CNN reporters and producers, equipped with high-powered laptops and smartphones, operate at a distance much of the time.
But even companies that are comfortable operating by remote connections, and confident in the connections' security, have business segments that can't be sent home. For BellSouth, it's call centers. For Turner's networks, it's the groups who manage the mechanics of broadcast: directors, camera operators, people who load cartridges of tape. And among those networks, CNN must face the possibility that, if a pandemic begins, it won't just be unable to keep its people away from infection — it will be sending reporters, producers and technicians to wherever the epidemic flares.
"We don't assign people to war zones" or the pandemic equivalent, Powell cautions. "We ask for volunteers." But because employees of different divisions face such different levels of risk, the corporation is planning on different levels, she says. Personnel at CNN and the Hong Kong operations of parent company Time Warner have already received explicit coaching in protecting themselves from infection, wearing protective equipment, and the possibility of site closings, Powell says.
CNN isn't the only company whose business model requires sending personnel into harm's way. Though health planners concede that a pandemic flu strain could arrive in the United States by many avenues — in an infected traveler or via smuggled poultry or in the migratory waterfowl that are influenza's reservoir in the wild — the CDC and WHO agree that the Asian avian flu is the most likely current candidate to spark a pandemic. That makes business travel to Asia a disquieting proposition.
The Starting Point
Few Atlanta companies make more trips to Asia than 407,000-person UPS, which has employees in more than 200 countries and operates what is effectively the ninth-largest airline in the world.
"SARS was our starting point" for understanding the depth of disruption that an epidemic could bring to a region, says Jack McKlveen, UPS' corporate manager of crisis management. The company's 100-person contingency planning team built on its lessons from that epidemic, launching educational materials for workers on the Pacific Rim, investigating whether some employees such as pilots could minimize contact with strangers, and exploring whether stratagems such as extended shifts might compensate for absenteeism.
One challenge, he says, is the impossibility at this point of projecting whether a pandemic would depress business or boost it. If productivity sinks worldwide, demand for UPS' services might shrink — but if emergency response requires rapid shipping of medical supplies, or social distancing stimulates buying over the Internet, need might soar.
"You have to plan for the unplannable," says McKlveen, who estimates pandemic preparation now eats 80 percent of his time.
If one Georgia company exemplifies the perils of a pandemic's unpredictability, it might be The Home Depot. Telecommuting will protect only a limited number of its 355,000 employees; many of them operate its more than 2,000 retail and wholesale locations in the United States, Canada and Mexico. The company has sourcing offices in China, a call center in India and buyers regularly lapping the globe. And to secure its merchandise, it relies on the hallmark strategy of global goods trade: just-in-time delivery.
Those multiple exposures to different dimensions of risk have led the company into repeat rounds of detailed planning, says Tom Fricke, vice president of asset management. "We have a supply chain that goes deep into the rest of the world; we have to be sure we develop alternate sources of merchandise in case countries close their borders," he says. "We have people in those countries; we have to make sure they are safe. If we need to pull them out, we have to have a place where they can go."
The company's 20-person planning team has worked through multiple scenarios for how pandemic flu might arrive in the United States — "We could have nine months to see this coming, or we could have nine hours," Fricke says — and through layers of contingencies, from government-mandated store closures to limit infection, to how few employees can keep a store open, to how to handle disposing of dead birds in a parking lot.
Home Depot keeps much closer tabs on its business travelers, making sure they are briefed before they enter areas where bird flu has been reported. And it's prepared to fire up its Atlanta "war room," a crisis center it shares with key vendors during hurricanes, to facilitate rapid decision-making during a disaster.
"Like everyone else, we are a lot further along than we were four months ago," Fricke says. But when asked if The Home Depot is prepared for a pandemic's impact, he said: "Candidly, we are not ready. I don't think anybody in the American business community is ready, though some are closer than others."