Feb 14, 2006 (CIDRAP News) Speakers at a national conference in Minneapolis today sought to impress business leaders with the potentially disastrous effects of an influenza pandemic without scaring them into thinking that preparing for one is futile.
The meeting brought predictions that a major pandemic would put the world economy into reverse and could kill more people than the pandemic of 1918, in which an estimated 50 million to 100 million died. But speakers also said that even in such a disaster, 98% of people would survive, and preparation for "foreseeable risks" will help businesses weather the storm with less damage and legal liability.
"We can't hope our way out of this, and we can't just sit and say, 'Woe is me.' Comprehensive and serious planning is not optional," said Michael T. Osterholm, PhD, MPH, director of the University of Minnesota Center for Infectious Disease Research and Policy, publisher of the CIDRAP Web site.
About 300 people, mostly business officials, are attending the 2-day meeting, called Business Planning for Pandemic Influenza: A National Summit, at the Minneapolis Convention Center. The meeting is sponsored by CIDRAP and the US and Minnesota Chambers of Commerce.
In opening the session, US Health and Human Services Secretary Michael Leavitt said the Hurricane Katrina disaster taught the lesson that "the unthinkable happens, and we need to be thinking about the unthinkable."
Leavitt sounded themes that he has used repeatedly in state meetings on pandemic preparedness around the country, warning that every business, government agency, community, school, organization, and household should develop and test a pandemic preparedness plan.
He recounted watching figure skater Sarah Hughes turn in the performance of her life in the 2002 Winter Olympic games in Salt Lake City, when he was governor of Utah, and said that the pandemic threat should elicit a comparable preparedness effort. "We as a public health community and as a business community need to skate the performance of our lives," he said.
Parallels between 1918 virus and H5N1
Osterholm sought to background the audience on the science of pandemics in an hour-long talk he called "Influenza 101." A major theme was that recent research has uncovered chilling similarities between the H5N1 avian influenza virus now circulating in Asia and the H1N1 flu virus that took the world by storm in 1918.
Researchers recently have concluded that the 1918 virus jumped directly from birds to humans, which bears comparison with the way the H5N1 avian virus is infecting some humans, though it has not spread from person to person. Further, certain mutations seen in the 1918 virus have also been found in H5N1 viruses, Osterholm said.
"I can't come to any other conclusion than that H5N1 and the 1918 H1N1 [viruses] are kissing cousins of the highest order," he said.
He warned that modern medicine won't offer a great deal of protection in the first several months of a pandemic flu, if ever. Given the time it takes to develop and produce a vaccine for a new flu strain, "Don't count on a vaccine to get us out of this, at least in the first stage," he said.
The flu drug oseltamivir (Tamiflu) also has its limitations, he said. "The way we use Tamiflu now may not work for H5N1it's likely to be needed at a much higher dosage for a much longer time period."
Major economic impact predicted
Economic strategist Dr. Sherry Cooper painted a gloomy picture of the potential economic effects of a pandemic on today's densely interwoven world.
Cooper, executive vice president of BMO Financial Group in Toronto, said the SARS (severe acute respiratory syndrome) outbreak in Toronto hinted at the possible impact of a pandemic. The virus infected only 252 people and caused 44 deaths in the city, but that was enough to trigger the quarantine of 15,000 people. Hospitals filled up and had to stop all nonessential services, while the World Health Organization warned against traveling to Toronto, causing tourism to collapse.
Cooper spoke of the "blurring" of national economic boundaries in a world of multinational corporations, global travel, and international supply chains focused on "just-in-time" delivery of parts and products.
"All of us now depend on imported products, and all of that depends on the free movement of people and goods across national borders," Cooper said. Travel now accounts for 10% of the world's gross economic activity and 8% of jobs, she added.
In such a world, a severe pandemic would mean a sharp economic downturn, Cooper said. "It is our rough estimate that . . . the global economy would lose roughly six percentage points worth of growth in a 3-month period. It would mean the economy would decline at a 2% annual rate." The US economy would take a $670 billion hit, she estimated.
Among the "immediate losers" in a pandemic would be tourism, transportation, the hospitality industry, life and health insurers, and the entertainment industry, Cooper said.
She advised businesses to expect absenteeism rates of about 30% at the peak of a pandemic, along with "months of slowdown."
Utility service could be disrupted. "Imagine no waste management, no clean water, no electricitynot just for a couple of days, but perhaps for weeks," she said. Fuel shortages, consumer hoarding of things like bottled water, shortages of medical supplies, and other difficulties would make matters worse.
The good news in all this gloom is that "98% of the population will survive," Cooper said. "It's not the end of the world."
"Planning will lead to a much calmer environment," she concluded. "Let's hope these plans won't be put to use any time soon."
Careful risk assessment urged
Attorney Cheryl Falvey advised business leaders to carefully assess the risks a flu pandemic would pose and then take documented steps to limit them. Falvey is a partner with Akin Gump Strauss Hauer and Field LLP in Washington, DC.
She said the pandemic threat poses a dilemma for preparedness advocates in business. "Pre-pandemic we can sound alarmist, yet post-pandemic we can look as if we didn't do enough," she said.
The foreseeable consequences of a pandemic, she said, include economic losses, supply-chain disruptions, employee absenteeism, quarantines and travel restrictions, an increase in demand for health care, and a decline in tourism.
Falvey invited business people to imagine what kind of lawsuit they could face in the aftermath of a pandemic.
"You need to develop a record to show that management has met its obligations to its various constituencies," such as customers, employees, shareholders, subsidiaries, and the community, she said.
Most juries in liability suits understand that accidents happen and human errors occur, Falvey said. "What juries don't forgive is a failure to assess, a failure to act, to commit money and resources to deal with a problem," and to involve top management in that effort, she said.
"Jurors want to know that there was an adequate planning process and that all possibilities were considered, and they were balanced," she said.
For example, Falvey said she represented a refinery operator in Belize that worked for years to prevent an explosion. The company had a computerized alarm system, and officials worked with neighborhood groups and local doctors to prepare them to respond.
Despite the precautions, the feared explosion finally occurredand the computerized alarm system failed in the event, she said.
When the company landed in court, Falvey reported, "What happened was that the jurors respected the process of planning and due diligence. . . . They didn't penalize the company for a failed alarm system, because there was a documented record of monthly tests. That kind of evidence of planning and proactive efforts at mitigation and relief helps limit your liability."
Echoing a point made by Cooper, Falvey urged businesses to make sure they have sick leave and medical policies that don't discourage workers from staying home when sick.
She also advised the audience to educate their employees on pandemic-related risks and on company policies.
"I think it comes down to the concepts in the law of foreseeability and reasonable response to foreseeable risks," she concluded.
In a question period later, Falvey was asked how aware the business world is about the pandemic threat. "I don't think everyone is getting it, but companies that provide pandemic-related products and services are," she said. "There's lots of movement at the highest levels in America to plan for this."
Osterholm was asked if he would advise people to stockpile oseltamivir. In reply, he admitted that he has stockpiled some himself, as have colleagues who have been known to counsel the opposite. But he also said it's essential to make sure there are adequate supplies of antivirals and other medical products for healthcare workers and first responders.
