By Jane Garcia and Kim Powell

As anyone who works in an office or catches public transport would testify, influenza is a highly contagious virus. New strains regularly emerge and make the prospect of wide-scale vaccination rather difficult.

The regular garden-variety flu usually strikes infants and the elderly the hardest, however this is not always the case. The Spanish flu pandemic (1918 -1919) killed between 20 and 40 million people worldwide in little more than six months, with the highest number of deaths in young and healthy people. In Australia 11,500 people died, with 60 per cent of them aged 20 to 45 years.

Put simply, it goes from being a few people with the sniffles to a pandemic when a new influenza virus emerges and no one is immune to it, and it is easily spread between people causing severe disease. It has been about 35 years since the last influenza pandemic.

The World Health Organisation (WHO) has warned there is a ‘substantial risk’ of an influenza pandemic occurring in the near future, and Avian influenza – or bird flu – is emerging as a likely infectious agent.

WHO uses a series of six phases of pandemic alert to inform the world of potential serious illness and the need to progressively increase preparedness. The Avian influenza H5N1 subtype has the world at level three of alert: a new influenza virus subtype is causing disease in humans, but is not yet spreading efficiently and sustainably from person to person.

The first documented bird to person transmission of Avian influenza was in Hong Kong in 1997, in which 18 people were infected and six died. According to WHO figures, there have been 229 cases of bird flu worldwide since 2003, resulting in 131 deaths.

So why all the concern?

There are two types of the disease in birds: low pathogenic, which causes mild symptoms such as a drop in egg production; and highly pathogenic, which spreads rapidly, affects internal organs and has a mortality rate of almost 100 per cent.

This latter form is what health authorities and governments are now looking at with the current outbreaks of bird flu. While ‘regular’ flu will have a person off work for a week, the disease caused by this strain of bird flu is very aggressive: pneumonia and multi-organ failure are common, and most of the people who have died so far have been healthy children and young adults.

However, the bigger risk is the one occupying the minds of many people: what happens if the virus mutates and becomes highly infectious?

A worrying aspect of pandemics is they can affect more than a quarter of the total population. This would have a devastating impact on global economies, international travel (which is already under pressure from terrorism fears), manufacturing, communications – and almost every industry and aspect of society you can think of.

The Australian Department of Health and Ageing (DoHA) estimates that if a highly virulent outbreak occurred in Australia and there was no vaccine or treatment available, there could be 13,000 to 44,000 deaths within the first eight weeks. Potentially, 5 million people in Australia alone could be infected – it would be like wiping out the entire population of Victoria and Tasmania combined.

DoHA’s Australian Management Plan for Pandemic Influenza (see www.dhac.gov.au) targets those involved in planning for and responding to an influenza pandemic: health planners, health care providers, border workers, state and territory health departments, essential service providers and those in the media and communications industries.

There are two major strategies in Australia’s response to a pandemic threat: containment through border control, isolation of the sick, quarantine and antiviral medication; and maintenance of essential services in the event that containment is not possible or does not work.

Testing times

In June, a new Malacca Straits influenza strain was detected in fishermen who were rescued by a cruise ship after their boat capsized. When the ship docked, the passengers disembarked and headed off to their respective destinations, unaware they were infected with this highly contagious virus.

Within a very short time, countries in the Asia-Pacific region were experiencing an outbreak of pandemic proportions, putting governments on high alert, health services under immense pressure, and having the potential to wreak havoc on economies.

This was the scenario tested by the Asia Pacific Economic Cooperation forum (APEC) pandemic response exercise in the middle of this year. The exercise was part of the organisation’s initiative on preparing for and mitigating an influenza pandemic, and was conducted to test communication networks across the 21 APEC countries.

Charlie McKillop, spokeswoman for Attorney General Philip Ruddock, said the initiative committed APEC economies to “maintaining effective surveillance, transparency and openness, as well as close coordination and collaboration to prepare for a possible influenza pandemic”.

It involved emergency management staff and health and government officials, as well as international observers including the WHO, the Food and Agriculture Organisation and the World Organisation for Animal Health, making real-time decisions based on the hypothetical scenario.

It was the first time the APEC economies had conducted this type of exercise together and Singapore, the co-facilitator with Australia, will host a follow-up workshop in August.

As no field operations were part of this simulation, a domestic exercise will be held in October to further test Australia’s preparedness.

The Federal Government has dedicated $100 million over four years to combat the threat of pandemics and other emerging infectious diseases in the region. Of this funding, $10 million is for specific APEC activities on Avian influenza, including developing a register of experts with specialist skills in human/animal health and disaster response.

“The main objectives of the exercise are to test emergency responses and communication channels among APEC member economies, in particular their effectives in sharing information and providing regional assistance [and] providing advice to bordering economies and other regional partners,” Ms McKillop says.

The exercise lasted 26 hours across eight times zones, and more than 500 messages were sent between the countries in English and translated into Chinese, Vietnamese and Spanish.
According to Ms McKillop, the exercise successfully tested communication responses during the period.

“The exercise set out to confirm a list of principal authorities responsible for disaster response, to ensure timely and effective communication channels are established between APEC economies and that necessary information is shared,” she says.

Practical response

Professor Graham Brown is an infectious diseases physician who is the head of the University of Melbourne’s Department of Medicine and the former head of the infectious diseases service at Royal Melbourne Hospital.

He says Australia is lucky to have good public health resources, and the fact Australian governments have taken a pandemic influenza threat seriously means we’re as prepared as we can be.

“I think people need to note that it couldn’t be seen as a failure of government if we do have major illness and death from a pandemic flu because history tells us that these epidemics can be very, very serious,” he says.

“If you have slight changes from year to year in the flu, then your immunity from last year will protect you. But if you get a complete change then your immune system doesn’t recognise it.

“That is what happened in the major flu epidemic 100 years ago, it’s what happened in the Asian flu epidemic in the 50s and Hong Kong flu in the 70s. The major change we’ve seen in the birds with H5N1 is a major shift in type, which means that we may be highly susceptible.”

Professor Brown does not endorse the idea of people stocking up with their own anti-viral drugs. He says the general public will not really know when to use them and how long to use them for.

“We also know that when anti-virals have been used [in an unsupervised manner by the public] in Thailand and elsewhere, they’ve ended up with a flu virus that is resistant to the drugs when people use them inappropriately or the wrong way,” Professor Brown says.

“Moreover, the drugs are then not available for people who may need them most. For example, let’s say someone had the flu coming back from somewhere in a plane then it would be very appropriate to give it to everyone sitting next to and around that person in the plane. But to have people with it in their fridges is not the best way.”

If the worst case scenario proves true and Australia should experience a pandemic, the public service has a responsibility as an employer to try and minimise the impact on its workers, and try and maintain critical services as best they can.

As an employer it is important for government to develop a strategy for dealing with the effects of having up to a quarter of its workforce incapacitated, although some aspect of this may already be covered by risk or critical incident planning.

Professor Brown says it is vital for government to be a source of reliable and timely information as a pandemic unfolds. It should develop human resources policies and procedures and business continuity plans, and keep employees well informed of the strategy.

Office environments should assist people to practice good personal hygiene, providing good hand washing facilities, and employers need to take care with the maintenance of air conditioning and common areas such as lunch rooms.

“We should be doing all the important and traditional things to stop the spread,” he says.

“Remember the important things that help prevent the transmission of any disease, for example you don’t cough over other people and you don’t cough over your hands then shake hands. People are saying maybe we should cough down our shirts or into a crooked elbow.

“People who should have regular flu vaccines should continue to have their flu vaccines.

“Organisations can think about how they would manage if a lot of their workforce was sick. For example, vital aspects of a workplace should not be known by only one person, it shouldn’t just be one person who knows how to start the generator or the air conditioning.”

In the event of an epidemic people should avoid any unnecessary contact with other people, especially large groups. For example, people should consider if they are able to walk to work rather than going on a bus or whether they can conduct business over email rather than attending meetings, Professor Brown says.

“In Hong Kong they talked about ‘social isolation’ a lot and how you can try and reduce the contact between people,” he says.

“In Hong Kong one of the doctors there said people wouldn’t touch a lift button, they would use the car key or use their elbow. They looked for mechanisms that avoided large crowds.

“We should be thinking about how can people work from home? If you’re buying a new computer instead of a desktop computer, maybe get a portable computer so if the office had to close people could be networked with broadband from home.”

Jean Turgeon, Nortel Global Enterprise CTO Office, enterprise solutions engineering leader, was recently in Australia meeting with government about increasing the awareness of the importance of business continuity in the public sector.

He says an effective business continuity strategy to limit financial and productivity loss during a pandemic may include using telephony, and video conferencing, and encouraging employees to work from home while staying connected to the organisation by broadband internet.

“I know with dealing with some of the folks in North America and Europe that there are periods of time or specific events where the importance of the infrastructure and business continuity is critical, for examples during elections or when people are filing taxes,” he says.

 “We need to constantly go back and tie business continuity in with specific events so they’re prepared and don’t have to necessarily re-engineer or make changes to infrastructure as they go along.

“Do your homework first, planning for possible events, and then you’ll be ready and won’t have to scramble at the last minute to meet those requirements.”

Mr Turgeon says it is difficult for an organisation to control all the different types of devices that may be used for mobility, but there are solutions to allow the virtualisation of the office or contact centre, maybe to allow workers to stay at home and remain productive.

“How do we address the security concerns that they may have? How do we ensure that the data is not compromised?” he says.

“It requires a lot of planning. For government sectors, virtualisation of offices without compromising security can be accomplished and delivered.” GN

Brisbane City Council

In 2005, Brisbane City Council began developing a strategy to protect the day to day operations of the council and its employees in the event of a pandemic.

Councillor Judy Magub is the Lord Mayor’s spokeswoman for public health and safety. She says the role of Brisbane City Council would “primarily be one of supporting the lead agencies dealing with a potential pandemic situation”, rather than orchestrating the entire process.

“The experience of many international cities, especially our Asia-Pacific neighbours, has highlighted the potential risk of a pandemic like avian influenza occurring in Brisbane,” Cr Magub says.

“Council’s effective disaster management and business continuity management processes made it a natural progression to revise and expand our business continuity plans for essential services, to include the impact of a significant reduction in personnel through a human influenza pandemic scenario. This was a risk assessment based on the likely consequences of such an event occurring.”

A business impact analysis process was carried out to determine which services must be continued during any period of immense and sustained disruption, and what resources would be needed for this.

The process identified the twelve essential services of waste management, water supply and treatment, sewerage networks and treatment, human resources, marketing and communication, immunisation services, traffic management, traffic control, cemeteries, animal management, fire services, emergency city works and the customer contact centre.

“In the event of a pandemic, non-essential services may be affected and there will be an ongoing assessment of capability and core functions to allow management to make informed decisions,” Cr Magub says.

A further eight business continuity plans (BCPs) for supporting services – such as payroll, parking, procurement services – are in place to support the essential services, as well as new plans for emergency and disaster management. Each BCP has a plan owner who is responsible for keeping the plan current.

“The key issues for each BCP are essential worker lists, succession planning, communication plans, both internal and external, and sustainability of service through an extended period,” she says.

Brisbane City Council has also developed a Pandemic Influenza Disaster Management Plan to deal with the community consequences of a pandemic. It is linked to key stakeholders, including Emergency Management Queensland and Queensland Health.

“The key challenge for local government with the human influenza pandemic is that because Federal and state authorities would take the lead in a pandemic, it is vital for local authorities to align their plans to fit into and support the higher-level authorities,” Cr Magub says.

Brisbane City has developed a Pandemic Issues Paper and distributed it to councils in South East Queensland. This paper is also available through the Local Government Association of Queensland. For more information see www.lgaq.asn.au