The H1N1 is an influenza virus that became part of our common lexicon when it jumped species and was introduced to humans earlier this year.  Originally acquired from infected pigs (hence the early name, swine flu) it is easily transmitted from person to person.  Transmission has now spread throughout the six different regions of the world prompting designation by the World Health Organization (WHO) as a worldwide pandemic.  WHO predicts that by 2011, nearly one-third of the world’s population may contract H1N1 because most of the world’s population has not been exposed to this type of flu strain. The Centers for Disease Control and Prevention (CDC) is tracking human cases of the H1N1 virus in the United States and important information is available on its website: www.cdc.gov. 

Signs and Symptoms
According to the CDC, the symptoms that result from infection by the H1N1 virus are those of the common human flu including fever, sore throat, body aches, headache, chills and fatigue.  Most cases of H1N1 are mild, even milder than regular flu, but there appears to be a variant or group of individuals that develop severe respiratory symptoms and require hospitalization.  Although there have relatively few serious cases of H1N1, caution is warranted as already regular seasonal flu accounts for 30,000 deaths (or more) each year in the US.  Like seasonal flu, H1N1 may cause worsening of underlying chronic medical conditions and thus more heavily impact those with weakened immune systems.

Transmission
Individuals are highly contagious after the onset of symptoms.  Like many well publicized diseases, rumors quickly developed regarding transmission of swine flu.  For example, some initially believed that one could contract H1N1 from eating pork products, however, this is untrue and it now known that the spread of H1N1 occurs in the same manner as seasonal flu. People infected with the flu spread the virus by coughing and sneezing.  Individuals may be contagious 1 day before exhibiting symptoms up to 5 or 7 days after the onset of symptoms. It is also possible, to become infected after contacting a surface or object contaminated with flu virus and then touching your mouth or nose. According to the CDC, studies have shown that the influenza virus can survive (and remain infectious) on environmental surfaces for 2 to 8 hours after being deposited. This  prolonged contagious phase is of great concern to employers.

Considerations of Appropriate Response Strategies
All employers must balance a variety of objectives when determining how best to decrease the spread of influenza and lower the impact of disease in the workplace. Employers should determine and communicate objectives, which may include one or all of the following: (a) reducing transmission among staff, (b) protecting people who are at increased risk of influenza related complications from getting infected with influenza, (c) maintaining business operations, and (d) minimizing adverse effects on other entities in their supply chains.

Workplace Precautions
Review or establish a flexible influenza (pandemic) plan and involve employees in developing and reviewing the plan. Thoroughly communicate the influenza plan with employees and explain the policies, workplace and leave flexibilities, and pay and benefits options available.

  • Encourage the covering of mouths and noses with a tissue when you cough or sneeze and the disposal of the tissue afterwards. (Make tissues readily available).  Coughing into your sleeve or arm is a useful practice.
  • Ensure adequate air circulation and post tips on how to stop the spread of germs in the workplace.
  • Encourage the washing of hands often with soap and water and make alcohol-based hand cleaners available throughout your work environment.
  • Avoid touching eyes, mouth, or nose because these are the most common ways viruses and bacteria are spread.
  • Frequently clean all commonly touched surfaces in the workplace, such as workstations, countertops, telephones and doorknobs.  (Use the cleaning agents normally used in these areas, perhaps increase the frequency).
  • Possibly most important step to prevent an outbreak, would be to insist that employees stay home when sick.  Organizations should consider allowing employees the flexibility to stay home to recuperate or care for sick relatives, at least when flu like exposure is suspected.  One option could include establishing telecommuting for workers who may be at higher risk for contracting the disease, such as pregnant women, or those with existing health problems, including asthma, diabetes and chronic heart disease.  It is also vital to alert employees that it is not appropriate to come to work after hours or on weekends when symptomatic, as they may be contagious and the virus can live on surfaces for hours after being contaminated.

Immunization
Employers should consider revising leave policies to address this illness and to follow public health guidance, including inoculation if possible.  At present, only about 45 million doses of H1N1 vaccine are expected to be available by October 15, 2009. The vaccine will go to health care professionals and vulnerable populations first.  It is anticipated that two injections will be required and that H1N1 immunization will be required in addition to the regular seasonal flu shot this year.  About 20 million doses will be available every week after October 15 until the 195 million doses purchased by the government are available.

Adamas Pharmaceuticals, a Bay Area start up, is developing a three-drug treatment to fight the quickly developing influenza.  With statistics soaring to a possible 1.8 million hospital admissions and 90,000 deaths, Dr. David Chernoff, Chief Medical Officer at Adamas Pharmaceuticals, recommends “This year companies should have their employees vaccinated as soon as possible against both strains of the flu (regular influenza and H1N1).” 

Significance
Scenario estimates show that in a worse-case scenario as many as 33% of employees could become ill at the pandemic’s peak this fall and winter.  Employers must take it upon themselves to play a key role in protecting employees’ health and safety as well as limiting the negative impact to the economy. We argue that developing a workplace plan for the upcoming flu season is imperative.

We recommend that employers establish a task force and make a plan immediately to prevent the spread of the disease and to be able to continue to operate if significant portions of the workforce are impacted.  Some employers are establishing technology links to promote remote work, others are making additional sick leave available over the next year so symptomatic workers can afford to stay home and not hide the symptoms and come to work.  If you need help with your plan, contact our offices.