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Preparing for H1N1 fall resurgence

By Mari-Len De Guzman
| www.cos-mag.com

(PART 2 OF 4)

Following is part of the transcripts from the first COS Roundtable on Emergency Preparedness, held on August 12 at the Centre for Health and Safety Innovation in Mississauga, Ont. COS editor Mari-Len De Guzman moderated the discussion.

Panelists:

John Hollands, corporate account manager, Ontario Service Safety Alliance

John Parish, chief, provincial fire sector, Municipal Health and Safety Association

Andrew Harkness, senior strategy advisor, healthy workplaces, IAPA

Ralph Dunham, board member, Canadian Centre for Emergency Preparedness

Doug Morton, director, life sciences and business management, CSA Standards

Jason Lakhan, Gowlings

John Saunders, provincial director, disaster management and international response, Canadian Red Cross – Ontario

Moderator:

The H1N1 pandemic we saw last spring is potentially going to resurface this fall flu season. How are organizations preparing for a potentially larger and more widespread comeback of this virus?

Dunham:

The organizations that I have talked to or dealt with are all focusing on being better prepared for the fall. A lot of them are looking at what they need to do as a minimum in order to be consistent with their industry and with their equivalence in the public sector and private sector. And they certainly are trying to become more prepared.

I think that the challenge that they keep raising is: ‘What is the level of preparedness that we should be at? How far do we go?' And in a lot of cases they look to what are the legislative requirements, and there’s not a lot there from a business perspective. They look to their industry associations, and maybe they will have some guidelines and maybe they won’t. They look to their competitors and the medical officers of health outside of their organization and say, ‘What are the best practices or where should we be?’

And in a lot of cases it’s not open discussions. There’s a confidentiality factor and a lot of organizations just won’t release what their pandemic plans are going to entail.

So there is a lack of consistency because this is a relatively new situation. It’s not like a fire. It’s not like a building falling down, it’s not like an earthquake where we have experience upon which we can draw. Now, they did learn a lot through the herald wave at the beginning of this year, in the springtime. And learned things like how effective WHO (World Health Organization) phases are versus severity impacts. So they’re updating those programs and everything else. But again, it is so driven by how much attention it is being paid by the media: If it’s front and centre on the nightly news, then the next day there’ll be a lot of work done. If there’s nothing in the nightly news, the next day there wont be any work done on it.

I think the whole topic - and this is a very interesting approach to emergency preparedness because it’s almost defining the roles and responsibilities - there’s this assumption by business that governments will look after these things. And there’s an assumption by the government that 85 per cent of the critical infrastructures are in the private hands, therefore they will look after things. And there’s never been this meeting of the minds as to what are you going to do and what am I going to do and there’s a lot of, ‘Well you tell me first.’

So until we break down that communication barrier – whether it’s with H1N1 or whether it’s what to do with the large regional evacuations – until we understand the private-public sector interlocks and where they do miss and where there are gaps, we’re going to have a lot of difficulty, I think, in having that consistent emergency preparedness capability.

Parish:

Part of the discussions a while back I think when they started talking about worst case scenarios and one of the things in the municipalities that came up was, if in the worst case scenario we had all these deaths and all these things taking place, what were they going to do with the bodies. And understanding that the undertakers and the funeral homes and so on can only handle so much. So the thing came up: ‘Well that’s no problem, we’ll just fire up the arenas and put them all in the arenas and stockpile them,' and things like that. And when everything fixes itself again and the world went back to normal, whenever that was going to be, then we’ll deal with these situations after.

I think, we just saw Toronto go through the garbage strike and they filled the arenas and the rinks full of garbage and now people are starting to say, we probably don’t want to go back there again. And we probably don’t want to be there because of contamination and so on and all those issues.

So in the municipality side, being the local government they will be looked at as trying to fill in some of these gaps and deal with some of these situations. So now after you fill an arena full of bodies and again as part of the discussion that came up was, ‘ well what if the refrigeration system quits?’ So we always look at the ‘what ifs’. It ended that there wasn’t any answers and we kept going through, which we always do in these types of things, looking at the worst-case scenarios. And they came to a situation in saying, 'well I guess the only thing we would do then is to take them out and dig a whole and burn them and bury them' and stuff like that.

So there’s a lot of unknown answers in the municipal sector as to how they would deal with some of these things if it went to the worst-case scenarios. If it didn’t, then it probably wouldn’t be too bad, they will be able to do things. So we really don’t know what’s going to happen and I think municipalities are having a really hard time – being the local government – trying to figure out how they would deal with things if they go to the worst case.

So it was just a discussion that ended up going nowhere because it came to a point where nobody had an answer and I think this happens quite often, and maybe this garbage strike, putting everything in the rinks, there may be some answers after that. But who knows what contamination has been leashed out in the soils and all other stuff from a situation like that that we normally don’t ever have to deal with.

Saunders:

I think that’s another example – from Ralph’s comment – by way of communication breakdowns. A lot of that type of situation has been addressed by the provincial pandemic steering committee by way of planning, by way of the discussions surrounding rinks. Unmarked refrigerator trailers was the recommended option by way of, should there be short term or longer term necessity for overflow while coroners and funeral homes are trying to keep up with, trying to maintain dignity as much as possible. And there was a decision made eventually that there would never be mass graves in Ontario, that is not a viable option within the province or an acceptable option.

If that is not being communicated well from the province and the feds to municipalities, it’s another example of where the communication aspect by way of all the partners involved needs to be improved. So that corporations have a good idea what the province and the municipalities are doing – does an individual corporation know what their municipal plans are? Is that conversation happening?

I don’t want to redirect the conversation too much in this regard, but for the most part larger industries are doing a good job in emergency management. They are devoting some good resources toward safety, towards emergency planning. Where the biggest gap is in the small and medium sized businesses who just don’t have the resources – material or human – to invest in a large way in business continuity planning.

Public Safety Canada recognized that. They have brought the Canadian Red Cross and other members of the voluntary sector together. One area that we were looking at is, for example organizations that provide support to people in their homes. So that they can age at home as opposed to going into an old age facility or hospital. So there are all these different community associations, sometimes they’re 10-people shops. How do they invest in business continuity planning? But yet during a pandemic, their role is going to be vital so that we don’t have a further wave of people needing to be introduced into the hospital setting.

So how do we keep those organizations running? Public Safety Canada funded the volunteer sector to put together a website, it’s called Readyforcrisis.ca. It was designed primarily as a not-for-profit to do home support but it gets into the concepts of business continuity, it gets into some templates and the basic planning that’s needed. So that at least it gives them the tools to move forward so that they can start pecking at it.

Just being realistic, again, it’s a 10-person operation, it’s a not-for-profit. Where do they come up with the money to hire a consultant to develop a business continuity plan for them? So initiatives like that are happening but we need to start sharing that information. And again, really want to emphasize the point that companies need to talk with their municipalities, municipalities and provinces need to talk better. And provinces and the feds need to start communicating better by way of – what discussions have already happened? What decisions have already been put into place that would have business impacts so that we aren’t duplicating efforts, we are working together. Because that really is the other evolution of emergency management is the partnerships – doing it alone just doesn’t work.


Hollands:

I was thinking of last year’s pandemic simulation that was held between the public and the private sector and those simulations are very powerful and probably one of the best experiences of your time that an organization can go through. Both of those were not-for-profit, sponsored in some cases by organizations, very affordable.

Each company’s representative or team, would be engaged in their specific sector, as far as that very realistic simulation was concerned. And it made them really think about who are their stakeholders, who are their suppliers, who else relies on them, how do their plans fit in with the public sector side of things, what should they be doing better? And some organizations even found that developing their plan – especially if they are a critical service going out there into the public domain – if they could enhance their preparedness and their skills then, that was seen as a brand enhancer as well.

And because of all the questionnaires and supplier responses they are asked of – Are you as my supplier prepared to support me in what I feel are my critical operations? What would you do? What is your role? And how can I rely on that?

That brings people together into those conversations quite well, especially from the business point of view where you’re really looking at critical operations.

But from the simulation, I still like to plug that again, I know it was delayed this year … but I believe it will go forward. They are planning a cross-Canada simulation to feed that. And that was going to create a national conversation around who would do what in this kind of very public-private crisis.

Morton:

Going back to Jason’s comment about some province’s mandatory requirements to have an emergency management plan, I have also heard that while in some provinces that is required, the quality or the completeness of plans can vary widely even in provinces where it is mandatory. So I think there is still an issue there in terms of bringing the level of quality up.

To John and to Ralph’s point about communication, certainly I would wholeheartedly agree. In traveling across the country we know that there sometimes is a lack of communication between federal governments and provincial governments.

About two weeks ago there was an article in The Globe and Mail, the Federation of Canadian Municipalities was still voicing concern that eventhough issues of disasters or pandemic or whatever will hit at a municipal level, they still don’t feel that their voices are being heard in terms of that planning.

Maybe it's this issue of where you put bodies is an example of the lack of communication. And certainly across the country we see provinces taking their own initiatives because there isn’t that direction in terms of a national perspective. And we even see some municipalities, in Ottawa for example, there’s now an emergency management group for the hospitals that are trying to come to grips with what they should be doing.

So all of these separate initiatives, while commendable and important, really point to the overall lack of integration and communication.

Harkness:

John made a good point as well with regards to understanding where our suppliers are going to fit into the process. Just anecdotally, when IAPA was going through our initial response in May and what we were going to be needing for resources for our staff, it was really scary how quickly supplies dry up and getting access to whether it’s the respirators or it’s cleaning lotions or gloves or whatever it’s going to be. It was incredible how quickly we had difficulty getting the basic stuff, and even stuff that we thought was on its way never made it. And I’m thinking that’s another piece that can be quite challenging for us. It’s this expectation that not only do we have to manage this from our own perspective, but it’s almost an assumption that yes, our suppliers will still be able to support us, just like everything else. And they are going to be in the same type of glitch and concerns too. Food for thought.

Parish:

On the supplier side, the transportation industry is going to be another one because everybody depends on just-in-time freight and shipping and stuff like that. People don’t warehouse things anymore so all the supplier, if they are able to make it, then has to travel from point A to point B, which could be across border. So there’s a whole group in there that’s affected, too. So when we look at things that are needed right away it starts out with the supplier, but then we have to get it.

The trucking industry people being exposed to a lot of people would be a whole other area that if they start to lose drivers, which there is already a shortage on a regular basis, then now the trucks are going to sit and the other thing that will happen is that the trucks that were loaded are going to sit too, and they could be who knows where. So it goes from point A to point B and there’s a lot of things in between there that can be affected, that can raise some major concerns for us as to how we actually do get them.

I know with the N95 masks there’s a real shortage on trying to get them right now because they were heading to the States and being made in the U.S. They were protecting their interest by maybe withholding stuff like that and not allowing it to be shipped outside of the US. So there’s a lot of little loop holes I guess we’ll call it, that are in there that can affect us that we sometimes have a hard time even being able to control, even with emergency planning and so on.

 
Saunders:

As a practical recommendation for organizations when looking at identifying alternate or tertiary suppliers, having a supplier at 123 Main Street and the alternate supplier being at 125 Main Street, probably is not the best idea because if one is impacted, probably the one next door to it is, as well.

So if your supplier is in Indonesia, you might want to look at either another country as a secondary or as a redundant supplier so this way you are looking at geographical solutions as well. During a pandemic, who knows how it’s going to work out? But it does increase your odds of continuing a supply chain if you do have those alternate suppliers.

And further to that recommendation is to test those alternates. Every once in a while place an order with them. It continues the relationship, but it also builds your trust that you will still be able to count on that as a back up supplier for whatever your primary materials are.

Somewhat of a separate issue and a challenge for all of us as emergency management professionals, as well as the occupational health and safety or emergency management personnel, is how to deal with misinformation. So media is a great way for keeping topics on the front page and keeping corporate buy-in there. But unfortunately, we’ve all seen instances where either items have been hyped, misinterpreted, and/or overly, in some cases, minimized.

For example, halfway through SARS they realized that N95 masks probably weren’t even required or necessary. There is no scientific proof that N95 masks provided any extra benefit unless it was the person who is sick that is actually the one wearing it. But yet everybody and their brother wanted an N95 mask during SARS. No one even knew what an N95 was before SARS unless you’re in the industry.

It’s the same thing now, we’ve got family members going out and buying N95 masks. Again they don’t work well if you don’t know how to fit them properly, so you’re actually causing potentially more of a risk because people are using equipment without having the proper knowledge about how to properly use it.

So looking at how do we vet information, researching information and just not believing every story that comes across our desks and doing the research before going out and investing in it. I don’t want the company to stockpile antivirals. We’ve got some companies looking at that as an example. Under the Emergency Powers Act, the province could confiscate those supplies anyway. So you may be doing the government a favour by stockpiling on behalf of your company. I’m not saying that the province or the feds would do that, but they do have the powers to confiscate it if it is in the greater good of the country.

So taking a practical aspect with what is it you need to do to protect your people, your business and your community. And keeping it balanced, perhaps is the overall message there about how we approach these things, and not allowing ourselves to be caught up in the flurry of activity or in the passion of the moment.

Related discussions:

Are you ready for an emergency?

Social networking as part of emergency planning

Better coordination between public-private organizations

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