Swine flu outbreak and occupational health

Our TV screens have been full of reporters clad in (probably useless) face masks, standing in Mexican hospital corridors and speaking in grave tones. Schoolchildren have been sent home, and chief medical officers have sounded dire warnings.

But should occupational health (OH) practitioners, who will be on the frontline if workplaces start to empty, hospitals become over-run and schools close, be unduly worried about the swine flu pandemic? Or should they be more concerned about the knock-on panic that even the word ‘pandemic’ seems to engender? Or, indeed, should they be grateful that an as yet relatively mild flu virus has rung a timely alarm bell, especially if the virus emerges in a more virulent form in the autumn?

Present response

At one level, it’s clear that swine flu is not something that OH professionals can afford to be complacent about. The first person to catch it in the UK without having gone to Mexico was an NHS worker from Falkirk. The Department of Health has warned that a quarter of UK employers could end up being contaminated, potentially costing the economy £1.5bn a day.

Thousands of people have been contacting the NHS flu helpline – with NHS Direct cancelling staff holidays to cope with the extra demand – and the Health Protection Agency has said more than 600 tests are being carried out across the UK on possible cases. Research by Birmingham University has even suggested that, in the event of a serious flu pandemic, the NHS might be faced with absence rates as high as 85%.

More widely across the working population, absence management firm FirstCare has suggested there has already been an 8.2% rise in the number of staff calling in sick because of cough, cold or flu-like symptoms, putting it on a par with the norovirus outbreak in January 2007. And OH professionals have been bombarded with a mass of guidance on how to respond (see below).

But there also needs to be an element of perspective. So far, swine flu appears to be a relatively mild variant and, as OH adviser Gail Collins points out, at her organisation at least – Burton’s Foods in St Albans, which employs about 1,000 people at that site and some 4,500 nationally – the impact has been minimal, as it probably has been in many similar workplaces around the country.

“I have been very surprised that it has not led to more work,” she says. “We expected queues of people asking daft questions but we have had nothing. I make sure I go to all the main websites every day and just check the most up-to-date advice.

“One of the good things about it is that it has prodded the senior management team into looking at their contingency plan but, at a practical level, it has been really calm,” she adds.

Mixed messages

There has also been some confusion around some of the messages coming through to OH practitioners. One anonymous poster to the Institution of Occupational Safety and Health’s website, for example, complained about the Health and Safety Executive’s advice that employers should carry out a risk assessment, arguing that, in the current circumstances, it would be a waste of time.

“If we undertake a risk assessment we also have a duty to ensure its findings are communicated to all employees – a case of reinventing the wheel if ever I heard one!!!”, says one respondent. “I am also concerned that we are advised to ‘send employees displaying flu like symptoms home’ and ‘advise staff to stay at home if they have flu like symptoms’. Surely this is the role of the medical profession and any decision on this should be made between an employee and their GP?”

Similarly, there has been a vigorous debate on the OH Jiscmail forum around the merits of focusing on the availability (or not) of flu vaccines versus simply advising on better hygiene and hand washing.

Panic attack

Amanda Savage, senior OH adviser for West Midlands Fire Service, agrees the fear factor is, if anything, much more the issue right now.

“We had one firefighter ring up about someone who had been to Mexico and had come back with a bit of a cold, but for the most part, it is just fear and worry,” she says. “What we have done, though, is to revisit our avian plan, and we are planning for it to re-emerge and get worse in the autumn or winter. It will just be a case of waiting and seeing.”

While the World Health Organisation was at a level five alert when this article was going to print, things will not start to get serious in the UK until it reaches level six, at which point the UK moves to level one. At this level, for Savage at least, the serious planning gets under way, with her OH team ensuring, for example, that drugs fridges are in place. “At level two, we start to order in vaccines and make sure we have extensive first-aid kits in place in case the hospitals shut down. At three we stop running OH clinics, and at level four, we actually close completely and operate predominantly as a phone service, although we will still be planning to go around the fire stations,” she explains.

Contingency plans

The disaster planning around a pandemic assumes a worst-case scenario of her workforce being halved, she adds, with the service drawing up plans to co-ordinate with the police and ambulance OH teams in the area. “It is a good idea to have a regional strategy so that you are not on your own if the worst does happen.”

If things really got serious, there would also be the possibility of OH advisers being drafted back into the NHS as nursing auxiliaries, points out Collins. But, for now at least, the pandemic has growled rather than roared and, in the process, possibly simply given the world, and employers, a vital wake-up call and window of opportunity to prepare.

“What has been very useful is to have drafted a contingency plan. With Sars there was a sense of panic, but with this, at least for now, it all feels under control and that we do have all the information we need,” she says.

“It is a bit like a fire alarm going off, an early warning,” adds Collins. “I do not think you should ever be complacent about these things. You should always take note of official advice and never ignore it.”

What should employers do?

NHS Employers has outlined key recommendations for what employers should do to contain an influenza pandemic. These are:

  • Assess the likely impact of pandemic flu on their workforce and carry out a skills audit to identify any gaps that could be filled.
  • Ask employees for a range of data that would assist in contacting staff during a pandemic and identifying those most at risk of being unable to attend.
  • Assess how staff could be redeployed if normal working was suspended and set up a reserve pool of staff that could be drawn on in the event of pandemic.
  • Ask all staff who retire or leave the service whether they would be available to assist during the pandemic.
  • Develop protocols on the treatment of staff who are absent, particularly on the treatment of staff who are absent because of childcare or other caring responsibilities and work with local partners.
  • Make arrangements for staff to work more flexibly and to train staff to take on new tasks.
  • Train managers on how to handle disciplinary and grievance issues in the event of a pandemic.
  • Ensure they have arrangements in place to monitor working hours in order to maintain health and safety and plan for more than one wave of pandemic and for a recovery period after the end of the pandemic.

Official guidance

One thing OH professionals have not been short of over the past few weeks is advice and guidance. The Health Protection Agency (HPA) has not only been publishing daily updates but has put out specific guidance for healthcare professionals on how to respond, as well as guidance on to how deal with it within the workplace. This includes models for risk assessment, advice on reducing transmission and on effective isolation, as well as communication of the risks to others.

The HPA site also includes algorithms to help decision-making by those carrying out investigations, and guidance for those considering whether symptomatic individuals should be excluded from schools or workplaces as a precautionary “containment” measure. In early May, for example, the agency recommended the closure of four schools where pupils had recently returned from Mexico.

Employers, GPs and OH professionals are being advised, too, that they can obtain up-to-date advice from their local health protection units, which can be located using a postcode tool on the HPA’s homepage.

Similarly, the Health and Safety Executive has issued general advice to employers, including the importance of practising good personal hygiene measures, advising staff to stay at home if they display flu-like symptoms, and sending employees displaying similar symptoms home as quickly as possible. The HSE has also stressed that, for now at least, there is little need for workers to wear masks routinely when in contact with the general public.

The Department of Health, too, has not only leafleted every household in the country, but published guidance for businesses and healthcare professionals should a serious pandemic take hold. This includes displaying signs telling those infected not to enter the building, reminding people of the importance of basic hygiene, considering alternatives to direct meetings, reducing interaction by staggering lunch breaks and asking staff to maintain a distance of one metre from other people.

NHS Employers has also issued guidance, as has the Institution of Occupational Safety and Health, and the Nursing and Midwifery Council has issued a range of “position statements” on the role of registered nurses during the pandemic.

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