Cast your mind back over the countless number of self-certificates for absence from work because of flu, followed by a miracle cure as the afflicted find themselves fit to return to work before they need to see a doctor. Now, back to basics.
What influenza is not is an illness from which there is a rapid recovery within a day or two of symptoms. The influenza that is the subject of a formal medical certificate, usually requiring a couple of weeks off work for recovery, is caused by a family of viruses which, in different forms, affect birds and mammals. To put matters into perspective, flu is a potentially serious illness causing the deaths of 250,000-500,000 people a year throughout the world. Generally speaking, humans have developed resistance to human influenza virus, and deaths occur not because of the infection, but because the sufferer is compromised by a pre-existing condition, or because of complications.
If a new strain happens to be virulent, the risk of death increases, as we do not have resistance. The illness is relatively easy to spread: one cough or sneeze projects a spray containing the virus over an arc of several feet. Hands that have wiped dripping noses can contaminate taps and handles, facilitating the transfer of the virus to the next person who happens to use the washroom or open the door.
The current flu pandemic relates to the outbreak of swine flu, caused by a new strain of flu virus. The Health Protection Agency (HPA) describes the transmission of this virus as occurring in the same way as seasonal flu, and appears confident that, although there is not yet a vaccine to prevent infection, the condition can be treated with antiviral medication.
The problem is how to contain an outbreak so that there is no repetition of previous occurrences. The Spanish flu pandemic of 1918 killed more than 50 million people, while the 1957 outbreak of Asian flu, which had spread worldwide within a matter of months, killed two million people. And Hong Kong flu, which erupted in 1968, killed more than a million.
Unlike swine flu, whose most virulent effects so far have occurred among young adults, Hong Kong flu deaths occurred mainly in those over 65 years of age. The significance for occupational health (OH) practitioners is that a large number of swine flu cases would affect the working population to a significant degree.
There has been a high alert to the possibility of another pandemic since the late 1990s, when the avian flu virus began to infect humans working with poultry. Although the illness could only spread from infected birds to humans, as with all viruses, a small change in structure could, and did, lead to the possibility of infection between humans.
In 2007, an outbreak of bird flu, which spread from the Netherlands to the UK, was found to be a potentially serious risk to humans. The risk was averted by the slaughter of more than 300 million birds in 61 countries in Asia, the Middle East, Africa and Europe. A scientific estimate suggests that, had the risk not been reduced by such stringent, government-imposed health controls, there may possibly have been 100 million bird-flu fatalities worldwide, of which 500,000 would have been in the UK.
Swine flu was officially declared a global pandemic by the World Health Organisation in June, with nearly 30,000 cases worldwide, including more than 1,000 in the UK. And there have been more than 140 deaths since, including more than 70 in Mexico and three in the US since March 2009, and its first UK victim in June. Although patients have mostly responded to antiviral treatment, the world’s disease control agencies remain on alert.
In the micro-environment of the workplace, disease control takes on a different aspect in light of the human-to-human transmission of swine flu.
The HPA has a vast range of information for health professionals who are in any doubt about symptoms and steps to be taken to make a diagnosis. It is essential to read all the information, but useful background is contained in the information sheet, which provides “standard practical advice for investigating individuals with possible swine influenza infection.” It also has a list of contact telephone numbers for HPA and NHS Flu Response Centres. At present, swine flu is not a notifiable disease under the Public Health (Control of Disease) Act 1984, or the Public Health (Infectious Diseases) Regulations 1988. But emergency legislation could be brought into force to make any other illness, including swine flu, notifiable, and to impose a vast array of restrictions, not least of which would reduce or stop the movement of the public.
The main features of the Act would read like the script of a disaster movie, were they not written in the dispassionate terminology of the law. They are:
It is a criminal offence to expose people to infection
Persons suffering from notifiable diseases are prohibited from trading
Schools may be closed and children may be excluded from places of entertainment
Infected articles may not be placed in dustbins
There may be compulsory disinfection of premises
Persons may be removed from infected houses
Restrictions may be placed on the functioning of public transport
There are legal provisions for ordering medical examinations and removal to and detention in hospital
Death from a notifiable disease may result in isolation of dead bodies with provision for immediate burial
Legal restrictions apply to the holding of public funerals or ceremonials.
Keeping it at bay
OH personnel should become involved in the preparation of a contingency plan to ensure that illness is contained. It is true now more than ever before that serious harm can be caused by sickness presence, particularly if people persist in coming to work with flu-like symptoms.
It is always difficult in the hayfever season to distinguish between sore eyes, upper respiratory tract symptoms and general malaise. If any or all of those are accompanied by a temperature, it would be advisable to seek a formal diagnosis by way of a nose or throat swab under formal clinical conditions. If the employee’s GP does not know how to arrange testing for swine flu, the HPA will be able to advise.
Part of the contingency plan will be to ensure that if the person is well enough to work, or if the office needs to close because a person is infected, homeworking should be investigated as a temporary strategy, possibly with the use of video-network links where face-to-face meetings would otherwise have been needed.
HR and general management will be involved in this process, which may be the only way to cope with mandatory closure or a useful way of keeping the business going in a time of crisis. Staff need to be informed that homeworking is a temporary measure, unless the organisation is planning to extend it beyond the period of the flu outbreak. Equally, management needs to reassure staff that other measures, such as online purchasing rather than using shops, is not the way that the organisation will continue to work.
Although the use of online shopping sounds a sensible way for the retail sector to work around the travel problems that could arise if there were a national public transport closure, it does not take much imagination to realise that those who operate the other end of the computer line and warehousing, packing and despatch are equally at risk of similar restrictions on the ability to work.
A pandemic has disastrous economic consequences that may not necessarily be resolved by studying the range of skills available so that key roles can merge or understudies take over, either for periods of absence or during public health restrictive edicts, both of which are sensible precautions for which plans should be made.
On a practical level, the OH team is ideally suited to design clear and effective communication to workers so that they may understand the nature of the illness, the symptoms that are of concern, and to enable them to deal with an eminently treatable illness swiftly and efficiently.
Meetings or provision of leaflets can reassure people that, if they feel unwell, they should seek medical advice as soon as possible. Although it will be interesting to see whether more symptoms are reported by those with the highest preceding level of short-term sickness absence, all people should be treated equally and absence issues dealt with by performance management with all its safeguards.
Some managers are concerned that swine flu could become a malingerer’s charter but even if it is, staff must be instructed to stay at home if any of the key symptoms occur. Even so, a medical certificate must be provided certifying the cause of absence and, if the illness is swine flu, a certificate of fitness to return is essential.
People are being inundated with advice to the effect that it will be advisable to cancel or postpone work events involving travel or social gatherings. In practice, this will depend on whether an outbreak of the illness is so severe that it is mandatory to work from home.
There are huge humanitarian concerns when a community is blighted by illness. If the worst happens, the entire medical model will be put into process, starting with vaccination, if an appropriate vaccine is available. Thereafter, medication, hospitalisation and, where treatment is successful, recuperation.
The economic model, as we see in today’s world, is less adapted for recovery. For all reasons, prevention is better than cure. Perhaps the advice seen recently in a US newspaper is better than all the contingency plans: make sure that you cough or sneeze against your arm, not into your hand. It appears this permits less diffusion of droplet infection. If that is so, the better and more practical advice that can be given is to wear long sleeves.
Linda Goldman, BDS, LLB, is a barrister at 7 New Square, Lincoln’s Inn. Joan Lewis, MCIPD, MA (Law & Employment Relations) is an independent employment law consultant, licensed by the General Council of the Bar under BarDirect. Any enquiry about this article may be made to Joan Lewis at [email protected] Telephone 020 8943 0393