Normally by this time of year I am giving weekly updates regarding the spread of influenza in Minnesota’s long-term care environments.  The good news is that 2010 appears to have been an excellent year in terms of minimal flu outbreaks in Minnesota’s long-term care locations.

That does not mean we are “out of the woods” for 2011.  Despite the availability of vaccines, the U.S. sees 36,000 deaths and more than 200,000 hospitalizations each year attributable to the flu.  The annual economic toll due to influenza is $10 billion in the U.S. alone.

Three strains of flu are expected to circulate in the 2010-2011 season.  The three flu strains, identified by the Center for Disease Control’s (CDC) Advisory Committee on Immunization Practices, are the A/H3N2 strain, a B strain and the 2009 H1N1 pandemic strain.  This year's flu vaccine provides protection against all three strains, and unlike last year, vaccines are in abundance.

Symptoms of seasonal flu can include fever, runny nose, body aches, headache, tiredness, diarrhea, or vomiting.  The CDC recommends that sick workers stay home if they are ill with influenza-like illness until at least 24 hours after they are free of fever (100° F [37.8° C] or greater) or signs of a fever without the use of fever-reducing medications.  This would require employees to stay home for 3 to 5 days in most cases regardless of whether or not antiviral medications, like Tamiflu®, are used.

If the flu does pop up at your location in 2011, note that the Centers for Disease Control and Prevention (CDC) has updated its Questions and Answers on Antiviral Drugs for Seasonal Flu.  As the CDC notes, it is very important that antiviral drugs are used early to treat flu in people who are sick with flu and have a high risk condition or are in an age group that increases their chance of getting serious flu complications, e.g., 65 years and above.

Regarding last year’s H1N1 virus, it is extremely difficult to predict how the virus may or may not change this season.  The severity of illness that the H1N1 influenza flu will cause or the amount of illness that may arise during the 2010–2011 flu season cannot be predicted with certainty.  Therefore, your organization should prepare to respond in a flexible way to varying levels of severity by taking the following additional steps if a pandemic flu develops early in 2011.

1. Make arrangements for widespread telecommuting, just in case.

2. Brief employees on sick leave policies and any employee assistance covered under any employee-sponsored health plans.

3. Document extraordinary sick leave policies that are flexible, non-punitive, and well communicated to employees, stressing that workers who have the flu should stay home and away from co-workers.

4. Allow workers to stay home, within reason, if they have to care for sick family members.

5. Allow workers flexible schedules or other accommodations in the case of school or day care closures so they can mind their children and keep them safe at home.

6. Determine who will be responsible for assisting individuals who become suddenly ill in the workplace.

7. Update your present business continuity plan so that if there is significant absenteeism during a major flu outbreak you can maintain operations or make a determination of a company wide shut down, if feasible.

8. Establish an emergency communications plan identification of key contacts for tracking and communicating business and employee status.  Consider an outbound notification system or recorded “help line.”  There are also systems like those offered by companies like Telecom Recovery Inc, which can actually redirect inbound work calls to cell phones and stay-at-home workers, transparently to customers.  Take a look at them.

9. Do everything you can to create a corporate culture that encourages sick workers to stay at home without fear of any reprisals from the boss.

10. Promote personal hygiene in the workplace by providing tissues, no-touch trashcans, hand soaps and hand sanitizers, disinfectants, disposable towels and antiseptic wipes for employees to clean their work surfaces.

11. Provide education and training materials to employees.  The CDC web site for H1N1 is a good inexpensive source, as well as other sites like http://www.flu.gov.

12. Instruct employees who are otherwise well but have a sick family member to go to work as usual, but be able to monitor their health every day.  They should be instructed to notify their supervisor and stay home if they become ill.

13. Encourage everyone to get a flu shot.  If it is not covered in the company medical plan, reimburse employees the $30.  In the long run it’s a good investment.

14. If an employee does become sick while at work, quarantine the employee in a separate room or area away from other workers until they can go home.

In addition, instruct employees to follow common sense measures, such as:

1. Wash hands frequently with soap and water for 20 seconds or use an alcohol-based hand sanitizer if soap and water are not available.

2. Avoid touching nose, mouth and eyes.

3. Cover your coughs and sneezes with a tissue, or cough and sneeze into your upper sleeve.  Dispose of tissues in no-touch trash receptacles.

4. Keep frequently touched common surfaces clean; for example, telephones, computer equipment, door handles, etc.

5. Try not to use other workers’ phones, desks, offices, or other work tools and equipment.  If necessary, consider cleaning them first with a disinfectant.

6. Get plenty of sleep in the wintertime.  You are most likely to get sick when you are tired, stressed, worn out or just working too hard.

The symptoms of H1N1 flu are similar and include fever or chills, cough and sore throat.  In addition, symptoms of H1N1 flu can also include runny nose, body aches, headache, fatigue, diarrhea, or vomiting.  Like seasonal flu, H1N1 flu may cause a worsening of underlying chronic medical conditions.

While we may be temporarily out of the woods regarding the 2009-2010 H1N1 scare, we still live in a world full of virulent microbes, and the threat of a pandemic is always present.  Remember, it is extremely difficult to predict how the flu virus may change from year to year; therefore, the severity of an outbreak in the 2010–2011 flu season cannot be easily predicted in advance.  Your organization should keep a watchful eye and prepare to respond in a flexible way to varying levels of severity, yet still be prepared to take additional steps if a pandemic flu develops early in 2011.  Make sure that you have a plan.

Doug Beardsley
952.851.2489
dbeardsl@careproviders.org