Recently in Pandemic Influenza Category

Source: American Society for Quality, March 2010

From the press release:
Amid continuing H1N1 influenza concerns and shrinking budgets, U.S. public health departments face tough challenges. At the top of the list: fewer resources to help ensure that residents get vaccinations and other services in a timely manner. But more agencies are finding a prescription for improved efficiency and public safety with the help of process improvement methods, according to a new report released today by ASQ (American Society for Quality).

The report notes the experiences of several public health agencies, which with the help of quality professionals and organizations such as Public Health Foundation (PHF) and the National Network of Public Health Institutes, are integrating continuous improvement tools and techniques. Results include improved vaccine distribution, waste elimination, more client satisfaction with vaccination services and strengthened communications to ensure a smooth flow of information.

Source: Steven M. Berliner and Camille Y. Townsend, California Public Employee Relations Journal, no. 198, February 2010
(subscription required)

The threat of H1N1 appears to have abated for now. Certainly the widespread media coverage of the illness has diminished. Nonetheless, a great number of questions still are unanswered, and they will remain pertinent in flu seasons to come. Employers should use this lull in H1N1 cases to prepare for a possible increase in the future.

Source: Robert Drago, and Kevin Miller, Institute for Women's Policy Research, IWPR No. B264, February 2010

During the recent flu pandemic, workers were urged to stay home when ill. Many employees in the U.S., however, either cannot take leave when they or a child are sick or do not receive pay for doing so, forcing them to choose between their paycheck and the health of their children, customers, coworkers, and selves. 2009 Bureau of Labor Statistics survey data reveal that two of five private sector workers lack paid sick days coverage, though 89 percent of state and local government employees and virtually all federal workers receive paid sick days.

This paper uses data from the U.S. Centers for Disease Control and Prevention (CDC) and the U.S. Bureau of Labor Statistics (BLS) to estimate the number of infected workers during the H1N1 pandemic's fall 2009 peak, looking separately at the public and private sector workforces. Findings suggest that workers in the public sector, where paid sick leave coverage is usually provided, were more likely to stay home when ill with H1N1 compared with workers in the private sector, where paid sick leave is less common. The analysis also suggests that flu pandemics may be resolved more quickly when access to paid sick leave reaches the near- universal rates seen in the public sector. Addressing the gap in paid sick days coverage among private sector workers could result in a reduction in the number of Americans affected by seasonal and pandemic disease outbreaks.
See also:
Sick at Work
Source: Nanacy Folbre, New York Times Economix Blog, February 10, 2010

Source: Alex McEllistrem-Evenson, Healthcare Workforce News, November 2009

Pandemic places stress on health care systems and staff in surprising and complex ways.

Little attention, however, has been paid by the media to the certain challenges and controversies faced by health care providers, clinicians, administrators, and other members of the health workforce who must, by necessity, deal with this pandemic on the front lines.

There are health concerns that arise any time health care providers have to deal with viral infections on a broad scale, and controversies about mandatory employee vaccinations and required time off have surfaced in many facilities. There are more subtle issues as well, which only emerge when talking directly to practitioners and administrators. In that regard, increased employee stress levels, broader needs for employer-sponsored daycare services, and ethical concerns which ask administrators in some areas to weigh employee safety against budget constraints are just a few of the ways that the H1N1 pandemic has trickled down through our health care system thus far.

Source: Joe Carlson, Modern Healthcare, November 16, 2009
(subscription required)

With hospital administrators working to address the myriad biological considerations swirling around the H1N1 flu pandemic, they might have overlooked one big social effect of the virus: the leverage it can lend to labor unions.

Source: Shannon Brownlee and Jeanne Lenzer, Atlantic Monthly, Vol. 304 no. 4, November 2009

Whether this season's swine flu turns out to be deadly or mild, most experts agree that it's only a matter of time before we're hit by a truly devastating flu pandemic--one that might kill more people worldwide than have died of the plague and aids combined. In the U.S., the main lines of defense are pharmaceutical--vaccines and antiviral drugs to limit the spread of flu and prevent people from dying from it. Yet now some flu experts are challenging the medical orthodoxy and arguing that for those most in need of protection, flu shots and antiviral drugs may provide little to none. So where does that leave us if a bad pandemic strikes?

Source: Mark Loeb, Nancy Dafoe, James Mahony, Michael John, Alicia Sarabia, Verne Glavin, Richard Webby, Marek Smieja, David J. D. Earn, Sylvia Chong, Ashley Webb, Stephen D. Walter, Journal of the American Medical Association, published online, October 1, 2009

Data about the effectiveness of the surgical mask compared with the N95 respirator for protecting health care workers against influenza are sparse. Given the likelihood that N95 respirators will be in short supply during a pandemic and not available in many countries, knowing the effectiveness of the surgical mask is of public health importance. Among nurses in Ontario tertiary care hospitals, use of a surgical mask compared with an N95 respirator resulted in noninferior rates of laboratory-confirmed influenza.
Related:
IDSA: N95 versus Surgical Mask Findings Retracted

Source: Sherry Baron, Kathleen McPhaul, Sally Phillips, Robyn Gershon, and Jane Lipscomb, American Journal of Public Health, Vol 99, No. S2, October 2009

From the abstract:
The home health care sector is a critical element in a pandemic influenza emergency response. Roughly 85% of the 1.5 million workers delivering in-home care to 7.6 million clients are low-wage paraprofessionals, mostly women, and disproportionately members of racial and ethnic minorities.

Home health care workers' ability and willingness to respond during a pandemic depends on appropriate communication, training, and adequate protections, including influenza vaccination and respiratory protection. Preparedness planning should also include support for child care and transportation and help home health care workers protect their income and access to health care.

We summarize findings from a national stakeholder meeting, which highlighted the need to integrate home health care employers, workers, community advocates, and labor unions into the planning process.

Source: Department of Health & Human Services, Agency for Healthcare Research and Quality, AHRQ Pub. No. 09-0016, September 2009

From the summary:
This guide from Department of Health & Human Services' (HHS) Agency for Healthcare Research and Quality (AHRQ) can help community planners prepare for public health emergencies, such as pandemic flu, when demand for medical resources outweighs supply. The guide includes information on ethical and legal issues, and on the provision of services to address pre-hospital, acute hospital care, alternative care sites, and palliative care during a public health emergency.

To illustrate how to apply these basic principles, the guide includes a special section on influenza pandemic preparedness. This new guide is an abbreviated version of Mass Medical Care with Scarce Resources, published by AHRQ in 2007.

Source: Howard Lempel, Ross A. Hammond, Joshua M. Epstein, Brookings Institution, September 30, 2009

From the abstract:
School closure is an important component of U.S. pandemic flu mitigation strategy. The benefit is a reduction in epidemic severity through reduction in school-age contacts. However, school closure involves two types of cost. First is the direct economic impact of the worker absenteeism generated by school closures. Second, many of the relevant absentees will be health care workers themselves, which will adversely affect the delivery of vaccine and other emergency services. Neither of these costs has been estimated in detail for the United States. We offer detailed estimates, and improve on the methodologies thus far employed in the non-U.S. literature. We give estimates of both the direct economic and health care impacts for school closure durations of 2, 4, 8, and 12 weeks under a range of assumptions. We find that closing all schools in the U.S. for four weeks could cost between $10 and $47 billion dollars (0.1-0.3% of GDP) and lead to a reduction of 6% to 19% in key health care personnel. These should be considered conservative (i.e., low) economic estimates in that earnings rather than total compensation are used to calculate costs. We also provide per student costs, so regionally heterogeneous policies can be evaluated. These estimates permit the epidemiological benefits of school closure to be compared to the costs at multiple scales and over many durations.