Six years after SARS ushered in the worst health crisis since the 1918 flu pandemic, Preparedness Consultant Thomas Appleyard said Thursday that the cornerstone to responding to pandemic influenza is still proper hand hygiene and alcohol based hand sanitizers.

“People think they wash their hands really well and they don’t,” Appleyard told an audience in an online seminar through the Wellesley Institute in Toronto in which he also defended as necessary coughing or sneezing into your sleeve, not coming to work sick, proper environmental cleaning and disinfection, wearing protective equipment (i.e. masks) where necessary, and encouraging vaccination when it’s available.

He appealed to the non-profit community to look inside and outside their organizations and to build on what is already available, noting that Toronto Public Health has put out some useful planning guides as have various provincial and national associations. “Talk with your usual partners about how they think this is going to play out,” said Appleyard. “What sort of planning have they done? How are they imagining their responses?”

Most non-profits already have parts of emergency plans in place: plans for how to close an organization; how to deal with high absenteeism; and how to deal with seasonal influenza. Appleyard also found it useful for organizations to talk about what they learned in the first wave of H1N1 and during the SARS outbreak.

He asked them to think about what their organization will look like during a pandemic. “What’s it going to look like to walk into your organization during a wave of pandemic influenza?” asked Appleyard. “Will there be people at their desks or will they be empty? Will people be wearing masks?”

For many, it will look a lot like it does during seasonal influenza.

In Ontario, he added, many of the assumptions for flu pandemic haven’t held up: We’re not seeing an overwhelmed health care system. The severity of the cases doesn’t match what people were concerned about when doing pandemic flu planning.

Yet very few people have said that pandemic planning wasn’t a worthwhile exercise.

Appleyard was referring to the planning that occurred for a possible avian flu outbreak. He reminded people to respond flexibly (which is what’s happening now), improvise in their response and called on organizations to clarify organizational roles and priorities.

The latter is probably most useful in severe pandemic scenarios, said Appleyard, who argued that it’s still an important step to take even in the absence of a flu pandemic risk. Differentiate between “must have” and “nice to have” services. Determine what “new” services need to be offered. What operations (e.g.: payroll) must keep going in a timely manner?

“Once you have a fairly short list of service and operational priorities,” said Appleyard, “think about the roles that need to be in place to do those things.” They might only be the existing roles but there might be different ones too, particularly in high absenteeism scenarios. Some proactive organizations have already named key people to their response teams, including a pandemic manager and a backup.

“Part of the challenge that many organizations have had is that we’ve been doing this in the context of the great recession,” said Rick Blickstead, the CEO of the Wellesley Institute, a research and policy think tank. “Clearly it’s been a difficult process for organizations to be dealing with this kind of change while dealing with the economic situation.”

Blickstead proposed several changes including:

– Creating a culture that encourages people to stay home even if it means additional payroll costs

– Setting up systems for employees so they can work from home

– Setting up job sharing programs

– Creating (and budgeting for) a new pandemic sick policy

– Partnering with other organizations to replace front line people who can’t work from home

– Mitigating client risks for those that need to come to your organization to access services

– Tracking clients who should be coming to your organization on a regular basis

Appleyard called on organizations to think carefully about the precautionary principle. With this in mind, precautions and prevention must take into consideration the mode of transmission of the virus, as well as opportunities to protect individuals from infection. Some organizations have told him that they did “okay” with their handling of SARS, even in the absence of a plan, because it allowed them to be nimble and flexible.

Others said they were “completely overwhelmed with information and needed better processes in place and wished they had better personal protective supplies.” Still others have begun to experience “safety drift”, where people and organizations start taking safety less seriously because they haven’t been facing a crisis situation.

Since SARS, for example, promises made about infection control haven’t always been fulfilled. “This even happens in individuals,” said Appleyard. “I know lots of people who haven’t been sick for a while that have said to me ‘I don’t really need to take the flu shot every year’.”

Part of the problem is that non-profit leaders are strapped for time. “On average, executive directors spend 45 per cent of their time administrating or looking for funds,” said Blickstead.

“There’s not a lot of time to be a conceptual leader. So safety drifts because there are so many other things to do.”

John Bonnar

John Bonnar is an independent journalist producing print, photo, video and audio stories about social justice issues in and around Toronto.