Center Articles and Publications

Conference Report
Risky Business: Planning for Pandemic Flu
Beth Maldin and Kathleen Criss

Biosecurity and Bioterrorism. Volume 4, Number 3, 2006. © Mary Ann Liebert, Inc. Reprinted with permission.

Sections:
Synopses of Speaker Presentations: 
   - Pandemic Influenza 101 (T. O'Toole)
   - Potential Impact on Business and Society (R. Larsen)
   - PA DOH Pandemic Plans and Planning Assumptions (J. Blystone)
   - Allegheny County Pandemic Plan and Communications (B. Dixon)
   - The Doctor Is In (C. Mackett)
   - HR Practices for Pandemic Influenza (S. Vismor)
   - Global Pandemic Preparedness Planning for Financial Continuity (S. Schenk)
   - Keeping Our Shelves Stocked (J. Saunders)
   - Maintaining Local Operations (M. Comiskey)
   - Keeping the Lights On (B. Riordan)
   - Getting from A to Z in a Pandemic (D. Flanagan)
   - Working from Home During a Pandemic . . . Maybe Not (R. Clark)
Appendix: Organizations in Attendance

Risky Business: Planning for Pandemic Flu was a full-day conference on avian influenza for senior business leaders and decision makers with responsibility for business continuity, health, human resources, information technology, and security. Held on June 21, 2006, in Pittsburgh, Pennsylvania, the event was cosponsored by the UPMC Disaster Management Center, the Center for Biosecurity of UPMC, the University of Pittsburgh Center for Public Health Preparedness, the Three Rivers Contingency Planning Association, and the Pittsburgh Regional Business Coalition. The conference brought together experts and leaders from the medical, public health, and business continuity sectors to apprise Pittsburgh leaders of the threat of avian influenza and to offer suggestions on what the Pittsburgh business community could do to prepare and respond. The symposium was attended by more than 200 individuals from more than 100 different organizations (see Appendix).

The objectives of the conference were: (1) to apprise Pittsburgh business leaders of the current pandemic influenza situation, (2) to provide a forum for business leaders to share information and inform each other about existing plans and issues, (3) to support the creation and implementation of company-specific planning, and (4) to begin a long-term initiative to bring business and healthcare leaders together to protect the community. As Secretary Leavitt has stated repeatedly, “Any community that fails to prepare with the idea that somehow, in the end, the federal government will be able to rescue them will be tragically wrong.” With this in mind, leaders in medicine, public health, critical infrastructure, and regional business were eager to share information and experiences.

Synopses of Speaker Presentations
Transcripts and presentations (where available) are posted at http://www.upmc.com/dmc/seminar. What follows are synopses of lectures delivered at the symposium, with a focus on key judgments and recommendations.

Pandemic Influenza 101: Tara O’Toole, MD, MPH, CEO and Director, Center for Biosecurity of UPMC

Dr. O’Toole discussed the differences between avian influenza and the typical influenza we experience each year, the current status of avian flu, and the antivirals and vaccines that may or may not be available during a pandemic. Dr. O’Toole also discussed national and international plans to prevent and respond to an influenza pandemic.

Potential Impact on Business and Society: Colonel Randy Larsen, USAF (Ret.), Founding Director, Institute for Homeland Security, and Senior Associate, Center for Biosecurity of UPMC

Col. Larsen discussed the impact a pandemic may have on society and the implications for business and the local community.

• Those who plan are more successful in an emergency: “Plans are useless, but planning is essential.” Planning must include identifying core business functions and key players, as well as developing a “deep bench” of personnel and expertise to support critical functions. It is most useful if company personnel, not outside consultants, are directly involved in the planning, because company personnel must be familiar with the plan in order for it to be successfully implemented.
• Past disasters have shown that two-thirds of businesses that do not reopen within 2 weeks following a disaster will file for bankruptcy within 1 year.
• One of the hardest hit companies on September 11, 2001, was Cantor Fitzgerald, which lost 650 employees that morning. What would have made the company’s situation even worse would have been for the surviving employees to be out of a job. Instead, when the markets reopened on September 16, Cantor Fitzgerald was open for business. In less than 2 months, they were back to their pre-9/11 levels of trading, more than $1 billion a week.
• UPS demonstrated that it was a robust company when a “hundred-year ice storm” hit their primary hub, Louisville, Kentucky. The mayor ordered virtually everyone to stay home for 4 days; however, the runways at the airport were cleared in 1 day. Because of standardized procedures and interoperable training, UPS employees from other parts of the country were flown into Louisville to run the overnight sorts, which enabled UPS to continue to deliver packages around the world.

PA DOH Pandemic Plans and Planning Assumptions: Jeffrey A. Blystone, Public Health Program Administrator, Bureau of Community Health Systems, Pennsylvania Department of Health

Mr. Blystone discussed Pennsylvania’s plans for mass triage centers, mass distribution of vaccine and antivirals, and disease control.

• The Pennsylvania Department of Health has identified potential Points of Dispensing (POD) sites throughout the state. If it is necessary to administer vaccine or antiviral medication to the entire state population within 48 hours, it will require 588 PODs and 171,696 volunteers to operate (on a 24-hour basis) vaccine PODs and 63,504 volunteers to operate antiviral PODs.
• Volunteers are currently being recruited through the Medical Reserve Corps (MRC), the Citizen Corps, and the Emergency System for Advanced Registration of Volunteer Health Professionals (ESAR-VHP).
• The Pennsylvania Department of Health will be conducting a survey to evaluate existing facilities, barriers, and funding to establish locations to serve as alternate care facilities, which would be necessary to care for patients in the event that hospitals are overwhelmed. However, the level of care that can be provided at these facilities is still being researched.

Allegheny County Pandemic Plan and Communications: Bruce W. Dixon, MD, Director, Allegheny County Health Department

Dr. Dixon discussed local plans for managing ongoing county health operations, public communications, and the establishment of mass care sites as well as local plans for controlling the spread of disease.

• The Allegheny County Health Department (ACHD) is working with the medical community to improve its system of disease detection and identification.
• The ACHD is also considering using the David L. Lawrence Convention Center as a temporary hospital and/or triage center; the facility could accommodate approximately 3,000 people.
• The ACHD will likely recommend restriction of movement within the county. The department estimates that 90% of the population would comply and remain at home, thus allowing essential personnel to move throughout the city.

The Doctor Is In: Charles W. Mackett III, MD, FAAFP, Executive Vice Chair, Dept. of Family Medicine, UPMC

Dr. Mackett discussed the likely availability of healthcare services during an influenza pandemic, access and security at healthcare facilities, and UPMC’s plan for alteration of standards of healthcare services during a pandemic.

• UPMC has established a task force for pandemic planning that has as its mission to protect staff and address their concerns, to design and implement innovative treatments, to make fiscally responsible decisions, and to act as a member of the community and a leader in the healthcare industry.
• To increase surge capacity, UPMC is planning to prioritize ICU care, reconfigure and expand ICU and negative-pressure beds, and increase critical care personnel through cross-training.
• During a pandemic, healthcare providers and the community will need to understand that not everyone will receive the necessary level of care. UPMC is developing plans for “graceful” degradation of services, because hospitals will simply not have enough staff, space, or medical equipment to treat everyone.
• UPMC, in developing the plan to “gracefully” degrade services in an emergency, is hoping and planning to receive input from the community, including business and religious leaders.
• UPMC has a mass notification system that will enable it to contact employees and health plan patients during a pandemic to provide critical information and situation updates.

HR Practices for Pandemic Influenza: Susan M. Vismor, Senior Vice-President, Corporate Crisis Management, Mellon Financial Corporation

Ms. Vismor discussed human resource policies for pandemic influenza, the process for developing these policies, and barriers that have and have not been resolved within Mellon.

• Mellon Financial Corporation is educating staff now about staying home from work when they are sick. The company will be offering free flu shots (which usually cost $20) to all employees for the upcoming flu season.
• Realizing that employees may need to care for sick family members or that it may be impossible to obtain a note from a physician during a pandemic, employees will be permitted to be absent for 7 days before going on short-term disability.
• Mellon will offer flexible work hours for staff who are fearful of contagion, allowing those individuals to come to work during less crowded hours.
• Mellon Financial has identified critical functions that would be affected by an assumed 30–40% absenteeism rate, and it has evaluated how long each function could be discontinued. In addition, Mellon identified critical personnel and realized that 36% of these key staff can work from home.
• Ms. Vismor highlighted the importance of cross-training staff in order to build internal capacity and redundancy for critical functions. For example, because staff and offices at Cantor Fitzgerald were cross-trained, the London office was able to take over for the New York City office after the September 11 terrorist attacks.
• Since public transportation may be affected during a pandemic, Mellon recommends that companies consider having a transportation company on retainer. For example, following the July 7 London bombings, Mellon Financial staff were able to get to work because the company had a pre-established agreement with a transportation company and had predetermined pickup and drop-off locations.
• Ms. Vismor stressed the need to communicate with staff, and she encouraged organizations to have pre-established communication methods. For example, because of the political unrest during the G8 summit in Scotland, Mellon Financial employees received a phone call at home every morning instructing them whether or not to report to work in order to avoid putting staff in potentially dangerous situations.

Global Pandemic Preparedness Planning for Financial Continuity: Stephan Schenk, Vice President and Director for Business Resiliency and Operating Risk, PNC Financial Services Group, Inc.

Mr. Schenk discussed business plans to ensure the availability of cash and financial services for individual customers as well as initiatives that may be available to support businesses and ongoing trade.

• PNC Bank uses scenario-based planning to understand the impact of potential disasters on business continuity.
• Behaviors will likely change in the midst of a pandemic, as people may attempt to avoid crowds. For example, people may begin to use more remote ATM machines to get cash. This emphasizes the need to continually monitor emergency situations and to have flexible plans that can adapt to surprises.
• PNC has developed a multilevel response plan that identifies actions that may be taken during three phases of a pandemic: (1) limited outbreak with no business impact, (2) outbreak with limited business impact, and (3) major outbreak with severe business impact.

Keeping Our Shelves Stocked: John Saunders, Director of Computer Services & IT Procurement, Giant Eagle, Inc.

Mr. Saunders discussed Giant Eagle’s plans to keep shelves stocked and pharmaceuticals available during a pandemic in light of the reliance on a just-in-time delivery supply chain.

• Giant Eagle has 214 retail grocery stores containing just fewer than 200 pharmacies; it also has 6 distribution centers and 100 convenience store locations. The company serves 4 million households.
• Giant Eagle is working to educate employees and customers about pandemic influenza and recommends that organizations have labor unions review human resource policies as soon as possible.
• The company is preparing to increase the use of credit and debit cards to reduce cash handling, and it is expecting to increase drive-through services.
• With a just-in-time supply chain and more than 40,000 products sold in its stores, Giant Eagle aims to have products spend as little time as possible in the warehouse. For example, Mr. Saunders pointed out that perishable food items are not stored but are distributed via just-in-time inventory. Since additional supplies will be needed during a pandemic, it will require additional warehouse space, which is something the company is currently exploring.
• Commercial drivers may be in short supply, and therefore Giant Eagle is ascertaining whether other staff members have commercial driver’s licenses and whether they are willing to drive in an emergency.
• Giant Eagle does not currently offer internet shopping; however, this is something the company is considering.
• Giant Eagle is developing a plan to determine how and when it might begin rationing “core” items and developing a process for notifying and explaining this to customers.

Maintaining Local Operations: Michael P. Comiskey, Executive Director, Pittsburgh Regional Business Coalition for Homeland Security

Mr. Comiskey presented an overview of the Pittsburgh Regional Business Coalition for Homeland Security (PRBCHS), which provides mechanisms to regional businesses to support critical infrastructure protection and the resilience of the local economy.

• The Pittsburgh Regional Business Coalition for Homeland Security was created following Hurricane Ivan to help businesses prepare for and respond to a disaster.
• Mr. Comiskey presented the three goals of the PRBCHS: (1) making information available and fostering business-to-business communication, (2) maintaining an inventory of assets of varying kinds, and (3) providing education and training.
• According to the 9/11 Commission report, private sector preparedness is not a luxury but rather a cost of doing business in the post-9/11 world.
• Since 85% of critical infrastructure is privately owned and because the private sector is essential in any response to a disaster, the PRBCHS is working to catalogue the resources and assets available in the Pittsburgh region so that they can be made available quickly in an emergency through a single phone call.

Keeping the Lights On: Brian L. Riordan, MBA, General Manager, Corporate Risk Management, Allegheny Energy, and John L. Shaner, General Manager, Restoration and Emergency Preparedness, Allegheny Power

Mr. Riordan and Mr. Shaner discussed how Allegheny Power is planning to maintain services and how it will prioritize degradation of services, should that become necessary.

• Allegheny Power serves customers across more than 30,000 miles in Pennsylvania, Maryland, Virginia, and West Virginia. To increase its ability to maintain critical services, Allegheny Power is looking at essential functions and identifying areas in which staff could be cross-trained.
• It is a member of the Regional Mutual Assistance Groups, which allows for receiving and donating aid to other areas during disasters; these agreements have been tested during regional disasters.
• Allegheny Power has certified staff members in the National Incident Management System (NIMS), which allows the company to engage with government and emergency agencies in responding to disasters.
• Allegheny Power has a personnel shortage plan in place that could be activated during a pandemic or other large-scale disaster; the plan is in alignment with the North American Electric Reliability Council (NERC).

Getting from A to Z in a Pandemic: Daniel J. Flanagan, Industrial Hygienist, Port Authority of Allegheny County

Mr. Flanagan discussed how the Port Authority is planning to maintain services and, if necessary, how it will prioritize degradation of services.

• The Port Authority of Allegheny County provides transportation for 240,000 riders each weekday. It manages 1,000 buses, 83 light rails, 75 mini-buses, and 430 ACCESS vehicles (the ACCESS program provides transportation primarily for senior citizens and the disabled).
• A Pandemic Planning Committee was formed, and planning is being coordinated with various local and regional public health agencies.
• Issues have been identified and are being addressed, such as prioritizing which workers will be vaccinated once vaccine becomes available, communicating schedule changes to the public, and exploring methods for disinfecting trains and buses.

Working from Home during a Pandemic . . .Maybe Not?: Robert Clark, Manager, Business Continuity and Emergency Management Group, Verizon Business

Mr. Clark discussed company plans for mitigation, disaster recovery, and business continuity during a pandemic or unplanned emergency.

• Verizon plans to allow many of its critical employees to work remotely, which has become easier as technology continues to improve. Verizon also is planning to stagger shifts to balance the load on networks.
• Mr. Clark noted that it is likely Verizon will shift work to areas of the globe where the pandemic is having less of an impact, assuming that the pandemic will not affect the entire world population with the same severity at the same time.
• Mr. Clark suggested that organizations identify their communications requirements now and contact vendors regarding additional needs before the next emergency. He also emphasized that Verizon is testing its solutions now and recommends that all businesses do the same.

Acknowledgments
The conference organizers thank the speakers for volunteering their time and energy to prepare for and participate in this event. The organizers also thank staff from the UPMC Disaster Management Center and the Center for Biosecurity as well as the members of the conference Advisory Committee for their support, time, and thoughtful guidance in the development of the program. Their efforts were critical to the success of the conference. From the UPMC Disaster Management Center: George Huber, Loren Roth, and Mary Jo Tutchko. From the Center for Biosecurity of UPMC: Andrea Lapp, Molly D’Esopo, and Jennifer Nuzzo. From the conference Advisory Committee: Kathleen Criss, Virginia Dato, Thomas V. Inglesby, Andrea Lapp, Charles Mackett, Beth Maldin, Tara O’Toole, Charles Rodger, Dori Ruschmeier, Samuel Stebbins, Eric Toner, and Susan Vismor.

Additional information on Risky Business: Planning for Pandemic Flu can be found at http://www.upmc.com/dmc/seminar

Appendix. Organizations in Attendance at Conference

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