Topic : Pandemics in BCM Speaker : Catherine E. Ammon Company : ADVIMED SARL Designation : Consultant

1. Continuity and Resilience (CORE)
ISO 22301 BCM Consulting Firm
Presentations by speakers at the
5th Middle East Business & IT Resilience Summit
20 – 21 April 2016 – Palace Hotel DownTown Dubai
Our Contact Details:
INDIA UAE
Continuity and Resilience
Level 15,Eros Corporate Tower
Nehru Place ,New Delhi-110019
Tel: +91 11 41055534/ +91 11 41613033
Fax: ++91 11 41055535
Email: neha@continuityandresilience.com
Continuity and Resilience
P. O. Box 127557
Abu Dhabi, United Arab Emirates
Mobile:+971 50 8460530
Tel: +971 2 8152831
Fax: +971 2 8152888
Email: info@continuityandresilience.com
Please write to us if you would like to get in touch with the Speaker

2. Pandemics in BCM
Catherine E. Ammon
MPH, MBCI
21 April 2016
5th Middle East Business & IT Resilience Summit

3. • Spanish flu pandemic 1918
• Influenza historic
• Flu prevention and vaccine
• New challenges
• Pandemics in BCM
• Goals and Measures
Presentation Steps

4. Spanish Flu
1918 - 1919
50 to 100 Million deaths
2.5 – 5% of the world population

6. Spanish flu 1918-1919
• Four years of war
• Mobilization
• Insecurity
• Rationed food

7. Morbidity and Mortality
• Three waves, first one during summer
• Started in the army
• Spread to civilians
• 50% of the population infected (1918)
• Fulminant forms
• Men and young adults

8. Medical Sector
• Coped with difficulty
• Physicians caught flu
• Army: 50% of the sanitary services infected
• Call for volunteers

9. Private and public sectors
Numerous perturbations
Up to 80% employees infected
Public transports scarce and full
Workers disinfecting a classroom at a high school in Texas
(NYT, 27 April 2009)

10. Public Health Measures
• Extension of school holidays
• Closing of schools
• Watering of streets and hallways
• No public gathering
• Restriction on hospital visits
• Opening of lazarets

11. Tonhalle in Zurich

12. Lausanne – Outdoor mass

13. Consequences
• Severity of measures
• No reinsurance
• Rumors and misinformation
• Doubts about the disease
• Influenza was unknown
• Unknown transmission
• Fear

14. 1918-1919
2.5 – 5% of the world
population died
if today, same virulence:
180-350 millions deaths

15. Yesterday versus Today
• Travel by sea and land
• Few travelers
• Limited surveillance
• Limited communication
• Unknown disease
• Tentative treatments
• Air travel much faster
• Massive number of travelers
• Better surveillance (WHO)
• Fast communication technology
• Scientific diagnoses of illnesses
• Vaccine, treatment and
medication

16. Historic (1)
• 1933 Isolation of Influenza virus
• 1944 First vaccinations
• 1957 Asian Flu :1 Million deaths
30-50% of world population contaminated
• 1968 Hong Kong flu
40 Millions cases worldwide
• 1976 Swine flu

17. Influenza in animals
1980 25% seals of North Atlantic Coast died
in a few months
But also horses, tigers, whales,
cats and dogs, etc.

18. Historic (2)
1997 Avian flu
1st transmission animal > human
18 hospitalizations, 6 deaths
1.5 Million chicken killed

19. Historic (3)
2002 - 2004 SARS
• Less contagious than flu
• 8098 cases
• 774 deaths
• Impact on world economy

20. Historic (4)
2004 Avian Flu (H5N1)
• Vietnam : 22 cases, 15 deaths
43 Million chicken
• Thailand : 12 cases, 8 deaths

21. H1N1 Pandemic
WHO notify the outbreak on 11 June 2009
61 Million cases
300’000 hospitalizations
12’470 deaths
Ended 10 August 2010

22. Influenza Epidemics
Every year: 5% - 25% of the world infected
Children
• Low mortality
Adults
• 90% of flu-infected persons <60 years
• 50% deaths >65 years
Elderly
• High lethality
• Incidence 60% in closed community

23. Transmission
Direct contact
• Hand
• Sweat
• Saliva
Aerial dispersion
• Droplets
• Sneezing
• Coughing

24. Transmission
Indirect contact

25. ~ 30 - 50%
flu are asymptomatic
(healthy carriers)
but spread the virus!

26. Mortality & Morbidity
General population
5-25% infected
Complications 10% of
infected
Death 0.1% of infected
J.-C. Manuguerra

27. Someone’s flu becomes
everyone’s flu…
3°
2°
1°
Community
• Schools
• Colleagues
• Social contacts
Home
• Kids and adults
• Grand-parents
• Family, friends
Index case

29. Epidemic - Pandemic
Epidemic drift
Common disease, spread in a limited
geographical area and limited in time
Pandemic shift
Worldwide spread of the disease

30. Potential new viral recombination
from human, pigs, birds…
Pandemic

31. Antigenic constitution
3 antigenic types : A, B, C
• A drift very rapidly and cause many deaths
• B drift slowly, responsible flu in kids
• C difficult to isolate, responsible for benign
infections, minor role in human

32. Strains
• Antigenic type
• Location of 1st isolation
• Strain number
• Year of isolation
• Sub-type
A/California/7/2009 (H1N1)pdm09-like virus

33. Prevention

34. Composition of vaccine
2016-2017
Northern hemisphere (25 February 2016)
A/California/7/2009 (H1N1)pdm09-like virus
A/Hong Kong/4801/2014 (H3N2)-like virus
B/Brisbane/60/2008-like virus
+ B/Phuket/3073/2013-like virus

35. Production of flu vaccine
Solvay

36. Vaccination for
• Elderly > (50) 60-65 years
• Patients with chronic diseases
• Patients hospitalized during the year
• Residents of nursing homes, long term care,
hospitals, clinics, etc.
• Medical staff
• People in contact with individuals at risks
• Anyone who wish to be protected
• Limited supply of pandemic vaccines

37. Impact - Burden of Disease
• Individual / self
• Social, family and friends
• Health care system
• Education, Government
• Police, Customs, Public Transports
• Catering, Supply chains
• Community, Society
• Tourism

38. Example France
Peugeot Citroen factory (PSA) - Rennes
• 10’000 employees
• 25% vaccinated
• Occupational doctor part of the surveillance network
If > +6% sick leave
=> Production chain stops
Dr. Patrick Gilbert, PSA

39. Costs
Direct
• Consultation
• Medicine
• Exams
Indirect
• Days of work loss
(10% of all sick leave)
• Productivity loss
• Social impact

40. Key words
• Human impact (170-340 millions)
• Influenza cannot be eradicated due to
animal reservoir host
• Prevention
• Communication
• Information
• Fear, panic

41. Zika
• Mild disease
• Mostly asymptomatic
• Aedes mosquito (chikungunya, dengue, yellow
fever)
• Transmission through sex and body fluids
• Onsets in Africa, Americas, Asia and the Pacific

42. Zika
Aedes mosquito
• During the day
• Weak flyer (400m max)
Protection
• Prevent mosquito bites, use repellent and
window screens
• Wear light colored clothes
• Eliminate potential mosquito breading sites
(emptying water containers, buckets, pots, etc.)

43. MERS-CoV
• Viral respiratory disease
• Symptoms: from common cold to Severe Acute
Respiratory Syndrome (SARS)
• Appeared in Saudi Arabia in 2012
• 36% died
• Animal to human transmission
• Then human to human transmission (close
contact)
• Camels are reservoir host

44. MERS-CoV
• Present in Egypt, Oman, Qatar, Saudi Arabia
• Onset in Korea (traveler)
• No vaccine or specific treatment available
Prevention
• General hygiene measures
• Animal and social distancing
• Appropriate handling and cooking of food
• Pasteurization of camel milk

46. BCM Scenario
• No building
• No ITT
• No staff
• Mass absenteeism, unavailability of staff
• First on NCEMA’s risk identification list
• People are the most critical resources of
an organization

47. Pandemics on Risk Matrix

48. Impact
• Impact on team (overload of work, human
relations)
• Inability to respect delays (disgruntled clients,
loss of clientele)
• Slowing down of production
• Failure to meet organization’s objectives
• Financial loss
• Reputational damage

49. BCM Goals
• Protect collaborators and limit absenteeism
• Protect customers and assets anytime
• Secure the interest of the company
• Insure the continuity of services and activities
• Avoid productivity loss
• Protect reputation and image of company
Major risk is the downgrading of a service
due to high absenteeism

50. Identification of Key Assets
• Workforce, skills, knowledge (HR)
• Workspace facilities
• Supporting technologies (ITT)
• Data and information (Vital Records)
• Equipment and supplies, supply chain
• Stakeholders (Partners/Suppliers/Vendors)
BIA: What cannot be stopped?

51. Public Health strategies
Influenza
• Raise awareness
• Modify the risk perception
• Implement basic hygiene measures
Vaccination
• Vaccinate on work place
• Inform on efficacy
• Insist on benefits of vaccination
• Vaccination for everyone
• Improve the image of vaccine

52. Public Health strategies
Zika, MERS-CoV, Dengue, etc.
• No vaccination, no treatment
• Raise awareness
• Modify the risk perception
• Communicate
• Hygiene measures
• Mosquito nets and screen
• No mosquito breading source

54. Restrictive Measures
• Avoid contact / Social distancing
• No meeting
• Enhance Visio conference
• Closure of company’s restaurant
• Closure of common premises
• Limit travel (monitor travelers)
• Sick people stay home

55. Cleaning Measures
• Intensify cleaning of premises
• Disinfect work places
• Keyboards and phones
• Distribute antiseptic gel
• Distribute masks (adequate disposal)

56. Communication Measures
• Inform, inform and inform
• Identify speaker (and replacement)
• Hotline for staff
• Update regularly
• Pre-write flyers and posters

57. Air treatment Measures
• Regenerate the air
• Place filters
• Disinfect technical pipes

58. Organizational Strategies
• Staff come to work normal
• Some staff work from home W/home
• Some staff transferred to other site sharing
• Staff works in 3 shifts (24h) rotation
• Some staff work from home other on hold backup
• Teams are split in the building split
• Activities transferred outsourcing
• Stop all or part of the activities cessation

59. BCM Practicalities
• Pandemics alert notification
• Follow up surveillance system
• Identify essential staff
• Identify replacement
• Monitor absenteeism
• Exercise and practice
• Training, training, training

60. BCM Pandemic Planning
• Tailored made
• Adapted to your company
• In line with the culture
• Contact with providers
• Working from home (HR and legal issues)
• Pandemic plans of your suppliers

61. Who should have a plan?
• Countries
• Governments
• Hospital and Health Care facilities
• Companies
• Family

62. Which is more infectious,
virus or fear ?

63. Pandemics in BCM
Catherine E. Ammon
MPH, MBCI
21 April 2016
5th Middle East Business & IT Resilience Summit

64. Ebola
• Hemorrhagic fever
• Appeared in 1976 in Rep. Democratic of
Congo and Soudan
• Transmission from wild animals to human,
then from human to human
• Lethality 50% (25%-90%)
• Potential pandemic

65. Ebola
• No treatment
• Rehydration and comfort care
• Vaccines in evaluation
Transmission
• direct contact with blood or body liquids or
with infected objects

66. Continuity and Resilience (CORE)
ISO 22301 BCM Consulting Firm
Presentations by speakers at the
5th Middle East Business & IT Resilience Summit
20 – 21 April 2016 – Palace Hotel DownTown Dubai
Our Contact Details:
INDIA UAE
Continuity and Resilience
Level 15,Eros Corporate Tower
Nehru Place ,New Delhi-110019
Tel: +91 11 41055534/ +91 11 41613033
Fax: ++91 11 41055535
Email: neha@continuityandresilience.com
Continuity and Resilience
P. O. Box 127557
Abu Dhabi, United Arab Emirates
Mobile:+971 50 8460530
Tel: +971 2 8152831
Fax: +971 2 8152888
Email: info@continuityandresilience.com
Please write to us if you would like to get in touch with the Speaker