NACWA Member Update (MU06-08)

As concern grows about the possibility of influenza caused by the H5N1 virus—an avian strain with pandemic potential, NACWA has been working with other water sector organizations to identify important actions utilities can take to prepare for such an emergency. This Member Update includes the product of that effort in the form of a Pandemic Influenza Checklist. The Checklist was culled from a variety of resources including the World Health Organization (WHO), the North American Electric Reliability Council (NERC), the Centers for Disease Control & Prevention (CDC), the Business Roundtable, and others. NACWA credits the Association of Metropolitan Water Agencies (AMWA) for its leadership in compiling this information and its willingness to share it broadly with the water sector. The Association also wishes to thank Robert C. Steidel, Chair of NACWA’s Security & Emergency Preparedness Committee and Deputy Director of the City of Richmond Department of Public Utilities, for his important input.

For eight years, WHO and other health experts have been monitoring H5N1— a particularly virulent strain of influenza virus. Influenza pandemics happen when a new viral subtype emerges that has not previously circulated in humans. To date, H5N1 has only infected humans who have had close contact with infected birds. A strain of the virus that can easily be passed from human to human has not yet emerged although the possibility exists.

The public health community and the federal government are taking that possibility very seriously. Their concern is based on the continued and expanded spread of the highly pathogenic—and now endemic—avian H5N1 virus across eastern Asia and other countries. The H5N1 virus has raised concerns about a potential human pandemic because:

• It is especially virulent;
• Of the nearly 200 individuals who have contracted the virus, about half have died;
• It is being spread by migratory birds;
• It has been changing genetically and has developed the ability to infect more and more species of birds;
• It can be transmitted from birds to mammals and in some circumstances to humans; and
• Like other influenza viruses, it continues to evolve.

Business Continuity Planning Assumptions
A number of parameters have been developed for purposes of business continuity planning in the event of an influenza pandemic. Many, if not all, of the assumptions are appropriate for consideration by public utilities. The assumptions are listed here with a checklist of possible actions. (Please remember these are not predictions, but assumptions that may be used for situational planning.)
Pandemic Influenza Assumptions:

1. The timing of the outbreak of a pandemic is uncertain and depends on many factors.
2. Once human-to-human transmission begins, the disease will spread very rapidly around the world within three to eight weeks.
3. The attack rate for the general population is expected to be in the range of 25 percent, and these people would be very ill for up to a week.
4. Absentee rates for employees may not be uniform across an organization, but could be in the range of 35 to 40 percent for the duration of the pandemic due both to illness and other factors such as the need to take care of family members.
5. A pandemic outbreak may last six to eight weeks in an infected community, and multiple waves of the illness could occur, with each lasting two to three months.
6. Persons who contract the virus are not expected to become ill from it a second time because of a buildup of immunity. However, if the virus mutates, recurrences for the same individual would be possible.
7. Personnel will need to be managed differently to conduct essential business processes and to minimize the spread of the virus.
8. Not enough anti-viral medicines or vaccines will be available for the entire population. There may be none in the early stages and then limited quantities for select populations. Anti-viral medicines, such as Tamiflu, present a variety of difficult issues such as availability, effectiveness against specific virus strains, and dosage levels for pre-infection prevention as compared to post-infection treatment.
9. It will be important to provide accurate and timely information to employees, labor organizations, and government agencies before and during the pandemic.
10. Interdependencies with other sectors as well as contractors and suppliers will be severely tested during an influenza pandemic.

Pandemic Influenza Checklist
The following Pandemic Influenza Checklist is intended to provide utility managers with “food for thought” when considering what steps might be warranted in light of the current information on a potential pandemic. The Checklist identifies specific activities utilities could use to prepare. The Checklist is divided into six key areas as follows:

1. Develop Plans
2. Develop Policies
3. Conduct Training, Drills, and Exercises
4. Provide for Protective Equipment and Prepare Facilities
5. Prepare Response Actions
6. Maintain Awareness and Communication Channels

Public utilities are encouraged to prepare for the challenge of continuous staffing and evaluate how to maintain business continuity for both water treatment and distribution (including solids handling) and wastewater collection and treatment (including solids handling). While the Checklist provides a good place to start, the unique and uninterruptible obligation for water and wastewater utilities to protect public health and safety may necessitate additional work. NACWA member utilities may wish to consider additional initiatives to complement the Checklist, including the development of policies and procedures for continuous staffing of the facilities and the initiation of negotiations with local health officials for priority prophylaxis for utility staff and their families. Such efforts are likely to be extremely important because even though the infection pathway does not pass through wastewater—nor is it water borne, rumor and speculation may cause suspicion of the water supply, wastewater treatment, and biosolids land application.

National Plan Under Development
The National Response Plan (NRP) will be the mechanism for coordinating the federal pandemic response. Under the scenario, the Department of Health & Human Services (HHS) will coordinate the medical and public health response; the Department of Homeland Security (DHS) will ensure the integrity of infrastructure and domestic security and coordinate overall response; and the U.S. Environmental Protection Agency (EPA) will continue its work as the lead for the water sector. In this role, the EPA’s Office of Water will provide technical support, including guidance on environmental management systems and cleaning practices. They will also develop guidance that includes information on the persistence of the virus in the environment, the effectiveness of utility treatment processes in killing the virus, and the potential threat to utility employees.

The use of and strategy for allocating vaccines and antiviral drugs is also receiving attention at the federal level. Water and wastewater utility staff are among those being considered as potential early recipients of vaccines and antiviral drugs due to the critical nature of their role in protecting public health.

Policy Forum to Feature Briefing on Pandemic Preparedness
The upcoming National Clean Water Policy Forum will include a briefing focusing on pandemic influenza preparedness. The briefing, Pandemic Preparedness for Public Utilities, will provide the latest in planning and preparedness developments take place on Monday, May 1 from 4:00 – 5:00 pm. Please visit http://www.nacwa.org/meetings/06may/ to register for the 2006 National Clean Water Policy Forum and make your hotel reservations prior to the April 7 cut-off date.

NACWA will continue its efforts to keep clean water utilities informed on this issue. The following websites also provide current information on pandemic influenza:

http://www.pandemicflu.gov
http://www.who.int/csr/disease/avian_influenza/en
http://www.cdc.gov/flu/avian/index.htm
http://epa.gov/safewater
http://www.usda.gov/birdflu
http://www.waterisac.org

ATTACHMENT:

• Pandemic Influenza Checklist (PDF)