Preparing for pandemic flu — guides for families, businesses, healthcare providers

1 May 2009

Trust for America's Health (TFAH) has re-issued its series of It's Not Flu As Usual guides on pandemic flu preparedness for families, businesses, medical providers, and community groups.

"Worry and fear will not protect us — knowing the facts and planning ahead will," said Jeff Levi, PhD, Executive Director of TFAH.  "All of us want to do the right things to protect ourselves and our families in the event of a health emergency. These guides provide information that can help prepare for not just for a potential pandemic flu outbreak, but also for many other types of health emergencies."

The It's Not Flu As Usual guides provide recommendations in case a major pandemic breaks out.  In the event that high levels of illnesses develop and worries about the disease spread, "business as usual" may cease.  Public health officials may recommend to closing schools, limiting public gatherings, and staying home from work or school.

During a severe pandemic, experts predict that businesses and organizations may face cumulative absentee rates of 10% at any given time or 40% over three to four months.  Absentees could include sick employees, those who are caring for others who are sick, and individuals who may want to avoid the workplace for fear of being exposed to the virus.


  • Learn about common-sense precautions to prevent the spread of flu and teach them to your children or other family members.  Avoid close contact with people who are sick, stay at home when you're sick or have flu symptoms, cover your mouth and nose with a tissue when coughing or sneezing, clean your hands, avoiding touching your eyes, nose, or mouth, and practice general good health habits.
  • Practice other good health habits.  Get plenty of sleep, be physically active, manage stress, drink plenty of fluids, eat nutritious foods, and avoid smoking. 
  • Discuss important health issues with your family and loved ones.  Ask them about how/where they would want to be cared for if they become ill and discuss what would be needed to care for them at home. Think about who will care for children/people with special needs if all adults in the household are ill, and determine if there are other family members available to help. Make plans now and communicate with all who need to know.
  • Have generic medical and health supplies on hand.  Examples include supplies like soap or alcohol-based hand wash, medicines for fevers, fluid with electrolytes, and tissues.
  • Anticipate shortages of common prescription drugs and plan accordingly.  If you or a family member has a chronic disease and regularly takes prescription drugs, talk to your physician/pharmacists/insurance provider about having several weeks of medications stockpiled at home.
  • Anticipate shortages in perishable foods, water, and common household emergency supplies.  The federal government recommends stockpiling non-perishable food items, water, portable radios, batteries, flashlights, garbage bags, and manual can openers.
  • Anticipate social disruption and make back up plans.  Schools may be closed for an extended period of time, so consider pooling child care resources with neighbors and learn if there will be community-designated child care facilities for those who are not ill.  Since being able to go to work may be difficult or impossible, talk to your employer about the possibility of telecommuting or working from home.  Transportation services may be disrupted, so consider carpooling options to go to work, schools, and supermarkets to reduce your reliance on public transportation.  Other public and community services may be disrupted.  These could include services provided by hospitals and other healthcare facilities, banks, stores, restaurants, government offices, and post offices.  Think about how you and your family might compensate if you are cut off from these services.
  • Understand your company's sick leave and family and medical leave policies.
  • To fight the annual flu, get a flu shot.
  • Do NOT go to work, school, or to any public place if you become ill.


  • Check that existing business continuity contingency plans address long-term absenteeism rates.  In particular, check to see if core business activities can be sustained over several weeks with only a minimal workforce available.
  • Identify your company's essential functions, which might include accounting, payroll, and information technology, and the individuals who perform them.  The absence of these individuals could seriously impair business continuity.  Cross-train employees to perform essential functions to ensure resiliency.
  • Plan for interruptions of essential government services like sanitation, water, power, and transportation, or disruptions to the food supply.  For example, employees may need back-up plans for car pools in case mass transit is interrupted.
  • Determine which outside activities are critical to maintain operations and develop alternatives in case they cannot function normally.  For example, what transportation systems are needed to provide essential materials?  Does the business operate on ‘just in time' inventory or is there typically some in reserve?
  • Update sick leave and family and medical leave policies and communicate with employees about the importance of staying away from the workplace if they become ill.
  • Establish or expand policies and tools that enable employees to work from home with appropriate security and network access to applications.
  • Collaborate with insurers, health plans, and major healthcare facilities to share your pandemic contingency plans and to learn about their capabilities and plans.
  • Maintain a healthy work environment.  Ensure adequate air circulation.  Post tips on how to stop the spread of germs at work.  Promote hand and respiratory hygiene.  Ensure wide and easy availability of alcohol-based hand sanitizer products.
  • Tell your employees about the threat of pandemic flu and the steps the company is taking to prepare for it.  Establish an emergency communications plan and revise periodically.  The plan should include key contacts (with back-ups), a chain of communications (including suppliers and customers), and the processes for communicating pandemic status and actions to employees, vendors, suppliers, and customers inside and outside the worksite in a consistent and timely way.


  • Determine the possible impact of a pandemic on your organization's regular activities and services.  Take into account the possibility of high rates of absenteeism or mandatory closings, consider circumstances that may require you to increase, decrease, or stop the services your organization delivers.
  • Identify your organization's essential functions and the individuals who perform them.  Cross-train staff and volunteers in other jobs so that if someone is ill, others are able to carry on the work.
  • Plan accordingly for interruptions of essential government services like sanitation, water, power, and transportation or disruptions to the food supply. 
  • Update sick leave and family and medical leave policies so staffers will not be penalized for personal illness or for caring for sick family members during a pandemic.  Volunteers and employees should remain home until they are well.
  • Determine whether your volunteers and staff have "cross over skills" like nursing or mental health counselling that could be used during a health crisis, and make that information known to local health authorities.  Your local health department may already be compiling rosters of individuals in the community who can be called upon to help during an emergency.
  • Evaluate your organization's activities and services that involve close person-to-person contact, including child care, elder care, and religious rites, especially those that involve hand-holding or sharing food and drink from common dishes or glasses.  Establish policies to modify these activities to prevent the spread of pandemic flu and communicate them to your staff, volunteers, and people you serve.
  • Determine supplies needed to promote respiratory hygiene and cough etiquette, like tissues and alcohol-based hand sanitizer products, and develop a plan for how to obtain them.
  • Share information about your pandemic preparedness and response with volunteers, staff, congregants, and the people you serve.  You may consider activating phone chains, distributing flyers and sending mass emails to get your message out.  During times of anxiety people turn to those they trust, so clear and frequent communication is essential.
  • Ensure that what you communicate about pandemic preparedness is appropriate for the cultures, languages, and reading levels of those you serve.  Identify those with special needs and be sure to include their needs in your preparedness and response planning.


  • Be sufficiently educated about pandemic influenza and transmission risks.
  • Be vigilant about the possibility of severe or emerging respiratory disease, especially in patients who have recently traveled internationally.
  • Plan for how to manage high-risk patients and communicate the plan to your staff.
  • Develop a plan to prevent contagion, including use of close-fitting surgical masks in isolation areas, and for patients and staff. Distribute alcohol-based hand rubs to all sites of patient care.
  • Review staff infection control procedures and train staff in the use of personal protective equipment.
  • Get vaccinated against annual influenza each year and urge all staff to be vaccinated annually, too.
  • Plan accordingly for possible interruptions of essential services like sanitation, water, power, and disruptions to the food supply.
  • Work to ensure that the practice or clinic has access to adequate supplies of antibiotic and antiviral medications, as well as commonly prescribed drugs like insulin or warfarin, in the event of a disruption to the pharmaceutical supply chain.

More information on pandemic flu preparedness

The It's Not Flu As Usual guides were funded by The Pew Charitable Trusts, a supporter of the Pandemic Preparedness Initiative, and they are available on TFAH's Web site:

WHO Influenza A(H1N1) web site

WHO guidance for Epidemic and Pandemic Alert and Response (EPR) — a complete list of WHO documents:

EU Public Health — influenza news

UK Health Protection Agency swine influenza page

US National Institute of Allergy and Infectious Disease, National Institutes for Health

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