Preparing Small Businesses for the Challenges of 2009-H1N1 Influenza

CDC Congressional Testimony

Testimony before the Committee on Small Business United States House of Representatives

Rear Admiral Anne Schuchat, M.D.
Director, National Center for Immunization & Respiratory Diseases
Centers for Disease Control and Prevention
Assistant Surgeon General, U.S. Public Health Service
U.S. Department of Health and Human Services

Good afternoon Chairwoman Velázquez, Ranking Member Graves, and distinguished members of the Committee. I am Dr. Anne Schuchat, Director of the National Center for Immunization & Respiratory Diseases at the Centers for Disease Control and Prevention. Thank you for the opportunity to update you on public health challenges of 2009–H1N1 influenza and its potential impact on small businesses. I′d like to begin with brief information about the current situation in the United States, followed by a discussion of the impact of the virus on American small businesses and related elements of the public health response.

Small businesses and their employees may have been impacted by the spring and summer outbreaks of 2009 H1N1 influenza. Outbreaks of the new 2009 H1N1 influenza already have started in several states and are expected to increase across the United States during the coming months. As fall begins, CDC anticipates that even more communities may be affected than those that saw cases this past spring and summer. In addition, communities may be more severely affected, reflecting wider transmission and potentially greater impact. Seasonal influenza viruses may cause illness concurrently with 2009 H1N1 this fall and winter. It will not be possible to determine quickly if ill workers have 2009 H1N1 influenza, seasonal influenza, or other respiratory conditions based on symptoms alone. It is also difficult to predict the severity of these outbreaks, the number of hospitalization and deaths that 2009 H1N1 influenza will cause, or the severity of illness that seasonal influenza may cause. Small businesses play a vital role in community functioning during an influenza pandemic. They form the critical backbone of supply chains for larger businesses and are central to the strength of local economies. Many healthcare providers are also small businesses and are critical to delivering vaccine, treating affected individuals, and helping track and manage influenza. Yet they also suffer disproportionately during disasters, and they are especially susceptible to the negative economic impacts of an influenza pandemic. Small businesses usually do not have a dedicated business continuity planner or infrastructure. An estimated 25 percent of businesses do not reopen following a major disaster, according to the Institute for Business and Home Safety. CDC/HHS collaborates closely with the Department of Homeland Security (DHS), the Department of Labor (DOL), the Department of Commerce (DOC), and the Small Business Administration (SBA) to help small businesses address issues they may face during an influenza pandemic. In response to the anticipated spread of 2009 H1N1 influenza, CDC has updated its recommendations to assist businesses and other employers of all sizes. CDC released guidance for businesses on Aug 19th in collaboration with DHS entitled: “CDC Guidance for Businesses and Employers to Plan and Respond to the 2009–2010 Influenza Season,” which is available on the CDC and websites. At the same time, we also released a communication toolkit for businesses and employers to provide information and communication resources to help businesses and employers implement the recommendations from CDC′s Business Guidance. This week, HHS/CDC, DHS, and SBA plan to release guidance specifically developed to help small businesses prepare for influenza pandemics.

The Guidance for Small Businesses recommends that small businesses should plan for and respond to two possible scenarios: 1) a continuation of the current level of severity of influenza as was observed during the spring and summer of 2009, and 2) a more severe outbreak. The first situation is what is being experienced in some communities now—an outbreak of similar severity of 2009 H1N1 to the spring. However, even if the severity of the virus does not change, planners should expect that there will be more people who are ill in the fall and winter, as 2009 H1N1 outbreaks coincide with the seasonal influenza season. Small businesses should be especially aware that this may significantly raise the level of absenteeism and could have an impact on business operations. The second scenario involves an outbreak of greater severity including more people with severe illness and thus, more people hospitalized for influenza complications, more deaths from influenza, and a probable escalation of absenteeism.

Even small businesses in communities that have not yet felt effects from 2009 H1N1 influenza should plan now for an influenza outbreak this fall and winter. Businesses need to be ready to implement strategies to protect their workforce while ensuring continuity of operations. During an influenza pandemic, all sick people should stay home and away from the workplace, hand washing and covering coughs and sneezes should be encouraged, and routine cleaning of commonly touched surfaces should be performed regularly. If the severity of illness increases, employers should be ready to implement additional measures while continuing to rigorously implement the interventions recommended for an outbreak similar to the spring/summer 2009 H1N1 outbreak. Public health officials may also recommend, if severity increases, a variety of methods for increasing the physical distance between people (called social distancing) to reduce the spread of disease, such as school dismissal, child care program closure, canceling large community gatherings, canceling large business–related meetings, spacing workers farther apart in the workplace, canceling non–essential travel, and recommending work–from–home strategies for workers that can conduct their business remotely.

A key influenza control measure in this guidance is to encourage ill employees to stay home. Employers of all sizes should consider plans to implement flexible sick leave policies. Employers also should advise workers to be alert to any signs of fever and other signs of influenza–like illness before reporting to work each day. Symptoms of influenza–like illness include fever or chills and cough or sore throat. In addition, symptoms of flu can include runny nose, body aches, headache, fatigue, diarrhea, or vomiting. Workers need to notify their supervisor and stay home if they are ill.

CDC recommends that employees with influenza–like illness stay home until at least 24 hours after they are free of fever (100° F [37.8° C] or greater), or signs of a fever, without the use of fever–reducing medications. Sick employees would be out for about 3 to 5 days in most cases, even if antiviral medications are used. Also, businesses should not require a doctor′s note for workers who are ill with influenza–like illness to validate their illness or to return to work. Doctor′s offices and medical facilities may be extremely busy and may not be able to provide this type of documentation in a timely manner, and it may encourage unnecessary doctor visits.

Businesses should inform employees that some people are at higher risk of complications from influenza. People at higher risk for complications from influenza include pregnant women; children under 5 years of age; adults and children who have chronic lung disease (such as asthma), heart disease, diabetes, diseases that suppress the immune system and other chronic medical conditions; and those who are 65 years or older. Those at higher risk should check with their health care providers if they become ill. Early treatment with antiviral medications is very important for people at high risk, because it can prevent hospitalizations and deaths. (For information on high–risk groups and those prioritized for seasonal and H1N1 vaccines, please see and CDC also recommends that businesses encourage employees recommended for seasonal influenza vaccine and 2009 H1N1 vaccines to get vaccinated as soon as these vaccines are available.

Small businesses should consider developing other flexible leave policies to allow workers to stay home to care for sick family members or for children if schools dismiss students or child care programs close. Schools in some communities may dismiss students and childcare programs may close, particularly if the severity increases. It also may be helpful to consider ways to cross–train personnel to perform essential functions, so that the workplace is able to operate when key staff members are absent. More details about guidance and recommendations for small businesses, including an FAQ document for workplaces can be found on

This morning, Dr. Robert Blendon of the Harvard School of Public Health (HSPH) released findings of a telephone poll on H1N1 influenza conducted in July and August this year that included over 1,000 businesses in the United States. About one third of the random sample of businesses polled were small businesses (defined in this survey as those having fewer than 100 employees). I would like to share with you a few key findings from this poll:

  • Large (40%) and medium (43%) sized businesses were significantly more likely to offer paid family leave than small businesses (27%).
  • Large (76%) and medium (82%) sized businesses are significantly more likely to offer paid sick leave than small businesses (67%).

Businesses should keep in mind that the intensity of an outbreak may differ according to geographic location, and that local public health officials will be issuing guidance specific to their communities to help guide small business′ response. Small businesses can help prepare by assessing their essential functions and the reliance that others in the community have on their services or products. To maintain critical operations, small businesses should be prepared to change business practices as needed during an outbreak. For instance, small businesses should prepare to identify alternative suppliers, prioritize customers, or temporarily suspend some operations as needed.

In closing, I would like to reiterate four things that small businesses should do:

  • Plan now to prepare for the impact of influenza this fall/winter;
  • Take into account, in developing plans, two possible scenarios:
  • Widespread influenza infection through the fall/winter flu season with most workers experiencing relatively moderate illness; and
  • A more severe outbreak, including more people with severe illness and thus, more people hospitalized for influenza complications, more deaths from influenza, and a probable escalation of absenteeism;
  • Protect the workforce by encouraging people to stay at home if they are sick; and
  • Take steps to maintain continuity of operations, even during high levels of absenteeism.

At HHS/CDC, we are working with our Federal partners, State and local health departments and with business organizations to provide clear, practical guidance and tools that small businesses can use to protect their workforce and maintain operations during the upcoming 2009–2010 flu season. It is important to recognize that there have been enormous efforts in the U.S. and abroad to prepare for this kind of an outbreak and a pandemic. Our nation’s current preparedness is a direct result of the investments and support of the Congress and the hard work of state and local officials across the country. While we must remain vigilant throughout this and subsequent outbreaks, it is important to note that at no time in our nation′s history have we been more prepared to face this kind of challenge. We look forward to working closely with the Congress to best address the situation as it evolves.

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