Special Feature (July 2009)

Swine Flu – Your questions answered

In spite of the best efforts of the authorities, cases of swine flu continue to rise in the UK. The World Health Organisation has declared a Global Pandemic and it is now feared that the virus could reach epidemic proportions in the UK by the autumn.

Although the swine flu virus seems to be very unlikely to cause death – the usual symptoms include a high fever and other flu-like symptoms – both the numbers of people who are likely to catch it and the possibility of quarantine arrangements to stop the virus spreading mean employers should make contingency plans now.

Below we set out some frequently asked questions and answers to help.  If you need further detailed assistance, please contact our Employment Law or Health and Safety Telephone Advice Service.

• Health and Safety Q and As
• Employment Law Q and As

Health and Safety Q and As

A(H1N1) Swine Flu: from containment to treatment

On 11 June the World Health Organisation raised its alert to level 6, recognising that UK have agreed to move from a containment into a treatment phase. This means that the virus is too virulent and widespread to contain and so health professionals have now been instructed to:

• Rely on symptoms rather than swabbing to diagnose the virus.
• Stop tracing close contacts of those diagnosed with swine flu.
• Only offer anti-virals to those diagnosed with swine flu.

The vast majority of cases of swine flu in the UK have been mild with a small number of more severe cases.

What are the common symptoms?

The symptoms of swine flu are broadly the same as those of ordinary flu, but may be more severe and cause more serious complications.
The typical symptoms are:

• sudden fever
• sudden cough

Other symptoms may include:

• headache
• tiredness 
• chills
• aching muscles
• limb or joint pain
• diarrhoea or stomach upset
• sore throat
• runny nose
• sneezing
• loss of appetite

Most people who have contracted swine flu recover within a week and do not suffer complications, even without being given antiviral medication.

People who are infected with the virus may be infectious for one day before they show symptoms. It is not yet known how long the period is from exposure to people developing symptoms. People may be infectious for up to 7 days after the symptoms appear.

Should I clean more frequently?

It is advisable to implement enhanced cleaning regimes during the pandemic. However it is recognised that there is an important role for individuals to play in enhancing the hygiene standards within your work area.

You can reduce the spread of germs during a pandemic by telling employees to wipe down their personal workspace on a daily basis. This includes:

• Phone
• Keyboard
• Mouse
• Wiping down shared areas such as meeting room tables and staff room tables before and after use.

Use bactericidal wipes for the above. Wipes need to be disposed of in a suitable waste bin.

What if my business has a close degree of customer contact?

Your aim is to provide a business as usual approach. Good hygiene is vitally important to reduce the risk of infection.

• Have tissues available in interview and meeting rooms and have a waste bin with a waste bag for the tissues.
• Wash hands after meetings and interviews and where you have shaken hands.
• Consider using other meeting formats, e.g. audio and video conferencing.

Is there a vaccine?

There is no vaccine for pandemic flu. This takes considerable development time after the virus has been isolated. First batches should be available in the autumn.

What about medication?

The most commonly recognised drug is Tamiflu.

Each country has its own strategy for the provision of anti–viral drugs. The health authorities will provide the drug to those who already have the flu. It is hoped that this will reduce the severity and length of the illness.

Who is most at risk?

Some groups of people are more at risk of serious illness if they catch swine flu and will need to start taking anti-viral medication as soon as they are confirmed with the illness. These groups are not more likely to catch the virus but are more likely to suffer complications:

• chronic lung disease
• chronic heart disease
• chronic kidney disease
• chronic liver disease
• chronic neurological disease
• immunosuppression (whether caused by disease or treatment)
• diabetes mellitus
• patients who have had drug treatment for asthma within the past three years
• pregnant women
• people aged 65 years and older
• young children under five years old.

Are there any complications?

For most people, the illness appears to be mild and self-limiting. Cases have been confirmed in all age groups, but children and younger people seem much more likely to be affected, whereas fewer cases have been confirmed to date in older adults.

For a minority of people, the virus has caused severe illness. In many, but not all of these cases underlying risk factors have been identified that are likely to have contributed to the severity of the condition.

Where complications do occur, they tend to be caused by the virus affecting the lungs. Infections such as pneumonia can develop.

How long does the virus live on surfaces?

The flu virus can live on a hard surface for up to 24 hours and a soft surface for around 20 minutes.

What is the incubation period for swine flu?

According to the Health Protection Agency, the incubation period for swine flu (time between infection and appearance of symptoms) can be up to seven days, but is most likely to be between two and five days. It is, however, too early to be able to provide details on virus characteristics, including incubation period, with absolute certainty at this time.

When are people most infectious?

People are most infectious to others soon after they develop symptoms, although they continue to shed the virus (for example, in coughs and sneezes) for up to five days (seven days in children). People become less infectious as their symptoms subside, and once their symptoms are gone, they are no longer considered infectious to others.

Should I avoid contact with people suspected of having swine flu?

All suspected cases that have swine flu symptoms will have been asked to self-isolate at home and restrict their contact with people. The vast majority of people should go about their normal activities, including going to school or work. This includes children who attend a school with a confirmed case of swine flu.

There is no need on risk grounds to avoid contact with people who might simply have come into contact with those having the illness but who are not themselves ill.

Should we expect a more severe second wave of the pandemic in the winter?

Features of previous flu pandemics suggest that the current viral strain will become even more widespread in the autumn or winter, causing more illness and death. It is possible that the virus will mutate into a more potent strain.

Is it possible to catch swine flu twice?

Yes, because the virus can mutate. If you become infected with the swine flu virus, your body produces antibodies against it, which will recognise and fight off the virus if the body ever encounters it again. However, if the virus mutates, your immune system may not recognise this different strain and you may become ill again, although you may have some 'cross protection' due to encountering a similar virus previously.

How to protect your business

The principal risk to the continuity of critical business functions in a pandemic is the shortage of employees both within your own business and in suppliers and subcontractors.

To reduce the impact of these potential problems, businesses need to ensure that they have:

• identified critical activities that must be maintained and, by implication, what work can be deferred
• identified the resources needed to deliver these critical activities, particularly employees
• considered both the number of employees they will need and which specialist skills, knowledge or authority those employees will require
• trained enough employees to cover the critical tasks in order to deputise for others
• put in place arrangements so changes in work priorities can be implemented and resources realigned, in order to maintain critical activities
• put in place arrangements to maintain good communications with staff, customers and suppliers

You may wish to hold a meeting to plan how you would manage the effects of flu on your business. This continuity plan should account for key risks and outline how to manage them. Planning is essential as most companies don't realise the costs involved in business disruption - the cost of not planning is likely to be greater than anticipated. How would your business cope with large scale absence? Would temps from an agency or other employees be able to conduct critical roles? Do you have all your important business information to hand and in order? What about client deadlines and your reputation? The Government has published a checklist for businesses specially designed for business continuity throughout this pandemic. It can be downloaded from:

http://www.cabinetoffice.gov.uk/media/132464/060516flubcpchecklist.pdf

Your employees – absences

Employees could be:

• ill with flu, or ill for other reasons (normal sickness levels)
• caring for others who are ill, or caring for children if their school is closed
• delayed due to transport and other possible difficulties
• absent due to other reasons, e.g. fear or avoidance of infection

The number of people who will fall ill at any time is difficult to predict. Many factors affect the rate of spread of the infection, including local circumstances, personal attitudes and behaviour. Also, the characteristics of the virus, its severity and ease of transmission may change. Although exact predictions are not available, for planning purposes it is prudent to consider how you would respond to absences of 25 to 30 per cent lasting seven weeks, and absences of 35 to 45 percent during the worst fortnight.

Your suppliers

Businesses should consider the effect of employee absences on the suppliers and subcontractors on which they depend. Absences in suppliers may affect the services that businesses are able to provide and the availability of some raw materials.

Planning is essential and keeping business disruption to a minimum is beneficial to all parties. Ring our Advice Line on 0800 634 7000 selecting option 2 or contact your Consultant for more details.

Other helpful web sites / phone numbers

NHS24 on 08454 24 24 24.

http://www.cabinetoffice.gov.uk/media/132464/060516flubcpchecklist.pdf

http://www.nhs24.com/

http://www.nhs.co.uk/

www.direct.gov.uk/swineflu

www.dh.gov.uk/pandemicflu

Employment Law Q and As

What types of absences from work are there for swine flu?

These are Quarantine Leave and Sickness Absence.

What is Quarantine Leave?

You need to consider whether a system of "Quarantine Leave " might be appropriate to try to prevent the spread of the virus within the business.

Quarantine Leave is designed to keep an employee who might be infected with the virus away from business premises, to prevent the spread of the virus among customers and other staff.

NHS advice is that, even if they have been in contact with somebody with swine flu, employees should go to work as normal unless they have symptoms.

However, to try to protect other employees and customers and to prevent the spread of the virus, you might wish to impose a period of Quarantine Leave on such an employee.

When should I consider imposing Quarantine Leave?

You should consider imposing Quarantine Leave on a person who has been in close contact with someone with swine flu (for example, a relation or a work colleague).

How long should a period of Quarantine Leave be?

The NHS recommendation is up to 7 calendar days. This is to allow time to see if swine flu symptoms develop.

Should Quarantine Leave be paid?

Yes, Quarantine Leave should usually be paid at the employee's normal rate of pay because it is you, the employer, who is sending the employee home.

Can I ask staff on Quarantine Leave to work from home?

It would not be unreasonable to ask staff on paid Quarantine Leave to do some work from home, but what work could actually be done would obviously depend on the job.

If you are considering operating such a scheme, it is best to discuss possible arrangements with staff as soon as possible, before any cases arise.  Although the legal position is not clear-cut, if you make it clear that Quarantine Leave will be paid as normal, and discuss what work it is appropriate for staff to do from home, most employees would be prepared to act reasonably.

What if an employee goes off sick with swine flu?

This would count as a normal period of sickness absence, and would be paid at Statutory Sick Pay rates or your business's own contractual sick pay rates, if your business operates a contractual sick pay scheme.

How long is an employee likely to be off work with swine flu?

Although the symptoms are severe, they are relatively short-lasting, so around a week's sickness absence would be reasonable. However, illness affects different people in different ways, so this is only a guide.

Can I insist on a doctor's sick note with a diagnosis?

The normal rules about GP's sick notes apply – an employer cannot insist on a sick note for the first seven days of absence (although if your business pays contractual sick pay, you may have a policy where a "private" sick note can be required as a condition of receiving contractual sick pay).

Additionally, the diagnosis arrangements vary across the country, with many GPs refusing to see people suspected of having the virus personally, to avoid further infection. In some cases, an assessment is made over the phone and will clearly be prone to error.

What can I do if I suspect an employee is "playing the system" – taking sick leave but not being genuinely ill?

There is, in truth, very little you can do. For obvious reasons, we would not recommend a "home visit" to the employee. You should also bear in mind the NHS's own problems with providing accurate diagnoses, as outlined above.

For employers who pay Statutory Sick Pay only, in practice employees have very little to gain by taking up to a week's sick leave, and this should prevent people "playing the system".

What about an employee who claims to have been in contact with a "swine flu" case, and so demands Quarantine Leave?

There is no legal requirement to grant Quarantine Leave, so you need not do so.

However, if you have made the decision that you want to operate a system of Quarantine Leave to protect other staff and customers, you might prefer to take the safer option and send the employee home on Quarantine Leave.

Can I take sickness absence from swine flu into account when taking disciplinary action for excessive or frequent intermittent sickness absence?

This question would apply in cases where an employee was already subject to a disciplinary warning for taking excessive, or frequent, sickness absence.  The question is whether a period of sickness absence due to swine flu would take the employee to a further warning.

Given the pandemic nature of the illness and the requirement to avoid spreading infection, it would be unfair and unreasonable for an employer to count a period of absence from swine flu towards any sickness absence totals.