According to the US Centers for Disease Control and Prevention (CDC), more than 50 percent of international travelers become ill during their trips to developing countries; some of these illnesses are preventable. Many people are unaware of their vaccine status or new vaccines that have recently been developed. Lacking cognizance of either factor can put individuals at risk when they set out for their international travel.
Travel Risks and Immunizations
A person who is vulnerable to a vaccine-preventable disease runs the risk of transmitting it to another vulnerable person when entering a new area. It’s imperative that travelers research which vaccines are recommended or mandatory prior to traveling. In 2018, it is expected that pockets of diseases such as measles, mumps, pertussis, and diphtheria will emerge in areas where these diseases had seen previous control.
The recommended immunizations for all global travelers are as follows:
Depending on your destination, health authorities may recommend other vaccines, in addition to the above list. Keep in mind that some recommended vaccines require multiple doses administered over time; pre-travel planning is imperative. Scheduling a pre-travel consultation with a medical professional who understands the vaccination rate and current trends in outbreaks can help prevent the inadvertent spread of diseases.
2018 Health Trends to Watch
In the first few months of 2018, health authorities have noted a marked increase in the global number of measles cases. Even areas with traditionally high vaccination rates have seen some communities experience declining immunization in the past several decades due to religious reasons or misinformation about vaccine safety. This trend of declining vaccination rates is alarming, as areas that had seen nearly complete eradication of measles are experiencing outbreaks once again. The cost for direct and indirect illness care, care for sick children, lost productivity, and disease-associated complications can be substantial. Travelers should know their immunization status to prevent becoming victims during an unexpected outbreak of measles or other vaccine-preventable diseases.
Vaccinations are important to protect individual human capital, as well as for broader, continued corporate productivity. Organizations can facilitate getting appropriate immunizations by identifying in advance those who are slated to travel and getting them to the proper healthcare professional to ensure they receive appropriate vaccinations. Finally, check with the CDC and/or state department for information on required vaccines and documentation before traveling abroad.
To stay up to date on health trends and threats around the globe, iJET’s Intel Central Health Intelligence subscription provides up-to-date trends on infectious disease and other concerns, as well as location-based health information and disease fact sheets.
]]>Hurricanes Harvey, Irma and Jose have hit, are hitting, and will soon be hitting the United States, and first and foremost, employers need to make sure their employees, customers, and guests are safe from the storm.
Natural disasters such as hurricanes, earthquakes and tornadoes have posed unique human resource (HR) challenges from wage-hour to FMLA leave and the WARN Act. The best protection is to have a plan in place in advance to ensure your employees are paid and well taken care of during a difficult time.
Although no one can ever be fully prepared for such natural disasters, it is important to be aware of the federal and state laws that address these situations. Our guidance can be used by employers in navigating through the legal and business implications created by events such as Hurricanes Harvey, Irma, and Jose. In addition, the information may be applicable to other crises and disasters, such as fires, flu epidemics and workplace violence.
Frequently Asked Questions
If a work site is closed because of the weather or cannot reopen because of damage and/or loss of utilities, am I required to pay affected employees?
The Fair Labor Standards Act requires employers to pay their non-exempt employees only for hours that the employees have actually worked. Therefore, an employer is not required to pay nonexempt employees if it is unable to provide work to those employees due to a natural disaster.
An exception to this general rule exists when there are employees who receive fixed salaries for fluctuating workweeks. These are nonexempt employees who have agreed to work a specified number of hours for a specified salary. An employer must pay these employees their full weekly salary for any week in which any work was performed.
For exempt employees, an employer will be required to pay the employee’s full salary if the work site is closed or unable to reopen due to inclement weather or other disasters for less than a full workweek. However, an employer may require exempt employees to use available leave for this time.
Is it lawful to dock the salaries of exempt employees who do not return to work when needed after an emergency or disaster?
The U.S. Department of Labor considers an absence caused by transportation difficulties experienced during weather emergencies, if the employer is open for business, as an absence for personal reasons. Under this circumstance, an employer may place an exempt employee on leave without pay (or require the employee to use accrued vacation time) for the full day that he or she fails to report to work.
If an employee is absent for one or more full days for personal reasons, the employee’s salaried status will not be affected if deductions are made from a salary for such absences. However, a deduction from salary for less than a full-day’s absence is not permitted.
We recommend caution, however, in docking salaried employees’ pay and suggest that you first consult with legal counsel. Moreover, many employers instead require employees to “make up” lost time after they return to work, which is permissible for exempt employees. This practice is not allowed for nonexempt employees, who must be paid overtime for all hours worked over 40 in a workweek.
What other wage and hour pitfalls should employers be aware of following a hurricane or other natural disaster?
On-call time: An employee who is required to remain “on call” at the employer’s premises or close by may be working while “on call,” and the employer may be required to pay that employee for his “on call” time. For example, maintenance workers who remain on the premises during a storm to deal with emergency repairs must be compensated — even if they perform no work — if they are not free to leave at any time.
Waiting time: If an employee is required to wait, that time is compensable. For example, if employees are required to be at work to wait for the power to restart, that is considered time worked.
Volunteer time: Employees of private not-for-profit organizations are not volunteers if they perform the same services that they are regularly employed to perform. They must be compensated for those services. Employers should generally be cautious about having employees “volunteer” to assist the employer during an emergency if those duties benefit the company and are regularly performed by employees.
Can employees affected by a hurricane seek protected leave under the Family and Medical Leave Act (FMLA)?
Yes, employees affected by a natural disaster are entitled to leave under the FMLA for a serious health condition caused by the disaster. Additionally, employees affected by a natural disaster who must care for a child, spouse or parent with a serious health condition may also be entitled to leave under the FMLA.
Some examples of storm-related issues might include absences caused by an employee’s need to care for a family member who requires refrigerated medicine or medical equipment not operating because of a power outage.
If a work site or business is damaged and will not reopen, what notice must be provided to affected employees?
The Worker Adjustment and Retraining Notification (WARN) Act, a federal law, imposes notice requirements on employers with 100 or more employees for certain plant closings and/or mass layoffs. However, an exception exists where the closing or layoff is a direct result of a natural disaster.
Nonetheless, the employer is required to give as much notice as is practicable. If an employer gives less than 60 days’ notice, the employer must prove that the conditions for the exception have been met. If such a decision is contemplated, it is advisable to consult with legal counsel about the possible notice requirements to ensure compliance with the WARN Act.
Our HR department has been disrupted, and it may be weeks before things are back to normal. Will the government extend any of the customary deadlines governing employer payment for benefits, pension contributions and other subjects during this recovery effort?
During previous natural disasters, particularly Hurricane Sandy and Katrina, many governmental agencies and entities extended the deadlines for certain reports and paperwork. Therefore, it is expected that with future natural disasters, the government will provide some deadline extensions, but, as with every natural disaster, the government’s response will vary.
Regardless of what extensions may be granted, employers should be fully aware of state laws and implement any policies or plans necessary to minimally interrupt the payment of wages to their employees.
Employees from other states want to donate leave to affected employees. Is this lawful?
Yes. Employers can allow employees to donate leave to a leave bank and then award the donated leave to the affected employees.
Disaster Preparation Checklist
Natural disasters can pose a myriad of HR challenges for employers. While many employers are working around the clock on recovery efforts, other employers find themselves unable to function for extended periods of time because of damage or loss of utilities. The economic effects of a natural disaster will have long-term consequences on businesses in the affected region.
]]>Securing the largest possible recovery for a storm-related loss requires careful expert analysis of your insurance policies. For example, many claims for losses caused by Harvey will present significant challenges for policyholders who have little or no coverage for “flood.” However, just because damage is caused by water does not necessarily mean it falls within a flood exclusion or sublimit. Also, damage that results from wind and rain may not be excluded by subsequent flooding of the same damaged property. Therefore, for large losses policyholders should assemble a team of experts to prepare and negotiate the claim, including risk managers, accountants or loss adjusters, and coverage counsel. Insurance companies understand the importance of such expertise, and are busily at work now assembling teams to devise strategies to minimize their exposure to Harvey claims. Policyholders may find themselves at a distinct disadvantage if they fail to bring the same expertise to bear when pursuing their claims.
Provide the insurance company with all relevant information about your loss without waiting to be asked. Also, do not wait until all of the information about all elements of the loss can be presented in a neat package. Provide information as it becomes available. Further, some attorneys are advising policyholders in Texas to submit property damage claims before September 1, 2017, in order to possibly avoid the impact of a Texas statute that takes effect on that date. The statute will reduce the rate of interest awarded to a policyholder who is successful in an insurance coverage lawsuit. While immediately notifying your insurance company that you have suffered a loss is always advisable, be careful not to make unsubstantiated assertions in the interest of meeting this filing date. In particular, be mindful that asserting a loss amount without justification can cause problems that outweigh the possible benefit of earning additional interest if you prevail someday in a coverage action.
Under the best of circumstances, major insurance claims tend to be resolved only when the policyholder pushes them to resolution.When competing for attention with countless other policyholders after a catastrophe, it is imperative that the policyholder make clear at the outset of the adjustment process that it will cooperate fully and provide information promptly, but that the claim must be settled by a date certain. Pick a realistic date and stick to it, if need be threatening to file formal proofs of loss or to assert claims of bad faith claims handling. Also be sure to explain to your insurance companies – in writing – any financial pressures created by the loss that make prompt payment of your claim important.
Most property insurance policies impose a number of requirements upon the policyholder, including timely notice and deadlines for the filing of proofs of claim and the commencement of coverage lawsuits. The failure to comply with these requirements might result in a forfeiture of coverage. So, be sure to comply with these requirements or obtain the written agreement of the insurance company to adjourn deadlines.
Typically, the insurance company will make a “good faith” partial payment and then pay little or nothing more until a final negotiation over all of the open issues. This allows the insurance company to hold onto funds that should be paid out for undisputed portions of the claim and increases its leverage for later negotiations. Counter this strategy by forcing the insurance company to commit to a position on coverage and to pay the amounts due under its own analysis of the claim. Start by demanding a coverage determination. Typically, insurance companies issue vague reservation of rights letters that quote numerous policy provisions without explaining how those clauses apply to the claim. Such a letter is intended to protect the insurance company from a waiver of defenses, but does not fulfill its obligation to provide a timely coverage determination. Respond to the reservation of rights with a demand for a detailed and specific coverage determination, reminding the insurance company that its failure to do so may constitute bad faith. Also, demand payment of the undisputed amount of each element of the claim. For example, a dispute over the period of restoration for business interruption coverage should not delay payment for property loss. If the insurance company will not agree to make partial payments, submit partial proofs of loss, which will trigger the deadlines for payment under most states’ unfair claims handling statutes.
The resolution of claims, particularly catastrophe claims, can be slow-tracked by a high turnover among insurance adjusters or just a lack of attention by claims personnel. Policyholders should not only be persistent in their demands for attention, they should also create a written record of everything that happens with respect to the handling of the claims, including their responsiveness to requests for information and the insurance companies’ delays and lack of responsiveness. The chronology should be presented to the insurance company in writing on an ongoing basis to deter dilatory conduct and to make a record for a possible bad faith claim later on.
If the claim cannot be resolved through negotiation, you may have a choice of proceeding either to appraisal or litigation. Appraisal is a form of arbitration provided for under many insurance policies that either party can demand to resolve disputes over the amount of the loss. It can be a quick and inexpensive way to quantify disputed amounts of the claim. However, appraisal is not required, and may not be appropriate, when there are coverage issues to be resolved. For example, if the parties disagree over the amount of a business interruption loss because of a dispute over whether market conditions after the hurricane should be considered when calculating damages, the policyholder would be entitled to have that coverage issue decided in court, where the rules of insurance policy interpretation are generally favorable to policyholders, and unfavorable to insurance companies. Appraisers, who typically are in the building trades, generally are not qualified to address such issues. Also, bad faith claims fall outside the scope of an appraisal clause and will have much greater value if placed before a jury. So, the policyholder must carefully consider its options and not necessarily feel compelled to agree to an appraisal simply because the amount of damages is one issue in dispute.
The key to getting insurance claims satisfactorily resolved within a reasonable period of time is for policyholders to take control of the process and to demonstrate a resolve to secure the coverage they paid for. This requires hard work, but will pay handsome dividends.
]]>One of the most searing images of 09/11 is the progressive collapse of the upper floors of both World Trade Center towers and the “pancaking” of the floors on top of each other. Various theories have been proffered by design and construction experts on the exact sequence of events that triggered the collapse. However, all agree that the “inner core” of the building most likely could have withstood collapse if it had been constructed of reinforced concrete, rather than steel. In fact, the US Institute of Standards and Technology (IST), in its final report on the collapse of the Twin Towers, noted that alternate weight bearing and weight distribution technologies as well as the use of more robust fire resistant materials in construction would contribute to enhancing structural integrity in a fire or dynamic impact to a high rise building.
It is clear that 09/11 ushered in a sea change in the thought process, design and architecture of skyscrapers, defined in this article as those structures exceeding 1250 feet (381 meters) in height. One of the most promising developments since that tragedy is the use of Ultra High-Performance Concrete (UHPC). The material is fire resistant due to the inclusion of polypropylene fibers and provides for greater load bearing and shifting capabilities in the event of aircraft impact or significant ground movement due to earthquake. It is up to 1,000 times more durable than standard construction concrete and lasts 2-3 times longer. Its compressive strength is outstanding and due to its low porosity, it is resistant to cracking and water infiltration. Its use in the construction of bridges, both in the US and Europe, has taken hold and various versions of UHPC are being tested for use in high rise construction.
The fire suppression systems in the WTC were in large part rendered inoperable due to the extremely high temperatures caused by burning aviation fuel and other volatile chemicals. In an effort to enhance autonomous on-site fire suppression, the builders of new superstructures are encasing sprinkler mechanisms in concrete and adding high capacity exhaust and ventilation systems. Laminated, heat-resistant glass is being incorporated into window design. The architectural firm which designed the new One World Trade Center, Skidmore, Owings and Merrill, has added chemical and biological agent air filters and increased the width of escape staircases by 50%. In addition, it has added an emergency staircase for the exclusive use of first responders. In an effort to impart clear guidance to building occupants in an evacuation, the New York City Fire Department, for its part, will now take over the building’s PA system upon arrival, thus avoiding possible conflicting guidance given by the building’s security personnel and first responders. It is noted that on 09/11, may occupants of the Twin Towers returned to their office space after beginning evacuation inasmuch as the pre-recorded building security announcement instructed them to do so. This caused an unknown number of people to perish.
A school of thought has emerged that the use of elevators to escape a building fire should not be automatically prohibited. In fact, both in Europe and in China, service elevators specifically designed for the use of first responders in an evacuation are being designed. This would assist firefighters in extinguishing a blaze on the upper floors and would facilitate the arrival of emergency equipment on site. Response time would be shortened and occupants would not have to wait hours in smoke-filled or burning floors for help to arrive. The elevators and their mechanical and electrical components are designed using fire resistant materials and are powered by a dedicated electricity source. Encased in the reinforced concrete core, the elevators can also be used by properly trained personnel to facilitate emergency evacuation.
Obviously, 09/11 was the catalyst for significant enhancements in building construction, but one must not forget the need for security safeguards at ingress and egress as well as the need to train. In the US, the visitor to a high rise is now routinely challenged should the person not possess a card key allowing access to the building and even the elevators. Turnstyle-like barriers are in place recording each and every swipe of an access pass and concrete barriers are visible on the building’s exterior. Fire drills have been made mandatory both by building owners and by city officials and sprinkler systems and alarms have become so advanced that fire departments can receive electronic notification of the exact floor and location of a hazard through a signal sent from the device to the department’s dispatch. Clearly, these are positive developments that will contribute to first responder efficiency and occupant safety. Tragically, many of these cutting edge enhancements were not in place in London and what was available was not maintained or properly used. Additionally, a retrofit of existing buildings is not always possible.
The US firm that supplied the cladding for the Grenfell Tower, Arconic, said it was said discontinuing sales of Reynobond PE for tower blocks due to “issues” identified by the fire, which is feared to have killed at least 79. The government of UK Prime Minister Theresa May said 75 buildings in 26 council areas had now failed fire safety tests – every one tested so far. Tower managers from across the UK are being urged to send in samples of their building’s cladding components for combustibility tests. Ironically, Ms. May’s government, while urging further testing, acknowledges that it did not propery define the degree of “combustibility” that exterior cladding was required to withstand when it promulgated its latest rules, which are widely thought to be insufficient and poorly monitored. There is no excuse, however, for fire alarms systems that were defective or for a building design that allowed for one fire escape staircase only.
The London Grenfell Tower fire shows that in spite of existing, advanced standards for building construction and fire suppression, if the political will and the financial support do not exist, such improvements are little more than paper changes. In London as in New York, the results were tragic. The challenge for modern societies is to ensure that safety, both in design, construction and in emergency procedures, keeps apace with new technology. City managers and councils must ensure that building fire codes are written reflecting the incorporation of the most cutting-edge technologies. Advanced and recurrent training for first responders and building occupants must not be an afterthought and government agencies charged with oversight must be held accountable as well.
]]>1. Compliance with Chapter 22 of the Texas Labor Code: This law protects from discrimination employees who are absent because if an evacuation order. This law has certain exceptions, including emergency services personnel or those required to provide services for the general public during emergency situations. That said, companies who require such employees to work during a storm must provide emergency shelter.
2. Payment for Employees Who Are Absent Due to Weather: The FLSA treats exempt employees differently from non-exempt. Non-exempt employees must only be paid for actual hours worked. Exempt employees, however, must be paid if the work site is closed or unable to open because of weather for less than a full workweek.
3. On-Call/Waiting Time: Weather events often create unique circumstances that don’t fall neatly into existing policies. Employees may be stuck at work waiting for the weather to clear before they go home – is this compensable time? What if employees are on-call to return to the office after the storm has passed. Is this compensable “on-call time?”
4. Protected Leave Under FMLA: Disasters often create family issues, especially where there are elderly or sick family members who must be moved or cared for during such an event. These situations could trigger protection for absences under the FMLA.
5. Payday: No one wants to miss a paycheck. Make sure your company has a contingency plan in place to communicate with employees and maintain personnel functions like payroll and benefits processing even during a disaster.
]]>With the continuing spread of the zika virus, “more than one-third of respondents had moved or canceled meeting that were scheduled to take place in high-impact areas” and many others are taking increased precaution. Additionally, attendee attendance in these sensitive areas has decreased. Helms Briscoe has laid out a “compilation of the most up-to-date information” put together by the U.S Travel Association.
Click here to read the full article.
]]>Except for Tropical Storm Andrea, which formed in the Gulf of Mexico in June and crossed Florida to New England, the United States has been spared a hit. Last year, four tropical systems struck, including Hurricanes Isaac and Sandy (the latter dubbed a “Superstorm” by the governors of New York, New Jersey, and Connecticutt due to differences in deductibles applied), which together caused more than $52 billion in damage and killed at least 179 people.
“The season looks to be a huge bust,” says Phil Klotzbach, lead author of Colorado State University’s annual storm forecast. “That’s one of the fun things about being in the weather business. It definitely keeps you humble.” For the last four years, the CSU weather team has projected one major and multiple minor hurricane strikes on the U.S.
Colorado State pioneered seasonal hurricane outlooks. In April (and reaffirmed in August), CSU predicted an above-average eighteen storms, eight of them hurricanes and three of them major systems. NOAA also missed the boat, predicting a seventy percent chance for thirteen to nineteen storms, six to nine of them hurricanes and three to five of them major.
The predictions were based on warmer sea temperatures, a strong West African monsoon, and the lack of a Pacific El Niño, a phenomenon which can create Atlantic wind shear. However, the shear (winds that blow at different speeds or directions at varying altitudes) was and is present and has been ripping storms apart. In fact, the shear “has been relentless out there” despite the absence of an El Niño, says Matt Rogers, president of Commodity Weather Group in Bethesda, Maryland.
Mid-level relative humidity across the tropical Atlantic, typically about thirty percent, has also been lower than usual in 2013. “It’s been dry out there, and when I say dry, I mean dry,” Klotzbach says. “I’m still not quite sure why it’s been as dry as it has.” If no major hurricane–one with winds of 111 mph or more–forms in the Atlantic this year, “it will be the first time since 1994,” according to Rogers.
This year’s first hurricane, Humberto, was born at 5:00 a.m. EST on September 11, just missing the record for the latest storm formed since satellites began watching the entire Atlantic in 1967 (in 2002, Hurricane Gustav developed at 8:00 a.m. on the same day). Humberto disintegrated in the central Atlantic. Storms Chantal, Dorian, Erin and Gabrielle all dissipated when they ran into the wind shear and dry air. Because of the shear and dry air, several tropical waves never had a prayer to become full-fledged storms.
One of the few areas in the hemisphere that has been somewhat favorable for hurricane development in 2013 is the Bay of Campeche and southwest Gulf of Mexico, with storms Andrea, Barry, Fernand and Hurricane Ingrid, all of which hit Mexico.
The calmer weather has offered a reprieve for U.S. property insurers, as well as rate increases generated from the loss history due to storms of the recent past. Traveler’s Chief Executive Officer Jay Fishman said this month that his company bought back $633 million of its stock since June 30 amid lower natural disaster losses. That’s the highest amount for the insurer in a third quarter since it was formed by the 2004 merger of Travelers Property Casualty Corp. and St. Paul Co. “The third quarter, as everyone knows, has been benign and quiet from a windstorm perspective,” Fishman said September 11 at an investor conference in New York hosted by Barclays.
Dan Kottlowski, a meteorologist at AccuWeather in State College, Pennslyvania, says wind patterns are forming that will prevent any storms from developing nearby or threatening the U.S. As of now, no storm has made landfall on the Texas coast past the middle of October, due to weather fronts sweeping across Texas as fall season sets in.
While we can’t write off hurricane season altogether until early December, lower water temperatures combined with cold fronts sweeping further south this time of year usually signal the end of tropical systems. One very notable exception: Last year, Hurricane Sandy was born on October 22.
So if the weather channel folks seem sad these days, you know why. Hurricanes hitting the U.S. make for ratings bumps. And exciting photo ops.
]]>Travel managers and mobile employees alike must concern themselves with the reality of facing a nuclear incident like Fukushima while traveling and working abroad. While very rare, nuclear plant malfunctions can prove disastrous for the region around them, resulting in dangerous radiation exposure and widespread evacuations. When mobile employees travel to areas in which a nuclear reactor is located, consider the following factors:
1. Weather. The Fukushima plant met its end not by operator error, but rather the simple misfortune of being located on a coast when a tsunami struck. Nuclear plants located in coastal regions where tsunamis and typhoons are more prevalent, such as the shores of Southeast Asia, have an elevated risk of incident. Also watch out for reactors in locales with a recent history of significant seismic activity.
2. Size. There are reactors, and then there are reactors. The Syrian reactor outside Damascus, for example, is a Miniature Neutron Source Reactor (MNSR); designed in Canada during the 1970s, MNSRs operate on just a few hundred fuel rods and typically serve an experimental role instead of being a regional power source. Fukushima, in comparison, operated on several thousand fuel rods. The potential radiation release from multi-unit regional power reactors like Fukushima and Chernobyl is far greater than that of an MNSR.
3. Safety. In 1986, a Soviet nuclear reactor called Chernobyl experienced a catastrophic failure and released lethal amounts of radiation all across the Ukrainian countryside. Thirty-one people died and some 120,000 more were evacuated from the surrounding area. An international investigation later discovered the cause of the meltdown to be a combination of widespread operator error and design deficiencies. Nuclear reactors are arguably the safest power source in modern times, but that safety relies heavily upon the regulations and diligence of the company/state operating the reactor.
4. Security. It hasn’t happened yet, but every nuclear reactor standing today is a dream target for terrorist groups, offering the opportunity to turn a few hundred pounds of conventional explosives into a radioactive regional disaster. If the company or government operating a reactor in a given region is providing substandard security around the facility, this increases the likelihood of a nuclear incident occurring.
Originally published on Wednesday, September 25, 2013
788 views at time of republishing
Although the risk of actually contracting EVD remains extremely low for most travelers and expatriates, serious ancillary risks have created significant travel and business disruptions -particularly in Guinea, Liberia, and Sierra Leone – for which many nations now recommend against nonessential travel. Other concerned African countries have taken additional measures to attempt to prevent importation of the disease by refusing entry to any traveler who has been in countries experiencing EVD outbreak within the previous 21 days.
Specific concerns are two-fold. The first concern is the rapidly increasing number of cases, which appear to be undeterred by extensive attempts at control measures (e.g., intense world health response; quarantine and isolation of confirmed patients, suspected cases, and contacts of those confirmed and suspected cases; treatment of the infected; intense screening activity at borders and points of entry/exit; application of experimental treatments; etc.), coupled with the continued circulation of rumors among local populations that medical practitioners are actually seeking to harm those at risk or infected, causing the sick to hide, flee, or even riot in some cases, thereby spreading the disease – potentially across borders. The second concern is that the operational and travel threat matrix in West Africa has increased exponentially, as those operating in the region may encounter border closures, strict security and health screenings when attempting to cross borders, a lack of goods and services as personnel – especially healthcare professionals – vacate for what they believe are “safer” areas, and the potential for quarantine. Additionally, many global and regional commercial air carriers have begun to suspend travel to the most affected areas. Recent guidelines provided by global health authorities and international partners, as well as nations who have implemented internal EVD protocols, have eased medical evacuations some, but air carrier service for providers, as well as intensive permissions necessary for transporting patients, are still a hindrance in many areas.
SummaryWest Africa EVD Outbreak
As of Sept. 5, international authorities have reported at least 3,970 EVD cases and more than 2,030 EVD deaths in West Africa. These include 823 EVD cases and 522 deaths in Guinea, including 621 confirmed cases; 1,839 EVD cases and 1,051 EVD deaths in Liberia, including 606 confirmed cases; 1,292 EVD cases and 452 EVD deaths in Sierra Leone, including 1,174 confirmed cases; 21 EVD cases and seven deaths in Nigeria, including 16 confirmed cases; and one confirmed case in Dakar, Senegal. As these figures demonstrate, the focus of EVD activity has shifted to Liberia and Sierra Leone since May, and persistent disease activity has finally led to the international exportation of infections to additional countries.
Whereas disease activity during the first wave of the outbreak March-May was centered in rural areas of southeast Guinea and northwest Liberia – with a significant focus in the city of Conakry with epidemiological links to southeast Guinea – disease activity has now shifted to include significant urban centers such as Freetown, Sierra Leone and Monrovia, Liberia, where quarantine facilities and treatment centers have been erected to render management options to a growing number of cases. Additionally, the Nigerian foci in Lagos and Port Harcourt – both populous centers of business – via the travel of infected individuals highlight the enormous challenges to the tracing of all contacts of potentially infected individuals and the prolonged isolation of potentially exposed individuals to prevent further spread of disease. In some locations, armed military escorts have been called upon to accompany the transport of high-risk patients to quarantine centers and to ensure the safety of healthcare personnel at these locations.
Media have reported significant numbers of healthcare workers abandoning their posts due to EVD concerns. For example, nurses at JFK Hospital in Monrovia called a strike Sept. 3 over lack of appropriate personal protective equipment (PPE). Although the Nigerian Ministry of Health was able to end the long-standing physician strike in Nigeria in an effort to address staffing needs in the wake of hundreds of isolated patient contacts and other clinical requirements, Guinea, Liberia, and Sierra Leone have not been as fortunate. The infection of several prominent physicians volunteering with aid organizations in the course of this crisis – as well as multiple local national doctors, nurses, and ancillary staff – has led to several violent incidents targeting local government offices and hospitals treating EVD patients. Increased security has been provided to facilities and towns to discourage protests and mass gatherings, which can also facilitate disease spread, and governmental and non-governmental officials have promised increased protection through more personal protective equipment (PPE) and cleansing materials. However, after a UN staff member contracted EVD and necessitated medical evacuation to Germany, the WHO removed more than 60 staff members from Sierra Leone, which has hampered efforts there to accurately diagnose and adequately treat the disease. Many aid organizations are calling for global assistance from any provider with expertise in infectious disease processes and handling special virus samples, as fatigued crews and staff shortages not only underserve the afflicted but create room for error while working and may be partially a cause of the heightened rate of healthcare worker infections, despite careful protocols.
The shortages are not only affecting healthcare workers. Shortages of food and clean water are increasing dangerously due to a number of secondary economic effects: businesses closing due to the outbreak or the repatriation of expatriate workers, farmers being unable to tend to their crops, and cargo vessels refusing to dock at ports where the virus may be present. Disease control efforts at international borders further restrict the delivery of food and other products. Economic recovery in Guinea, Liberia, and Sierra Leone may be slow, even when EVD is finally controlled – which experts have projected to take at least six to nine months.
These infections have also prompted several foreign missions, including the US Peace Corps, to suspend operations in Guinea, Liberia, and Sierra Leone and to repatriate personnel operating in the region. Other organizations, such as mining, extraction, and financial organizations, have reduced staff to essential personnel or have vacated entirely. Nigeria may be able to cope better due to its more fully established infrastructure and more coordinated response efforts, but international authorities have expressed concern that the cluster of EVD cases in Port Harcourt could surge following that index patient’s many contacts with coworkers, friends, and family members. So far, few nations have recommended against travel to Nigeria. However, media have reported that some hospitals in Lagos are rejecting patients with non-EVD-related complaints due to fears that healthcare personnel may be unknowingly exposed to EVD.
Analysis
In both scope and scale, this outbreak has become the largest recorded EVD outbreak in history. Previous EVD outbreaks largely occurred in extremely remote areas that prevented the geographic spread of disease activity. However, this outbreak has affected nearly the entirety of three neighboring countries, including significant areas of urban and peri-urban transmission. Prior to this outbreak, the largest known Ebola epidemic occurred in Uganda in 2000, when officials reported 425 confirmed, probable, or suspected cases. In this epidemic, though, officials have identified nearly 4,000 suspected, probable, and confirmed EVD cases, and some experts anticipate up to 20,000 cases before the end of the outbreak.
One of the primary explanations for the severity of EVD activity in Guinea, Liberia, and Sierra Leone relates to widespread community resistance to disease control measures. This outbreak is the first known incidence of EVD activity in West Africa, and – unlike populations living in countries such as Uganda or the DRC – communities in Guinea, Sierra Leone, and Liberia were largely unfamiliar with the measures necessary to control this disease. Even after more than six months of disease activity and response efforts, local populations remain suspicious of authorities. In at least one instance, a community rioted when officials sprayed disinfectant, because local residents believed that they were being sprayed with the disease and intentionally infected. Although many teams are making headway with cultural relations and communications, it is generally accepted that more connection is needed for wider messaging. Recently, the government of Uganda and the African Union had both pledged assistance in durable goods, personnel, and financing to aid in control measures. As Uganda has vast experience in EVD outbreaks, this may assist quite a bit in cultural sensitivity and processing.
Many communities are also deeply distrusting of international medical teams. In some cases, local communities blame these teams for bringing the disease into their country; at other times, communities merely believe that infected individuals will receive better care at home. In either case, media have reported many instances in which community members have forcibly removed confirmed or probable EVD patients from isolation, or patients have eloped quarantine to return home. For example, the EVD cluster in Lagos, Nigeria was caused by an EVD-infected traveler, who may have been seeking more advanced medical care outside Liberia, according to his wife. Furthermore, the EVD cluster in Port Harcourt, Nigeria was caused by a companion of that traveler, who fled quarantine in Lagos to seek care elsewhere.
Unrelated to the cases in West Africa, the Democratic Republic of the Congo (DRC) notified the WHO of a confirmed case of EVD on Aug. 26. In the midst of a hemorrhagic gastroenteritis outbreak not caused by EVD in or near the Equateur Province, the Ministry of Health was able to delineate that a separate strain of EVD had, in fact, occurred in a woman from Ikanamongo Village near Boende and spread to family members and healthcare workers who were caring for her. In total, 58 suspected and confirmed cases and 31 deaths from EVD have been reported as of Sept. 4. Experts from the DRC and WHO have isolated the area, and other expert aid partners have been called to manage the outbreak, which so far appears confined to that specific area.
With disease projections continuing to increase in Guinea, Liberia, and Sierra Leone, the risk profile for most travelers and expatriates remains unchanged: individuals should strongly consider deferring nonessential travel to these areas. The risk of EVD is highest for healthcare workers, family members caring for ill patients, those attending traditional funerals or burials, and the consumption or proximity to processing primate or bat bushmeat, which has since been ruled illegal in the affected areas. However, even individuals not involved in such activities – for whom EVD risk is low – are at risk of increasingly severe healthcare shortages and increasing potential for civil unrest in disease-affected areas. Furthermore, individuals requiring medical evacuation, even for non-EVD-related issues, face extreme challenges when leaving outbreak zones.
Disease response efforts continue in Lagos and River State, Nigeria. Impacts to travelers or expatriates in these areas should be nominal, and the risk of spread outside of these areas is generally low to moderate given the current climate. The one case identified in Dakar, Senegal, with multiple contacts under surveillance, should not pose any significant risk to travelers or expatriates. However, the general reaction of other countries to nations having had EVD has so far been significant. The WHO has still not instituted any travel or trade restrictions on any of the affected countries, but many countries have implemented enhanced health screenings at borders or international airports and restricted flights or border crossings from affected countries. Individuals and organizations should review risk tolerance levels in anticipation of sudden changes in security and travel impact. Furthermore, individuals in or near EVD-affected areas should practice diligent personal health precautions, keeping in mind the following EVD-specific information:
| Although EVD is considered “highly contagious,” it is not highly transmissible. The risk of transmission among people not involved in healthcare or funeral settings is small.Local hospitals in the three most affected areas are at overcapacity, and personnel operating in the area and requiring nonemergency care may consider soliciting provider care at a hotel in lieu of a clinic. Many times, intravenous fluids, respiratory therapy, and other types of care can be administered by healthcare professionals in quality hotels. However, durable medical equipment, fluids, and medications are in short supply. Healthcare workers currently operating in the area are most at risk, since EVD is passed through blood, organs, tissues, bodily fluids, and close personal contact with infected individuals. Occupations with personnel at risk of trauma need to consider their proximity to appropriate care facilities and the possibility of exposure to EVD or other diseases while being treated. Managers charged with site safety and health should be able to recognize the signs of EVD and other hemorrhagic fevers: headache behind the eyes, flu-like symptoms, high fevers, diarrhea, and petechiae – a red or purple “rash” that may appear under areas with pressure. Bleeding, which may only be a late symptom in EVD and also appears in a number of other infections, cannot be relied upon for identification. Frequent and thorough hand-washing with soap and water may reduce the incidence of disease. If soap and water is unavailable, use of a hand sanitizer with at least 60-percent alcohol is an adequate substitution.Do not consume “bushmeat” or the meat from any primate, rodent, dog, or bat in the affected areas. Social distancing and avoidance of crowded venues may reduce risk of disease transmission, and in some areas, it is now mandated. Be aware of increasing travel disruptions related to this outbreak Plan ahead for increased processing times at borders and international airports as countries implement health screenings of travelers from affected areas. Consider deferring nonessential travel to Guinea, Liberia, and Sierra Leone due to infrastructure difficulties and significant travel and medical evacuation restrictions. Be very aware of recent updates in travel restrictions and take these into your risk threshold matrix. Consider the potential supply chain difficulty as borders become restricted, inspections become more thorough, and transit times become more cumbersome. Some goods and services may take longer than others to arrive. Check with your insurance provider and assistance/response company prior to your departure to understand your level(s) of service, their policies and protocols, and their threshold for rapid decision making. Maintain contact with these partners during your trip and keep abreast of the current information for your decision making. |
Bear in mind that some restrictions may not apply only to Guinea, Liberia, and Sierra Leone. Some West African nations may be seen as “at risk” and treated with similar precautions of screening by other nations upon arrival. Certain facilities and laboratories throughout the world have been designated by their respective countries to receive and isolate any “suspected” EVD cases upon screening at points of entry. Special guidance and precautions have been sent out through many health ministries regarding the signs and symptoms of the disease, as well as the potential areas of exposures. There are a various other diseases that may mimic the initial phases of EVD. Fever, headache, nausea, vomiting, aches, and fatigue are seen in a plethora of West African ailments, including malaria, dengue, influenza, and others. Taking appropriate precautions against these diseases will lessen your chance of being identified and potentially quarantined by health personnel when entering or exiting a country.
There currently remain no definitive preventive vaccines or treatment options for EVD. Although recent research and efforts into several unique pharmaceuticals have shown promise in nonhuman primates and have been used experimentally during this crisis, it remains to be seen whether or not these are effective or safe treatments or preventive measures. Data from the field during an epidemic – which lacks supporting data or controls – is extremely difficult to assess. Numerous variables may account for the apparent success or failure of such an agent in any given individual. For example, the administration and subsequent recovery of two American patients from EVD after receiving one such medication may be due to the effectiveness of the medicine, may be coincidental, or may also be dependent on other factors. Likewise, the death of a Spanish missionary after receiving the same experimental treatment may or may not be indicative of that drug’s efficacy. Conclusions as to the effectiveness of these drugs are extremely premature at this juncture.
Originally published on Wednesday, October 29, 2014
1405 views at time of republishing
With the summer Atlantic hurricane season upon us, now is a good time to review storm emergency preparation procedures and to assemble the necessary supplies to sustain you and your family should your area be hit by devastating winds, rains and flooding. For those who do not live in the likely path of a hurricane, many of the below measures are also useful in other emergency situations, such as in the immediate aftermath of a tornado, earthquake or tsunami.
First off, pay attention to local and national weather forecasts and follow the advice of local officials. Do not leave your safety to chance, as you risk death or serious personal injury if you fail to take the precautions issued by public safety personnel. This is especially true if you delay evacuation when told to do so. First responders also need to watch for their own personal safety and are instructed not to enter certain zones or to respond to hard hit areas until their own safety can be reasonably assured. This means that if you fail to evacuate, you may be without assistance once the storm bears down hard.
In the 72 hours before the arrival of a hurricane or tropical storm, assemble those items essential for survival and those necessary to provide nutrition and a source of light for you and your family if you remain in your home. You can also accumulate these items and store them year round, preferably on an upper floor or in a high cabinet or shelf. Specifically, ensure to have adequate, non-perishable food supplies, such as canned goods, sealed or vacuum packed items, such as dried fruits, granola or protein bars and fresh fruit that requires no refrigeration for extended periods, like apples or oranges. Paper plates and napkins, disposable plastic silverware as well as a manual can opener will be necessary. Personal hygiene supplies, including moist towelettes, should be stocked. A gallon of water (approximately four litres) per day, per person will be essential.
If you have domestic animals or livestock, prepare an adequate food supply for them as well.
Flashlights and batteries will be required, as electrical power will likely be cut. Ensure to have a basic tool kit in order to shut off the gas supply to your residence-this needs to be done before the storm hits and creates a gas leak. Make a checklist of all medications needed by you and your family members and refill prescriptions in the days preceding the storm, if possible. A well-stocked first aid kit should be purchased or you can assemble the items separately. Have a local map handy in case you are required to relocate using alternate routes. Solar powered lanterns and cell phone chargers will come in handy. It’s also a good idea to have a few pairs of heavy-duty work gloves in your emergency kit. Make sure your vehicle has a full tank of gas. Do not transport containers of gasoline in your trunk or passenger compartment of a vehicle as the volatile liquid can explode even in a minor crash. Fuel tanks are insulated to reduce the risk of explosion.
Remember to communicate your evacuation plans in advance to a family member or friend who resides outside of the area affected by the storm. This simple measure will allow someone who is not affected by the disaster to alert authorities of your possible location should they be unable to locate you. You should also designate an assembly meeting point for you and your family in case you become separated during the storm.
For those travelling or contemplating travel, remember that your safety is not worth the risk. If you can possibly defer travel, do so. Most airlines and other travel service providers will refund your money or rebook you at no cost if a severe weather event is predicted in the area where you will be travelling. They do not want the liability that could be incurred by transporting you to an area under severe threat and they do not want to risk the loss or damage to their aircraft or ship. Hotels have all-contingency emergency evacuation and shelter-in-place plans at the ready, as do cruise ships. Follow the instructions of the trained staff. Although your hotel may provide some degree of protection from the elements, it becomes quite uncomfortable after a few days without heat or AC, not to mention the diet of ready to eat meals and the lack of reliable toilets or showers.
In tornado zones specifically, be sure to identify a below ground shelter area in the vicinity of your home if your home does not have a basement or cellar. Your local Red Cross, state police or other first responders will have a list of safe locations identified and prepared for use. If you are uncertain of where to go, contact local authorities before the storm for guidance.
Evacuation in severe weather is a difficult, dangerous and often traumatic experience. This can be made a little easier if you take the time to prepare in advance of a potentially life-threatening situation. You will not likely have the presence of mind to remember all the essential items to sustain you and your family if you postpone getting ready until severe weather is imminent.
Listen to emergency personnel. Take measures in advance. Protect yourself and your family.
Helpful resources:
www.ready.gov
www.myflorida.com
www.txdps.state.tx.us
www.gohsep.la.gov
www.noaa.gov