Estimates and assumptions, when repeated often enough, often take on a life of their own, and soon are accepted as nearly `fact'. One we hear constantly is that during a pandemic, nearly every industry would have to deal with up to a 40% absenteeism rate.
Of course, this sounds pretty bad. Operating any entity with but 60% of normal staffing would be difficult. Hospitals, likely over run with flu patients, would be particularly hard pressed. As it is, they run at nearly maximum efficiency now, and nursing and staff shortages are commonplace.
The `assumption is', that up to 40% of all employees would either be out sick, or home taking care of a loved one who was sick. Certainly not for the entire pandemic, but at its peak, up to 40% could be absent.
But, is it realistic? Would the remaining 60% of healthy employees come into work?
Well, not according the latest study to appear in the may 2007 edition of the journal Academic Emergency Medicine.
First the study, then some discussion.
St. John Hospital and Medical Center
A recent public health survey found half not likely to report to duty during an influenza pandemic. The CDC pandemic preparedness plans address ill workers, but there is no discussion of a potentially decreased workforce (from fears of contracting illness). Assessing the likelihood that hospital personnel would report to work, and issues that may affect this decision are important in the preparedness for any pandemic.
To determine the willingness of hospital personnel to report to work in the hypothetical event of avian influenza pandemic (the avian influenza virus became person to person transmissible).
A voluntary, confidential, IRB approved survey was administered to 178 hospital personnel regarding their willingness to report to work, and what issues would be important in this decision, should an avian influenza pandemic occur.
Of 178 surveys, 169 completed (95% response rate), with 34% doctors (Docs), 33% nurses, 33% clerical and other (OTHER) (average age = 38 years, Male 32%). When asked: In the event of an avian influenza pandemic, and patients were being treated at this hospital, would you report for work as usual: 50% yes, 42% maybe, and 8% no. Docs were more likely than Nurses or OTHER to respond Yes: Docs 73% (42/57), Nurses 44% (24/55), OTHER 33% (19/57); No: Docs 2% (1/57), Nurses 15% (8/55), OTHER 7% (4/57), p < 0.001. Males were more likely to respond Yes: 66% (34/51), Female 42% (45/108) p < 0.01. For the Maybe responders, the factor making the biggest difference (83%) was: How confident I am that the hospital can protect me. In 18% (30/169), financial incentives would not make a difference for them to report to work, even up to triple pay.
Personnel absenteeism during a pandemic due to fear of contracting an illness may result in significant personnel shortage and this issue should be addressed in pandemic disaster plans. Ensuring worker confidence in adequate personal protection may be more important than financial incentives.
This study is consistent with others over the past year showing that half or less of hospital employees would report to work during a pandemic. Last march I highlighted a JEMS study here, that stated:
The researchers discovered that initially almost 80% of the survey takers would respond to work. However, when it was determined that the agent was transmissible with no proven treatment, the response dropped to 18%.
While the JEMS study paints a far starker picture, for the sake of argument, lets be generous, and go with the higher figures in today's study.
First, though, we have to remove from the table the 40% presumably sickened or caring for a loved one.
Of the remaining 60%, roughly half stated they would work. Another 42% fell into the `maybe' category, and only 8% said `no'. Those in the `maybe' category would need assurances for their safety.
Presumably, as long as the PPE's (Personal Protective Gear) held out, and antivirals were available, and hospitals were able to maintain operational security, then many of these `maybes' would still be willing to work.
Few hospitals will have adequate PPE's for more than a few weeks into a pandemic and the supply of antivirals will run low at roughly the same time. Hospital security is an open question. Overrun with patients, and desperate and distraught family members, maintaining order will be problematic.
While early on, this study suggests that staffing might be maintained at a 50% level, that is likely to degrade over time. If hospitals become chaotic, and protections are not afforded to employees, the numbers drop to 30% or less.
With a doubling or tripling of patient load, and a reduction of staffing by at least 50%, one can't help but wonder how long before most hospitals simply collapse under the strain.
And it must be remembered that hospitals are not run by doctors and nurses alone. Nearly half of all hospital employees fall into the `other' category; Technicians, lab workers, nurse's aids, housekeeping, security, food service, clerical, etc. They are just as essential in keeping the doors open, and the hospital operating, as the primary medical staff.
Patients have to eat, laundry must be done, rooms must be cleaned and sanitized, lab samples analyzed, and a hundred other essential services are needed to backup the doctors and nurses. These workers, even those without direct patient contact, are going to fear exposure to the virus, and will expect protective measures.
Today, few hospitals are stockpiling consumables such as masks, gowns, and gloves in sufficient quantity to handle a pandemic. Once a pandemic begins, restocking and resupply issues will likely prevent the timely acquisition of additional supplies.
Already, N95 masks are in short supply, and that problem will only grow worse once it is apparent a pandemic is imminent.
Hospital employees deserve the highest level of protection we can afford them, as they will be asked to do a nearly impossible job, under terrible conditions, should a pandemic erupt.
If we are to have any hope of keeping the doors of our health care facilities open during a pandemic, hospitals need to begin to aggressively stockpile the supplies they will need, organize their security to handle the influx of patients and their families, and set aside anti-virals for their staff.
But to do anything less is to invite a total collapse of the health care system.