Editor’s note: It’s here; the novel H1N1 influenza is rapidly morphing into its second wave assault. We’re all making our last-minute plans for response and preparedness an immediate reality. One of the most important actions we can take right now to reduce H1N1 transmission in the workplace is to keep infected employees out! One of the real national leaders in elevating the importance of this action is Lisa Koonin, Senior Advisor of the Influenza Coordination Unit at the Centers for Disease Control and Prevention. I feel very fortunate today to have Lisa provide a guest column on this important topic in place of usual Osterholm Briefing. It is a must-read. During the next 8 to 12 months, every organization will be confronting the issue of sick workers. Lisa addresses it with great clarity; it’s a compelling blueprint for action.—Michael T. Osterholm, Editor-in-Chief(CIDRAP Business Source Osterholm Briefing) – As fall and the 2009-2010 flu season begin, outbreaks of the new 2009 H1N1 flu have already started in some states and will likely increase across the United States during the coming months. Based on symptoms alone, it will not be possible to quickly determine if ill workers have pandemic flu, seasonal flu, or other respiratory conditions. What’s more, predicting the severity of outbreaks (ie, number of hospitalizations and deaths) caused by 2009 H1N1 or the severity of illness caused by seasonal flu is also difficult.Given these uncertainties, the Centers for Disease Control and Prevention (CDC) is urging businesses and employers to consider developing a flexible flu response plan now. Having such a plan in place can protect the health of employees while ensuring business continuity as 2009 H1N1 and seasonal viruses circulate. These plans can also help limit the impact of a flu outbreak on the community at large.What you can expect to seeAs we know, one of the best ways to reduce the spread of flu is to keep sick people away from healthy people. The symptoms of 2009 H1N1 flu (like seasonal flu) include fever, cough, sore throat, runny or stuffy nose, body aches, headache, chills, and fatigue. Some people may also have vomiting and diarrhea. Still others may have respiratory symptoms without a fever and be infectious. Therefore, it will not be possible to exclude from the workplace everyone who is ill.Especially during a pandemic, employers should not expect that employees who are ill with flu-like symptoms be able to get a confirmatory lab test. Healthcare providers are likely to use their clinical judgment to diagnose and treat mild cases of respiratory illness and reserve testing for people who have more severe illness.The CDC recommends that all employees with flu-like symptoms stay home, or, if they become ill at work, go home as soon as possible and not come back to work until at least 24 hours after their fever has gone away, without the need for fever-reducing medicine. If local conditions become more severe, sick workers may be asked to stay home longer.The problem with ‘presenteeism’When sick employees show up for work, they’re not only less productive, they can expose co-workers, thus increasing absenteeism and reducing the company’s overall productivity. The term “presenteeism” has been used to describe when employees show up for work sick but can’t fully do their job. This phenomenon can have a significant and costly impact on an organization, not only in terms of the risk of increased spread of disease to other employees, but also in terms of diminished productivity for the ill person.The problem is that many sick employees might not be able to afford to stay away from work. Nearly half (48%) of all private-sector workers in the United States—some 57 million people—do not have paid sick-leave benefits. Only 44% of full-time workers who earn less than $15 an hour have paid sick leave; that percentage plunges to 23% among part-time workers, according to US Department of Labor statistics.Employees and financial worriesThe issue of sick leave was highlighted during the spring outbreak of 2009 H1N1 flu. Public health officials warned workers to stay home from work if they were sick or had flu-like symptoms, but the media reported that many went to work anyway because they simply could not afford to stay home.A June 2009 survey conducted by the Harvard School of Public Health found that 68% of respondents said that they could stay home for about 7 to 10 days* if they had 2009 H1N1 flu and health officials recommended that they stay at home; about 17% said they could stay home for part of that time. However, 44% of respondents said that they or someone in their household would lose pay or income and have money problems if they missed 7 to 10 days of work due to illness, and a quarter said they feared they could lose their jobs or businesses altogether.These concerns were no doubt magnified by the current economic turbulence that has forced many businesses, especially small enterprises, to close or severely downsize. But the fact remains that sick employees dragging themselves to work can have a negative impact on the business and the workplace by causing more workers to get sick.What your organization can doAs the pandemic and seasonal flus converge, the CDC recommends that employers:Adopt flexible leave policies that allow sick workers to stay home and away from the workplace until at least 24 hours after their fever has gone away, without the use of fever-reducing medicationsReview human resource policies now to explore how to create more flexible leaveDiscuss these policies with managers, supervisors, and employees so everyone is up-to-date on sick-leave policy, leave donation, and employee assistance servicesEnsure that leave policies are flexible and do not punish employees for staying home if they are sickNot require a sick employee to have a doctor’s note to prove they are sick or to state when they are ready to return to work; healthcare providers will likely be very busy in the coming months, so they might not have time to provide this documentationLeave policies that are flexible and consistent with public health recommendations can help employers:Reduce the number of workers who become sick due to exposure at the workplaceGive healthy workers more confidence to come to workAllow sick workers the time to stay home and recover from their illness, without penaltyLeave policies should also allow workers to stay home if they need to care for other family members who are sick or have been otherwise affected by flu. Some communities, for example, may have to close child care centers or dismiss students from school to reduce the spread of the virus when there is high absenteeism at a school or if a more severe pandemic develops.Employers can identify workers now who may have to stay home to care for children if schools or child care centers close. To ensure business continuity, consider such options as letting these employees work from home, allowing them to work staggered shifts, or cross-training other workers to carry out their responsibilities. Bottom line for organizationsThe effects of 2009 H1N1 flu and seasonal flu will vary across the country. Businesses and employers should base their flu strategies on information from local and state public health authorities. Regardless of size or function, all businesses should plan now to allow and encourage sick workers to stay home without fear of losing their jobs. The CDC recommends this strategy for all levels of flu severity in the coming months.*At the time that the Harvard School of Public Health poll was conducted, the CDC’s guidance recommended that ill workers stay home for at least 7 days or 24 hours after fever had resolved, whichever was longer. The guidance was updated last month to advise sick workers to stay home and away from the workplace until at least 24 hours after their fever has gone away, without the use of fever-reducing medications.—Lisa M. Koonin MN, MPH, is Senior Advisor of the Influenza Coordination Unit for the US Centers for Disease Control and Prevention. E-mail: LKoonin@CDC.gov (link sends e-mail).