Guest blog by Lt General Louis Lillywhite, Chatham House and Occupational Medicine Consultant
The COVID -19 outbreak has already disrupted the global economy, and the demand for hospital care is exceeding the capacity of many nations’ health systems. The pace of transmission of the virus and the responses by governments will mean that the detail of any commentary on the outbreak will be out of date by the time of publication. However, trends from the historical response of the international system to global diseases and the emergence of the response to this outbreak may provide insights to the future outcomes for business and occupational health from this crisis.
Infectious disease outbreaks are commonplace and increasing[i] and are usually successfully managed with only local implications. Infectious diseases which spread, or have the potential to spread, outside the borders of the country of origin are less common but potentially have a significant cost with potential impact across society[ii] which are both direct, owing to infection (disease and death), and indirect owing to impact on business (affecting workforce and customers) and wider society. Perhaps the sector affected most in any significant outbreak is that of travel and tourism which in 2019 contributed $2.8 trillion directly to the global economy and indirectly accounted for 10.4% of global GDP ($8.8 trillion), 310 million jobs, $1.6 trillion in exports, and 27.2% of services exports.[iii] The emergence of COVID-19 and its impact should thus not be surprising, and although the full impact has yet to be assessed it will undoubtedly exceed the effect from previous outbreaks.
Mitigation of the Consequences
However, mitigation of the consequences of an outbreak of a global disease is possible with appropriate planning and response. Such planning requires an understanding of the drivers which underpin the global, national and local response to outbreaks as well as the realities of such a response, characterised in many cases by uncertainty, confusion, contradictions exacerbated by real time research findings.
The planning and response of businesses to an outbreak of infectious disease will depend on numerous factors. Clearly, the nature of the infecting agent and the illness it causes is the major driver and businesses may need access to expert opinion to fully assess its implications. Its impact on business will critically depend on the nature of the business (eg manufacturing versus office based); where their workforce is situated (eg in a high income country or in a low and middle income country); the nature of their workforce (eg age profile); the need for travel across international boundaries; and the nature of any customers (eg patients, tourists).
The nature of the business will also impact on the practicality of the potential responses. Those businesses that need to have a comprehensive health service in support of their everyday operations (eg extractive industries in a low- and middle-income country) will differ in their outbreak planning from a business which comprises a dispersed office-based workforce in a developed country with a robust public health system.
In developing their response, employers should be able to build upon existing business continuity and resilience plans to internal and external crises and the severity of the impact of a health crisis for employers will depend on the effectiveness of pre-planning including the analysis of second and third order effects such as the potential for interruption of travel and of objectively inappropriate responses by others.
Adjustment of Plans
Such plans will also need adjusting and amending depending on the specific nature of a disease threat as it emerges, taking into consideration the response of authorities and the response of other businesses (eg. clients, supply chain, insurers). They will also need to take account of employee (and their representatives), customer and wider public concerns and be able to answer questions such as “our competitor business is doing such and such, why are not us”, particularly as peer pressure has been found to modify the behaviour of both states and employers[iv]. Peer pressure can be particularly problematic when businesses are working side by side. For example, if one is using face masks and another is not despite face masks being an ineffective as the public protection measure, the customers may favour the business that is wearing face masks. If the disease is new, such as COVID-19, or changes its character, managing the outbreak will also have to take account of ongoing research which may change recommendations. It may also, as in COVID-19, have to take account of a limited supply of equipment needed to support the plan. Social media has added another dimension, and on the one hand is a powerful tool for spreading supportive messages but on the other is a source of inaccurate and sometimes deliberately misleading messaging. A plan must therefore be a start point rather than an end point. The Chief Executive and Board must expect any response to evolve and set their planning horizon to match the levels of uncertainty within a crisis. To use a military maxim “no plan survives contact with the enemy”. There is the need to have expert medical advice on hand to support the planning process.
Preventive measures and sensible precautions are enough in some cases to protect the workforce and sustain output, whilst in others spread is almost inevitable and the emphasis should be on mitigation. More serious outbreaks will result in international, national and local measures including travel restrictions and a variety of non-health related responses which may impact on the supply chain, on demand for goods etc.
Health Issues for Recovery
Even whilst businesses implement and adjust plans for managing an outbreak it needs to also plan for recovery. As with the plans to manage the crisis, much of this will be outside the health area, such as repairing disrupted supply chains. However, there will be some significant health issues. Many such outbreaks, and COVID-19 is likely to be such a case, will tail off rather than just stop; there will be workers who have recovered but have residual symptoms or functional loss; in some countries there may be an ongoing need to address weakened health systems; and of course there may also be the need to recruit replace those who have died or are too ill to return to work.
This article was produced with the support of International SOS and developed with the input of Lt Gen (Rtd) Professor Martin CM Bricknell, King's College London.
[i] Christiansen J: Global Infections by the Numbers, Scientific American 1 May 2018; https://www.scientificamerican.com/article/global-infections-by-the-numbers/ accessed 1 April 2020
[ii] https://intelligence.weforum.org/topics/a1G0X000006O6EHUA0?tab=publications accessed 13 March 2020
[iii] World Travel and Tourism Council. Travel and Tourism: Economic Impact 2019 World. 2019 https://www.wttc.org/-/media/files/reports/economic-impact-research/regions-2019/world2019.pdf
[iv] Reported at Chatham House Round Table