Ask The Executive: An Interview with Dr. Nancy Welch of the Virginia Depart. of Health

Dr. Nancy Welch is a district health director for the Virginia Department of Health. She has served in that role since 1976, first at the Allegheny Health District and currently at the Chesapeake and Western Tidewater Health Districts. Dr. Welch earned her medical degree from Duke Medical Center, and holds both an MBA and a master’s degree in health administration. She is board certified in both pediatrics and preventive medicine, a professor of clinical pediatrics at Eastern Virginia Medical School and a staff member at Children’s Hospital of the King’s Daughters and Chesapeake Regional Medical Center. Dr. Welch is also a retired colonel in the U.S. Army Reserve and has served in numerous pediatric and preventive medicine clinics, including assignments in Desert Storm, Panama, and the Mojave Desert.

Kirchner: Would you please begin by telling us a bit about the Virginia Department of Health and how governmental health organizations, in general, can be useful to businesses as they engage in developing, maintaining, and executing their business continuity/disaster recovery plans?

Welch: The mission of the Virginia Department of Health is to promote and protect the health of all Virginians. You can think of that mission in terms of 3 Ps: promote health, prevent disease, and protect from environmental hazards. While all states have departments of health, their structure and composition vary by state. Virginia’s Department of Health is composed of 35 districts supporting programs of environmental health, healthy living, diseases and conditions, health equity, drinking water, birth/death/marriage certificates, licensure/certification, and emergency preparedness. Traditionally, departments of health have concentrated on serving the community at large. However, business is an integral focus of public health, so the distinction between public and private is a bit artificial. Any large business has a public health environment in terms of threats like disease and environmental hazards. Incorporating the 3 Ps into the business community helps the Virginia Department of Health integrate into a significant component of the community at large. The same Ps that apply to the larger community also apply to its sub-sectors, including businesses. The importance of businesses to the public health sector was my basis for getting an MBA – I needed to understand the business world and be able to communicate using business language. The Virginia Department of Health, in turn, is a valuable resource for businesses. We want businesses to call us!

Kirchner: The role of the Virginia Department of Health is to keep the community healthy and prepared for health-related emergencies. What kinds of health-related high-impact disasters/situations has the Virginia Department of Health faced, and what has been the potential for them to affect businesses in significant ways?

Welch: Here’s an example of an actual nightmare situation. A health care worker had lived and worked for a long time with an active case of TB, which was not discovered until the person died. We activated our health department emergency operations center (HDOC) and its incident command system (ICS) to identify/track all of the people who had been exposed, using reverse 911 for addresses to reach families and others with whom the health care worker had contact. Almost half of those people were not local residents (we tracked one down in Germany), so this was an extensive effort. We reached over 90 percent of them. With TB, we not only need to test those who are potentially affected, we also need to read the tests and provide medications to those who need them. That requires a massive clinic operation for evaluation and treatment. What is notable about this case is that it is the first time our incident command center had been used for a health event rather than a traditional disaster event. What keeps me awake at night? Slow reporting of communicable diseases is a big issue. Contagious situations in which diagnosis does not occur or notification of public health does not take place result in lack of early intervention to contain them. Although reporting requirements exist for communicable diseases, that communication may not occur immediately. Traditional medicine deals primarily with the individual and only tangentially with implications for the community. Often, doctors are focused on treating the individual patient, and the actual reporting to the Virginia Department of Health comes from families and organization nurses. It’s important to note we also work with private businesses on infectious disease issues.

Kirchner: To what extent do infectious disease outbreaks or other serious situations impact the Virginia Department of Health and affect its ability to keep Virginia healthy? Does the Virginia Department of Health have its own disaster recovery/continuity plans?

Welch: In major disaster situations, we have to prioritize and reallocate resources, for example, modifying clinic schedules and limiting services. Here’s an example: we had a case of a rabid cat and needed to notify people who may have been bitten. We swung into action with 1,000 flyers, and everyone from our nurses to our environmental people distributed them door-to-door. As a result, we were able to identify and work with four people who had been bitten but not reported the incident (in addition to three who previously reported). We do have our own disaster recovery/continuity plans and review them regularly to enhance them. We are currently evaluating the potential of relocating from one health department facility to another in the event of a disaster. Health departments were not originally oriented towards exercises. However, a number of our planners have been retired military people who are proficient in that area. Federal Emergency Management Agency (FEMA) training has provided the tools and skills necessary to effectively develop exercises and improve our plans. We now conduct several exercises each year, ranging from table-top discussions to live, operational exercises. An example is a recent practical exercise conducted with city government to assess efficiency of distribution. The scenario involved plane-spraying of anthrax in a large area and the need to conduct residential delivery of an antidote. Thanks to the exercise, we know we can deliver prophylactic medication quickly to every household.

Kirchner: You encourage businesses to look differently at continuity of operations, focusing more on a day-to-day basis rather than on large-scale, but rare, disasters?

Welch: Businesses fully understand that one of their most valuable assets is human capital; what I want them to better appreciate is the fragility of that capital in an environment that has been termed an “incubator for infectious disease.” Organizations are far more often affected by communicable diseases than by natural disasters or terrorist attacks. I’m not saying we should abandon the conventional approach, but I do believe it is vital we expand to include the smaller-scale, but more frequently occurring, situations. Here are a few examples. Mumps in a Chicago business cost over $56,000 and 700 lost work days. Measles in Boston affected more than 1,000 people who were exposed, necessitating over 250,000 vaccinations. Recent measles outbreaks infected over 160 persons and families, most of whom are involved, directly or indirectly, with a workforce. Normal business operations are interrupted by these kinds of events, and they are costly, both financially and because of their effects on the confidence and loyalty of employees.

Kirchner: What diseases concern you most in terms of their personal and business impacts?

Welch: First and foremost is influenza, or flu. This disease causes upward of 30,000 to 49,000 deaths annually and more than 25,000 hospitalizations per year. Between 10 percent to 15 percent of the population becomes ill, and surveillance of our local emergency room visits indicates that, during the season, 10 percent or more of ER visits are due to the flu. The national economic burden is astronomical – $6.2 billion in lost productivity, $10.5 billion in direct medical costs, and, if you factor in work absences, the total economic burden is estimated at $87.1 billion! Overall, flu has been estimated to cause more than 75 million lost working days in the U.S. each year, contributing to $16.3 billion in lost earnings. An ROI analysis projected a $20,000 loss during a flu season for a 100-employee company. 42 percent of infected people who were surveyed believed they got the disease from a co-worker. These figures should make business leaders stand up and take notice!

Kirchner: These are worrisome numbers. How can businesses avoid the costly impacts of flu?

Welch: Educational, policy and pro-active intervention options are available to employers. Educate employees abut flu symptoms, respiratory etiquette, and good hand-washing. Remind them of the company’s policies on paid time off, FMLA, and alternate work arrangements (make them as liberal as possible). Strongly support a policy that encourages employees to stay home if they are sick, and advise ill employees at work to go home. Consider providing flu vaccinations for employees. Emphasize to your cleaning staff the need to pay extra attention to cleaning the environment, including wiping door handles, phones and other commonly touched surfaces.

Kirchner: What other infectious diseases can cause serious impacts to businesses?

Welch: Equally as important as flu is norovirus. It is the gastrointestinal infection that has been dubbed the “cruise ship virus,” but that is a misnomer that, unfortunately, results in our being lax with appropriate precautions. The reality is that only 1 percent of all reported norovirus outbreaks occur on cruise ships. Approximately 20 million Americans are sickened with norovirus each year, causing up to 800 deaths and $777 million in healthcare costs. Norovirus is better known as the “salad bar virus”, because one in 5 restaurant employees work with norovirus symptoms! It is highly contagious and requires only a miniscule amount to transmit disease – the number of viral particles that fit on the head of a pin would be enough to infect more than 1,000 people!

Kirchner: Norovirus sounds more contagious than flu. What can a business do to prevent its spread?

Welch: In many ways, norovirus is more easily spread than flu because of the small quantity required to transmit disease and its ability to linger on common surfaces. It also tends to spread because employees may have a tendency not to tell anyone if they get sick in the bathroom, and in that case, proper environmental cleaning doesn’t occur. Studies have found a high level of contamination on office surfaces of germs in general, not just norovirus. For example, studies show 75 percent of faucets, 48 percent of microwaves, 21 percent of vending machine buttons and 27 percent of keyboards are contaminated with organisms. Since they are often harmful, the precautions are similar to flu – stay home when sick and wash hands, wash hands, wash hands! A caveat with norovirus is that even more intensive environmental cleaning is necessary. Create an environment that encourages an employee who becomes sick in the bathroom to inform someone, so the bathroom can be closed off until intensive cleaning occurs.

Kirchner: How would you summarize appropriate interventions for businesses?

Welch: That is very easy: Vaccination for flu! Home when sick! Frequent hand-washing! Clean, clean, clean the environment!

Theresa A. Kirchner, Ph.D., MBCP, MBCI (theresa.kirchner@hamptonu.edu) is an associate professor of management with Hampton University. She is president of the Hampton Roads Association of Contingency Planners (HRACP), a member of the Hampton University Emergency Management Advisory Council, and a member of the Disaster Recovery Journal Editorial Advisory Board.