H1N1: Are you Ready?

Daily news stories and consistent announcements regarding proper coughing and sneezing etiquette have heightened awareness of the H1N1 virus. Unlike previous flu seasons, H1N1 appears to be hitting the young and healthy, causing greater unease than in previous years. As the U.S. flu season gets into full gear in the Northern Hemisphere, the Centers for Disease Control (CDC) has acknowledged an increase in influenza cases in the United States, with widespread activity in 46 states.

A simple sneeze can cause internal panic in a bus rider or unleash concern in an otherwise healthy pregnant woman. Public transportation systems are accepting responsibility for keeping rail and bus commuters and workers protected from deadly viruses by increasing cleaning regimens and posting signs to educate riders on ways to avoid and stop the spread of germs.

The United States Department of Homeland Security (DHS) has identified the transportation sector as “one of 13 critical infrastructures that are designated essential in maintaining the nation’s continuity of operations in the event of a flu pandemic.”

Transportation as a Pandemic Vector
“This flu season, scientists expect both 2009 H1N1 flu and seasonal flu to cause more people to get sick than a regular flu season. More hospital stays and deaths may also occur,” says the CDC.

In Transportation and Pandemics, Drs. Jean-Paul Rodrigue, Thomas Luke and Michael Osterholm, see public transportation as a pandemic vector, “particularly for passenger transportation systems.”

Crowded areas and group gatherings can cause equal damage in terms of spreading the virus of a worldwide pandemic, but the infrastructure of public transportation meets much of the criteria when it comes to spreading germs quickly and efficiently.

Public transportation is responsible for millions of passenger trips daily for school children, teachers, healthcare and public safety workers, business professionals and more.

The thought process of an infected rider eager to get home is recognized in transportation and pandemics and showcases how easy an infection can spread caution. “An infected individual beginning to show symptoms is likely to cancel an outbound travel, but will do the utmost, even breaking quarantine (or warnings), to go back home. In some cases, the velocity of global transportation systems is higher than at the regional level, which paradoxically implies that a virus can spread faster at the global level — between major gateways — than at the regional level.” When SARS was at its peak, China was checking the temperatures of passengers at railway stations.

The Canadian Broadcasting Centre (CBC) spent time at the World Health Organization’s (WHO) Centre for Influenza in Melbourne, Australia, in an effort to consider how H1N1 affected the Southern Hemisphere’s flu season. Its director, Dr. Anne Kelso, acknowledged a link between the spreading of the virus and transportation’s role. The city of Melbourne failed to closed schools quickly enough and experienced an explosive outbreak.

“The virus seemed to travel along the public transport lines that kids use to get to school,” said Kelso.

The schoolchildren acted as “super spreaders” and when the schools were finally shut down, the “super spreaders” returned to their communities and the H1N1 diagnoses grew.

“Social distancing” has recently been added to the medical vocabulary as a means to reduce person-to-person transmittance of influenza, H1N1 and other viruses. The CDC estimates that “large-particle droplets” can travel only short distances (3 to 6 feet) via a sneeze or cough. “Social distancing” refers to maintaining a distance of 3 feet or more between people.

Other ways to affect person-to-person contact include asking employees to limit casual interaction; limiting face-to-face contact for deliveries or pick ups; engaging in staggered break times; and avoiding conferences or group gatherings.

Unlike other forms of transport, subways and buses will be affected by psychological and physical aspects of riders, making it crucial to employ a fluid contingency plan should a nationwide pandemic interfere with the way children get to school, adults get to work and transport workers healthy.

Maintaining a healthy workforce is a primary concern, but a sick relative or child can affect the overall workforce and require schedules to be adapted. DHS first encourages employers to ensure that their employees are vaccinated, either through a workplace directive or through an outside medical resource. Second, consistently educating employees on the benefit of hand washing can be one of the best defenses against absenteeism.

A scientific study from the London School of Hygiene and Tropical Medicine last October found that one in four commuters tested had bacteria on their hands. Throughout our daily routine, our hands touch more surfaces than we may be aware of, picking up germs and relocating them from one area to another.

Encouraging employees to routinely wash their hands throughout the day with soap and water or with an alcohol-based hand sanitizer limits the transfer of germs and can maintain a healthy environment.

Other mitigating steps to ensure a healthy workplace include:

  • Internal communications that stress infection control practices such as respiratory hygiene and cough etiquette
  • Dissemination and easy access to alcohol-based hand sanitizers
  • Providing tissues and reminding employees of appropriate disposal
  • Ensure that all employees have access to personal protective equipment (PPE), such as masks, gloves and NIOSH-approved filtering face piece respirators for workers

The DHS offers a checklist online outlining healthy initiatives at www.flu.gov/professional/business/businesschecklist.html

One Surface, Many Victims
Influenza virus and H1N1 droplets deposited from a cough or sneeze onto surfaces can live up to 24 hours, but amounts necessary to infect a person live up to 8 hours after being contaminated. The virus is spread when a person touches the germs and then touches his or her nose, eyes or mouth.

As millions of passengers enter and exit buses, rails and subways daily, transport agencies are stepping up cleaning and sanitizing schedules to protect passengers.

Washington Metro Area Transit Authority (WMATA), which serves more than 1 million riders daily in Maryland, Virginia and D.C., and 10,000 employees, utilizes public announcements to continuously remind passengers about ways to avoid spreading and getting germs, says WMATA spokesperson Cathy Asato.

Its Web site also urges vigilance, “Metro riders are urged to take basic precautions to protect themselves and their fellow riders, including frequent hand washing, covering the mouth and nose with a tissue when coughing or sneezing, or coughing or sneezing into the upper sleeve, not hands when a tissue is not available, and avoiding touching the eyes, nose and mouth.

To keep their hands clean while traveling, riders should carry tissues, waterless hand-sanitizing gels or disinfecting wipes.”

In October, WMATA began increasing its disinfecting regimen on all its Metrorail and Metrobus systems from once every two weeks to once a week. For sanitizing, WMATA uses an environmentally friendly cleanser that is applied by spray on all surfaces and as a fogger on some equipment.

“Touch surfaces such as fare boxes, telephones and fare gates are cleaned daily,” adds Asato.

Washington Metro developed the first disease preparedness plan to address ongoing global infectious challenges. The Metro Pandemic Flu Preparedness Plan includes guidelines and policies established by the CDC and WHO that address challenges with workforce absenteeism, the implementation of sanitizer stations in several workplace locations and an employee hotline and Intranet to establish fluid lines of communication during a heightened pandemic.

According to the CDC, the “Influenza virus is destroyed by several chemical germicides, including chlorine, hydrogen peroxide, detergents (soap), iodophors (iodine-based antiseptics) and alcohols which are effective against human influenza viruses if used in proper concentration for a sufficient length of time.”

The Environmental Protection Agency (EPA) evaluates the efficacy of disinfectants and currently lists more than 500 products registered to kill influenza A viruses on hard, non-porous surfaces, which it believes is effective against the 2009-H1N1 strain.

Areas of note, according to the CDC are:

  • Armrests
  • Seatbacks (the plastic and/or metal part)
  • Tray tables
  • Light and air controls, cabin crew call button
  • Adjacent walls and windows
  • Individual video monitor
  • Lavatory(ies) used by the sick traveler: door handle, locking device, toilet seat, faucet, washbasin, adjacent walls and counter
  • Luggage compartments
  • Tables and chairs in dining, lounge or café cars
  • Door handles and countertops
  • Grab handles, rails, straps and similar fixtures used by passengers in transit

In October, Bombardier, a U.S./Canada-based company introduced its Healthy Transit Program at the American Public Transportation Association’s (APTA) Annual Meeting. The Toronto Transit Commission has purchased the product to protect the interiors of its new subway cars. Ottawa’s OC Transpo will, over the next month, be treating the interiors of its “O-Train” fleet.

The program includes Bombardier’s antimicrobial surface treatment, an environmentally friendly, permanently bonding and non-leaching product that is applied using electrostatic fogging equipment, that ensures the entire interior of the transit vehicle is coated. The process is efficient and eliminates up to 99 percent of micro-organsims.

“We provide certified application of products, training for employees on pre- and post-treatment cleaning protocols and certification plaques for each treated transit vehicle,” says Mike Hardt, vice president of Services for Bombardier Transportation North America.

Once applied, germs that come in contact with the treatment are destroyed. Published data shows that the active ingredient is effetive at inactivating a wide range of viruses from the Influenza Virus A group for up to one year, which includes the H1N1 virus, bird flu, SARs and commom cold and flu viruses.

OC Transpo’s General Manager Alain Mercier says, ”With the seriousness of the current situation relating to the protection of our employees and of our customers who use and work in our transit systems, the benefits of the Bombardier program in relation to providing the highest level of protection is a good fit and is of true value to OC Transpo.”

A Changing Plan
Asato admits that the WMATA plan is fluid and able to adjust to pandemic diversions and changes. As the illness spreads, changes will be made to routes, or schedules to accommodate lower than normal riders. WMATA has also ramped up its supply chain should it require essential equipment such as filters, belts, tires, lubricants and sanitizing equipment.

The DHS plan asks that all public transport agencies consider the challenges of workplace absenteeism, looking to other organizations to fill in for temporary help.

Lastly, it asks that all transport companies meet with local government and emergency response offices on potential triggers and support plans.

DHS and the CDC continue to update information hourly at www.flu.gov. To learn more about transportation planning for a potential pandemic visit - http://flu.gov/professional/transport/index.html.