Swine flu strategies


petri dishThe H1N1 swine flu is everywhere. People are contracting it, and some are dying. There is nothing the travel industry can do to stop that, but there are things it can do to keep the pandemic from having a damaging effect on business.

First, it can take steps to ensure that the risk of catching swine flu while on a vacation or business trip is no greater than the risk of catching it at the mall or the supermarket.

Second, it can take that message to the traveling public and to local, state and national governments.

But the real challenge for the travel industry is that it can't succeed at one task and fail at the other.

It has to do both.

A nervous Caribbean

Although the term "pandemic" means, literally, that the bug is everywhere, its potential for economic dislocation is not evenly distributed. Some regions are more fragile than others, and one area of particular concern is the Caribbean, whose peak season coincides with the flu season and where memories of Mexico's earlier struggles are both fresh and troubling.

Throughout all of the Americas, according to the Pan American Health Organization, there have been more than 146,000 cases of H1N1 in 35 countries as of Oct. 2. Of those, some 10,000 have been identified in 20 of the 22 English-speaking Caribbean countries that make up the Trinidad-based Caribbean Epidemiology Centre, also known as Carec. The cases resulted in nine deaths in six of those countries.

The Pan American Health Organization described the Caribbean region's situation as one of "low or moderate intensity and an increasing trend."

A spokesman for the Caribbean Tourism Organization, which represents 33 countries in the region, said, "There is no panic here. We have been and are proactive. The H1N1 virus is more of a medical issue than a tourism issue, but CTO has been in contact with Carec, the Pan American Health Organization, the World Health Organization and the U.S. Centers for Disease Control [and Prevention] as we gather and update information from member countries and post it on our website."

It is the national ministries of health and the chief medical officers on each island who are running this show, with the goal of preventing the H1N1 virus from ruining travel plans for visitors and for keeping locals virus-free. Most islands have adopted a step-by-step pandemic preparation and response plan to deal with prevention, detection and containment, using guidelines dictated by the Pan American Health Organization, WHO and CDC.

The WHO has stockpiled supplies of the antivirals Tamiflu and Zanamivir for the Caribbean region, to be released as needed.

Jamaica's Ministry of Health activated its response plan on April 27, launched a public awareness campaign two days later and stepped up the level of communication when the first two cases were confirmed on May 29.

Since then, a toll-free hot line has been set up, information workshops have been held for government agencies and disaster simulation exercises have been conducted as part of the response plan.

Aruba's Department of Health opened a diagnostic center in May to address and treat all suspected H1N1 cases. Since July, flu vaccines have been made available to Aruba residents.

Each resort on Aruba has a plan that incorporates hygiene protocols, preventive measures and service teams to meet the needs of guests who show signs of swine flu. Guests who develop symptoms must be evaluated by doctors at the diagnostic center to determine medical treatment.

Aruba, like most islands in the Caribbean, is also requiring airlines and cruise lines to report any suspected cases to local health officials upon arrival; incoming visitors receive a card with diagnostic center information. Antigua and Barbuda also distribute health alert cards at ports of entry, and Anguilla's port officers are being trained to handle travelers who have flulike symptoms.

Resorts adopt policies

Resorts throughout the region are being proactive, as well. Many are instituting measures beyond the recommended guidelines, including training and flu shots for staff, extra attention to sanitation and a policy to quarantine guests if they are diagnosed with flu. Many have also adopted flexible cancellation and refund policies.

The 2,300-room Atlantis on Paradise Island in the Bahamas has nurses' stations throughout the property; any guest with flulike symptoms is directed to a station for assessment.

Sandals will accept guests if they are deemed without risk by medical teams at the airports, said David Roper, director of industry relations for Sandals Resorts. If the incoming passengers have flulike symptoms, "they may be quarantined at the airport and transported to the public hospital for medical checks."

Riu Hotels & Resorts' virus outbreak protocol, developed prior to the H1N1 outbreaks, has been in use at the company's Mexican properties since March and is now in effect at Riu's 100 properties in 16 countries. Its hygiene measures include continual cleaning of anything that is within guests' reach, such as door handles, elevator buttons and tables. Guests who fall ill are quarantined at the resort or sent to the hospital. Guestrooms are "thoroughly disinfected" after checkout.

Hotels' lessons from SARS

Most major hotel companies globally adopted swine flu preparedness and education plans for their properties following last spring's H1N1 outbreak in Mexico.

Many of those plans built upon responses implemented after the 2003 SARS scare in Asia.

Marriott International said it has had in place a companywide pandemic preparedness task force for several years.

"As the H1N1 flu outbreak continues to evolve, we are monitoring travel and health advisories from government and health agencies around the world and are updating our policies and procedures based on those advisories," said Catherine Leitner, a company spokeswoman.

"The task force meets regularly and continually reviews and updates our procedures, including education for associates and maintaining extra supplies such as hand-sanitizing solutions and masks."

Hilton Worldwide said its plans are largely based on guidelines from the American Hotel & Lodging Association, which has published a 26-page guide offering suggestions for handling everything from employee hygiene to property decontamination to dealing with sick guests.

The AHLA also recently sponsored an educational webinar for members. Participants included Nina Fairweather, senior manager of health and safety programs for Starwood Hotels & Resorts in Europe, the Middle East and Africa. Fairweather said that hotels face tough questions when deciding how to handle guests who are infected: Do they suspend services such as housekeeping and room service to those guests? Do they limit the movement of guests in the hotel?

"You may have to limit or suspend services," Fairweather said. "It's an ever-evolving subject." As an example, she pointed to Mexico City's decision to shut restaurants and public places after the outbreak there.

If an outbreak reached a certain point, she said, Starwood would close facilities such as spas and kids' clubs.

In one recent Starwood case, she said, a couple whose baby had the virus was allowed to come and go freely, but the hotel required that the baby be quarantined. The parents had to hire a baby sitter for those times when they left the property.

Different ports, different policies

Cruise lines face some of the same issues as hotels with respect to housekeeping, sanitation and treatment of guests, but they have the additional challenge of ensuring that their ships are not turned away from ports of call due to fears of the H1N1 flu.

Most islands require passengers to fill out health questionnaires at ports of entry. If a symptomatic passenger has been confined to the cabin, most destinations permit the ship to dock and other passengers to disembark -- but not always. In two cases last spring, ships were turned away.

  • In May, P&O Cruises Australia's Pacific Dawn was not permitted to visit any of the ports scheduled on its 10-day Australia sailing due to an outbreak of the flu on the ship's prior cruise.
  • In June, Royal Caribbean International's Adventure of the Seas was turned away from St. Lucia due to fears that the vessel was infected with the virus. Officials in Antigua told the ship not to come, as well.

While both ships had infected passengers onboard, in the end there was no real outbreak.

Royal Caribbean said two crew members and one passenger had experienced flulike symptoms, but they were all isolated, treated and did not infect anyone else onboard.

On the Pacific Dawn, no passengers tested positive for it, and the crew members who were sick after having been infected on the prior cruise were isolated and didn't infect anyone else.

Michael Crye, CLIA's executive vice president for technical and regulatory affairs, is asking the island nations of the Caribbean, where the bulk of cruise capacity spends the flu season, to standardize protocols to which both the industry and ports would adhere in the event a crew member or passenger shows flu symptoms.

Crye, who is working with the CDC and WHO as well as with Caricom, said that one of the industry's priorities is ensuring that vessels are not denied entry into a port.

"That's the educational component, and we do that through communication with port authorities in various locations," Crye said. "We need to reassure [the health authorities] that we are doing the right thing and that the chances of the illness coming ashore from a cruise ship are much less than through other conveyances.

"Your chances of contracting this illness are much greater on the Washington, D.C., Metro or any airplane than on a cruise ship," he said.

Crye said cruise lines have the advantage of having developed passenger health-screening protocols during the SARS outbreak in 2003 and in a constant effort to prevent the spread of norovirus.

Lines say they are stocked with flu-testing kits and antiviral medications. Crye said passengers would not necessarily be denied boarding if they showed signs of the flu, especially on long cruises, because they could be taken care of in onboard isolation.

CLIA member lines have been using enhanced flu-screening procedures since May, and some have developed their own flu-detection systems.

In August, MSC Cruises began employing thermal-imaging cameras to detect whether passengers had higher-than-normal body temperatures, a principal indicator of influenza infection.

And Crystal Cruises said that during onboard parties, ship captains would no longer shake hands with passengers.

Keeping the skies healthy

Airline officials say that, like the hotel and cruise industries, they're ready to handle the impact of the H1N1 virus during the coming flu season. They, too, cite their previous experience with the SARS scare and other health issues as a reason for confidence.

Giovanni Bisignani, IATA director general and CEO, said at a press briefing last month that carriers and airline organizations had developed a ready rapport with the WHO. "We are much more prepared because of the relationship we have with WHO," he said, admitting that during the SARS scare, "We were not prepared."

For now, though, airlines point out that there are no official proscriptions that would keep passengers off planes.

"Neither CDC nor WHO has placed any restrictions on travel," said Air Transport Association President and CEO James May.

"There is also no greater risk when traveling by air than going to school or work," May said. "In fact, the quality of cabin air is better than most schools and public buildings, because airlines use hospital-grade filters."

Airline executives and other industry officials have emphasized the same common-sense strategies put forward by the WHO and the CDC for preventing a flu outbreak: washing hands, sneezing into sleeves and staying home when symptoms appear.

Most airlines say they will consider cases on an individual basis regarding whether to waive ticket-change fees.

IATA and the ATA have also offered suggested procedures for airlines that encounter flulike symptoms in passengers or crew aboard flights.

Emphasizing hygiene on tours

Prevention is also top of mind for tour operators, whose business depends on being able to bring people together comfortably and safely for group travel.

Since the swine flu broke out last spring, tour operators have amped up health and hygiene measures and education on group tours and will continue to do so as the flu season takes full hold.

"Every tour manager buys a whole lot of Purell" alcohol-based hand sanitizer, said John Galvin, CFO of Collette Vacations. "It's available on the coach, it's available before every meal. We make sure that the tour managers are speaking to the passengers about hygiene," which, he said, was not something Collette tour managers did before the outbreak.

Other operators are taking similar measures, primarily providing hand sanitizers on motorcoaches. But what's less obvious is what actions they will take if and when people manifest flulike symptoms while on tour.

"It's something we've had a lot of meetings about," said Tom Armstrong, corporate communications manager at Tauck World Discovery. "What we have told our tour directors is that the first thing they need to do is to get in touch with us. There are so many possible variables that it's really hard to say, 'Here's a policy, and we'll stick with that.'?"

For example, he said that in some cases, if a tour is one day from being over, it might be best for everyone to continue home. If the tour is in a remote area, the situation is entirely different, he said.

Armstrong said there was also the added challenge of the nuance of diagnosis. "It does raise the question, what if one guest has the sniffles?" Armstrong said. "Should something come up, it's not going to be obvious."

In other words, it might not immediately be clear whether the passenger is suffering from a common cold, seasonal flu or H1N1, among other possibilities.

Tour operators generally have teams who deal with crisis management, ranging from medical emergencies to natural disasters to terrorist attacks. Now they are simply monitoring swine flu in addition to everything else.

After the initial H1N1 outbreak, for example, Pawtucket-based Collette signed up with Rhode Island's health department to get updates on the situation and to have certain employees attend seminars about preparedness and response.

But at the end of the day, Galvin said, Collette is a tour operation, not a medical operation, "and if someone's feeling ill, the tour manager will get them medical attention, and then you let the medical professionals dictate what happens from that standpoint."

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