H1N1 Flu Preparation

Retailer Facilitation of Neighbor-helping-neighbor

2009-09-10 (trivial edits 2017-02-20)

Status

This is an early, partial draft that is intended to:

• Jumpstart thinking by stakeholders about what might be done
• Provide structure to the considerations
• Record ideas and constraints that have emerged

Primary contact: Douglas Moran, 650-856-3302, Email

Abstract

The H1N1 flu ("Swine flu") has shown itself to be highly contagious and the rate of inflection within families has been much higher that for seasonal (normal) flu. With the normal flu, there usually are members of a household who are not sick and can take care of those who are. But if whole families are sick (as expected), this creates pressure for sick people to run errands. We don't want infectious people taking trips to stores for supplies: It is bad for the community (spreading disease) and bad for them (exposure to other diseases while in a weakened state). Recognize that the least sick person is often the most infectious. (Backgrounder on the flu is at the end of this memo).

This is an attempt to create an attractive alternative that allows/encourages sick people to stay home. For merchants, it could also help offset the reduction of normal business resulting from widespread illnesses.

Barriers to neighbor-helping-neighbor

• People tend to be more willing to help than ask for help : While neighbor-helping-neighbor could be done on an ad hoc basis, there will be many people who are:
  • hesitant to ask for help (impose)
  • hesitant to offer help unprompted (intrude, presumption,...)
  Need: Semi-official program to create the expectation that people should ask and offer (an excuse to reduce social awkwardness and delay).
• Complexity/Uncertainty: People are much for willing to ask/offer to help if the task is simple (no big deal). An ad hoc approach has high risk variations that may seem minor, but that raise the cost of helping above the threshold. Uncertainty--for example, "Is the store I shop at participating?"--can be the biggest disqualifier of all.
• Delivery service problems: Some retailers have their own delivery services (for example, Safeway) and there are delivery services for market segments (for example, Waiters on Wheels). In normal times, these might be able to handle much of the need. However, during an epidemic, one should expect a significant portion of the delivery people to also be sick, reducing the number of employees available to handle the increased demand for those services.
  Note: There may be resistance from the delivery services and the merchants using them: The delivery people, having frequent contact with infectious people (customers), are prime vectors for spreading the disease back to the merchant's employees.
  Resource: Meals-on-Wheels has considerable experience coordinating volunteers and scheduling deliveries.
• Payment for services: Many people expect to pay for services, even a basic pickup by a neighbor. This can be a variant of Complexity/Uncertainty. Possible solutions: market it as Pay-it-forward.
• Neediest with limited computer literacy: Internet-based solutions naturally enhance the social distancing that is a key element of containing an epidemic. However, there are likely to be many people for whom this is not a viable solution (example: seniors, especially those living alone). Remember that even those with Internet-literacy are likely to be operating under the influence of influenza (and medications): They will have reduced ability to concentrate, reduced sharpness (spotting problems and alternatives), and reduced endurance (to explore alternatives), ...
• Physical payment a vector: Physical payment, especially cash and checks, is a well-known pathway for spreading disease:
  • Paper is relatively hospitable to germs
  • While plastic—credit/debit cards—is easier to sanitize, that doesn't mean that those cards will be
  • Physical proximity during transfer (the opposite of social distancing).

Retailers and Role of Business Groups

The business groups, such as the Chamber of Commerce (CoC) and California Avenue Area Development Association (CAADA), to be organizers, facilitators and distributors for the merchant community.

1. Develop protocols for surrogates (neighbors,...) to pick-up orders
   • Survey: What is possible? What is desirable? (relative to the merchants)
   • Simple enough for wide range of merchants to implement (if they don't already have such a scheme).
   • Simple enough for customers to actually use
   • Consistency: Few enough (across the merchant community) to minimize confusion among customers.
2. Collect, maintain and distribute information from merchants
3. Publicize (in cooperation with other stakeholders)
4. Collect and distribute suggestions to simplify surrogates' tasks for pickups

Issues:

• Common/consistent vocabulary for the following (simplicity, reduce ambiguity/confusion)
• Payment schemes:
  • Example: taking orders over the phone with credit card payment that will not be presented/available for confirmation at pickup (by a surrogate).
  • Example: Paypal as intermediary?
• Surrogates: Authorizing by customer and Authentication/Verification by merchant: What information is necessary and sufficient. Needs to be explicit so that the customer has it when they place an order and the surrogate is carrying it when they do the pickup.
• Limitations on surrogate pickups:
  • Example: Are there legal restrictions on who can pick up prescriptions?
  • Where would there be greater demand for "blessed" delivery services?
• Encourage merchants to consider and collaborate on delivery options:
  • Remember that drivers are also subject to the epidemic
  • Protocols to reduce drivers becoming vectors
• Verification of deliveries
  • Issue for both commercial services and volunteer groups (people other than friends and neighbors)
  • Goal: Minimize contact between delivery person and sick people. The normal process of recipient signing for delivery needs an alternative.
  • Goal: Minimize chance of mis-delivery (for example, delivery to a similar address)
  • Example: An identifier is assigned to an order and that identifier is given to the delivery person and to the customer. The customer puts a copy on the doorstep to be picked up by the delivery person when the order is left. The IDs should be sparse, that is, have multiple differences from other IDs in use (additional details deferred). This particular scheme provides only moderate verification, but that may be good-enough for our circumstances.
• One (common) central set of web pages (simplify publicizing, maintenance,...)
  • Consistent content and look-and-feel.
  • To be linked to by a wide range of stakeholders, that is, it would be acceptable to those stakeholders as web pages that they would have on their sites.
  • Acceptable conventions for the merchants and other organizations being listed.
• Determine which categories of merchants are most relevent
  • Grocery and drug stores are obvious
  • People working from home while sick but not incapacitated (what supplies??)
  • Entertainment for children (if they don't have enough already)
  • Entertainment for (sick) family (when NetFlix is not fast enough)
  • ???
• Suggestions to merchants on how to simplify pickup:
  • How-to's and examples to jumpstart them thinking about what their particular store might do
  • Grab-and-go packs of likely combinations of basic supplies (also reduces number of things that a possibly infectious person touches in the store)
  • Signage: on items that surrogates are most likely to be looking for. These surrogates may not be current customers of that store, and the merchant could see this as an opportunity to make a good impression.
  • "Concierge service": Designated, and highly identifiable, clerk to assist with surrogate pickups.
• Suggestions to retailers who might want/need to be prepared to modify their business for the effects of the epidemic
  • Example: Restaurants that don't normally offer take-out or that don't advertise that it is available. During an epidemic, people will be dining out less: Those that aren't sick may well be avoiding places where there are higher risks of getting infected. Adding take-out options (new/modified items or select items from the sit-down menu) could help offset that loss of business.
    Remember: The period where taste doesn't matter is only a small portion of the time you are sick and recovering from the flu.
• Where do the business organizations have coverage gaps, and who might help?
  • Example: south El Camino business district is poorly represented. Representatives of nearby neighborhoods might be effective in carrying the message to them.
  • Example: Midtown business district
• Bundling with related efforts: Although not part of neighbor-helping-neighbor, bundling it with other efforts related to preparedness for a flu epidemic might give the combination the critical mass to get attention from merchants.
  • Example: advice to merchants on how to conduct operations to reduce opportunities for infection.
  • Example: provide merchants with consistent signage to remind customers about "best practices". Consistent signage is more likely to get noticed (repetitions), more likely to be an effective reminder (visual trigger instead of needing to be read each time), and more likely to foster "reflexive" behavior.

Stakeholders

The current plan is to bring stakeholders into the planning incrementally. Key representatives of categories to start, and then expanding to more in that category.

1. Emergency Preparedness: E-prep committee of PAN (Palo Alto Neighborhoods): The primary group that has been involved in considering/implementing preparedness and activities at this level (neighborhoods and business districts). Aside: CAADA is a participant.
2. Public health (small scale such as nurses): Medical issues at level of individuals and families
3. Business organizations, such as CoC, CAADA: for the merchants viewpoint of what can be done
4. Groups for outreach to residents
   • Neighborhood Associations
   • Schools
   • Faith-based community
   • Senior groups and service centers, such as Avenidas
5. ???

Role for the Outreach Groups

• Recruit coordinators: multiple are necessary to prepare for some of them being sick (and to share the workload)
• Contact with community so that they know help is available and who to contact (the coordinators) should their own circle of friends not be able to help (sickness or too small circle).
• Coordinators maintain lists of those available to help (for example, surrogate shopping at Safeway)
• ?"Volunteer advice lines": People to supplement the official advice lines that are expected to be overloaded. Work load for volunteers would be limited by limiting the "client base", for example, a portion of a neighborhood or of an organization's membership (example, people with last name beginning with A-F).

Benefits

• Public Health, Residents: By making it easier for sick people to not have to venture into public places (self-quarantine)
  • Reduce the rate of spread: Even if you don't reduce the number of people who eventually get the disease, having fewer sick at the same time dramatically reduces the problems and disruptions.
  • Reduce the exposure of sick people to other diseases: Few people die from the flu itself; they die from opportunistic diseases, ones that the body would have fought off if it hadn't been in a weakened state (Pneumonia is the most common of these opportunistic diseases).
• Merchant health: ("Don't let a crisis go to waste"): build customer base (introduce, reacquaint)

Flu Background

Purpose: basic points to give people a sense of why this is a real possibility

• Rapid spread: 2009 Swine Flu More Transmissible Than Seasonal Flu. In a normal year, 5-20% of the population come down with seasonal flu. The most common projections are for 40% of the population to come down with H1N1 (and people will still get seasonal flu).
• Mutation: One of the key features of the influenza virus is how readily it mutates. In an infected personal/animal, it readily exchanges genes with other flu viruses. Many of these mutations don't survive and spread, for a variety of reasons including chance.
• Vaccine (in)effectiveness: This ability to rapidly mutate is why there is a new flu shot every year. Many times, the seasonal flu vaccine is effective, but people who have had the shot can still get the flu.
  • Sometimes the strains of flu targeted by the vaccine have mutated while the vaccine was being produced and distributed.
  • Other times, a strain of flu that wasn't included in the vaccine (because it wasn't expected to be significant) acquires a mutation that allows it to spread rapidly.
• Mutation likelihood: Probable, but unpredictable. Do not be lulled by reports that the H1N1 virus currently is stable (not mutating). Since this is the portion of the year when seasonal flu is rare in the Northern Hemisphere, this could simply be that the H1N1 virus isn't encountering enough people/animals with different strains of flu to swap genes with, and this will change once normal flu season begins this fall/winter. WHO Warns Of Severe Form of Swine Flu (New York Times, 2009-08-28).
• Climate effects and El Nino: Seasonal flu thrives in cold, dry environments (hence the "season").
  • One explanation for the temperature effect is how long a person is infectious ("peak shedding" of the virus): At 85, experiments have found no transmission. At 40, the peak infectious period was 40 hours longer than at 68 (many articles, e.g., Influenza Virus Transmission Is Dependent on Relative Humidity and Temperature).
  • Observations have found a relative humidity of 20-35% to be most favorable to the transmission of the virus and mid-range humidities to be unfavorable, with conflicting observations on high humidities. Lower relative humidities are created in the winter by normal residential heating systems as well as the climate control system in larger commercial buildings. The most common hypothesis is based on the flu viruses not being free-floating, but riding on droplets expelled when a person coughs: At higher humidities, these droplets become larger and more quickly drop out of the air (gravity and loss of momentum).
  • This winter (2009-2010) is predicted to be an El Nino year and the resulting differences in temperature and relative humidity could affect the transmission of flu.