Questions and Answers about How Federal Agencies can Prepare for and Respond to the 2009–2010 Influenza Season

October 1, 2009 12:00 PM ET

Q. How does CDC’s new flu guidance differ from previous guidance documents?

The new guidance applies to any flu virus circulating during the 2009­-2010 flu season, not only 2009 H1N1 flu. It may be difficult at first to determine whether someone who is sick has 2009 H1N1 flu or seasonal flu since they present with a similar clinical picture and routine testing to identify the type of flu virus is not recommended. The guidance offers specific steps to ensure that employees are protected, and to maintain continuity of operations. It provides guidance for the current flu conditions as well as for more severe flu conditions.

This guidance also recommends that, based on current flu conditions, employees with flu-like illness stay home until at least 24 hours after they no longer have a fever (100 degrees Fahrenheit or 37.8 degrees Celsius) or signs of a fever (have chills, feel unusually warm or cold, have a flushed appearance, or are sweating). This should be determined without the use of fever-reducing medications (any medicine that contains ibuprofen or acetaminophen). This is a shorter time period than the previous guidance, which recommended that sick employees stay home for 7 days after symptoms began. The 7-day period would still be recommended in work settings under more severe flu conditions.

Q. Should all federal supervisors and employees follow this guidance?

The guidance is intended for federal agencies. Preparing for the Flu: A Communication Toolkit for the Federal Workforce includes specific information based on this guidance for federal supervisors and employees. The toolkit can be found at: www.flu.gov/professional/federal/workplace/index.html. Federal employees who care for sick people as part of their jobs will need to take additional steps to protect themselves because of their risk at work.  Specific guidance for steps health care workers should take for 2009 H1N1 flu and seasonal flu can be found at: www.cdc.gov/h1n1flu/clinicians and www.cdc.gov/flu/professionals.

Q. What other guidance or policies should be reviewed by the federal workforce to prepare for the 2009-2010 flu season?

In addition to this guidance, supervisors, and employees who work for the federal government should review:

• any agency documents specific to emergency planning.
• applicable provisions in collective bargaining agreements.
• U.S. Office of Personnel Management (OPM) Web site, which includes policies, questions and answers, and tools specific to pandemic flu at:  www.opm.gov/pandemic.

Rationale for Planning

Q. Why is it important to plan for a flu response?

Federal agencies may have already been impacted by the spring 2009 H1N1 flu. Steps can be taken now to slow the spread of flu in the workplace. It is also possible that flu conditions may become more severe, so it is important to plan now for how to respond under those circumstances. Planning for a flu response will help continue and strengthen efforts to protect the federal workforce and ensure continuity of operations. A severe flu season could have a major effect on the global economy, including travel, trade, tourism, food, financial markets, and other types of businesses. Planning from the outset can help protect your agency and your employees if flu conditions become more severe. Planning can help:

• minimize disruption to government activities,
• protect employees’ health and safety, and
• limit the negative impact to the community, economy, and society.

Q. Why should we be concerned about the spread of flu in the workplace?

The workplace may act as a “point of spread,” where employees can easily spread flu to their fellow employees as well as to others in the community. The flu can have a major impact on continuity of operations, causing employees to stay home because they are sick or because they need to care for sick family members. They may also need to stay home and take care of their children, if schools dismiss students or early childhood development programs close. The guidance and this toolkit provide steps that supervisors and employees may take to minimize the spread of flu in the workplace.

How to Plan and Prepare

Q. What should federal agencies do to prepare?

• Review current pandemic and/or emergency plans or develop a new plan.
  • Conduct an exercise, drill, or discussion to test key components of the agency’s plan.
  • Share the plan and communicate with employees to explain what policies, leave options, pay, telework, and benefits may be available to them. Consult with human resources offices as needed.
• Review relevant agency and government-wide human resources policies and practices.
• Develop human resources management strategies to deal with human resources issues that may arise during a flu response.
• Review your collective bargaining agreement and specific policies, leave options, telework, and other options that may be available to employees.
• Consult with human resources offices as needed.
• Secure and maintain updated telephone contact information for all employees.  Review and update your list of mission critical/essential employees and make sure that employees understand their roles and responsibilities during emergencies.  Add a “widget” or “button” to your Government web page or employee website as a means of providing your employees with the latest information on the flu:

www.cdc.gov/widgets

www.cdc.gov/SocialMedia/Campaigns/H1N1/buttons.html

www.hhs.gov/web/library/hhsfluwidgets.html

www.flu.gov/news/socialmedia

Q. What should be included in a federal agency flu response plan?

OPM has issued guidance on pandemic planning which can be found at:  www.opm.gov/pandemic. The guidance is designed to help federal departments and agencies achieve two important goals—(1) protecting the federal workforce and (2) ensuring continuity of operations. Federal agencies should demonstrate to the American people that they can have confidence that the federal government will be able to carry out its mission, especially in an emergency. For this reason, the OPM guidance emphasizes the need to carry on the essential work of the government through whatever means are available. This may include:

• voluntary telework arrangements,
• the designation of an employee’s home (or alternative worksite not under government control) as a “safe haven” for evacuation during a pandemic,
• the assignment of any work necessary or required to be performed during the period of evacuation, and
• authorizing “evacuation payments” to protect employees’ pay if standard time and attendance procedures cannot be followed due to illness during flu season. 

OPM does not anticipate the need for widespread use of excused absences (i.e., “administrative leave”), which should be considered a last resort during a flu response. Departments and agencies should consult OPM’s guidance on excused absence, and if and when the need arises, OPM will publish a consistent government-wide policy on the use of excused absences for flu response.

Q. What leave options are available for federal employees?

An important way to reduce the spread of flu is to keep sick people away from those who are not sick. With this in mind, employees who have flu-like symptoms should be encouraged to contact their supervisors to request leave in accordance with leave regulations, policies, and practices. Once approved, employees should stay home and not come to work until at least 24 hours after they no longer have a fever (100 degrees Fahrenheit or 37.8 degrees Celsius) or signs of a fever (have chills, feel very warm, have a flushed appearance, or is sweating). This should be determined without the use of fever-reducing medicines (any medicine that contains ibuprofen or acetaminophen). It is possible that employees will need to take care of sick household members or care for children if schools are dismissed or are closed.

The federal government offers several leave options: sick leave; sick leave for an employee exposed to a communicable disease; sick leave to care for family members who are sick or need medical examination; sick leave for bereavement; sick leave to care for a family member with a serious health condition; annual leave; advance annual and/or sick leave; leave without pay (LWOP) as approved by the agency or as authorized under the Family and Medical leave Act (FMLA); excused absence (administrative leave) in limited circumstances; donated leave under the voluntary leave transfer program, voluntary leave bank program, or emergency leave transfer program; other paid time off such as compensatory time off, compensatory time off for travel, or credit hours.

Supervisors should also encourage telework and alternative work schedules to help prevent the spread of flu in their workplace. This will allow employees to continue to work or function while limiting contact with others, help maintain continuity of operations, and help employees manage their health and their family’s needs. Before approving a particular leave option, federal supervisors should review applicable policies set forth in collective bargaining agreements and agency-specific human resource guidance.

Q. Must an employee have a doctor’s note if requesting to use sick leave?

As the 2009/2010 flu season progresses, we would like to draw attention to the fact that agencies have the option of approving sick leave or Family and Medical Leave Act (FMLA) leave (if it is raised to the level of a serious health condition as defined in 5 CFR 630.1202) for employees with flu-like illness without requiring a doctor’s note or other medical certification. Under OPM’s sick leave regulations at 5 CFR 630.403(a), an agency may grant sick leave only when the need for sick leave is supported by administratively acceptable evidence. The regulations go on to say that an agency may consider an employee’s self-certification as to the reason for his or her absence as administratively acceptable evidence, regardless of the duration of the absence. An agency may also require a medical certificate or other administratively acceptable evidence as to the reason for an absence for any of the purposes for which sick leave is granted for an absence in excess of three workdays, or for a lesser period when the agency determines it is necessary. The Family and Medical Leave (FMLA) can be invoked if the employee or his/her family member has a serious health condition. If FMLA leave is taken, an agency may require medical certification, under 5 CFR 630.1207, but is not required to do so. Federal supervisors and employees should review applicable provisions in collective bargaining agreements and agency documents concerning medical documentation. Supervisors must use their best judgment and follow their agency practices for granting sick leave.

Q. Must an employee use leave if they have the flu?

If you have flu-like symptoms, need to care for a member of your household, or have general questions about using leave options or arranging off-site work alternatives, please contact your supervisor or your agency’s human resources office.

To reduce the spread of flu in the workplace, CDC recommends that employees who develop flu-like symptoms stay at home and not come to work until at least 24 hours after they no longer have a fever (100 degrees Fahrenheit or 37.8 degrees Celsius) or signs of a fever (have chills, feel very warm, have a flushed appearance, or is sweating). This should be determined without the use of fever-reducing medicines (any medicine that contains ibuprofen or acetaminophen). To make it as easy as possible for employees who have flu-like symptoms to stay home, employees and supervisors should discuss teleworking from home, alternate work schedule options, and the leave and time-off options that may be available. 

Leave options include sick leave, sick leave to care for family members who are ill or need medical examination, sick leave for bereavement, sick leave to care for a family member with a serious health condition, annual leave, advance annual and/or sick leave, leave without pay (LWOP) as approved by the agency or authorized under the Family and Medical Leave Act (FMLA), excused absence (administrative leave) in limited circumstances, and donated leave. Other paid time off options include compensatory time off, compensatory time off for travel, and credit hours.

See OPM’s Planning for Pandemic Influenza: Human Resources Information for Agencies and Departments at www.opm.gov/pandemic/OPM-Pandemic_AllIssuances.pdf for more information.

Steps for the Federal Workforce under Current Flu Conditions

Q. What steps can federal supervisors take to keep employees from getting sick?

Federal supervisors should take the following steps under current flu conditions to keep employees form getting sick with flu.

• Encourage respiratory etiquette by providing:
  • education and reminders about covering coughs and sneezes with tissues, and
  • easy access to tissues and trash cans.
• Encourage hand hygiene by providing:
  • education and reminders about washing their hands, and
  • easy access to running water and soap. If soap and water are not available, an alcohol-based hand rub can be used.
• Encourage employees to request leave if they are sick so they can stay home for at least 24 hours after they no longer have a fever (100 degrees Fahrenheit or 37.8 degrees Celsius) or signs of a fever (have chills, feel very warm or cold, have a flushed appearance, or are sweating). This should be determined without the use of fever-reducing medicines (any medicine that contains ibuprofen or acetaminophen).
• Encourage employees who become sick at work to go home. Remind employees to notify their supervisors and discuss leave options.
• Routinely clean surfaces and items that are more likely to have frequent hand contact with cleaning agents that are usually used in these areas. Additional disinfection beyond routine cleaning is not recommended.
• Encourage sick employees at higher risk of complications from flu to contact their health care provider as soon as possible. Taking antiviral medicines early might prevent severe complications from the flu, such as hospitalization or death. People at higher risk for flu complications include pregnant women and people with certain chronic medical conditions (such as asthma, heart disease, or diabetes).
• Discuss options with employees to ensure continuity of operations in the event that employees need to stay home. Employees may need to stay home because they are sick, need to care for sick household members, or because schools have been dismissed and they need to care for their children. Consider cross-training staff to perform essential functions or offering options for telework.
• Encourage all employees who want protection from flu to get vaccinated for seasonal flu. Also encourage employees who are at higher risk for 2009 H1N1 flu complications to get the 2009 H1N1 flu vaccine when it becomes available. People at higher risk for 2009 H1N1 flu complications include pregnant women and people with chronic medical conditions (such as asthma, heart disease, or diabetes). Please see www.cdc.gov/h1n1flu/vaccination/acip.htm for more information about higher risk groups. Employees should be encouraged to review their health benefits coverage. 
• Provide information to employees overseas about what to do if they become sick. Planning for Pandemic Influenza provides more information to supervisors and employees working overseas. This guidance can be found at: www.opm.gov/pandemic. In addition, health information for travelers can be found at www.cdc.gov/travel.

Q. What can a federal supervisor do if an employee appears to be sick at work?

• Supervisors may express general concern regarding the employee’s health and remind the employee of his or her leave options for seeking medical attention, such as requesting sick or annual leave. A supervisor may encourage an employee to go home if he or she is not feeling well. If the employee has no leave available, supervisors are authorized to approve requests for advanced leave or leave without pay in certain circumstances.
• When leave options are not practical and the employee is able to work, a possible alternative may be to allow the employee to work from home, either under a voluntary telework agreement, or in accordance with the agency’s policy on telework and any applicable collective bargaining agreement. The feasibility of working from home is dependent on several factors, including the nature of the employee’s duties, the availability of any necessary equipment (personal computer, etc.), and computer and communication connectivity. Supervisors should check with their HR office from time to time for the latest agency policy on flexibilities. 
• As a means of preventing the spread of the flu, supervisors are strongly encouraged to remind employees to stay home for at least 24 hours after they no longer have a fever (100 degrees Fahrenheit or 37.8 degrees Celsius) or signs of a fever (have chills, feel very warm or cold, have a flushed appearance, or are sweating). This should be determined without the use of fever-reducing medicines (any medicine that contains ibuprofen or acetaminophen).

Q. What is the best way to practice good hand hygiene?

Wash your hands with soap and water for at least 20 seconds (the time it takes to sing the “Happy Birthday” song twice). Be sure to wash both sides of the hands, between fingers and under the nails. That is the best way to keep your hands from spreading the virus.

If soap and water are not available, you can use an alcohol-based hand rub. Alcohol-based hand rubs containing at least 60% alcohol are a good alternative to soap and water. After applying the hand cleaner, rub hands until dry. If you cannot wash your hands with soap and water and do not have an alcohol-based hand rub, other hand sanitizers that do not contain alcohol may be useful.

Visit www.cdc.gov/cleanhands for more information on hand hygiene.

Q. How long should a sick employee stay home?

Under current flu conditions, employees with flu-like symptoms should stay home for at least 24 hours after they no longer have a fever (100 degrees Fahrenheit or 37.8 degrees Celsius) or signs of a fever (have chills, feel very warm, have a flushed appearance, or are sweating). This should be determined without the use of fever-reducing medicines (any medicine that contains ibuprofen or acetaminophen). The sick employee may decide to stop taking fever-reducing medicines as he or she begins to feel better and should continue to monitor his or her temperature until it has been normal for 24 hours.

If flu conditions become more severe, the sick employee should stay home for up to 7 days. An employee who is still sick after 7 days should stay home until 24 hours after their symptoms have gone away. The local and state health department where federal operations are located will help determine if the recommendation should be changed.

Unless medical care is needed, sick employees should stay at home to avoid contact with others. This may help reduce the number of people who get infected with the flu virus.

Q. Should an employee with a sick household member stay at home, too?

No, an employee with a sick household member may go to work. It is especially important that these employees monitor themselves for illness.

Employees with school-aged children may need to stay home to care for their children. Supervisors should review leave policies for the flexibility to allow employees to stay home if they need to care for their children or other household members who are sick. Read OPM’s Pandemic Influenza 2009: Questions & Answers for more information at: www.chcoc.gov/Transmittals/TransmittalDetails.aspx?TransmittalID=2452.

If flu conditions are more severe, CDC guidance for school-aged children is that they should stay home for five days from the time someone in their home became sick. However, this guidance does not apply to adults.

See www.flu.gov/professional/school/index.html for more information on guidance for children in school or early childhood development programs.

Q. What are fever-reducing medications?

Fever-reducing medications are medicines that contain acetaminophen (such as Tylenol®) or ibuprofen (such as Motrin®). These medicines can be given to people who are sick with flu to help bring their fever down and relieve their pain. Aspirin (acetylsalicylic acid) should not be given to children or teenagers (anyone 18 years old and younger) who have flu; this can cause a rare but serious illness called Reye’s syndrome.

Q. Can the flu virus live on surfaces, such as computer keyboards?

Studies have shown that flu virus can live on hard objects up to 8 hours. Flu viruses may be spread when a person touches a hard surface (such as a desk or doorknob) or an object (such as a keyboard or pen) where the virus has landed and then touches his or her eyes, nose, or mouth. Routine cleaning of surfaces will help stop the virus from spreading in this way.

Routinely clean surfaces and items that are more likely to have frequent hand contact (such as hand rails or door knobs) with cleaning agents that are usually used in these areas. Additional disinfection beyond routine cleaning is not recommended.

Symptoms

Q. How do I know if someone has 2009 H1N1 flu or seasonal flu?

It will be very hard to tell if someone who is sick has 2009 H1N1 flu or seasonal flu. Public health officials and medical authorities will not be recommending laboratory tests. Anyone who has the symptoms of flu-like illness should request leave from their supervisors. Once approved, employees should stay home and not return to work until they are free of fever for 24 hours without the use of fever reducing medicines.

The symptoms of seasonal and 2009 H1N1 flu virus include fever, cough, sore throat, runny or stuffy nose, body aches, headache, chills, and tiredness. Some people may also have vomiting and diarrhea. People may be infected with the flu, including 2009 H1N1, and have respiratory symptoms without a fever.

Q.  How do I recognize a fever or signs of a fever?

A fever is a temperature taken with a thermometer that is equal to or greater than 100 degrees Fahrenheit (37.8 degrees Celsius). Signs of a fever include feeling very warm, having a flushed appearance, sweating, or shivering.

People at Higher Risk for Complications

Q. Who is at higher risk for complications from flu?

Anyone (even healthy people) can get the flu (seasonal and 2009 H1N1), and anyone can have serious problems from the flu. Some groups are at higher risk for complications from the flu. These include children younger than 5 years of age, pregnant women, people of any age with chronic medical conditions (such as asthma, diabetes, or heart disease), and people 65 years of age and older are more likely to get complications from the flu.

Q. What should a pregnant employee do to avoid getting sick with flu?

Pregnant women should follow the same guidance as the general public about staying home when sick, hand hygiene, respiratory etiquette, and routine cleaning.

Pregnant women are at higher risk of complications from flu and, like all people at higher risk, should speak with their health care provider as soon as possible if they develop flu-like symptoms. Early treatment with antiviral flu medicines is recommended for pregnant women who have the flu; these medicines are most effective when started within the first 48 hours of feeling sick. See www.cdc.gov/H1N1flu/pregnancy/antiviral_messages.htm for more information.

Pregnant women should know that they are part of the first priority group to receive the 2009 H1N1 flu vaccine when it becomes available. Seasonal flu vaccine is also recommended for pregnant women and can be given at any time during pregnancy.

Steps for the Federal Workforce under More Severe Flu Conditions

Q. What additional steps should federal supervisors take if the flu becomes more severe?

In addition to the steps that supervisors should take under current flu conditions, federal supervisors and employees should consider adding the following steps if flu conditions become more severe.

• Consider active screening of employees who report to work, where health practitioners are present at the worksite. At the beginning of the workday or the beginning of each shift, ask all employees about flu-like symptoms and those with symptoms should be encouraged to go home.
• Extend the time sick employees stay home to at least 7 days. People who are still sick after 7 days should continue to stay home until at least 24 hours after symptoms have gone away, even if they feel better sooner.
• Try to change work duties, workspace, or work schedules for employees who are at higher risk for flu complications to reduce the possibility of getting sick at work. If this cannot be done, allow these employees to work from home, or stay home, if feasible. These employees should make this decision in consultation with their health care provider. People at higher risk for flu complications include pregnant women and people with chronic medical conditions (such as asthma, heart disease, or diabetes).
• Find ways to increase social distances (the space between people) in the workplace, if possible (see next question).
• Prepare for school dismissal or closure of early childhood development programs. School dismissals and closure of early childhood development programs are more likely when flu conditions are more severe. Be prepared to allow employees to stay home to care for their children if schools are dismissed or early childhood development programs are closed.
• Provide guidance to employees who are traveling overseas on what to do if they become sick. Also provide information about possible travel delays, health screenings, and other activities targeted towards travelers leaving other countries for the United States. Health information for travelers can be found at www.cdc.gov/travel.

Q. What can federal agencies do to increase social distance during a more severe flu outbreak?

During a severe flu outbreak social distancing may be required. Supervisors should think creatively about ways to increase the space between employees, while maintaining government operations. Some options for social distancing are:

• cancelling non-essential face-to-face meetings and trying conference calls or Internet-based meetings instead,
• cancelling non-essential business travel, and
• offering telework options for employees.

Q. How will the federal workforce know if the flu is more severe and if they should consider taking additional action steps?

CDC and its partners will continue to monitor the spread of flu, the severity of the illness it’s causing, and whether the virus is changing. State and local health departments will also be on the lookout for increases in severe illness in their areas and will provide guidance to their communities. Employees should visit www.flu.gov for the most up-to-date information about the flu. HHS will work closely with OPM and CDC to communicate changes in severity and the extent of flu-like illness to ensure that agencies have the information they need to choose the right steps to reduce the impact of the flu.