Risk management goes viral

The current concern over an outbreak of the Zika virus is not a new phenomenon. In fact, such fears are becoming increasingly commonplace: from Sars to Swine Flu to last year’s Ebola outbreak. However, what is different in this case is the lack of medical history around the virus and, indeed, the current lack of any treatment or vaccine.

Against such a stark backdrop, it is possible for misinformation and unfounded fears to spread faster and wider than the actual infection—and this is where risk managers can play a crucial role. They can help control the company message and ensure that staff are given sensible advice to ensure their own safety in the face of a potentially dangerous risk, according to Steve Tunstall, general secretary of the Pan-Asia Risk & Insurance Management Association (Parima).

Mr Tunstall was one of the speakers at a recent webinar held by Parima, which provided not only an update on the current situation regarding recorded outbreaks and medical guidance but also some advice for Asia-based risk managers on how they can best treat the business risks that might arise from an outbreak of the Zika virus.

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History of the virus

The audience was first briefed on the history and developing status of the virus by Dr Philippe Guibert, regional medical director consulting services, Asia region, International SOS, which provides medical and security advice to multinational organisations.

Unfortunately, there is very little information about the virus prior to 2007, with just 14 reported cases in east Asia and Africa. Then, in 2007, there was an outbreak on Yap Island in Micronesia, most likely as a result of travellers from Asia, with nine confirmed cases and an estimation that 73% of the island’s population was infected.

Interestingly, as far back as 2007, a World Health Organisation (WHO) report into this outbreak warned that the virus would spread beyond the island.

It stated: “The accessibility of air travel and the abundance of mosquito vectors of flavivirus in the Pacific region raise concern for the spread of Zika virus to other islands in Oceania and even to the Americas.”

And this is exactly what happened, said Dr Guibert. In 2013, the first large outbreak occurred in French Polynesia, with 19,000 suspected cases. It was also the first time that some neurological complications were reported, which caused strain on local intensive care resources. During the course of the next two years, the virus spread eastward to Easter Island, the Cook Islands, New Caledonia, the Solomon Islands and Vanuatu.

Then came the first report of cases in Brazil in May 2015. There have now been more than 6,000 suspected cases across six northeastern states. And since January 2016, the WHO has reported that there are now 30 countries within the Americas that have local transmission of the virus.

In total, there are 52 countries with reported Zika viruses. The vast majority (31) of these are in the Americas. So far there are just four Asian countries with indirect evidence of viral transmission—Cambodia, Indonesia, Malaysia and the Philippines. Only in Thailand is it an ongoing risk, with several cases of identified transmission.

There have been numerous travellers that have visited areas where Zika outbreaks have been reported, such as Brazil. Some have, however, been to areas where outbreaks have not been reported, such as the Maldives, Thailand, Cambodia and Indonesia.

More interestingly though, said Dr Guibert, an increasing number of cases have resulted from sexual transmission from infected men to women.

There have been several in the US as well as in France and Italy, certainly more than was first suspected. It is unknown how long the virus persists in semen but it has been detected as long as 62 days post-illness.

Other types of transmission include mother to newborn at time of delivery or during pregnancy, blood transfusion and, in rare cases, through monkey bites.

What is the virus?

Zika is classified as an emerging Aedes mosquito-borne disease, meaning that it is carried exclusively by mosquitoes and spread via mosquito bites to non-human primates and humans.

It was first discovered in the forests of Uganda in Africa in 1947 but prior to the recent outbreak there have been limited studies on the virus. This means that there is very little knowledge about how the virus affects the human body and, consequently, there is no specific treatment for the disease and no available vaccine at present, though a lot more research is currently underway.

There is some medical information available though. The virus has a mostly mild effect and the vast majority (80%) will be asymptomatic and not even know that they are carrying the virus.

Only one in five of those infected will get symptoms within a week of the mosquito bite and these symptoms are similar to other mosquito-borne diseases such as dengue, chikungunya and malaria, provided that they are treated within a couple of days of infection. They include fevers, rashes, muscle and joint pain, conjunctivitis and headaches. Typically, most people recover within a week.

However, there is growing evidence that there could be complications, said Dr Guibert, although it is not clear if Zika alone is responsible for the associated conditions. These include brain malformations such as microcephaly in the babies of women infected while pregnant, as well as an increased risk of miscarriage or stillbirth.

Zika has also been linked to Guillain-Barre syndrome, a muscular weakness that can be mild but in severe cases can lead to respiratory failure.

These possible links led the WHO, on 1 February 2016 , to state: “The recent cluster of microcephaly cases and other neurological cases reported in Brazil, following a similar cluster in French Polynesia in 2014, constitutes a Public Health Emergency of International Concern.”

Pregnant women have been advised to reconsider travel to countries with ongoing transmission and several affected countries have encouraged women to postpone pregnancy.

At present, diagnosis of the virus is first based on symptoms and a history of exposure through travel but can only be confirmed through specialised blood tests. As stated, no specific treatment is available but rest combined with plenty of water is advised. If medicine is being used to relieve fever or pain, it is advised that aspirin and non-steroidal anti-inflammatories are avoided, as these medicines can exacerbate bleeding.

Preventing infection

Given that there is no vaccine, the best way to prevent infection is to prevent mosquito bites. Appropriate clothing, insecticides, avoidance of mosquito breeding areas, insect repellent, air-conditioned accommodation, insect screens and nets all help.

It also helps to prevent mosquito breeding sites by clearing any standing water around your home and to prevent any sexual transmission of the virus through either condoms or abstinence.

When it comes to deciding whether to travel to a place with Zika, people have to make an individual risk assessment, Dr Guibert said during the Parima webinar.

“Some authorities are advising pregnant women to consider postponing travel, especially to areas with increasing or widespread transmission. Or they are advising women to delay getting pregnant until at least 28 days after visiting an affected area. In addition to the infectious risks, people should also consider the standard of available healthcare and obstetric and neonatal specialist support in that area.

It is important to monitor the information regarding travel advice from various national and international agencies because it is constantly changing. For example, the US Center for Disease Control and Prevention has so far issued travel notices for 20 countries it has identified as being at risk.

And it is advisable to monitor your health when returning from Zika-affected areas, said Dr Guibert. “If symptoms develop, seek medical care and advise your doctor of your travel itinerary. And if you are returning to an area with Aedes mosquitoes, keep on taking measures to prevent mosquito bites for a further two weeks to avoid becoming the next source of a new transmission.”

Dr Guibert also addressed how the virus might develop in the future. Zika is well circulated in the Americas and is expected to spread to all countries where the Aedes mosquitoes are present, with the possible exception of Canada and continental Chile.

According to the director of WHO, the situation is expected to gradually worsen before it gets better. Currently, 25 of 27 states in the Americas are reporting cases. With the onset of winter, the number of cases should lessen but in in the interim there will be more outbreaks this summer in the southern states of the Americas and also other Asian and African countries.

Less predictable however, is the development of any treatment of the virus. Dr Guibert said: “Although progress is being made with diagnostics, we are still only at the beginning of the development of a vaccine. Unlike with Ebola where there was already ongoing research into the development of vaccines, the world was really caught by surprise with Zika, so we are really starting at the beginning and it will be a year and a half before any human trials are completed. So a vaccine may not be available for anytime between three and ten years. The truth is that we don’t know but it will not be something we can rely on any time soon.”

Dr Guibert was asked whether it is unusual that a virus which has been in existence for more than more than 40 years without causing much panic, has now mutated into something so serious.

“This is the very nature of these infectious agents—to re-emerge and change the parameters of their transmission and to keep adapting to our way of living—for example, an urban environment in Africa. We are the hosts of these viruses and they adapt very well to our evolution; it is an ongoing process and we have to expect these agents to keep on re-emerging in the future,” he said.

Dr Guibert was asked about the probability that the Zika virus will spread in southeast Asia. “The answer is 100% because the virus is already here. Cases have been reported and there is evidence of local transmission, but we have not specifically looked for the Zika virus in all of these countries. The more we look for these cases, the more we will find but that does not mean we are looking at the same magnitude of outbreaks that we have seen in the Americas. We have to anticipate that we will see more instances of outbreaks from people either travelling locally or from the Americas.”

A risk manager’s perspective

Whenever there is a new virus that can possibly affect an organisation, there are a number of interesting steps that a risk manager can take, which can also help to show the value they bring to their organisation, said Mr Tunstall.

One of these is through communication. “The communication is very important. It is just a month ago that the director general of the WHO, Dr Margaret Chan, said that Zika had turned from a mild threat into one of alarming proportions. This is advice for policymakers in various jurisdictions rather than individuals, but a lot of people get hold of this information and it is not always dealt with in a way that is helpful.”

People are sometimes using this information to suit their own agendas, said Mr Tunstall, such as internet-based conspiracy theorists and wilfully uninformed people who deliberately use misinformation.

“There are some websites saying that this is caused by vaccines or by pesticides or by the Gates Foundation or by Monsanto. There is a long Reddit post that says it was caused by GM mosquitoes. There is no evidence for any of this. However, constituents within your organisation may read some of this,” he said.

More important than the wealth of unscientific theories in circulation is the fact there is currently no vaccine, said Mr Tunstall. “It is very important that risk managers work with their internal teams to see how they can allay any unnecessary fears within the organisation, particularly if there is a lot of travel involved for employees. It is a great opportunity for risk managers to link up with their HR teams and communications teams and make sure there is a sensible and consistent approach to these kind of exposures.”

The second issue that risk managers must consider is the company’s organisational resilience and what is being done to prepare not just for Zika but for any other virus that comes up said Mr Tunstall. “How are we thinking about our business continuity planning and how are we thinking of speed of communication in the event that something like this becomes a more pressing issue here in Asia?” he asked.

The way that technology is changing the way we communicate is critical to this issue, said Mr Tunstall. “We have been here before in Asia and I remember working with an organisation to put something together to deal with one of the H1N1 scares. The scare came and went and the organisation was left with something that was non-functional and not really adaptable to any other threat and was left on the shelf and forgotten about,” explained the Parima committee member.

“These days, we are seeing more of these viruses so risk managers have to think about how they are putting together systems and processes that help manage these type of problems, should they escalate. It is no longer about static BCP reports, it is about using people’s smartphones to get information to them quickly and to update people about latest developments. This is about broader resilience and an opportunity to get some of those projects kicked off. If this does happen to our organisation, how prepared are we to address any threats?” asked Mr Tunstall.

Non-essential travel

One of the most prescient issues for Asia-based companies is business travel. In light of the lack of a vaccine, some may feel the only way to prevent infection is either through protection from mosquito bites or by abstaining from non-essential travel.

“I think this is where the risk manager can really add some value by making sure there is not an alarmist response,” said Mr Tunstall. “It is difficult to define ‘non-essential’ travel in the corporate context so you need to present a considered view as to whether people should travel or not. I am scheduled to travel to two states in Brazil later this month so I am asking questions of myself: Is this the best time to travel? Is there a better time to travel? But I want to make that decision in view of the facts and not a knee-jerk reaction. I would not recommend issuing a blanket ban on travel,” he added. Another responsibility for risk managers is to ensure that they are able to update their pandemic preparedness plans in line with possible developments in the spread of the Zika virus or any other similar pandemics, said Mr Tunstall.

“Zika can be used as a trigger to examine how your resilience systems are designed at the moment and how they might deal with something like Zika if it becomes a much bigger issue,” he explained.

“We are seeing issues like Zika being communicated at a greater speed and often involving mixed messages. How do you ensure that people who need to know information in a hurry are contacted? How is that process being managed? For example, if you take process of a fire alarm, it is quite a linear process and everyone knows what their role is going to be, from the fire monitor to the emergency services,” continued the risk consultant.

“But for potential crises like Zika, which are coming up at an increasing rate, you need flexible systems that are open enough to deal with any of these issues and can be adapted quickly. If you have a crisis management process that is triggered through the security team or the management services team, how do you make that process open enough to be triggered from anywhere in the business—be that HR, communications, finance or something else entirely? These are really good questions to ask now, before your organisation is in crisis,” he concluded.