One of the key messages that health experts stress when it comes to preparing for the next flu pandemic is for people to stay home from work if they're sick. Easier said than done. For many, missing work means not getting paid. Not surprisingly, lost income is the biggest deterrent to self-quarantine. And in a society obsessed with success, taking time off clashes with personal ambition. So when that worldwide influenza outbreak strikes, it's going to take a lot more than frequent hand-washing to keep the virus from spreading out of control. It's going to take a shift in North American values.

“People will probably go to work if they can't afford to stay home, [or] if they don't have job security,” provincial health officer Perry Kendall told the Straight in a phone interview. “Will workaholics stay home? Will workaholics feel guilty if they stay home?...It's a broader health issue, and I don't think any country has really gotten around to addressing it. Culture is hard to change. That's why work forces need to start thinking about this now.”

Employees and businesses in Toronto got a taste of the impact of communicable diseases with the outbreak of severe acute respiratory syndrome in 2003. SARS challenged the current workplace mentality: the guy who used to boast about never having taken a sick day in his life was no longer such a dream employee if he was coming to work hacking and sneezing, exposing his coworkers to illness in the process.

Patricia Daly, Vancouver Coastal Health's medical director of communicable-disease control, says that sickness in the workplace is a complex issue.

“We're trying to work with the business community in pandemic planning so they understand that, for a lot of workers, this [staying home] is a very difficult thing to do,” Daly said on the line from her office. “We do have to change the culture a bit.”

Before a flu outbreak, companies need to evaluate their sick-time and leave policies, according to the B.C. Pandemic Influenza Preparedness Plan, a project of the B.C. Ministry of Health and B.C. Centre for Disease Control. To minimize the potential financial hit on employees, strategies include offering short-term disability plans as part of extended health benefits and allowing sick workers to use vacation time instead of having to take time off without pay.

Companies can expect to have about 25 percent of their staff off work for at least one day during an outbreak, Kendall said at a recent news conference about pandemic planning. Still others could be absent to care for ill family members.

To help individuals and organizations prepare for and cope with a pandemic, the provincial Ministry of Health and the BCCDC launched a Web site (www.health.gov.bc.ca/pandemic) at the May 12 briefing. The site has information on everything from self-care during a pandemic to the basics of hand-washing to prevent the spread of illness.

Pandemics occur every 10 to 40 years, and the last one was in 1968. Kendall said that up to 75 percent of British Columbia's estimated population of 4.2 million people could be infected by the influenza but that not everyone will get sick. Less than two percent of those infected, or about 18,500 people, will end up in hospital, and 0.4 percent””about 6,800 people””will die. In a normal year, 400 to 1,000 people in the province die during flu season. Posing an even greater potential threat is the virulent avian flu, which could mutate and trigger an even deadlier human pandemic.

Based on past experience, the next influenza pandemic will likely arrive in Canada within three months after emerging elsewhere in the world. A pandemic usually has two or more waves of illness, each lasting six to eight weeks and separated by a period of three to nine months, according to the provincial plan. However, a vaccine or antiviral medication won't be ready for at least six months after the initial outbreak, because flu viruses mutate rapidly, and no one can predict what form the virus will take.

“One never knows when it is going to come; one never knows what the precise nature of it will be when it does come,” Health Minister George Abbott said at the news conference.

That's why prevention is so vital. The virus is spread through breathing in tiny droplets that are in the air after an infected person coughs or sneezes, or from touching a surface that's contaminated with those drops then bringing your hand to your eyes, nose, or mouth. Someone who is contagious can easily infect others within about a metre through coughing and sneezing. Viruses can live on hard surfaces, like doorknobs, for as long as 48 hours, and can persist on porous surfaces, like cloth, paper, and tissue, for up to 12 hours. Once on the hand, the virus can survive for about five minutes.

Businesses have a legal duty to ensure the health and safety of their employees. At the office, measures to slow the spread of illness include increasing the physical distance between people and limiting the number of staff members in one place and the amount of time they spend together. Staggered shifts and working from home are practical approaches. Essential staff might have to be sequestered.

Workplaces should promote frequent, proper hand-washing, which means using warm, soapy water and washing for at least 20 seconds each time. Having alcohol-based hand-sanitizers easily accessible is also advised.

Then there's coughing and sneezing “etiquette”. Instead of coughing into your hands, do so into your sleeve or into a Kleenex that can immediately be thrown out.

Once someone is exposed to the virus, flu particles begin to replicate in the respiratory system. A person might be contagious 24 to 72 hours before the appearance of any symptoms and for three to five days afterward. Signs include fever, headache, coughing, body aches, and weakness. Sometimes symptoms last as long as two weeks. The most common complication of the flu is pneumonia.

Many people will be sick but won't need to see a doctor. Kids should get medical care if they have fast or troubled breathing, dark-coloured lips or skin, extreme drowsiness or crankiness, and are showing signs of dehydration, like not urinating regularly. Adults need to seek help if they have shortness of breath, pain in the chest or stomach, severe vomiting, confusion or disorientation, or if they're coughing up blood.