air traffic has continued to increase and it now constitutes a considerable proportion of the travelling public. The amount of long-hour flights has increased significantly. Based on the International Civil Aviation authority, air traffic can be anticipated to double amid till 2020. Airline travel, especially over longer distances, makes air travelers vulnerable to numerous facets that will impact their health and well-being. Particularly, the speed with which influenza spreads and mutates, via transportation routes, is the reason why the influenza pandemic is considered to be a huge threat to the human population. Pandemic is a term, which is used for a virus or microbe when it spreads over a large area, in severe cases even the whole world and large number of people start getting affecting by it (CDC, 2009).
In the past 300 years, there have been ten significant influenza pandemics outbreaks that have taken place in this world. The greatest outbreak among these ten is the 1918 Spanish Flu pandemic because of which around 30% of the world’s population got infected and from among those 50 to 100 million people died. The main reason behind the Spanish Flu’s quick spread was the modern and advance transportation system which started providing the global coverage in the 20th century, because of this not only the infected people were able to get to different parts of the world thus spreading the virus but the railway and shipment crew got extremely sick as well, and they picked up the virus from not only the infected passengers but also the infected places that they travelled to (CDC, 2009).
It is being considered by the experts that some other pandemic might occur again and it would cause a lot of havoc as the transportation system has become so advanced now. The SARS (Severe Acute Respiratory Syndrome) that spread in 2002- 2003 and later on in 2009 the Swine Flu that spread so quickly because of the global air travel system, it is now being considered that the next pandemic might cause a lot of damage to the human population (CDC, 2009).
Researchers have consistently highlighted two major factors that play a critical role in the relationship between pandemic outbreaks and the transportation system. The first one is the role of a vector that is played by the transportation. As, now-a-days quick and effective air travel has become very common, the infectious diseases can easily spread through this transportation. Researchers note that the passenger air travel system can cause this spread more effectively than any other system. Therefore the air travel can be called a vector in case of pandemic. Other researchers point out that the air transportation has been observed as a vector that spreads the pandemic in its early stages (CDC, 2009).
The second factor is the continuation of the distribution of freight, which is also a cause of concern. In today’s economic world it is not possible to carry out the activities without the continuous delivery of food, electricity, fuel and other resources. Therefore, some events that can cause hindrance in the delivery and transportation of such items can cause a lot more problems than a pandemic (CDC, 2009).
Purpose of the study
The purpose of this study is to examine the factors, which place airports and airlines at risk of spreading communicable diseases. Secondly, this paper studies the behavioral changes in the aviation workforce and air travelers during a pandemic outbreak. Lastly, this paper also investigates steps taken by U.S. institutions, both public and private, to minimize pandemic outbreak threats and maximize standard behavioral patterns in the aviation workforce and air travelers during a pandemic outbreak.
The aforementioned research questions can be transformed into the following research questions:
1. What puts airports and airlines at risk of spreading communicable diseases?
2. What behavioral changes take place in the aviation workforce and air travelers during a pandemic outbreak?
3. What steps have been taken by U.S. institutions to minimize pandemic outbreak threats and maximize standard behavioral patterns in the aviation workforce and air travelers during a pandemic outbreak?
Significance of the Study
This study carries significant value for the Department of Transportation and airline businesses associated with it.
1) The findings of this study can expand the knowledge about emergency preparedness during pandemic outbreaks.
2) It can provide valuable data, which can help make effective decisions to regulate and set higher standards for emergency preparedness programs during pandemic outbreaks.
3) This study and its findings will become an addition to and update of existing research on emergency preparedness programs, particularly pandemic outbreaks.
Chapter 2: Literature Review
The subsequent Literature Review assesses the link between pandemic outbreaks and air travel and steps taken by U.S. institutions to prevent and minimize pandemic outbreaks at airports and air travel. The Literature Review is comprised of nine sections. The first section provides an overview of the 2 factors that play a critical role in the relationship between pandemic outbreaks and transportation, which are (1) vectors and velocities; and (2) Continuity of Freight Distribution. The second section provides a background of past pandemic outbreaks and diseases spread via transportation system. The third section develops the argument being leveled against the aviation industry. The fourth, fifth, sixth and seventh sections describe the impact of pandemic outbreaks on airports, airlines, aviation workforce and the national economy. The eighth section describes how the federal and local governments are tackling this issue. Lastly, in the ninth section, Ratio Analysis of Cathay Pacific is carried out to assess the financial impact pandemic outbreaks on airlines. Lastly, a summary of the literature review is provided along with the need to carry out this study.
Section one: The link between pandemic outbreaks and air travel
Vectors and Velocities
The more the speed of the vector the quicker it will be in spreading the disease. Therefore, in today’s world when the speed of our transportation has increased to such a great extent it is very easy for a pandemic to cover large areas in a very short period of time. Today the railway, air transportation is being widely used to travel long distances because of which the concentration of passengers also occurs in all these places which again widely increases the risk of getting infected (Brigantic et al., 2009).
In the past a trend like this where large number of passengers had to travel together could have been helpful as, it would have been able to quarantine that transport, for example: during a voyage there would have been a lot of time for the infected people to show the symptoms of the disease and thus, that ship could be quarantined. However, in today’s transportation world as, the incubation period of a disease is a lot more than the speed of the transportation it has become almost impossible to find out if a person has gotten infected before he/she reaches another place before the symptoms surface. The reason behind this is the fact that usually the incubation period of a disease is 1 to 4 days while in that much time a person can reach the other end of the world, which clearly shows how easy it is for the translocation to take place thus, the occurrence of a pandemic becomes undeniable (Brigantic et al., 2009).
Another thing that usually happens when an individual develops the symptoms is the “denial phase,” in which that particular person would ignore the symptoms and the fact that he/she might has gotten infected, instead he would continue to travel. It has been noted that the person would continue travelling especially if he/she is going back to place that they belong to. Another trend that has been noted in the people who develop these symptoms is that they prefer to get on a plane back to home when they notice that they are getting ill rather than the place of their destination and doing so they further spread the infection in many other places that they go to or the people that they come in contact with. Also, it has been noticed that since the global transportation system is a lot faster than the regional ones so there is a chance that the pandemic might spread on the global level a lot quicker than it would on a regional level (Brigantic et al., 2009).
After the outbreak of a pandemic the transportation system can be shut down whether partially or completely and with or without the willingness of the passengers. This is exactly what happened in case of the SARS outbreak in 2003 when the transportation system was shut down, however, in this case the passengers were not willing to accommodate this action but nevertheless the system was shut down. In case of the SARS outbreak in China the public transportation wasn’t shut down but the amount of passengers decreased a lot as, people stopped using the public transportation to avoid getting infected. Similarly, trends of decrease in the number of employees was noted in the air transportation such as, the flights in Pacific Asia decreased by 45% as compared to the year before and there was a decrease of 69% in the flights between U.S. And Hong Kong (Brigantic et al., 2009).
However, it can easily be estimated from these above given scenarios that if an influenza pandemic did occur and stay for 12 to 36 months what would be the amount of damage that it would cause in the world (Brigantic et al., 2009).
Continuity of Freight Distribution
It is an established fact that an outbreak of influenza pandemic will have devastating effects on the human population on a global scale but along with that the communication and distribution networks will face serious side effects as well. It is being considered at the moment that the damage done by the pandemic to the freight distribution networks might actually cause a lot more problems than it would to the health of the people as, the world and the way it works as we know now might come to a complete halt since, the spare parts or the finished goods, fuel etc. is now essential for not only businesses but also the everyday life activities and in the past when the pandemic hit the world it didn’t affect the people that much when the freight distribution networks were stopped because at that time the production and distribution was mainly on regional basis, however, now the freight distribution network cover the whole global framework and shutting it down would cause a lot of problems (Brigantic et al., 2009).
In today’s world with such advancement in the transportation the cost of transporting goods is a lot less than managing the inventories; for this reason a lot of manufacturers have moved to the lower cost locations and, because of this, now they require continuous delivery of good and all the materials that they need, therefore, closing the transportation in case of pandemic would affect the business and the economy of the world a lot more than it would have in the past (Brigantic et al., 2009).
The supply-chains that would get affected the most by this transportation shut down are:
Food: In today’s world the production and distribution of the food is done by keeping the levels of inventory on a very low level in order to avoid the wastage of food. For this reason the perishable food items are there in the stores for about 2 to 5 days whereas, 1 to 2 weeks for other goods. Also, this fact has to be kept in mind that we are talking about the normal conditions here. However, in case of pandemic the food will get sold out a lot quickly as, the people will start hoarding stuff and this would result in food shortage.
Energy: The production and distribution of energy is essential for the smooth working of the world that we are living in today. The most important type of energy is electricity and about 40% of the world’s electricity is produced by burning coal and from it 50% of that produced electricity is used by U.S. The electric production plants don’t store a lot of coal usually they just store it for around 30 days and regular distribution of this coal is done through the coal mines. Therefore, shutting down the transportation in case of pandemic won’t immediately affect the electricity but it will affect the distribution network and ultimately the production of electricity will get affected.
Medical supplies: Obviously in case of pandemic the medical supplies would be essential and their use would increase a lot. There are very specific areas where the drugs are manufactured and theses areas are controlled by a few conglomerates in the world and most of the times at a specific place only a single type of drug is created. For this reason, in case the distribution network would be shut down it would affect the medical supplies to a great extent. As, in America 95% of the drugs being used are made in other countries along with other equipments such as, respiratory machines and masks etc. therefore, in case of pandemic not only will the already present drugs be used up very quickly but there will be a constant need for more of them and not having properly working distribution networks would create a lot of problems and even more deaths (Brigantic et al., 2009).
From the above mentioned examples it can be clearly understood that the occurrence of pandemic would not only use up the existing food, energy and medical supplies but it will create a lot of hindrance in distribution and productions of new items thus affecting the supply chains (Brigantic et al., 2009).
Section 2: Previous rates of infections of some viruses
In 1918 the Spanish Flu pandemic caused a lot of deaths. Influenza A-virus strain of subtype H1N1 is what caused this flu which is a very severe type of virus and was known as the category 5 influenza pandemic (CRS, 2009).
It was noted that in both the inter-pandemic years 1911-1917 (dashed line) and the pandemic year 1918 (solid line) 100,000 people died in each of the groups (CRS, 2009).
It was from 1918-1919 that the Spanish Flu lasted, however, according to Price-Smith’s data this flu might have originated in 1917 in Austria. According to the old estimated stats, around 40 to 50 million people were killed due to it. However, the new estimates suggest that all over the world there were 50 to 100 million deaths. This pandemic is suppose to have killed as many people as the Black Death and for this reason it is known as “the greatest medical holocaust in history,” however, the Black Death killed around one fifth of the world, which is a lot more than what the Spanish Flu did. In case of the Black Death over 50% of the deaths occurred due to the high infection rate and it is considered that this high rate of infection was a result of the cytokine storms (CRS, 2009).
The flu was very hard to diagnose at first because of such unusual symptoms. In fact, it was because of these symptoms that initially it was thought that this was cholera or dengue. It was asserted by one of the observers that one of the things that created the most complications was the hemorrhage from the mucous membrane, which occurred not only from the nose but also from the intestines, stomach and under the skin. Along with this there were bleedings from the ears as well. Although the virus itself caused a lot of deaths but most of the deaths that occurred were due to the bacterial pneumonia which is a secondary virus that results from influenza (CRS, 2009).
The Spanish flu pandemic actually spread on a global level, it reached as far as Arctic and the Pacific Islands. This disease was so severe that it is estimated that it killed around 2 to 20% of the infected people whereas; the epidemic morality rate of the usual flu is 0.1% (CRS, 2009). Another very uncommon feature possessed by this pandemic was that it killed the young adults mostly. This can be noticed by the fact that 99% of the deaths that occurred were mainly in people under 65 and between 20-40 years of age. This was a very unusual trend as, most of the time the people who get infected or killed by influenza are the children who are under 2 years and the people who are over 70 years of age (CRS, 2009).
Although the total number of deaths is not known but it was estimated that around 1% of the world’s total population died because of this pandemic. It was estimated that in the first 25 weeks approximately 25 million people were killed which is a huge amount considering the fact that HIV / AIDS has caused 25 million people to die in 25 years (CRS, 2009).
The Manchester Influenza Epidemic of 1937
The Manchester Influenza was an epidemic which never took the form of a pandemic as it was controlled by taking precautionary measures. These precautionary measures were taken by keeping the incidents of 1918 in mind. The people who did get infected were kept under very serious observation and were isolated from the family and their contact with other people was vastly limited (CRS, 2009).
It was noted that in 1937 there were approximately 620 claims that were made to the insurance companies for the sickness benefits (CRS, 2009).
Asian Flu (1957-1958)
Avian influenza was the virus whose category 2 flu pandemic outbreak was the “Asian Flu.” In the early 1956 it originated in China and it lasted till the tear 1958. It was instigated as a result of the mutation that took place in the wild ducks and got combined with the already existing human strain. It was in Guizhou that the virus was first identified . In February 1957 it spread to Singapore and by April it had reached Hong Kong and by June it was in U.S. Approximately 69,800 people died in U.S. The elder people were the ones who got infected the most (CRS, 2009).
Hong Kong Flu (1968-1969)
It was a strain of H3N2 which caused Hong Kong Flu which was also a category 2 flu-pandemic. This strain of H3N2 resulted from H2N2 by antigenic shift, what happened here was that the genes from various subtypes rearranged themselves to form this new virus (CRS, 2009).
Approximately 1 million people died in the Hong Kong Flu pandemic that lasted between the years 1968 and 1969. Among those who died majority were the ones who were over the age of 65 years. Around 33,800 deaths were recorded in the U.S. (CRS, 2009, also see SARS 2003)
2009 Flu Pandemic (2009-2010)
It was in March-April 2009 that an influenza-like illness whose cause wasn’t known occurred in Mexico. A statement was issued by W.H.O. On 24 April 2009 reporting the outbreak of an “influenza-like illness,” this statement was issued after the isolation of an A/H1N1 influenza in 7 patients who were ill and were in the southwest U.S. Later on there were 20 cases reported in the U.S. The very next day the number of the confirmed cases in the U.S. alone rose to 40, in Mexico the number was 20, in Canada 6 and in Spain 1 (CRS, 2009).
The disease kept on spreading during the spring and by 3rd May all around the world approximately 787 confirmed cases were reported (CRS, 2009).
The WHO officially declared this outbreak that they called “Swine Flu” as the first pandemic of the 21st century as well as the new strain of Influenza A-virus subtype H1N1 which was initially identified in April 2009. This virus was considered to be a mutation or rearrangement of four already known strains of influenza A virus subtype H1N1. One of these is found in birds, the other in humans and two of them are found in pigs (CRS, 2009).
The reason why this virus spread so quickly was that it was a new kind of virus, which has never occurred before and so there was no immunity against it in the human bodies. An update was given by the UN’s World Health Organization (W.H.O.) on 1st November 2009 which stated that over 482,300 cases of the influenza pandemic H1N1 infection, which have been laboratory confirmed, were reported in 199 countries and among these 482,300 cases there were 6,071 deaths (CRS, 2009).
Section 3: The world blaming the Aviation industry for the pandemic outbreaks
If one talks about the history there wasn’t much contact among the people living in different countries and continents. This trend has taken place in the very near past that people from all around the world have such easy access to each other and they can meet each other so quickly (Diamond, 1998).
If we look at the history it can be clearly seen that the disease has played a very important role in shaping our world. Most of these diseases were caused by the wars, migrants, crusades etc. And until the World War 2 the diseases brought in by the enemies killed a lot more people than the weapons used by them (Karlen, 1995). Most of the times the people who win the wars are not the ones with the most deadly weapons rather, they are the ones who bring with them the most dangerous and contagious pathogens (Zinsser, 1943; Diamond, 1998).
In the past, the spreading of a disease basically dependant on how fast and how much a person can walk, later on it became dependant on the speed of the horses and the ships, but in today’s world when the transportation networks has improved (Karlen, 1995) so much that the human mobility in the developed countries has increased over 1000 folds, for a disease to spread all over the world won’t take long (Wilson, 1995, 2003).
With the increase in the economy of the world the one thing that has improved and increased with it is the aviation, however, with it the chances of expansion of diseases have increased a lot as well, especially with the commercial aviation (Massey, 1933).
It has been noticed that since 1960 the number of passengers has increased as much as 9% yearly and it is expected that this rate will keep on increasing for the next 10 years by a rate of 5% per annum and similar trend is expected to be present in the air freight traffic (Upham et al., 2003).
The shipping traffic has also increased to a huge extent because of the globalization of the world economy, it has been noted that since 1993 the shipping traffic has increased over 27% (Zachcial and Heideloff, 2003).
Because of this development and advancement in the transportation system the people are at a huge risk of getting infected by diseases. In fact, this development in the aviation industry can contribute to a great deal in not only the creation of new strains of the already existing diseases but it can also result in the formation of new diseases as people and freight from different regions of the world travels to various other regions (Guimera et al., 2005).
Section 4: Impact of the Pandemic Outbreaks on the Airports
Effects on business, leisure, and recreational travel: In case of a pandemic outbreak in which the corporate and governmental travel agencies are closed or the nonessential travels are restricted, the airports along with all these agencies will suffer from great loss as; they will lose their passengers and ultimately their income. Not only will the shutting down of such places cause a decline in the amount of passengers but even the places which won’t be shut down will face such decline as, the passengers would stop or delay their travel plans for the duration of the pandemic in order to avoid getting infected.
Impacts of a pandemic event on air cargo services: of course the air cargo networks won’t really have a direct affect on the spreading of or getting infected by the pandemic. However, the staff and pilots can be at a risk, but still the proper working of the air cargo networks in case of a pandemic is very important as, they would be required for the medical help.
Another thing that can be done here is using the commercial flights for the delivery of the cargo as, it would not only help the airlines in earning their revenues and avoiding losses but it will also ensure the proper distribution of medicines and other important supplies, thus, protecting the supply-chains.
Air cargo effects from social distancing: In case of a pandemic there is a chance that the air shipments might increase. The reason for this increase is the fact that the people would try not to get out of their homes in the hopes of avoiding the infections and as a result the online shopping trend might increase.
Impacts of antitrust laws: In the scenario that a pandemic occurs these laws could play a very important role in ensuring the proper working of the aviation network and since this network can prove to be very advantageous in such a time it is now being considered that the areas where these laws could be relaxed a bit they should be given some room, so that in case a pandemic takes place proper measures could be taken.
Section 5: Impact of the Pandemic Outbreaks on the Airlines
Impact of severe acute respiratory syndrome (SARS): During the time of SARS breakout the air carriers suffered a lot as, not only did the amount of passengers declined but there was a decline in the cargo department as well. This decline was especially noticed in Asia. Even in Canada the airlines had a lot of difficulty in convincing the passengers that it was safe for them to travel by their airlines (SARS, 2003).
However, as a result of this all the airlines have now taken precautionary measures in order to ensure that if faced with a problem like this in the future they would have a proper solution for it (SARS, 2003).
Economic impact on international and domestic air carriers: In case of a pandemic event, the international air carriers would be facing a lot of loss especially if the outbreak is outside the concerned air carrier country (SARS, 2003). However, in case of the domestic air carriers there will be loss but it won’t be as bad as it would be in case of the international air carriers (SARS, 2003).
Economic connection amid the air carriers and airports: The financial conditions of the airports tells a lot about the financial conditions of the air carriers as, financially strong air carriers would have financially strong airports but this also differs with the types of airports such as, commercial, general, or aviator airports etc. (SARS, 2003). Similarly, when faced with an event such as pandemic the approaches taken by the airports and air carriers would be different depending on the type of air ports.
Unique impacts of a pandemic event: When a pandemic event takes place it means that it has affected the whole world. Therefore, when the air carriers get affected, the airports ultimately get affected, although, the extent to which the airports and air carriers get affected mainly depends on the duration of the pandemic event. The longer it is the worst it is going to be for the economy and the longer it will take the world to get out of those side effects (SARS, 2003).
Difficulty in preparing for an event surrounded by so much unpredictability: the outbreak of pandemic is something that is very hard to predict as, it can’t really be guessed when a disease will occur, in what areas will it occur, how long will it take for that disease to spread etc., for example, pandemic event may take place outside America but the air ports and air carriers would need to keep on working as, there might be people who would wish to comes back home (SARS, 2003).
Therefore, the proper planning is very important and with proper planning the air carriers can actually prove to be very helpful rather than cause any huge problems during the time of crisis (SARS, 2003).
Section 6: workforce issues during pandemic outbreaks
Workforce absenteeism at and during the outset of a pandemic event: As the heading itself suggests it is the absenteeism of the workforce that is observed in a scenario such as a pandemic. Employees don’t come, not only because they don’t want to get infected, but also because they can’t come for example, the employees living at long distances from their offices or who have gone out of city or country and later on the transportation gets shutdown. Therefore, pandemic would definitely affect the workforce in more than one way (Occupational Safety and Health Administration, 2009).
Distribution of essential supplies: In an event such as pandemic it is very important for the organizations to realize who the most important employees are. They need to know all this stuff in order to get to know whom they want in the offices the most and thus in this manner they can properly distribute the medical supply, precautionary masks etc., so that their employees can work in a proper way (Occupational Safety and Health Administration, 2009).
Here the help of federal agencies can not only save a lot of time but they can also make the process a lot easier as, they would have a lot better information of the aviator sector and thus, with the help of them the employees in the aviator sector could be administered in a proper way (Occupational Safety and Health Administration, 2009).
Multiregional coordination of resources at the time of a pandemic event: it is very important that assistance from the federal government is asked for as it would ensure that the medical and other necessary supplies are being distributed in a proper manner and that these supplies are reaching the required people (Occupational Safety and Health Administration, 2009).
A proper plan is very important here as, the supplies especially the medical supplies can be stocked since, they have a shelf life, therefore, there needs to be a system that would ensure that the supply chain hasn’t been affected because of the pandemic and this is where the federal agencies can play a very important role (Occupational Safety and Health Administration, 2009).
Employee networks and union regulations in the planning process: Although it is true that a pandemic doesn’t take place every other day, however, it is still thought that it is very important to make proper plan and adjustments in case it does occur. Therefore, proper planning about dealing with a pandemic also includes involving the union workers so that the employees can develop a better relationship with each other, this can be done by including clauses in their contracts telling them what to do at the time of a pandemic. In this way everyone would know their jobs and duties rather than not understanding what to do and where to go (Occupational Safety and Health Administration, 2009).
In this way the aviation staff would know which flights and what cargo they have to supply and to what places and which employees they need to keep at what time, in this way they would function in a very efficient manner and would keep the supply chains network running (Occupational Safety and Health Administration, 2009).
Modifying operating standards during a pandemic event: In case of pandemic when so many lives are at stake it is obvious that operating procedures would need to be modified for a short period of time as, they would ensure safety. However, it is at times like these that it is very difficult for the companies to decide what sort of changes to make and for how long, therefore, the federal government should overlook this process as, it would be able to implement it not only in a better way but they will also know the correct time duration for which a procedure like this should be in place (Occupational Safety and Health Administration, 2009).
Importance of free, consistent and lucid communication with and amongst employees across all processes and domains of the aviation industry: It has been realized by the authorities that it is very important that the employees in the aviation industry have a continuous communication among them in a situation such as, pandemic. The reason why the authorities are supporting this idea is the fact that they believe that continuous and healthy communication would discourage any sorts of misunderstandings and rumors, which would ultimately improve the work efforts which are very important at a time such as, pandemic (Occupational Safety and Health Administration, 2009).
Staffing levels during and after an event: During a pandemic event there is every chance that the staff would decrease in number which ultimately means that after the crisis is over there is a need for new employees. Therefore, policies need to be reconsidered along with the benefits and salaries of the employees. These are all the factors along with many others that need to be considered by the aviation personnel hiring or planning to hire the new employees (Occupational Safety and Health Administration, 2009).
Section 7: Economic losses from previous pandemic outbreaks (from the infective tuberculosis to the German E-Coli)
Although it is very hard to estimate or predict the extent of damage caused by a pandemic in the long-run such as, on the per capita growth outcomes but it is clearly obvious that the short-run effects of such a situation are always negative. The extent of damage caused by a situation like this depends on the duration of the pandemic, the amount of deaths it has caused and it also varies from place to place, however, their effects are still very negative.
These negative effects can be clearly seen from the example of SARS. Although there were very few people who died because of SARS and its duration was also for a relatively short period of time but in its short-run severe economic effects were faced and felt in a lot of countries. For example, it was estimated by Lee and McKibbin (2003) that in 2003 Hong Kong lost approximately 5.5% of GDP. It was also observed by other experts that there was a decline in the GDP from 1/2 to 1% in 2003 in the East Asia because of SARS (Economic Roundup, 2003).
Therefore, it can be clearly understood from the above mentioned example that even a small scale outbreak can affect the short-run economy on a global scale. It was noted that the affects of SARS were felt in Australia as well, as the number of the Asian tourists decreased in 2003.
In order to understand the short-run economy it is better if we relate it to our government, firms and households. For example, our households consume the imported and domestic goods, provide labor, save and invest whereas, the government provides us with the framework for our economy, imposes taxes, ensures proper redistribution of wealth and the firms hire laborers, invest in projects manufactures good for domestic consumption as well as for the import.
Therefore, all these above mentioned things add up to our GDP at the end of the day. In the next part of our paper we will discuss the affects that the pandemic has on various sectors and mainly we will discuss this in a scenario where the death rates are very high however, in some sections we will have a discussion by keeping in mind a scenario of low death rates.
One thing that would immediately happen after a pandemic is the reduction in the labor provided by the households. There can be three reasons for this:
One, deaths of the people;
Second, the people getting ill or infected;
Third, the social isolation or maybe the reluctance of the people on their own in order to avoid getting infected by mingling with other people.
The effect of a pandemic would also be on the consumption of household as, in case of deaths there will be permanent reduction in the consumption whereas in case of illness there will also be temporary reduction. However, the temporary reduction can increase a lot in the places such as, the tourist attractions because of the decline in the number of tourists.
Housing investment: housing investments will get effected in such a way that there will be a decline in the construction of the new dwellings as well as the fact that the prices of the houses and other household assets would decrease as, there will a lack or decline in the demand of those products.
The firms would get affected in a lot of ways by the pandemic such as there will be a reduction in the labor due to the decline in the household labor. The firms might get shut down because they get quarantine. Also, there will be a lack of demand in the products being manufactured by the firms as there will be a decline in the consumption of goods.
Wages, prices, labor market
Initially when the consumptions of the goods and products decreases in the pandemic event, there is a chance that the prices would fall as there will be less demand. However, afterwards the prices might increase for short-run when the people will start hoarding, they might further rise if the firms get shut down and there is a fear that the goods and products would get shot. However, the prices of the goods and products mainly depend on the level of demand.
The effect of a pandemic on the wages mainly depends on the rate of reduction in the demand of the labor and the actual availability of the labor. Initially when the death will be very high and there will be a shortage of labor the wage rate might increase however, later on if the firms get shut down and the demand for labor decreases the wage rate might decrease.
There is a possibility that the exchange rate will get affected in the pandemic as well. However, the effect that the exchange rate will have mainly depends on the extent to which the pandemic has affected the countries and the relationship that those countries have with other countries.
The financial sector will get greatly affected by a pandemic as; the businesses would face a lot of economic losses which would cause a lot of disturbance in the world on an economic level.
In case that there is a serious pandemic, it would not only cause the re-evaluation of some of the asset classes which would affect the bank-sheets etc., but it will also result in the difficulties that will be faced by a lot of businesses in fulfilling their financial commitments.
All these domestic effects can cause a lot of problems in the business world on a global scale and thus, can ultimately affect the financial flows and exchange rates.
Public services and government is one sector that would definitely get affected in a pandemic as, the public services’ main concern would be to provide the people with the medical services and to ensure the proper distribution of the medicines. Also, the funds for the health care would increase in a scenario of this sort.
The government would get affected by the pandemic in such a way that there will be decrease in the tax revenues, the spending would increase as all the medicines and health care is needed because of which there will be budget deficits.
Some other jobs carried out by the government that might get affected are regarding the monetary policies and the financial sector.
The global effects of the pandemic faced by the world will be a lot similar to the ones faced by the domestic economy. The trade flows, both the imports as well as the exports would decline not only because of the deaths and illness which would result in the decline of labor but also, because of the shutting down of the transportation networks in the hopes of containing the infections.
These above mentioned reasons along with the fact that the there is going to be a global decline in the demand for goods and products the exports would suffer a lot. This is the reason why it is said that the pandemic would affect the places all around the world as, all the countries will have to face its side effects even if they do become lucky enough to stop the disease from entering their respective countries.
The imports will also get affected along with the imports, as, there will be a decrease in the consumptions of goods as well as investments, and this would result in lower imports. However, this decline in imports would offset the disturbance caused by the decline in exports to some extent. Another reason why the imports might get affected is the disruption of the trade shows. However, this decline in imports can cause some problems as; the domestic goods can’t always substitute the foreign goods.
Today the companies across the borders have linked their production chains to such an extent that the shutting down of transportation in case of pandemic might cause them a lot more loss than it would have in the past. Although these companies can divert to some other companies in the countries where the pandemic isn’t that bad however, if those other countries have been quarantined as well then these companies would face a lot of loss depending on the duration of the pandemic.
Section 8: Steps taken by Governmental institutions in the Unites States
The role of Federal Aviation Authority
Transportation department had become Federal regulatory group over the transportation of U.S. air and the agency that was responsible for transportation department was FAA. Its responsibility was directly to oversee the functions of the U.S. airports. Airport certification was to be revoked by FAA (2004) if work was not done accordingly. These rules to govern the airport operations of U.S. were fixed by FAA (2004). According to the regulation, all airports were supposed to adopt a plan for emergency situations which would be according to the FAA Advisory Circular 150/5200-31A: Airport Emergency Plan (Federal Aviation Administration [FAA], 2009b). This was to tackle the situations of emergencies in a better way. The departments and organizations were give guidelines about the areas of their responsibilities and were given the required authority. A particular format was not prepared by FAA for the Airport Emergency plans but there were certain important areas that a plan had to cover. These were (a) introduction, (b)purpose, (c)definitions, (d)assumptions and situations, (e)logistics and administration, (f)maintenance and development plans, (g)operations, (h)distinctive planning concern, (i)maintenance and development plans, (j)references and authorities. The emergency plans of American international airports had these similar sections (Greater Orlando Aviation Authority, 2009).
The airport personnel were supposed to be trained so that all nine of the hazardous areas could be mitigated at the FAA airport (FAA, 2002). Even though the particular hazardous sections were assigned with their major responsibilities, still each airport was made responsible regarding the duties and decisions regarding each section by FAA. It was stated in the Airport Emergency Plan that the previous responses of the organizations was splendid when they faced emergencies, still there are some problems that area faced by overall management in such a situation. Problems that are faced include merging of different organizations, agencies and disciplines that were not habitual of working together (FAA, 2009b, p. 6-3). Chances of success were to increase in the event of communicable disease when there is proper planning, training of the involved people and proper implementation of the plan (United States Fire Administration, 2006).
The FAA outlined clearly, various fundamental operations within each and every particular risk area: direction and management, lucid communication structures, monitoring and relevant alerts, emergency public database, precautionary and defensive measures, implementation of established regulations, emergency and fire exits and alternative exits, health allowance and medical facilities, asset administration, airport functions, and sustenance. The health and medical department outlined the requirements for controlling an infectious disease which included the number of commuters onboard of the largest airplane, all utilizing this service. It also outlined the requirements for medical supplies and equipment from the Disaster Medical Assistance Team and National Disaster Medical System (FAA, 2009b).
The Federal Authority released CertAlert 09-09 which required airports to assess their epidemic and infectious disease response systems. The CertAlert suggested that airports should follow the Centers for Disease Control (CDC) approximation of 30% decrease in staff in order to deal with sick leaves. The Federal Aviation (2009a) also suggested that airports should embed best practices into their systems along with plans presented by: CDC; International Civil Aviation Organization; Department of Homeland Security, referencing the Pandemic Influenza, Preparedness, Response, and Recovery Guide for Critical Infrastructure and Key Resources (Department of Homeland Security, 2008b); and airport associations, referencing the Airports Council International (2009), Airport Preparedness Guidelines for Outbreaks of Communicable Disease.
CertAlert 09-09 (FAA, 2009a) was replaced by the restructured CertAlert 09-12 (FAA, 2009c) because it contained information about how to manage epidemic flue. The only major difference between both CertAlerts was the approximation of staff reduction. The CertAlert 09-12 increased their approximation from 30% to 40%. The new CertAlert notification outlined that most of the responses received due to CertAlert 09-09 were because of emergency situations. The CertAlert 09-12 added in its reference the Department of Health and Human Services, Department of Transportation, and Occupational Safety and Health Administration.
The role of Department of Homeland Security
A notification from The Department of Homeland Security (2008b) included a segment which focused on the various deficiencies in aviation: a) essential services, (b) integral resources and tools, (c) integral supplies, (d) integral employee and union factions, (e) integral and important interdependencies, (f) legal and administrative policy problems, and (g) influences from the social mitigation strategies. The CDC and The Department of Health and Human Services were recognized as the principal source for more info.
A look into the essential services distinguished the differences between essential and non-essential services. The operations at each airport should definitely posses all the basic and support equipment to sustain each important operation, as well as be able to support essential equipment in case of an epidemic for as long as 3 months. Essential supplies also outlined the need to maintain for 3 months, suggesting holding onto supplies adequately (Department of Homeland Security, 2008b). As the United States Fire Administration (2006) pointed out, the only material that responders would have at their disposal would be the ones which were acquired earlier, since the distribution systems would be very limited. The Department of Homeland Security (2008b) demonstrated a requirement for protective gear equipment and workplace safety, citing the CDC, Food and Drug Administration, and Occupational Safety and Health Administration for further information. Regulations and plans to manage employee safety should have been created and put into practice, along with vaccinations, disinfectants, and protective equipments (GOAA, 2008a). The Occupational Safety and Health Administration (2007) pointed out that healthcare employees are the most vulnerable group of people with the preference to receive vaccinations; however, only 40% of this group was vaccinated in 2003.
Role of the Occupational Safety and Health Administration
As a response for pandemic influenza, the Occupational Safety and Health Administration (2009) supplied regulation for healthcare workers, offering preparedness, a clinical control, infection control, and other unique standards. Distinction was made amid droplet, standard, airborne precautions and contact, by the infection controls section. Recognition of standard precautions was for the utilization in all patient care, defending responders from blood, unattached skin, mucous membranes and bodily fluids. Protection towards hands and face for coughing and sneezing patients, and usage of soap or alcohol-based cleaners and water before and after the utilization of personal protective equipment, would have helped in the achievement of that approach. Operating procedures were incorporated for disinfecting treatment areas, patient care equipment and surfaces which most probably would have been infected. Towards contact with patients having an easily contagious illness, the contact precautions were pointed out. Restricting patient movement, putting on standard personal protective equipment before getting into patient care area, and separating the patient from other individuals were some inclusions in those precautions.
Keeping the individual in a separate area, the utilization of surgical mask was an inclusion in droplet protection which was put on closer than a range of 3 feet of a patient carrying a contagious illness that was spread by large particle droplets. Keeping the individual suspected to have a serious illness in a negative pressure room, or in a separate area in case of unavailability of a negative pressure room; these form parts of airborne precautions. The room should have bathroom and washing amenities inside it, and should have doors for entry and exit when unoccupied and the personnel held in the room should be restricted to merely those required using NIOSH N-95 certified particulate respirators (Occupational Safety and Health Administration, 2009).
The role of the Food and Drug Administration
Under the Federal Food, Drug, and Cosmetic Act, clearance of personal protective equipment products for consumption by emergency response personnel was the duty of the Food and Drug Administration (2006) which was the U.S. agency. The Food and Drug Administration, after clearance of a product, kept a database of permitted products and manufacturers, tracked medical device problems, and made certain the proper manufacturing practices. Issuance of Emergency Release Authorizations was also under their power. Given that a particular criterion was met, the action would even permit the utilization of vague medical products. It even confirmed suitable diagnostic testing procedures and also released stockpiles of medicines.
The role of the National Fire and Protection Association
The requirement of the fire department to appoint a Health and Safety Officer, in order to administer the infectious disease program, was recognized by the National Fire and Protection Association (2007a). The personnel to be appointed should have received training in administering the process, by appropriate use of personal protective equipment, as per the National Fire Protection Association (2005) requirement. An Infection Control Officer was suggested to be appointed to administer the program and possess sufficient understanding on; personal protective equipment, identification and screening, post exposure management, immunizations, and health effects education (NFA, 2005). The plan requiring several actions utilized worker groups as an active resource, as stated by the Department of Homeland Security (2008b); though, worker sick leave usage would have estimated about 40% absence. Highlighting the workers being serious to continue vital functions and to classify their accountabilities was the initial action to be accomplished in this area. Various factors affect firefighters’ contribution during a pandemic, as stated by Delaney (2008). These include sufficient and satisfactory supply of personal protective equipment, workers compensation coverage, safety and concern for family, developed plans, and accessibility towards pharmaceutical interventions (NFA, 2009).
Role of Airport Authorities
As various agencies have some level of accountability throughout various phases of the travel process, therefore vital interdependencies were also serious at airports. Stating that airport operators would have recognized the necessities and synchronized with every agency which would be mandatory during a pandemic operation at the airport, the regulatory and government policy issues stressed the legality of the process (Department of Homeland Security, 2008b). “The coordination and communication among all groups, along with recognition of the roles and responsibilities of all groups are critical” (p. 18), was declared by Turnbull (2007) under procedures for managing responses at airports during a pandemic event. By representing that mutual aid alliances and coordination with the different social groups and community partners were important in order to make certain that community was suitably protected, the National Fire Protection Association (2004) demonstrated the significance of the operations section of the emergency service providers.
The CDS template and all of the E-net plans (American International Airports [MCO], 2008b; Massachusetts Port Authority [BOS], 2008; Miami International Airport [MIA], 2008a; Detroit Metropolitan Wayne County Airport [DTW], 2009; Washington Dulles International Airport [IAD], 2009; Fort Lauderdale/Hollywood International Airport [FLL], 2009) recognized; (a) public affairs, (b) airline and conveyance captain, (c) emergency management, (d) Airport Operations Center, (e) Transportation Security Administration, (f) emergency medical services, (g) CDC, (h) local public health, (i) Customs and Border Protection, (j) law enforcement, and (k) health care facilities, as having accountabilities during a communicable disease response. Immigration and Customs Enforcement, FAA, and volunteer organizations were specified in the CDC template, and Federal Bureau of Investigation was a stakeholder in the plans of MCO (2008b), FLL (2009), MIA (2008a) and DTW (2009). Under the Airport Operations Center on the CDC template, the Airport Operations roles were listed, and in five of the six plans; though, DTW demonstrated Airfield and Landside Operations in lieu of the Airport Operations Center. Apart from the basic security service from the airport law enforcement agencies, MCO and DTW proposed a separate mechanism. MIA and FLL were only observed mass transit plans along with IAD (2009), which was the single mechanism for communication departments’ role frames. The mechanism of CDC was not a part of public affairs however it was included in the other E-net plans (Greater Orlando Aviation Authority [MCO], 2008; Detroit Metropolitan Wayne County Airport [DTW], 2009; Fort Lauderdale/Hollywood International Airport [FLL], 2009; 2008; Miami International Airport [MIA], 2008a; Phoenix Aviation Department [PHX], 2009; Washington Dulles International Airport [IAD], 2009).
Initially, following options were considered
1. Aircraft risk management and firefighting;
2. Aircraft risk management and airport operations;
3. Airport security for customs of international passengers;
4. CDC department for global migration security and issues;
5. Medical risk management facility;
6. Law enforcement services.
A critical analysis on implementation of these guidelines by the aviation industry
BOS (2009) was the only response group initially which did not include the affected airline. The medical risk management and security management was included in the responses of the studies conducted by FLL (2009), IAD (2009), and MCO (2008b). FLL also served the transportation security service while MCO and IAD committed to emergency health security and medical services. DTW (2009) availed facilities from Department of Homeland security. The response groups who participated initially made up most of the larger response group, which also included state departments of states and counties for emergency medical services, the FBI, and transportation security administration in all plans of E-net but BOS. IAD proposed a staff for public safety and emergency centre operations. MCO availed services from Orlando fire department and Orange county fire rescue while five of six plans under E-net included accident reporting and information using the National incident management System (Fort Lauderdale/Hollywood International Airport [FLL], 2009; Detroit Metropolitan Wayne County Airport [DTW], 2009;Massachusetts Port Authority [BOS], 2008; Miami International Airport [MIA], 2008a); Greater Orlando Aviation Authority [MCO], 2008b).
BOS (2008) mechanism commanded a list of operational agencies to develop operational facilities for Cruise ship and aircrafts carrying flights both domestic and international. Following are the proposed agencies along with their purpose of command:
1. CDC for flight quarantine and isolation for domestic flights for medical security;
2. CDC department of Global migration and Quarantine was availed for services by medical service manager;
3. Medical assessment of international passengers before initiating their purpose of visit was facilitated by Customs and Border agency;
4. Safety and security was facilitated by the law enforcement agencies;
5. Aircraft and cruise ship managers supported incident operations and general operations on single command.
Greater Orlando Aviation Authority proposed MCO (2009) to control, manage and supervise departments and their operations during accidents or incidents of high priority under risk management, which are as follows:
1. Traffic control tower;
2. Aircraft risk management and firefighting
3. Landing operation at ground
4. Airline operations
5. Orlando Police department for incident security
6. Risk management – general
7. Construction, handling and environment
A research done for airport landing facility, named Landing NIMS (National incident management system) Compliance for FAA Airports under category Class One (Kann 2008), developed a list of departments that would become mobile during the emergency handling at MCO. These departments included:
Airport operations management;
Fire rescue service;
Law enforcement and security;
Control management and handling;
Public information and ticketing departments;
Risk management and material management
Kann (2008) also proposed level at which these departments will become mobile to provide swift services at a high priority incident.
Underlining the airport security and health facilities Airport council international (2009) devised a guideline for airport operation departments to make public welfare and health guarantees. These guidelines did not frame a law or regulation but proposed recommendations considering different conditions in different locations. It was focused to prevent possibility of spreadable diseases through people and staff under the conventions legalized by World Health Organization to encompass risk management.
World health organization developed a recommendation list for airport operations which airport operators will be liable for:
1. Luggage monitoring
2. Transportation monitoring and security
3. Sanitary cleanliness and tidy environment
4. Hygienic environment
5. Communication management especially at incidents
6. Supervision of all departments and information sharing
7. Communication with national focal point
Airports council international focused that communication and interaction through monitoring and risk management projected a better management of communicable disease control. This operational objective can only be realized by making a single point of direction in the case of communicable disease event and hence enhance their need to be a coordinated appointment of such a focal point directing the operations. This point of focus should have directions for:
Local public health coordination
The screening procedure was developed for international travelers having established communicable disease, severity and cost.
Due to its sensitive nature, screening has been done using different methods and procedures to envelope all logically important information. Accordingly with the communicable disease, different method of screening including visual inspection, temperature sensing, and questionnaire are used. World health organization has been researching and developing new screening techniques to result into most logical findings according to the considered form of epidemic, its source and subject (Airports Council International, 2009).
According to Department of Homeland security documentation (2008b), the U.S. state department sectioned the screening process into different stages while catering a pandemic influenza incident: contain, mitigate and control. However it was unclear about how these steps would go in the CDC (2000) documentation.
In the U.S., public health and entry/exit control mechanism for international passengers at the airports during the Pandemic influenza period developed an operational system for screening procedure with the help of Department of Homeland Security, Department of Health and Human Services and Department of Transportation (Centers for Disease Control, 2009). This standardized plan was motivated by an operational requirement from Department of Health and Human Services and Department of Homeland security to appropriately tackle the influenza spread in U.S..
Later, the Department of Transportation was also made part of the operational management of handling international flights at the airports along with Department of Homeland Security and Department of Health and Human Services. Department of Homeland Security acts as a Border agency securing the inside from external disturbances. On the other hand, Department of Health and Human Services aims to make medical facilities and security an ensured policy for all locals. Moreover, Department of Transportation fulfills the role to monitor transportation security system of the state.
State advisory on Pandemic events develop strategies for controlling, prevention, management and recovery in high priority conditions. Strategies were designed catering each locality differently. The basis of these strategies comprised of the following risks:
People may get infected unknowingly
Possibility of multi-disease outbreak
High demands of sudden outbreak
Possibility of lack of vaccines and medical facilities
Disruption in social structure
Disruption in transportation facility (Department of Health and Human Services, 2005)
According to CDC documentation (2009), recovery activities will commence within 48 hours of call. The receiving service of international flights and airports operations will stay intact until called upon, however, there were 19 locations with airports having risk management sectors already in place. Development of local staff and operational staff to cater responsive activities was also recommended by the documentation. Screening procedures were monitored and operated under number of agencies including Customs and Border protection Department of Transportation, FAA, operations staff, emergency staff, the Airline Company, law enforcement agencies, medical staff and laboratories.
The screening procedure was layered into two sections where the primary section was a low sensitivity section which screened the people at a lower level determining a rough issue, this issue was then critically determined under secondary screening section. The primary screening section includes general procedures including; health information; visual inspection; questionnaires and medical certifications, environmental effects; and passenger history for airline travel; (Centers for Disease Control [CDC], 2009). Passengers established ill were moved to secondary section for critical screening.
Secondary section included patient illness determination; infection control; physical inspection; medical and travel history; long-term contacts notice; information sharing by normal staff to secondary section staff about the issue, in severe cases, patients were escorted to hospitals.
In the primary section, the primary operational staff would carry out visual inspection, question answer with passenger, health declaration, entry exit time, perspective about health regulation and screening procedures from the passengers.
It was suggested to develop a risk management department to tackle events of high priority making sure to control and monitor all departments that are responsible for public welfare, health and security. After the secondary screening passengers would be allowed to travel according to their wish and ill passengers if any, will be moved to quarantine facilities.
It was advised that airport operations for quarantine should develop screening service not only for passengers but also for cabin crew. Along with these following were to be guaranteed:
1. Identifying passengers with illness records or persisting illnesses
2. Assigning travelers to quarantine sections
3. Monitoring screening facility security
4. Taking care of airport schedules
5. Arranging facilities of compensation and secondary flight
6. Communications management and information sharing
7. Providing correct health and medical facilities;
Brigantic, Delp, Gadgil, Kulesz, Lee, and Malone (2009) proposed a mechanism for screening operations in the U.S. airports. The reports suggested that about 12000 passengers passed undetected through the primary screening that were infected. It stated that 50% of the passengers passed through the screening process which did not help in controlling the influenza spread.
The exercise document outlined by MIA stated the procedure of secondary and primary screening of different international flight passengers. According to this document, primary screening area related to health must have reviewed the forms related to health declaration, terminal scan and visual exam. Passengers who are travelling from places where pandemic influenza exists, along with symptoms and signs of illness similar to influenza, short or long-term contacts with an ill passenger or person, elevated temperature, will be transferred to a secondary screening area. In secondary screening area, a complete review of his health declaration form will be conducted along with complete clinical examination. Individuals who have been found ill will be transferred to a medical facility, along with his close and long-term contacts quarantined. However, individual not determined ill after completing their screening for secondary screening area will be escorted to cohort out-processing area. Cohort area is designed for: determining travelling time; collection of health related forms; distribute antiviral and also observe the therapy; and provide health information, announcements, information related to condition and legal forms. All the passengers of a particular flight are kept in cohort area until all the passengers are processed through secondary and primary screening (Miami International Airport [MIA], 2008b). This Mia exercise procedure is also supported by the screen plan provided in CDC (2009).
Airports Council International (2009) stated that screening travellers departing form affected countries would most likely produce positive outcomes because, it is least likely that travellers exhibiting symptoms and signs in affected area will produce false positives. Therefore, departure (Exit) screening is less troublesome for societies and travellers and in case required, passenger will be undertaken as the plane lands at the airport, i.e. before the passenger passes through airside (p. 4). International border entry screening was found to be disruptive, expensive and the impact on spreading disease through global gateways was minimal. However, this technique can be utilized when there is a need indicated through epidemiological data or for islands. When exit screening or surveillance is not at its best in affected regions then, entry screening of the passengers should also be considered. If screening activities are determined necessary by the authorities, then costs that are associated with procurement of airport space, screening equipment, and also infrastructure support has already been allocated by the authority
According to Pandemic Influenza Plan, any indication of sustained human to human short or long contact, anywhere around the globe, would trigger U.S. pandemic response, which would be in accordance with the guidelines provided by W.H.O. Secretary of Department of Health and Human Services has been authorized by Public Health Service Act, to take appropriate steps and if necessary they could also declare emergency for public health. This includes, allocation of expenses, grants, supporting and conducting investigations and getting into different contracts. Moreover, it also allows Food and Drug Administration, to allow use of unapproved product for emergency use and also allow for unapproved utilization of approved products (Department of Health and Human Services, 2005).
Travellers considered to be at high risk for infectious disease, during screening, are transferred by medical authorities to a secondary screening area. If medical authority, after examining the traveller which was thought to have an infectious disease, makes positive assessment of infectious disease, that may have high health threats, then appropriate measures are to be taken and the traveller should not be allowed to leave. Quarantine and isolation facilities, as stated by Airport Council International (2009), should be established, by public health authorities, away from airports and also legal complications should also be taken into consideration, refer to the W.H.O. (2005) Article 23. IHR advised that, departing or arriving travellers may be required by the state authorities to provide: information related to future follow-ups, details related to concerned areas where traveller may have been, health documents, and providing approval for medical examination of non-invasive nature. Further, it also authorized state authorises to inspect conveyances and baggage. It is necessary that consent related to medical examination and other health related measures are taken prior to procedures, with an exception that is noted in Article 31. It is also stated that, travellers should be medically examined through least invasive ways and all follow-up procedures should also be in accordance. State authorities may compel travellers to undergo least intrusive and invasive medical examination which may include; (a) prophylaxis, (b) vaccination, (c) observing public health, (d) quarantine, (e) isolation. State authorities are also authorized to deny entry as stated in Articles 32, 42, and 45, in case traveller refuses to undergo medical examination of non-invasive nature or other procedures (World Health Organization [WHO], 2005).
As indicated in W.H.O. Articles 32, 42, and 45, state authorities must take into consideration the travellers’ dignity and rights; also take appropriate measure to reduce discomfort by taking factors like social culture, ethnicity and gender into account, and provide food, accommodations, clothing, water, means to communicate and protection. Moreover, all medical information must be kept confidential; however, in case there is a threat to public health the information may be disclosed. These articles authorise state agencies to conduct medical examination; if they find any risk to public health, as a condition on the travellers to enter the state. Conditions regarding entry are stated in Annexes 6 and 7 and Article 43. Regulations stated in Article 43, allows state authorities to take appropriate measures according to national laws, on condition that, they are greater than or equal to the health protection as suggested by W.H.O. According to Annex 6, prophylaxis or vaccination should be of appropriate quality, and Prophylaxis or International Certificate of Vaccination should be completed without deviating from the format. Yellow fever is specifically identified in Annexes 7, as an infectious disease, for which a traveller is required to show a vaccination certificate or must receive a prophylaxis as an entrance or exit condition (WHO, 2005b and 2004).
Legal information provided by Congressional Research Service (2009) shows that, airlines are not obligated to provide transport services to someone only because he has a ticket. There is a contract clause that allows Airlines to deny travel. Moreover, CDC and Department of Homeland Security have developed a restriction tool known as Do Not Board list. As stated by Airports Council International (2009), individuals with a known infectious disease that poses high level health threat, will be indentified and restricted to board the aircraft or arriving in U.S. airport. Aircraft coming to U.S., with suspected infectious disease, will involve several steps before the arrival of the aircraft; (a) landing of aircraft, (b) availability of facilities, (c) ventilation, (d) and accessibility of public health personnel. Travellers who are thought to be affected by the disease will be escorted to an isolated area for additional examination. Moreover, there must be a plan for customs, security clearance and obtaining baggage for the infected travellers who are to be treated/evaluated, in a facility away from airport.
Passengers travelling should be allowed to get off the aircraft immediately after public health inspector has assessed the situation. Until information related to seating assignments is obtained, crew members and travellers who may have been exposed to contagious elements must be kept separately from other passengers. Each individual must be provided with the information related to disease and potential precautionary measures. In the end, Airports Council International (2009) advised that airport operators must test attentively through different exercises and also recommended to contact, International Civil Aviation Organisation, International Air Transport Association and WHO for further information.
IHR was enforced by WHO (2005) on 15th June 2007, to protect against, prevent and control global spread of infectious diseases, in a way which is limited to health safety of general public and avoid any kind of unnecessary intervention with international trade and traffic (p. 2). United States has accepted the IHR; however they hold some reservations that are to be completed in accordance with the U.S. Constitution. For response and surveillance, few initial requirements have been outlined by WHO. Under this regulation, state parties are directed to utilize existing national resources and infrastructure to meet these requirements. These requirements, as stated by WHO include: the provision of safe environment to the travellers and immediate medical care and assessment should be present at the airport; trained personnel should be present to investigate conveyances; and, local public health should be able to — assess expected level of spread, gather and report necessary information and should be able to implement preliminary measures when necessary.
According to U.S. national plan, there are three main objectives of pandemic response: stop, slow or limits spread of the pandemic disease to U.S.; limiting national spread of pandemic disease; and also taking into account its impact on economy. It could be observed that aviation sector have a major role in all these areas, as it is a key component that involved airplane to carry potential sick traveller (Homeland Security Council, 2006). According to Turnbull (2007), during pandemic situation, tourism slow down and carriers which are heading towards vacation destination experiences decline in the number of passengers.
State of Florida Department of Health have outlined an approach, in case of infectious disease spread and formed a lead group, namely Emergency Support Function Eight (ESF-8) which will be handling public health threats. They have listed trigger events which will be result in activating plans under recovery, response, and preparedness activates, with the help of state bureau’s input including local public health. Department of Local public health is responsible for preparedness by testing and developing a response plan and assessing with healthcare resources including planning contingency plans. It is evident that, local public health is responsible for developing and implementing local plans. However, recovery trigger shows that there are no responsibility objectives of local public health.
To develop WHO technical Advice in Case Management of Influenza A (H1N1) in Air transportation, recommendations from International Civil Aviation Organisation, International Air Transport Association and WHO, are complied, which was latter formally accepted and adopted by World Health Organisation. It provides guidelines for staff members in planes or during flight, if they have suspected a person with an infectious disease. Moreover, it guides flight crews to ask for medical support, inform pilot and fill passenger locator card. According to WHO (2009), for the protection of aircraft passengers, the appointed pilot finished the general declaration of health sector of aircraft and alerted the Air Traffic Control. The airline and Air Traffic Control mutually alerts the local public health and operation sector of the airport.
It was declared by the International Air Transport Association (2009) that the reaction of the air carrier and nations plan should be parallel with each other. A quick contact was made between the air carrier and the Operations Control Director when they felt the emergency in the received information. After that Operations Control Director guided the airline Emergency Response Team to make contact with the responding agencies and find out how speedy the response needed to be. A medical airline representative is made to contact with CDC and local public health team and deal with airline equipment, quarantine, or disinfecting needs. After that it was assured by the airline representatives of each airport that the local information and airline Emergency Response Centre had a continuous chain of contact with them. This gathered information and data of each passenger was saved for future purposes by the representatives. They also shared it with custom authorities for better use afterwards.
An external contact was made among the customers and media with the airlines by coordinating to the health management team, airports and other sectors for the confirmation of accurate message delivered. The employees of the airlines were already guided that in case of such emergencies of diseased or infected people, they must keep the passengers to be seated till the local public health arrives in spite of the presence of the medical aircraft team. Before landing on the airport, all the passengers, crew, luggage and freight must have been refrained from being unloaded until it was permitted to do so by the CDC or local public health. Quarantine measures and other issues related to luggage and freight would have to be resolved by the local airline representatives. It should also have been considered that there must be opening of a local passenger or friends and family centre. According to International Air Transport Association (2009), it was the responsibility of the airline maintenance team to disinfect the aircraft first and then deal with cargo issues. It was all detailed in the guidance and regulations ordered by the airline medical representative. WHO (2005) stated that the transportation department should have facilitated the following issues with coordinating with the IHR:
Providing medical check up on the aircraft board
Applying necessary health measures
According to WHO (2009), the following activities were imposed from them on the local public health to be performed during arrival at the airport:
Proper notifications should be made
Provide medical facilities
Potentially infected passengers should be transported to quarantine, isolation, or treatment facility, far away from the airport
All trained personnel were responsible for pointing out the risk passengers via training health management and authorities of the border agency
Moreover, it is one of the duties to be performed by the airport to tell where the plane can be parked when it is about to land. The landing area could be the aircraft ramp or an isolated location s far off from the airport. During all this, it must be kept in mind that this might result in delay in medical responsive issues and passengers could be hard to be handled too. After all the matter is thoroughly assessed and observed by the public health, then the plane can land on the ramp or any sort of parking area. The next procedure followed is to collect the passenger locator cards from the front and back row and also from the infected passengers. The other passengers and crew members are guided about the infected patients on the plane, the level of their sickness and signs and symptoms of their disease. Moreover, they are asked to call for help if anyone of them experienced it within the following week.
All these plans included the compulsory parts detailed in the CDC template (Detroit Metropolitan Wayne County Airport [DTW], (2009); Fort Lauderdale/Hollywood International Airport [FLL], (2009); Miami International Airport [MIA], (2008b); Massachusetts Port Authority [BOS], (2008); Miami International Airport [MIA], (2008a); Washington Dulles International Airport [IAD], 2009). They also have various sub-categories like:
An introductory section
DTW (2009), FLL (2009), AIA (2008b), and MIA (2008a) included a reviewer’s signatory page
BOS (2008), DTW and IAD (2009) had emergency operations listed as follows:
BOS (2008) included operation that occurred on the spot
DTW covered illness issues and delivered emergency responses
IAD (2009) used operations
CDC template had an operation section in which the sub-sections and two-thirds of the DTW, FLL, AIA and MIA plans contained the following segments:
Parking and gate operations
Response from the plane
Commands offered in the case on any incident
Screening or detention
Issuing release on a condition
Amount of capacity available in case of overloaded passengers
The operation section of the IAD plan included response from the plane, defined areas for placing the affected planes and temporary isolated places. There was no sub-section under the operations of the BOS plan.
Useful information was gathered from various places by making the best possible comparison of the E-net plans and CDC template. CDC template and all the E-net plans (Detroit Metropolitan Wayne County Airport [DTW], (2009); Fort Lauderdale/Hollywood International Airport [FLL], (2009); Massachusetts Port Authority [BOS], (2008); Miami International Airport [MIA], (2008a) and (2007); Washington Dulles International Airport [IAD], (2009)) expressed the same goal i.e. To stop the introduction, broadcast or spread on diseases that could be passed from foreign regions to U.S.. The reviewer’s signatory page included in CDC template and DTW (2009), FLL (2009), MIA (2008a) pointed out that following were required to approve the plan:
Officer in charge of the Division of Global Migration and Quarantine
Customs and Border Protection Port Director
Director of local public health
Director of the airport
FLL added following authorities to the signatory page as well:
Director of Transportation Security Administration
Department of Law Enforcement
Department of Fire Rescue
However, this page was not a part of the BOS (2008) and IAD (2009) plans.
Five of the six E-net plans (Detroit Metropolitan Wayne County Airport [DTW], 2009; Fort Lauderdale/Hollywood International Airport [FLL], 2009; Miami International Airport [MIA], 2008a; Washington Dulles International Airport [IAD], 2009) included the definition section which was composed of the following 15 terms that existed in the CDC template too, they are:
1. Conditional release
2. Communicable disease
4. Contact tracing
7. Incubation period
10. Quarantinable disease
15. Transmission (Hufnagel et al., 2004)
It was made to a total of 18 terms by including the following three aspects in FLL (2009), AIA (2008b), and MIA (2008a) plans:
1. Close contacts
2. Other contacts
IAD (2009) added five more terms and made it up to 23 definitions in their plan, they are:
1. International traveller
2. Passive surveillance
3. Public health personnel
4. Travel contacts
5. Travel companions (also see Colizza et al., 2006)
BOS (2008) included six definitions. Four of them were already a part of CDC template definitions. However, it replaced Detention by Hold but the meaning was kept the same as before. According to Massachusetts Port Authority [BOS], (2008), trigger was a unique terminology that was not included in the definition section of any other plan. DTW (2009), FLL, MCO, MIA, and the CDC template had their background and overview section comprised of following factors:
Signs and symptoms
BOS and IAD did not have those background and overview portions. Despite of that, their other categories was filled with the same information.
Out of six, five of the E-net plans have tackled the responsibilities of emergency operations at the start of their assignments (Washington Dulles International Airport [IAD], 2009; Miami International Airport [MIA], 2008a; American International Airport [MCO], 2008b; Fort Lauderdale/Hollywood International Airport [FLL], 2009; Detroit Metropolitan Wayne County Airport [DTW], 2009). Transportation according to the suitability of medical facility, evaluation of patient and their treatment; passenger locater data collection; and a timeframe of 72 hours for the largest aircraft for the temporary quarantine facility for people present on board; were all different aspects of the plans which were formulated by the local public health and CDC. The assignment in which responsibilities of every agency or individual department was described was utilized by CDC template.
Out of six, five of the E-Net plans showed a consistency in the procedures of gate and parking, unless the passengers who were sick were evaluated by the CDC Division of Global Migration and Quarantine, the travelers had to remain in the designated place of the aircraft (Miami International Airport [MIA], 2008a; Massachusetts Port Authority [BOS], 2008; American International Airport [MCO], 2008b; Fort Lauderdale/Hollywood International Airport [FLL], 2009; Metropolitan Wayne County Airport [DTW], 2009). Leaving the passengers of the aircraft’s board was not specified by IAD (2009) and local public health’s arrival replaced the arrival of Division of Global Migration and Quarantine by FLL (2009). Leading agency for the domestic flights was designated local public health and leading agency for the international flights was Division of Global Migration and Quarantine as stated by the planeside response of MIA (2008a), MCO (2008b), FLL, DTW (2009). In order to approach the aircraft and evaluate the sick travelers and to isolate them and to make suitable notifications, they also showed that they would utilize the personal protective instruments. Procedures to obtain quarantine order, potential bioterrorism evaluation and local public health’s arrival were included by FLL. In order to receive the patients who are having communicable disease, it was required by the Division of Global Migration and Quarantine to activate all the mentioned plans (also see Colizza et al., 2006).
Every single plan of E-net contains the location where the passengers are initially screened and areas are specified for their detention and screening (Washington Dulles International Airport [IAD], 2009), Miami International Airport [MIA], 2008a; Massachusetts Port Authority [BOS], 2008; American International Airport [MCO], 2008b; Fort Lauderdale/Hollywood International Airport [FLL], 2009; Detroit Metropolitan Wayne County Airport [DTW], 2009). A time period of approximately 8 hours holding facilities on temporary basis are allowed as per IAD (2009) and DTW (2009). Responsibility was given to stated local public health against the facilities regarding off site, and a temporary holding transit lounge was specified by MCO (2008b) and IAD. Any limit of time was not specified by MCO but a time period of 72 hours was shown by the IAD for temporary holding. For the temporary holding, one bomb shelter building was identified by MIA (2008a). It was stated by the PHX isolation that until the local public health establishes the facilities of offsite structures, they would segregate a section of their terminal building for the temporary holding (Phoenix Aviation Department [PHX], 2009).
A passenger who is carrying any communicable disease with him can be allowed to travel as per the authorities given to the local public health or the Division of Global Migration and Quarantine by the template of CDC or E-net plans conditional release clause. (Washington Dulles International Airport [IAD], 2009); Miami International Airport [MIA], 2008a; Massachusetts Port Authority [BOS], 2008; American International Airport [MCO], 2008b; Fort Lauderdale/Hollywood International Airport [FLL], 2009; Detroit Metropolitan Wayne County Airport [DTW], 2009). MIA, FLL, CDC template and DTW (2009) approached Division of Global Migration and Quarantine and recognized the surge capacity for assistance of local municipal health care. There were some conditions declared by MIA (2008a), MCO (2008b) and FLL (2009) regarding provisional release of individuals, the Division of Global Migration and Quarantine should contain several facts and relevant information including circulated Health knowledge, illness notice and response, compiled Locator information of passenger, exclusively performed prophylaxis and released individuals who were pursued accordingly. Having said that, FLL further elaborates the pattern as in case of emergency how the concerned Medical services should respond and declared a stipulated time frame of 48 hours for national surge staff to react, Reaction can either be in two-level approachâ€¦preliminary surge by instant health services and LPH [local public health] who can respond on the spot. As far as long-term response strategy is concerned, that is more than 48 hours, to continue operations; a national response would also require the appearance of federal assets (Fort Lauderdale/Hollywood International Airport [FLL], 2009, p. 24).
Generally DTW declared that a national agency response would be necessary in any case which is meant for more than 48 hours stipulated time frame. MCO declared, in case of managing the surge situation, Municipal public Health would ask Division of Global Migration and Quarantine for assistance. A communication segment was bifurcated between International notification and media, declared in FLL (2009), DTW (2009), MIA (2008a), MCO (2008b) and template of CDC template. In order to communicate press releases, the communication segment would utilize an assigned Public Information Officer. The CDC was declared responsible in order to communicate with global partners, with the notification to the State Department, in case of any international flight or passenger held back or quarantined lawfully. A Response Plan was submitted regarding Communications of Public Health along with MIA (2008a) that is primarily a response plan planned to tackle the unanticipated spread of communicable disease. It delineated the features of Joint Public Information Task Force (JPITF) covering a (a) municipal public health care, (b) Red cross of America, (c) Firefighting for Aircraft Rescue, (d) security and communication division of Aviation department, (e) law implementation, (f) Customs and Border Protection public affair, (g) county Operation Centre for Emergency, (h) Security Administration of Transportation, and (i) Division of Global Migration and Quarantine CDC Division of Miami. It was defined in this plan that contact point of primary media was to be done through regional Emergency Operations Center, and contact point of secondary media was to be done through MIA Joint Information Center. (Miami International Airport [MIA], 2007).
International Civil Aviation Organization (2007) indicated various significant areas that it considered mandatory in a response plan of communicable disease for insertion. These included (a) aviation attentiveness plan joined with plan of national attentiveness; (b) all communicable diseases general guidance; (c) federal control system and planning command; (d) WHO direction towards international preparedness cohesion (2005c); (f) structure for municipal public health care notification; (h) interaction system; (i) WHO recommendations for refutation from entry into state, or requirements of health for entry; (j) anticipatory or prophylaxis measures along with airport and airline workers; and (k) obvious contact points, with IHR Articles 24, 27, and 28 reference. The articles highlighted, the transportation operators would be required with the standards of health to assure its compliance as per WHO recommendations (2005c). They were also obliged to maintain if a source of contagion and infection were found on conveyance then the conveyance should be considered as affected by the capable authority. There would be a need to implement the disinfecting activities for conveyance before which a suitable technique needs to be determined to control the health risk of the public (WHO, 2005).
There were various components in air preparedness according to the international Civil Aviation Organization. These components included: to develop plan for exit screening, establishment of contract points, detecting the appropriate position along with the responsibility of implementation, and communication. It had been observed that there is a need for exit screening to take place soon after the travelers arrive at departure airport. The assigned entry points are used by the travelers prior to the point of airside access. Cargo or passenger flow is mostly punctual. The equipment used for screening measure is reliable and the personnel are trained. The travelers do not have to face many delays. A system should be built which would be responsible for assessing the positive screening passengers according to the determination by public health that was local. It includes (a) from the capability of transport to suitable medical facilities, (b) personal protecting equipments, (c) segregated quarantine area available for aircraft and travelers,(d) medical staff,(e) location. Quarantine of many travelers would not be easy and spreading of outbreak could not be prevented after that acute phase. Logistics for the baggage, customers and security had been addressed which included a coherent authorized criteria and the actions that were taken to deny the travel (Hollingsworth et al., 2006).
It was also stated by International Civil Aviation Organization that a method should be established where preparedness could be assessed by the States. This would be done by live-exercises or the table-top. All the stakeholders would be a part of it according to core capabilities in IHR. There should be no consideration regarding the airport closure. If facility remains in outbreak area then the regular traffic needs to be stopped. It was stated by International Civil Aviation Organization that the staff of the airline was not responsible for the screening passengers while there were no external and internal communications to be established. A system for passenger care in case of illness or an emergency was developed to be supervised by the cabin crew and by the airlines. Alongside the main system, it was recommended to report the situation to the air traffic control tower to get assistance in handling the passengers. It is practiced that ill passengers were to be moved to a separate location from other passengers. Hygiene and sanitation during passenger handling was to be assured at every time of the procedure. It was required by the passengers before boarding to fill out a medical history form so that the handling can be done in a better way (Hollingsworth et al., 2006).
For the ground maintenance and in-flight maintenance crews, hygiene and sanitation equipment was allotted by the airlines to carry out cleaning of air filters and waste tanks. The maintenance crew was to be trained by the airline to keep a standardized sanitation and hygiene in the airline, differently in different parts of the aircraft to guarantee passenger safety and medical health. Cargo loading and baggage handling staff were also trained to practice sanitation, medical safety and hygiene during the loading and unloading of the cargo; these recommendations were set by local health department of the airport (International Civil Aviation Organization, 2007).
A manual as a framework to control the cases of spreadable diseases was framed by Department of transportation in collaboration with the Department of Homeland Security and the CDC. According to the manual all the airlines have the guidelines and regulations predefined, however, no such manual on handling and procedures of ill patients with communicable infections and their escorting and handling in the U.S. is defined or available (p. 1). It is noticeable that possible intrusion of an infection in the country is an important and potentially dangerous issue taking national integrity at stake, hence there needs to be a standardized design from the National response framework (Ferguson et al., 2005 and 2006).
HSPD-5 was executed by the President of the United States, directing the Secretary of Homeland Security to create and manage a National Incident Management System, in order to arrange for, react to, and recover from domestic incidents as well as supply a constant nationwide approach for State, Federal and local governments to be able to implement effectively and efficiently in a cooperative manner (Bush, 2003a, p. 3). The acceptance of a National Incident Management System was needed by this directive, so as to get federal preparedness aid. Specifying the way Federal departments and agencies would avoid and prepare for reaction to a terrorism incident, the Homeland Security Presidential Directive Eight (Bush, 2003b) acted as acquaintance to HSPD-5. The federal preparedness aids were classified by it as cooperative agreements, loan guarantees, agency grants, loans, and training (Ferguson et al., 2005 and 2006).
Instead of being familiar to emergency services operations, concentration was directed on the education of individuals with the proceedings of the execution of the National Incident Management System, as specified by Howitt & Leonard (2005). Constructive redesign and revision of IMS principles and practices would require efforts, thus, reshaping the operating conditions of professions that were absent from original participatory work done during spread of IMS (p. 42). Heifitz and Linsky (2002) argued the challenges of affording alteration in distinct kinds of organizations. The only general failure, as declared by them is that adaptive challenges are considered as technical problems especially by people having an authority (p. 14).
According to the Department of Homeland Security (2008a), a Presidential Disaster Declaration generated physical assets and financial assistance through the Robert T. Stafford Disaster Relief and Federal Emergency Management Agency and Emergency Assistance Act. National Response Framework was used by the Federal Emergency Management Agency, who was even accountable for directing government relief attempts. Federal agencies have certain roles and responsibilities which are recognised by the National Response Framework. According to it, whenever any incident occurs so intensely that it is beyond the State’s power, and then federal government provides aids. This in turn imposes chief responsibility on State and local governments to quickly respond to that incident. Collaborating with the National Incident Management System, the National Response Framework offered a scalable structure that can adapt to any situation. It tells the way the U.S. government should and will opt to deal with all occurring incidents. According to it, each sector of government must modify and apply the major rules by:
defining main functions of leadership and staff adopting capabilities-based planning imposing the discipline required to plan and operate in effective manner (State of Florida Department of Health, 2009)
It was the foremost duty of every organization to provide financial support and fulfil its responsibilities in any sort of urgent situation. Welfare of each citizen owes to the Governor of the State. That means if the resources were besieged, it is the duty of the Governor to get aid from other states by mutually consulting them or directly request for urgent assistance from the federal government (Grais et al., 2003).
A research was conducted by the Government Accountability Office (2007) in which the capabilities of federal government were calculated that was required to guide the nation in the time of any epidemic. The positive aspects found were the sufficient presence of:
New vaccine technologies
But it also had various flaws in defining proper leadership roles as given below:
The epidemic not only affected health, but also had worse effects on the infrastructure, economy, security, and movement of goods throughout the world.
The national strategy was not strong enough to tell that how the leadership would responsibilities could work in such situations.
Financial resources were also not defined that were necessary to practically start the plans. This resulted in a gap due to which the local stakeholders were not able to carry out their plans effectively.
A proper plan was made in order to protect the staff that had to deal with a quarantinable disease incident. This would make sure that they know the following aspects:
Necessity of the equipment required for the protection of the crew and staff
Limitations of such personal protective equipment
Proper donning and doffing of those personal protective equipment
Proper care, maintenance, and disposal of those personal protective equipment
A caution was made by the Department of Transportation (2006) that too much overdressing might increase the nervousness of the crew and travellers. There were many responsibilities of the in-flight response team such as:
Planning before an incident occurs.
Airplane parking location.
Determination of who comprised the initial response team.
Providing proper personal protective equipment for suspected disease.
Making sure that responding entities understand the National Incident Management System.
This all information should be passed to the travellers too. So it was recommended to get exact reliable information stated in the template of Centres for Disease Control (CDC).
The airport holding area is always configured on the arrival of every flight, until the quarantine facilities are made available. It is the duty of the CDC and local public health team to supply and make available the quarantine facility. An estimated cost for quarantine of 200 individuals for a time span of two weeks was divided into following 5 major areas by Sensenig and Stambaugh (2008):
1. supplies at $100,000
2. space at $7,500
3. activation at $20,000
4. 24-hour operation at $150,000
5. An additional $5,000 to close out the process
According to above statistical estimated amount, around quarter of a million is required to start and maintain a quarantine facility. On the other hand, it was still not known that who was going to pay for all this. It is in the hands of CDC to issue a quarantine order. But they also have the authority to pick up any home quarantine voluntary. It could be their option as it would be more expensive and a complex approach of choosing a facility.
Hospitals that had a Memorandum of Understanding with CDC must provide pre-designated hospital facilities to make sure that the sick patients are carefully transferred to the hospitals. The local public health must show a way to the responders regarding which hospitals to utilize when there was non-availability of hospitals or there were no hospitals at all in the area with established agreements. Restoration of transportation and environment were areas to judge, as airports were permitted to come back to its usual operations shortly by planning for the recovery from a communicable disease incident (Grais et al., 2003). An achievable incident response to a quarantinable disease event at an airport, as declared by the Department of Transportation (2006), would need, a finely organized attempt by airport operators, local health care facilities and support organizations, conveyance operators, state and local governments, and agencies of the federal government (p. 19).
The determination of authorities for distinct agencies essential in the plan was by the roles and responsibilities needed to be fulfilled, with the inclusion of contact information. Using the National Response Framework, the Department of Health and Human Services, created by the Pandemic and All-Hazards Preparedness Act, was regarded as the chief federal agency for organizing the response of public health emergencies (Department of Transportation, 2006). The foreign and interstate quarantine were regulated in Title 42, parts 70 and 71 (FAA, 2003a, 2003b), thus handing over the authority to the quarantine from CDC the facilities for medically examining, detaining, or conditionally releasing individuals. The determination of a quarantinable disease of public health importance in an incident was also carried out by the quarantine facility.
A person with a communicable disease would travel from one state to another if allowed by health officer of the state, as directed by FAA (2003b). In the absence of a written permit from the Surgeon General, a person carrying plague, typhus, cholera, or yellow fever were not allowed to travel on a conveyance. Military or public health personnel travelling under knowledgeable orders were exempted from this rule.
Staffs that have the duty to serve or escort the asymptomatic traveler were responsible to report to nearest concerned department. The notification included the detention, quarantine, isolation or probation of some individuals which would assists prevention and spreading of diseases. It was also mentioned that medical facilities including vaccinations and their administration and operation were liable to be included in the fee that could be collected at the time of secondary screening.
However, it was stated by the IHR Article no. 40 (WHO 2005, 2005b) that it was not appropriate to ask for a fee for medical administration, examination, vaccination or management of quarantine departments. It was moreover mentioned that additional fee was liable to be added in case of added costs to baggage, cargo or traveling, in alignment with the airline operators.
FAA framed laws and regulations to provide transportation and escorting facility for foreigners on U.S. airports. According to the recommendations, ill persons were defined as the person having any of the three conditions: 100F temperature for 2 or more days; rashes or injuries; glandular expansion; jaundice; pneumonia and Diarrhea resulting in 2 to 3 loose motions in a day. It was required by the captain of the related aircraft to convey the issue as soon as possible to the nearest related personnel in-charge for transportation to nearest facility.
It was stated that an ill passenger escorted or transported to a medical facility in the U.S. will not be further inspected until Department of Health and Human Services or CDC do not propose a possibility of potential threat of outbreak. In such cases, a partial clearance can be given to the conveyance, making detention at any time possible. Similarly, animal fitness and health was to be determined by veteran experts. Infected dead bodies having spreadable diseases were strictly not allowed inside U.S. unless they were put into highly sealed coffins or caskets after being cremated in exceptional cases (FAA, 2003b).
It was to be determined by the CDC officials or DHHS director to inspect individuals which were accordingly sent for isolation, quarantine, staff surveillance, conveyance along with materials that may have potential to cause an outbreak or harm to environment. Passengers noticed for inspection were to provide additional details about their medical history and current destination. FAA (2003b) also required U.S. airports to create a facility, a department that would be used by the government agencies free of cost, who will make sure the screening processes, isolation, quarantine, conveyance and inspection is done on constant basis i.e. 24 hours a day.
In case of any violation of the laws and regulations of the passenger handling, the violator will be liable to be fined from $1,000 to punishment of prison as long as 1 year.
The international traffic and passenger management and passenger handling inside the operational departments of the airport will be supervised by Division of Global Migration and Quarantine facilities which will encompass following tasks:
1. Supervising the screening process and inspecting each passenger with critical surveillance measures;
2. Information sharing and response management in case of high priority incidents;
3. Giving passengers relevant information about screening process and necessities along with health booklets for managing healthy environment;
4. Gathering information about locations from which passengers are arriving, to make arrangements accordingly.
The transportation department (2006) suggested that these rules and regulations need to be a result collaboration and coordination for management, operational and medical facilities by the interaction of airline companies, airport management, customs department, border regulatory agency, Homeland Security department, immigration department, transportation department, law enforcement and health management facility department.
While inspection, if there is a high priority incident related to a communicable disease, the matter is concurrently handed over to medical administration supervised under WHO’s Global Outbreak and Response Network or CDCs Travel and Health Alert Notices (Department of Transportation 2006).
The level of incident determined the level of alert for the travel notices. Following are the different levels of priority along with the situation:
News notice- when various undetermined passengers are reported for a disease
Outbreak notice – when outbreak exists in a specific location
Travel health precaution notice – when outbreak encompasses a larger geographical area. This notice also includes information about regulations and safety for passengers who visit the places.
Travel health warning – when the outbreak reaches an uncontrollable value in a larger geographical location which also might be undetermined. Along with this warning, information cells are opened for passengers if they reach the affected area, and warnings are issued to stop travelling without purpose (Centers for Disease Control, 2007).
Department of transportation (2006) developed a framework, suggesting a mechanism that would come into play in case of spreadable disease incident. This mechanism was operational with the following management elements:
1. Information sharing and surveillance
2. Handing over
3. Response management
4. Recovery and aid
At the airport level, multiple departments may be designed to cater the functionalities mentioned above.
Airport operations management function needs to notify its responsibility to the legal heads of Migration and Quarantine facility, Communication tower, Custom and Border agency and Transport department and Security operations management. Along with the air traffic control, the flight receiving, handling, landing and placement operations were also supervised by operations centre, Customs and Border agency, FAA and CDC. Moreover, it was to be regulated by the Airport operations centre to provide conveyance, transportation, health and medical, passenger welfare and care facility to normal patients and isolation and quarantine facility for inspected passengers or patients.
Airport communication facility was aligned to make information sharing at the time of high priority incidents to the Airport operations centre, Customs and Border agency, Division of immigration, medical operations function, fire fighting teams, law enforcement officials, environmental health facilities, transportation and security administration for handing over responsibilities (Department of Transportation, 2006).
Lastly, medical services department was allocated to cater the local public health and welfare in general, and after the handover was completed in special cases, it was allocated to inspect diseases and prevent spreading of infections. It was also under medical services department responsibilities to treat the ill passengers, handling the passengers from the aircraft, providing notification of patient conditions and information sharing with Customer and Border agency. The jurisdiction of the Department of Transportation (2006) was to supervise entry/exit routes of the aircraft as well the escort facilities for the passengers in operational areas. In case of an ill patient, law enforcement official was also advised to coordinate and assist the process of escorting the patient, with mutual supervision to tackle any possibility of disturbance.
Section 9: Ratio Analysis of Cathay Pacific
The purpose of this analysis is to study the effects of pandemics on aviation industry, which affected several airlines during the earlier years of this century. As a case study, Cathay Pacific has been selected for analysis and the effects may be witnessed by analyzing certain key operational ratios and trends over a period of three years, from 2002 to 2004.
Annual reports of Cathay Pacific (Company) for the years 2002, 2003 and 2004 have been used for the purpose. All figures are in HK$ millions unless otherwise stated.
Following relevant ratios have been considered for the purpose:
Acid Test Ratio (Quick ratio)
Return on investments (RoI)
Return on Capital employed (RoCE)
CURRENT RATIO (Current assets / Current liabilities)
Decline in 2004 represents decreasing revenue in 2003 with effect on receivables in 2004.
ACID TEST RATIO / QUICK RATIO (Current assets — stocks / Current liabilities)
Acid Test ratio
Decline in 2004 represents decreasing revenue in 2003 with effect on receivables in 2004.
RETURN ON INVESTMENTS (Return on investments / Total investments)
Investment in subsidiaries
Investment in associated companies
Other Investments- at fair value
Dividends on associated companies
Return on Investments
Return on investments has increased in 2003 due to increase in dividends on associated companies in the year and decrease in the carrying amount of investments in that year.
RETURN ON CAPITAL EMPLOYED (Profit for the year / Capital employed)
Profit for the year
Total Capital employed (A+B)
Return on Capital employed
‘* Capital employed includes share capital and retained profits (as they are employed further in business)
Return on capital employed has increased substantially in 2004 from the year 2003 due to substantial increase in profits by HK$ million 2,963.
OPERATIONAL EFFECTS OF PANDEMICS
The major impact of pandemics is operational with financial impact also. This has more strongly impacted financial performance rather than financial position as revenues and related operational figures / results have declined. The following may be considered:
Revenue tonne kilometers (Million)
Revenue passengers carried (‘000)
Passenger load factor (%)
The decline in the year 2003 is due to low passenger revenue for reasons of outbreak of pandemics, as it is the affected segment.
Summary of literature review and need for this study
It is clear from the studies revealed in the literature review that the world today has become extremely inter-reliant and interrelated and this offers countless prospects for quick unfolding of pandemic diseases. Amid this chaos, aviation industry has come under pressure to counter these emerging threats. Updating and expanding aviation industry’s emergency management along with business continuity procedures to safeguard not only its employees, but also its clients, supply chain associates, critical stakeholders along with business assets has become critical.
The literature shows that infectious diseases aren’t only spreading at a very rapid pace; they seem to be spreading at a pace considered to be the fastest in human history. The financial and economic impact of a pandemic outbreak shown in chapter 2 clearly illustrates that pandemic outbreaks will significantly impact the aviation industry. Furthermore, the literature also show that if the aviation industry does not put in place an adequate policy to counter any emerging pandemic, the implications of a pandemic threat can, once again, result in high rates of absenteeism and it can also result in financial losses affecting business continuity as well as liability as was seen in the case of Cathay Pacific.
Lastly, no study thus far has focused on implementation of federal guidelines by airport authorities. In addition, studies have also failed to provide consumer viewpoint regarding air travel during pandemic outbreaks. Therefore, this study will fill both these gaps. It will examine the factors, which place airports and airlines at risk of spreading communicable diseases. Another aim of this study was to investigate the behavioral changes in the aviation workforce and air travelers during a pandemic outbreak. Lastly, this paper investigates steps taken by U.S. institutions, both public and private, to minimize pandemic outbreak threats and maximize standard behavioral patterns in the aviation workforce and air travelers during a pandemic outbreak.
Chapter 3: Methodology
The methodology chapter will be focused on accomplishing two objectives: 1) it will detail the methodology being utilized for this research study and 2) it will reveal and justify the choice of methodology for the study. The primary sub-sections of this chapter are as follows;
1) Research philosophy
2) Research approach
3) Research type and Time line
4) Data Collection Methods
5) Qualitative and Quantitative Method
6) Qualitative and Quantitative Validity
7) Sampling Strategy
8) Research design
9) Data Analysis
The fundamental aim behind dividing the methodology chapter into these sections is to clearly reveal all the problems as well as aspects of the research and application so that it can be proven to be practical, beneficial as well-designed. Also, this division allows the researcher to offer a sensible as well as exploratory abstract of the overall aims and objectives of the research study (Cohen, Manion and Morrison, 2000).
1. Research Philosophy
Trochim (2001) in his study revealed that most of the researches are based on the idea that the accomplishment of the research aims will support the academia in logically comprehending the world around us; simultaneously, also figuring out the diverse viewpoints that might exist in numerous societies. This notion has been driven by two primary theoretical schools of thought. The first is Positivism, which means rebuking metaphysics; these researchers assert that all research studies ought to be rooted in the explanation of experiences). The second is Post-Positivism, which is classified as constructivist viewpoint, i.e. individual perceptions make us believe that the world and the organisms in it behave in a certain way). Both of these are particularly important in the sphere of traditional research studies.
Science, in line with a positivist, would help researchers achieve the real truth and logic of the world so that one can direct his/her actions in it better way. A positivist will always rely on determining the natural laws through direct examination and management. Most of the positivist argues that the issue of objectivity was an instilled characteristic of an individual who utilized scientific approaches. At the same time, the post-positivist argues that no individual could ever truly sustain to be objective in their viewpoint of an experience; and as a result, they believe that all personal points-of-view are subjective and biased to an extent. They classify unbiased-ness as a social experience only (Trochim, 2001). The post-positivist viewpoint is highly appropriate to fulfill the purpose of this study; as a result this study used post-positivism as its fundamental philosophy.
2. Research Approach
Once again, in line with Trochim (2001), there are two fundamental approaches towards research: the first is deductive and the second is inductive. Deductive reasoning, also referred as the “top-down” tactic, works from the more wide-ranging purpose to the more specialized aim. The inductive reasoning also referred to as the “bottom-up” tactic, works the opposite way i.e. It starts off from having specialized aims and then expands them into generalized as well as widespread practices and notions. In order to achieve the aims of this study; the researcher utilized both deductive and inductive approach.
3. Research type and Time line
The timeline of a research study is directly linked with its format. There are primarily two primary formats of a research study:
1) cross-sectional and
2) longitudinal studies.
In a cross-sectional study the concentration of the researcher is restricted within a single time-frame i.e. The researcher only acquires a segment of the whole phenomenon he/she is measuring or studying. However, in a longitudinal study the concentration spreads over a larger spectrum of time i.e. A lot more dependent and independent variables are included and modifications that take place over time are also noted before coming to concrete conclusions (Trochim, 2001). For this research study, with the time frame available to the researcher, we utilized the longitudinal format to assess the results.
4. Data Collection Methods
There are two kinds of data collection strategies: 1) quantitative, which is basically numeric representation and breakdown of all the data; and 2) qualitative, which involves distinct intangible dimensions and can incorporate videos, photographs, sound recordings etc. The latter is far more widespread then the former. In this study, the researcher utilized both individual opinions of the subjects (i.e. qualitative data) and the numerically proven statistical analysis (i.e. quantitative data).
5. Qualitative and Quantitative Method
Most studies whether qualitative or quantitative utilize one or a mixture of the following methodologies so as to gather their data/information:
a. Survey; which may involve both questionnaire and interviews
b. Structured interview
c. Semi-structured interview
d. Unstructured interview
e. Questionnaire (Trochim, 2001).
To accomplish the aims of this study, the researcher used 2 forms of survey, (1) semi-structured interviews and (2) questionnaire.
6. Qualitative and Quantitative Validity
The authenticity or validity of a study is what lies behind its failure or success. Even the smallest level of illegitimacy can create the whole research a drowned effort. For any kind of data the validity lays in the depth, integrity and capacity of the information collected along with the targeted sample and the impartial strategy employed by the researcher. In this study, the researcher utilized the survey method (questionnaire and semi-structured interviews) with the same process for all subjects in the sample. This ensured that the dissimilarities present in the responses are personal genuine; hence the methodology will not be disapproved for being subjective or impartial in any way (Trochim, 2001).
7. Sampling Strategy
The questionnaire (n=100) and interview (n=1 airport officials and 2 Microbiologists), both of a small sample size will be adopted while conducting this research. It is so because according to Saunders et al. (2003), when there comes a point of interpreting and reading the situation and background of a specific fact, then a smaller sized sample is considered more favourable comparatively.
The sampling strategy in the research is non-probabilistic. The sampling design to be utilized in the research is stratified sampling. The explanation for the stratified sampling design is that the airports could be seen as variables that will have relevance for their degrees of pandemic-outbreak preparedness and their own performance. The airports could be categorized in to strata based on group homogeneity and based on strata variability. An essential advantage to the stratified sampling method is that equivalent numbers could be sampled from strata that differ in dimensions; so that, the statistical strength of tests of differences between the strata could be better balanced. Over all, the accuracy of results is higher for stratified sampling when compared other sampling techniques. The sampling frame is really a comprehensive listing of airports positioned in USA and all the microbiologists working in the U.S. At the present time. The list will indicate the kind of airports, whether it has any regions of specialization, and the kind, size, and located area of the city where the airports can be found. This sampling frame enables the sampling units (in our case: (1) the airports and (2) microbiologists) to be allocated a numerical identifier; all the airports are available and prearranged in a systematic manner. This sampling frame will give the researcher every relevant part of the populace of interest and supply it only one time, excluding irrelevant elements. Any component of the populace which may be required for high level sampling later in the research could be one of them sample frame. Sample size is going to be based on the amount of airports, by having an expected sample size of 3 or fewer airports.
Study participants are going to be employed via email. The e-mail is going to be sent to the leadership of emergency services at the chosen airport and the microbiologist. Follow-up emails or phone calls will undoubtedly be carried out to ensure sufficient sampling does occur in each stratum.
8. Research Design
For carrying out this study, the researcher utilized the semi-structured and standardized form of interview as that enabled the researcher to get more in-depth as well as flexible data that would be unfeasible to acquire with a completely structured and formal interview format or an unstructured design. In addition, since the supplemented questionnaire would be formal and structured, all the statistical data that has got to be gathered could be collected from there.
The framework had been chiefly separated into different sub-categories so that the overall structure would pursue rational, consistent as well as free-flowing instructions that will be derived from the literature review. All the subjects were given copies of the questions before the time for the interview so that they may get time to acquaint themselves with the topic at hand. The format, evidently, will not be rigorous as the interview permits the respondent to convey what is important to from their perspective. For the researcher, this can pave the way for additional spontaneous questions that can be put together from the answers of the subjects. The researcher, in addition, has the option to carry out the interview with either video and/or audio setting depending on the approval of the subjects. This can turn out to be difficult if the subjects are not comfortable with having his/her each and every word recorded or does not possess socially-bound conversational skills (Saunders et al., 2003).
This study will follow the guidelines provided by Wilson and McLean (1994) as empirical evidence has evidently shown that the questionnaire offers researchers with statistically accurate data to perform their analysis. Furthermore, the researcher in this study will ensure that sufficient time is given to format and assemble the questionnaire so that accurate results can be acquired.
The utilization of questionnaire has some ethical issues that have got to be tackled before utilizing them for research purposes. For instance, the invasive character or insensitive method of the questions and the probable incursion of discretion of the respondent amongst others. It is noteworthy that the success of the questionnaire entirely relies upon the availability of keen and eager respondents. It will be unprincipled for the researcher to try and force or compel the respondents to reply to the questions. The respondents ought to be entirely in control of their involvement in the whole procedure and although the researchers can offer them with logical rationales to play a part in the study, the decision to leave or join the entire process cannot be managed by the researcher.
The common aspects amid the method that will be utilized in this study and the strategy proposed by Wilson and McLean are:
a. The topics as well as concerns that have got to be answered are clearly contended with and characterized in the questionnaire
b. All the fundamentals that might be pertinent are thoroughly assessed before exclusion or inclusion
c. The aim of the questionnaire is clearly and lucidly represented and understood
d. The questionnaire is profoundly reliant upon practical facts
e. All questions are ethical and direct devoid of any biased or improper presentation
f. The questionnaire utilizes the most unbiased and relevant data as its source for designing all the questions (Cohen, Manion and Morrison, 2000).
The researcher will email questionnaires to (1) Employees of the chosen airport (Joseph: please insert name) and (2) passengers of the airport (Joseph: please insert name). Likert scale will be used to assess the agreement/disagreement of the subjects with the question. Following 4 questions were asked from the employees and 3 from the passengers:
Questionnaires to Employees of an airport
1. Distribution of essential supplies can increase employee attendance during pandemic outbreaks
2. Using input from employee networks and unions in the planning process may help increase employee trust and thereby increase employee attendance during pandemic outbreaks.
3. Being flexible with operating procedures to align goals with the situation on ground may help employee trust and thereby increase employee attendance during pandemic outbreaks
4. Importance of free, consistent and lucid communication with and amongst employees across all processes and domains of the aviation industry may increase employee attendance during pandemic outbreaks
Questionnaires to passengers of an airport
1. My travelling behavior and/or choice of transit in a given airport changes in times of pandemic outbreaks
2. Current federal, state and local airport and airline policies if implemented can increase the passengers trust in an airline and/or transit airport in times of a pandemic outbreak.
9. Data Analysis
Quantitative Analysis (Questionnaire)
In statistical data analysis, the tool to measure correlation between the (research) variables is referred to as regression. In other words, regression is a tool to figure out effect of one variable with respect to the other. Regression analysis is hence employed to understand dependency of variables as well as relativity determining the relationship significance. For instance relationship between actual relationship and researched variable called approximated relationship, which will allow us to capture subjects’ perceptions.
Qualitative Analysis (Interviews)
The data evaluation for qualitative data, if it has not utilized similar standards as the quantitative data collection method; can be done via a separation of all the facts in relevant groupings. This will permit not only thorough but also efficient assessments of all responses as well as information collected. It has to be specified here that over the years, there have been a number of diverse methodologies offered for qualitative data; nonetheless, there is no universally approved strategy for this form of data (Saunders et al., 2003).
All through this study, the focus has carried on to be on the original goal of the researcher along with the methodologies that had previously been used in the same body of research work as well as the results and strategies that had already been established. All the responses gathered from the interviews were categorically interpreted and supported hypotheses were offered for future studies (Saunders et al., 2003).
Chapter 4: Data Analysis
Questionnaire sent to airport employees
The questionnaire sent to airport workforce had 4 questions. Question 1 explores the relationship between distribution of essential supplies and employee attendance during pandemic outbreaks. The answers of the respondents have been summarized in Table 1.1. Most (91) of the respondents asserted that it is “extremely likely” that distribution of essential supplies can increase employee attendance during pandemic outbreaks. Some (5) of the respondents asserted that it is “Quite likely;” A few (4) said that it is “slightly likely;” while none of the respondents (0) said that it is “Slightly unlikely,” “quite unlikely” “extremely unlikely” that distribution of essential supplies can increase employee attendance during pandemic outbreaks.
Q1. Distribution of essential supplies can increase employee attendance during pandemic outbreaks
Question 2 explores the relationship between “Using input from employee networks and unions in the planning process” and “employee attendance during pandemic outbreaks.” The answers of the respondents have been summarized in Table 2.1. Most (98) of the respondents asserted that it is “extremely likely” that using input from employee networks and unions in the planning process may help increase employee trust and thereby increase employee attendance during pandemic outbreaks. Some (2) of the respondents asserted that it is “Quite likely;” while none (0) said that it is “slightly likely;” “Slightly unlikely;” “quite unlikely” and “extremely unlikely” that using input from employee networks and unions in the planning process may help increase employee trust and thereby increase employee attendance during pandemic outbreaks.
Q2. Using input from employee networks and unions in the planning process may help increase employee trust and thereby increase employee attendance during pandemic outbreaks
Question three explores the relationship between “Being flexible with operating procedures” and “employee attendance during pandemic outbreaks.” The answers of the respondents have been summarized in Table 3.1. Ninety Four (94) respondents asserted that it is “extremely likely” that being flexible with operating procedures to align goals with the situation on ground may help employee trust and thereby increase employee attendance during pandemic outbreaks. None (0) of the respondents asserted that it is “Quite likely;” only one (1) said that it is “slightly likely;” two (2) said that it is “Slightly unlikely” and “quite unlikely;” and one (1) respondent said that it is “extremely unlikely” that being flexible with operating procedures to align goals with the situation on ground may help employee trust and thereby increase employee attendance during pandemic outbreaks.
Q3. Being flexible with operating procedures to align goals with the situation on ground may help employee trust and thereby increase employee attendance during pandemic outbreaks
Question four explores the relationship between “free, consistent and lucid communication with and amongst employees” and “employee attendance during pandemic outbreaks.” The answers of the respondents have been summarized in Table 4.1. Ninety Six (96) respondents asserted that it is “extremely likely” that free, consistent and lucid communication with and amongst employees across all processes and domains of the aviation industry may increase employee attendance during pandemic outbreaks. Four (4) respondents asserted that it is “Quite likely;” None (0) said that it is “slightly likely;” “Slightly unlikely;” “quite unlikely;” and “extremely unlikely.”
Q4. Free, consistent and lucid communication with and amongst employees across all processes and domains of the aviation industry may increase employee attendance during pandemic outbreaks
The questionnaire sent to passengers at the airport had 2 questions. Question one explored the relationship between “change in passenger travelling behavior” and “pandemic outbreaks occurrence.” The answers of the respondents have been summarized in Table 5.1. Thirty four (34) respondents asserted that it is “extremely likely” that their travelling behavior and/or choice of transit in a given airport changes in times of pandemic outbreaks. Ten (10) respondents asserted that it is “Quite likely;” Twenty Five (25) respondents said that it is “slightly likely;” Eighteen (18) said that it is “Slightly unlikely;” Thirteen (13) said that it is “quite unlikely;” however, none (0) of the respondents said that it is “extremely unlikely” that their travelling behavior and/or choice of transit in a given airport changes in times of pandemic outbreaks.
Q5. My travelling behavior and/or choice of transit in a given airport changes in times of pandemic outbreaks
Question two explored the relationship between “current federal, state and local airport and airline policies” and “passenger trust and travel habits during pandemic outbreaks.” The answers of respondents have been summarized in Table 6.1. Only twelve (12) respondents asserted that it is “extremely likely” that current federal, state and local airport and airline policies if implemented can increase the passengers trust and thereby passenger air travel in an airline and/or transit airport in times of a pandemic outbreak. None (0) of the respondents asserted that it is “Quite likely;” Thirty one (31) said that it is “slightly likely;” Twenty (20) said that it is “Slightly unlikely;” none (0) said that it is “quite unlikely;” and thirty seven (37) respondents said that it is “extremely unlikely” that current federal, state and local airport and airline policies if implemented can increase the passengers trust and thereby passenger air travel in an airline and/or transit airport in times of a pandemic outbreak.
Q6. Current federal, state and local airport and airline policies if implemented can increase the passengers trust and thereby passenger air travel in an airline and/or transit airport in times of a pandemic outbreak
The interview with the microbiologist consisted of 2 questions. The first question was: does the volume and number of people present in an airport make it like a giant incubator where viruses can freely travel from a host to another?
In response to the first question, the first interviewee said that the overall growth of air travel in the modern world was beyond merely on the rise, it had become the primary source of travel whether it was for business purposes or pleasure. The interviewee also asserted that there were certain portions of the population that preferred air travel more than the rest and hence invested in it excessively more so. These, he said, were those who used the frequent fliers facilities. These frequent fliers mostly traveled by air to fulfill their business deals. These frequent fliers tend to stick together and invest in the same hotels and peripheral packages. This is the perfect situation for a virus or an infection to therefore penetrate and spread from one host t o another, asserts the interviewee. This format of grouping is usually referred to as the assortative grouping where like-minded people tend to group themselves together in airports and on flights. Hence, the assortative grouping, asserted the interviewee, could very easily lead to the spread of an infection or a virus across the entire group and then penetrate into their home countries when they return back without showing any symptoms. The interviewee went on to quote the example of the spread of the SARS pandemic back in the year 2003. He explained that a total 16 infected individuals stayed in the same hotel and 6 of these ended up taking international flights out to 5 different areas namely Australia, Canada, Singapore, the Philippines, and Vietnam which led to the SARS outbreaks in the regions of Hanoi, Singapore, and Toronto only after a limited number of days in the SARS case of Hong Kong.
The second interviewee took a different approach in answering the above question in highlighting the overall size and connectedness of the modern day airports as well as the duration of the flights serving as the main source for the spread and penetration of an infection or virus. The interviewee also asserted that heterogeneity played a huge part in the inculcation of infections at the airport facilities. The interviewee also said that if and heterogeneity is focused on and the specific frequent fliers are consistently monitored to reveal infectious patterns, then the overall cooperative inclinations between airports to control pandemic outbreaks might be better served. The second interviewee insisted on another alternative approach to monitor and identify the spread of pandemic infections within the airports — he highlighted that the airport pandemic and infection control structures should primarily focus on implementing most interventions and precautionary measures on these frequent fliers as he believes that this methodology will significantly reduce the global penetration of any specific pandemic.
The second questions was When travelling in a pressurized cabin for a long period of time with infected passengers, does this give enough time for the virus to travel and infect other people?
In response to the second question, the first interviewee confirmed that there is little to no proof available on the vulnerability of the pressurized cabin during the flight. He asserted that the air flow of the cabin is completely monitored and controlled and all ventilation structures are designed to ventilate and change the entire air in the cabin more than 30 times in an hour. This is even more advanced in the modern aircrafts where there is a re-circulation system in place which recycles more than half of the air in the cabin and passes it through the HEPA (high-efficiency particulate air) filters to do so. These filters are normally used in hospitals and ICUs so that all forms of germs and viruses are filtered quickly and efficiently.
The interviewee then goes on to assert that the overall transmission of infection can possibly tale place amongst the passengers sharing a common area and having some form of physical contact. The transmission might also be triggered by a sneeze or a cough from the infected individual and hence release infectious germs in the proximity. Hence, all fliers within the proximity might be vulnerable to the disease but not the entire cabin as the germs will most likely be filtered out before they can spread across the entire cabin. Hence, this transmission is not something that is particular to air travel, asserted the interviewee, as close contact and proximity vulnerability can exist in any place where there is a crowd.
The interviewee then went on to add that if and when the ventilation system is not accurately working, the overall penetration can be disastrous especially for the highly contagious infections like influenza. But the overall perception of the interviewee is that the use of the air-recycling ventilation system during flight and the use of an auxiliary power system in the aircraft when it’s grounded disallow the air cabin to be a source of transmission for infections.
The second interviewee gave the example of how the transmission of the disease of tuberculosis (TB) back in the 1980s was documented as an important incident for a commercial flight which was scheduled for a lengthy flight. However, there was no documentation of a real case of subsequent TB reported for those on the flight in the years to follow. However, the air travel prevention tactics still include a very vigorous TB prevention strategy, especially on lengthy flights in accordance to the policies highlighted in the 2008 publication of the WHO policy standards titled ‘Tuberculosis and air travel: guidelines for prevention and control’. The interviewee highlights that there was no report of the transmission of TB in that flight to be because of the air cabin ventilation system but that was the first thing that was upgraded and improved. The interviewee asserted that it was because of the measures taken back in the 1980s after the TB outbreak that the SARS outbreak in 2003 was not as widespread as it potentially could’ve been due to the nature of the disease. Hence, the interviewee asserted, that if anything, cabin air ventilation was an element that was helping in the prevention of the spread of the pandemic during flight.
The interviewee is of the opinion, that aside from the measures taken on the national scale in aircrafts and at airports, efforts need to be made on a personal level as well as if the travelers feel unwell in any shape or form, they should choose to not travel till they give the okay by the doctor. He, furthermore, asserts that air travel should be completely off limits for those individuals who are suffering or recovering from a transferable disease. He is very strongly against the air travel of such individuals to the point that he claims that the airport authorities must be given the right to deny the boarding of such travelers.
Another supporting response by the interviewees was the strong air ventilation structure of the aircrafts. The fact is that most pandemics cannot be detected in flights, not because of the reduced time of travel, but because of the fact that the air cabin ventilation system is consistently filtering any and all infectious air within the aircraft during the entire time that the aircraft is en route to its destination. Hence, the primary cause of international penetration of a pandemic is personal contact with the infected individual which can and must be prevented on ground and the infected individuals must not be allowed to travel under any condition.
The interview with the microbiologist also consisted of 2 questions. The first question was: What organizational behavior and the Human Resources practices will become necessary in order for the airports and airlines to safely operate amidst pandemic outbreaks?
In answering this question, the first interviewee was adamant on the importance of the role played by air travel. He claimed that during a pandemic outbreak, the airlines will be under strict scrutiny as they will be most likely serves as the carriers of the pandemic onto other local districts as well as other countries. The interviewee asserted that the decreased level of travel time will not be an advantage in this case. Hence, the very first initiative would have to be taken by the airline and the airports in order to efficiently make the masses aware of their prevention policies in such a situation. Also, they must be completely stringent in the execution of these policies and make sure that the masses are aware of the fact that their air travel will be safe as the airport or flight will not give preferential treatment to anyone when it comes to ensuring that the infection is not carried onto the flight or within the airport facilities.
The second interviewee also supported the aforementioned strategies. He also added that the health and safety of all hired personnel on the flight and in the airport must also be consistently monitored so as to ensure that there is no penetration of the outbreak. Furthermore, the interviewee also highlighted the importance of coordination between both public and private entities involved to ensure that quick decision making and action-based strategies are rightly implemented.
The second question was: what can the aviation industry do to sustain operational staff load, despite the high number of employees’ absenteeism?
In answering this question, the first interviewee focused on preventive measures to decrease absenteeism of the employees as opposed to reacting to it happening during a pandemic outbreak. He highlighted that the primary strategy of all the airport facilities must be to take preventive measures by keeping a very strict health monitoring structure in place and ensuring that any employee with even the slightest signs of illness be diagnosed and treated appropriately in a timely manner. He also focused on the provision of proper medical packages for the employees so that they have access to the right vaccines and preventive drugs. He said that in the event of a pandemic break, the employees must be given the appropriate preventive suits and training in order to deal with a sick traveler if detected.
The second interviewee also focused on the provision of rightful gear, training and personal medical safety for the employees during an outbreak. He also asserted that with a limited staff, the first priority would be to not drain them out as well and prepare a suitable schedule so as to avoid an increase in absenteeism. He added that in case of increasing absenteeism, the aviation industry must reach out to the stakeholders, government agencies and unions to provide them proper backup and support during crunch times when the aviation industry is short staffed, which they can do by planning and implementing accurate distribution of resources and proper implementation of response actions on a nation-wide scale.
Furthermore, the top class treatment of the employees is also another aspect that the interviewees show strong support for, hence backing all theories presented in the literature. The scheduling is a very important aspect of employee satisfaction as it not only ensures that they will stay loyal but it will also ensure that they will stay focused and remain strong health-wise, physically and mentally to tackle the work load and added responsibilities during an epidemic. Furthermore, the premium medical packages given to the employees will also ensure that they are allowed to deal with their medical shortcoming with the best and timely remedies available.
Chapter 5: Discussion Section
As mentioned above, the questionnaire sent to airport workforce had 4 questions and the first question explored the relationship between distribution of essential supplies and employee attendance during pandemic outbreaks. Regression analysis of the relationship between these two variables was carried out. The result of the t-test of regression coefficient is 22.48163 and the P-value is 2.32E-05, which shows that a strong relationship exists between the 2 variables. The results of the t-test also revealed no substantial difference in confidence interval of Regression Coefficient (0.883745 and 1.132783). A practical implication of this result is that increased employee attendance during pandemic outbreaks is dependent upon distribution of essential supplies.
The result of this question corroborates the Occupational Safety and Health Administration (2009) viewpoint detailed in the literature review about the significance employee presence during pandemic outbreaks and its link with the provision of essential supplies. The tables below provide a detailed view of the regression analysis of this question.
Hypothesis Testing Of Regression B/W distribution of essential supplies and employee attendance during pandemic outbreaks:
Increased employee attendance during pandemic outbreaks is dependent upon distribution of essential supplies: (Regression Coeff. =0).
Increased employee attendance during pandemic outbreaks is not dependent upon distribution of essential supplies: (Regression Coeff. 0).
Level Of Significance:
Tc = (b-?)/Sb follows Subjects’t — Distribution.
where b=Regression Coefficient & Sb=Standard error about Regression Coefficient
Question 2 explored the relationship between “Using input from employee networks and unions in the planning process” and “employee attendance during pandemic outbreaks.” Regression analysis of the relationship between these two variables was carried out. The result of the t-test of regression coefficient is 43.83540236 and the P-value is 1.62E-06, which shows that a strong relationship exists between the 2 variables. The results of the t-test also revealed no substantial difference in confidence interval of Regression Coefficient (0.86707277 and 0.9843376). A practical implication of this result is that employee attendance during pandemic outbreaks is heavily dependent upon using input from employee networks and unions in the planning process.
The result of this question corroborates the Occupational Safety and Health Administration (2009) viewpoint detailed in the literature review about the significance employee presence during pandemic outbreaks and its link with using input from employee networks and unions in the planning process. The tables below provide a detailed view of the regression analysis of this question.
Hypothesis Testing Of Regression B/W “Using input from employee networks and unions in the planning process” and “employee attendance during pandemic outbreaks:”
Employee attendance during pandemic outbreaks is heavily dependent upon using input from employee networks and unions in the planning process: (Regression Coeff. =0).
Employee attendance during pandemic outbreaks is not heavily dependent upon using input from employee networks and unions in the planning process: (Regression Coeff. 0).
Level Of Significance:
Tc = (b-?)/Sb follows Subjects’t — Distribution.
where b=Regression Coefficient & Sb=Standard error about Regression Coefficient
Question three explores the relationship between “Being flexible with operating procedures” and “employee attendance during pandemic outbreaks.” Regression analysis of the relationship between these two variables was carried out. The result of the t-test of regression coefficient is 49.583509 and the P-value is 9.9E-07, which shows that a strong relationship exists between the 2 variables. The results of the t-test also revealed small difference in confidence interval of Regression Coefficient (0.919284587 and 1.028342862). A practical implication of this result is that “employee attendance during pandemic outbreaks” is strongly dependent upon “Being flexible with operating procedures.”
The result of this question corroborates the Occupational Safety and Health Administration (2009) viewpoint detailed in the literature review about the significance employee presence during pandemic outbreaks and its link with being flexible with operating procedures. The tables below provide a detailed view of the regression analysis of this question.
Hypothesis Testing Of Regression B/W “Being flexible with operating procedures” and “employee attendance during pandemic outbreaks:”
Employee attendance during pandemic outbreaks is dependent upon Being flexible with operating procedures: (Regression Coeff. =0).
Employee attendance during pandemic outbreaks is not dependent upon Being flexible with operating procedures: (Regression Coeff. 0).
Level Of Significance:
Tc = (b-?)/Sb follows Subjects’t — Distribution.
where b=Regression Coefficient & Sb=Standard error about Regression Coefficient
Question four explores the relationship between “free, consistent and lucid communication with and amongst employees” and “employee attendance during pandemic outbreaks.” Regression analysis of the relationship between these two variables was carried out. The result of the t-test of regression coefficient is 32.79268213 and the P-value is 5.157E-06, which shows that a strong relationship exists between the 2 variables. The results of the t-test also revealed small difference in confidence interval of Regression Coefficient (0.86742099 and 1.027890956). A practical implication of this result is that “employee attendance during pandemic outbreaks” is dependent upon “free, consistent and lucid communication with and amongst employees.”
Once again, the result of this question corroborates the Occupational Safety and Health Administration (2009) viewpoint detailed in the literature review about the significance employee presence during pandemic outbreaks and its link with free, consistent and lucid communication with and amongst employees. The tables below provide a detailed view of the regression analysis of this question.
Hypothesis Testing Of Regression B/W “Free, consistent and lucid communication with and amongst employees” and “employee attendance during pandemic outbreaks:”
Employee attendance during pandemic outbreaks is dependent upon free, consistent and lucid communication with and amongst employees: (Regression Coeff. =0).
Employee attendance during pandemic outbreaks is not dependent upon free, consistent and lucid communication with and amongst employees: (Regression Coeff. 0).
Level Of Significance:
Tc = (b-?)/Sb follows Subjects’t — Distribution.
where b=Regression Coefficient & Sb=Standard error about Regression Coefficient
Questionnaire sent to passengers at the airport
As mentioned above, the questionnaire sent to passengers at the airport had 2 questions. Question one explored the relationship between “change in passenger travelling behavior” and “pandemic outbreaks occurrence.” Regression analysis of the relationship between these two variables was carried out. The result of the t-test of regression coefficient is 1.906378805 and the P-value is 0.12928439, which show that a strong relationship exists between the 2 variables. The results of the t-test also revealed small difference in confidence interval of Regression Coefficient (-0.97775505 and 5.26239219). A practical implication of this result is that change in passenger travelling behavior is dependent upon pandemic outbreak occurrence.
As noted in the literature review, no study to date has focused on passenger viewpoint. The results of this study are the first of its kind and it shows that from the average travelers’ view point, the airport is definitely an incubator for diseases. Past studies have shown that close quarters, contact with unhygienic personal habits (for instance, not cleaning hands as well as inadequate techniques to lessen spread of illness through sneezing as well as coughing), and the quick spread of illness via international travel all result in the increased probability of illness being introduced to the work place. The results indicate that the consumers of air travel believe that in airport and airline surroundings, the rapid spread of illness, prompted by the speed and easiness of air travel, augments the probability of the quick introduction as well as spread of pandemics. The tables below provide a detailed view of the regression analysis of this question.
Hypothesis Testing of Regression B/W change in passenger travelling behavior and pandemic outbreak occurrence:
Change in passenger travelling behavior is dependent upon pandemic outbreak occurrence: (Regression Coeff. =0).
Change in passenger travelling behavior is not dependent upon pandemic outbreak occurrence: (Regression Coeff. 0).
Level Of Significance:
Tc = (b-?)/Sb follows Subjects’t — Distribution.
where b=Regression Coefficient & Sb=Standard error about Regression Coefficient
Question two explored the relationship between “current federal, state and local airport and airline policies” and “passenger trust and travel habits during pandemic outbreaks.” Regression analysis of the relationship between these two variables was carried out. The result of the t-test of regression coefficient is -0.27773 and the P-value is 0.794983, which show that no relationship exist between the two variables. The results of the t-test also revealed substantial difference in confidence interval of Regression Coefficient (-3.5948 and 2.941017). A practical implication of this result is that passenger trust and travel habits during pandemic outbreaks are not dependent upon current federal, state and local airport airline policies.
The results of this question ought to be alarming for the federal authorities. It seems that consumers lack trust in current federal policies. This could be due to either negative media publicity or lack of awareness. Or it could be due to the occurrence of past diseases, such as capturing their imagination because they grab headlines. The media stories as well as spread of such diseases may have cause widespread panic and fear. This fear may have caused the current lack of trust in federal and state policies. The tables below provide a detailed view of the regression analysis of this question.
Hypothesis Testing of Regression B/W current federal, state and local airport and airline policies and passenger trust and travel habits during pandemic outbreaks:
Passenger trust and travel habits during pandemic outbreaks are dependent upon current federal, state and local airport airline policies: (Regression Coeff. =0).
passenger trust and travel habits during pandemic outbreaks is not dependent upon current federal, state and local airport airline policies: (Regression Coeff. 0).
Level Of Significance:
Tc = (b-?)/Sb follows Subjects’t — Distribution.
where b=Regression Coefficient & Sb=Standard error about Regression Coefficient
As noted above, the interview with the microbiologist consisted of 2 questions. The first question was: Does the volume and number of people present in an airport makes of it like a giant incubator where viruses can freely travel from a host to another? In response, the first interviewee highlighted that “assortative groupers” and “frequent fliers” are highly susceptible and can very easily lead to the spread of an infection or a virus. This leads us to our first and second hypotheses:
H1: The higher the rate of “frequent flyers,” the higher will be the chances of spreading infectious diseases.
H1: The higher the rate of “assortative groupers,” the higher will be the chances of spreading infectious diseases.
The second interviewee took a different approach and focused more on controlling the threat of an infectious disease from spreading. He asserted that if heterogeneity is focused on and the specific frequent fliers are consistently monitored to reveal infectious patterns, then the overall cooperative inclinations between airports to control pandemic outbreaks might be better served. He also suggested that the frequent flyers need to be consistently monitored. This leads us to our third hypotheses:
H3: if heterogeneity is focused on and the specific frequent fliers are consistently monitored pandemic outbreaks might be effectively controlled.
The second question was: when travelling in a pressurized cabin for a long period of time with infected passengers, does this give enough time for the virus to travel and infect other people? Both interviewers negated the concept that airlines and passengers on board are at risk of infectious diseases and justified their reasoning by talking about the high quality of air filtering system on board an aircraft. This leads to our fourth hypotheses:
H4: the higher the quality of air filter system, the lower will be the risk of spread of an infectious disease.
The interview with the human resource managers also consisted of 2 questions. The first question was: what organizational behavior and the Human Resources practices will become necessary in order for the airports and airlines to safely operate amidst pandemic outbreaks?
In answering this question, the both interviewees highlighted the significance of communication with all stakeholders, i.e. employees and customers. He also focused on strict monitoring mechanisms to ensure that stakeholder trust is not shattered due to carelessness. This leads to our fifth and sixth hypotheses:
H5: Comprehensive communication to all stakeholders will lead to higher trust levels and decrease the likelihood of a pandemic outbreak.
H6: the higher the employee monitoring mechanism, the lower will be the risk of spread of an infectious disease.
The second question was: what can the aviation industry do to sustain operational staff load, despite the high number of employees’ absenteeism? While answering this question, both interviews focused on preventive measures to keep the employees healthy and give them a sense of security. Medical supplies should be available to not only test each and every employee but also to treat those found infected. Lastly, they also talked about managing roles, responsibilities and shifts in an appropriate manner so that stress and workload can be sustained. This leads to our seventh hypotheses:
H7: Comprehensive preventive measures, such as availability of medical and food provisions along with fair distribution policies on shift and workload will decrease employee absenteeism during a pandemic outbreak.
Chapter 6: Conclusion and Recommendations:
The purpose of this study was to examine the factors, which place airports and airlines at risk of spreading communicable diseases. Secondly, this paper studied the behavioral changes in the aviation workforce and air travelers during a pandemic outbreak. Lastly, this paper also investigated steps taken by U.S. institutions, both public and private, to minimize pandemic outbreak threats and maximize standard behavioral patterns in the aviation workforce and air travelers during a pandemic outbreak.
The results indicate that airports seem to be at risk while airlines, due to their high quality ventilation system are not at risk of a pandemic outbreak. With regards to behavioral changes, employee absenteeism seems to top the list for aviation workforce and low passenger turn out seems to be the pattern for air travelers. The transportation workers can be trained by the union members, the pandemic resource teams, government assigned officials on how to stay safe and away from getting infected. It is the duty of the transportation stakeholders as well as the government to ensure that proper plans are in place to ensure that each and every employee knows there jobs and that these plans cover the responsibilities, roles and resources, as, with the help of this smooth running of the functions can be ensured.
It is very important that the authorities across the borders completely understand the importance of providing the medical care to the transportation workers regardless of the fact that they are not from their country or region as, the transportation workers have to cross a lot of borders thus, there health would mean the safety of the place that they are going to as they won’t be taking any sort of infection with them. Therefore, in order to make sure that all the foreign as well as local authorities understand the importance of providing the medical assistance to the ill workers proper guidelines should be provided by the health experts.
Customers have also started realizing their value and rights and because of the globalization and popularity of the internet they are now able to compare the prices, quality and other features of the various airline products from different brands and safety features associated with it. They do this to ensure that they choose the one that suits them the best. Realizing this change in trend businesses related to air travel should become more and more attentive to the average customers. They should realize that it is these customers who would help them the most in increasing their base. These organizations should give more importance to their average customers as compared to the business customers, their revenues and profits. Lastly, task forces should be prepared by the airline businesses to ensure that they provide the passengers who get infected with proper and immediate medicine. Consumer trust and satisfaction should be the utmost priority of all businesses related to air travel.
With regards to the steps taken by U.S. institutions, the main reason for the failure of most of the pandemic plans is the fact that they are made with the hope that they national economies like U.S. is self-reliant, which is not true in the least. Under this assumption the functional and geographical economies are misinterpreted which results in the failure of the plans. Shutting down the important freight transportations networks can cause a lot more problems than solving them, for this reason it is very important that the transportation workers are given proper treatment, prophylactic anti-viral and vaccines as well as proper health care access so that they can work in a proper manner during pandemic. In case that these workers become ill they should be treated immediately as losing them would cause the company a lot more time not only in finding the next suitable employee but also, in getting him acquainted with the job.
The understanding gained out of this research study should end up being an invaluable resource for just about any U.S. airport to follow along with. However, first they need to have awareness about the existence of this research study. The first recommendation would be to present this study to the American Association of Airport Executives (AAAE). This will help in the dissemination of information to any or all FAA airports in United States. Furthermore, the Aircraft Rescue Firefighting Working Group (ARFWG), which is responsible for fighting fire in the airport vicinity, also needs to be brought on board on this study’s findings. Such steps can bring about paradigm shifts in not just the mindset but also the policies in effect at U.S. airports. Furthermore, it will also assist in enhancing public safety at all U.S. airports.
Additional studies ought to be carried out to assess the fundamental elements for carrying out table-top as well as full-scale exercises, which are in compliance with National Incident Management System. This could range from the assessment of a Homeland Security Program referred to as “After Action Report” to determine the outcomes of the program. Additional research also needs to be carried out on NIMS (National incident management system) and test its compliance at different local airports and how local workforce is aligning their day-to-day tasks with the standards revealed in NIMS.
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