Most Americans are ready to make major changes in their lives and cooperate with public health officials' recommendations when faced with serious outbreak of pandemic flu according to the latest national survey conducted by the Harvard School of Public Health (HSPH) Project on the Public and Biological Security.
However, the survey also finds that a substantial share of Americans would have no one to care for them if they become ill or would face serious financial problems if they had to stay home from work for a week or more.
Pandemic flu is a term used to describe a virulent human flu that causes a global outbreak, or pandemic, of serious illness. Because there is little natural immunity, the disease can spread easily from person to person. Currently, there is no pandemic flu, but health officials are concerned that the H5N1 avian flu which has caused about 250 illnesses and deaths among people in Asia, Africa, and Europe could become a pandemic flu. No humans or poultry in the Americas have been infected with this avian flu virus.
This HSPH survey was conducted to help public health officials in planning for a possible outbreak of pandemic flu and will be presented Thursday, Oct. 26 in Washington, D.C. at an Institute of Medicine workshop: Modeling Community Containment for Pandemic Influenza. HSPH Professor Marc Lipsitch will also be presenting historical analyses of interventions in the 1918 pandemic, comparing cities that intervened early and those that intervened late, to assess the difference in epidemic curves in these groups of cities.
This is the first report to attempt to tap the public's intentions when faced with the specific circumstances of an outbreak. The people interviewed were first read a scenario about an outbreak of flu that spreads rapidly among humans and causes severe illness. They were then asked how they would respond to and be affected by the circumstances that would arise from such an outbreak.
Willingness to Cooperate with Public Health Recommendations More than three-fourths of Americans say they would cooperate if public health officials recommended that for one month they curtail various activities of their daily lives, such as using public transportation, going to the mall, and going to church. More than nine in ten (94%) say they would stay at home away from other people for seven to ten days if they had pandemic flu. In addition, 85% say they and all members of their household would stay at home for that period if another member of their household was sick.
Nine in ten Americans (90%) say that if public health officials recommended that they and the other members of their household stay in their town or city, they were likely to stay.
These findings speak to the resilience of the American public in the face of a potential health crisis, said Robert J. Blendon, Professor of Health Policy and Political Analysis at the Harvard School of Public Health.
The area where anticipated cooperation is lowest involved the workplace. While a majority (57%) of employed adults say they would stay home from work if public officials said they should, even if their employers told them to come to work, about one-third (35%) say they would go to work.
Home More than eight in ten Americans (85%) say they would be able to take care of sick household members at home for 7 to 10 days, if public health officials recommended it (Figure 2). However, about three-fourths (76%) say they would be worried that if they stayed at home with a household member who was sick from pandemic flu, they themselves would get sick from the disease.
Nearly three-fourths (73%) say they would have someone to take care of them at home if they became sick with pandemic flu and had to remain at home for seven to ten days. However, about one in four (24%) say they would not have someone to take care of them. More than four in ten people living in one-adult households (45%) and about one third of low-income (36%), African-American (34%), disabled (33%), and chronically ill (32%) adults say they would not have anyone to take care of them if they were sick and had to remain at home that long.
A substantial proportion of the public believes that they or a household member would be likely to experience various problems, such as losing pay, being unable to get the health care or prescription drugs they need, or being unable to get care for an older or disabled person, if they stayed at home for seven to ten days and avoided contact with anyone outside their household.
School Closings If schools and daycare were closed for one month, 93% of adults who have major responsibility for children under age 5 in daycare or age 5 to 17 and have at least one employed adult in the household think they would be able to arrange care so that at least one employed adult in the household could go to work. Almost as many (86%) would be able to do so if schools were closed for three months. However, six in ten (60%) say that at least one employed person would have to stay home if schools were closed for a month.
Only one-fourth (25%) of employed people who have major responsibility for children under age 5 in daycare or age 5-17 in their household say that if schools and daycare closed for one month, they would be able to work from home and take care of the children.
More than nine in ten (95%) adults with major responsibility for children age 5 to 17 report that they would be willing to give school lessons at home if schools were closed for three months.
More than eight in ten (85%) of these adults also think that if schools were closed for three months and public health officials recommended it, they would be able to keep their children and teenagers from taking public transportation, going to public events, and gathering outside home while schools were closed.
"A surprisingly large number of people would be able to keep their children home and away from others if schools closed during a severe pandemic," said Blendon.
About six in ten (64%) of these adults would need only a little or no help at all in order to deal with the problems of having to stay home and keep children at home for a long period of time. Of those who say they would need a lot or some help, half (50%) would rely most on help from family, 11% on friends or neighbors, and 34% on outside agencies.
Work The survey asked employed Americans about the problems they might have if they were asked to stay out of work for seven to ten days, a month, and three months because of an outbreak of pandemic flu in their community.
The longer people are out of work, the greater the number of people who will face financial problems. While most employed people (74%) believe they could miss seven to ten days of work without having serious financial problems, one in four (25%) said they would face such problems. A majority (57%) think they would have serious financial problems if they had to miss work for one month, and a total of three-fourths (76%) think they would have such problems if they were away from work for three months.
Only about three in ten (29%) say that if they had to stay away from the workplace for one month, they would be able to work from home for that long.
Employed Americans were also asked about their current employers plans and policies for dealing with an outbreak of pandemic flu. Few working people (19%) are aware of any plan at their workplace to respond to a serious outbreak of pandemic flu. About one in five employed adults (22%) are very or somewhat worried that their employer would make them go to work even if they were sick. Half (50%) believe that their workplace would stay open if public health officials recommended that some businesses in their community should shut down. Only about one-third (35%) of employed Americans think that if they stayed home from work, they would still get paid; 42% think they would not get paid, and 22% do not know whether they would get paid or not.
"These findings are a wake-up call for business, that employees have serious financial concerns and are unclear about the workplace plans and policies for dealing with pandemic flu," said Blendon.
Methodology This is the 25th in a series of studies by the Harvard School of Public Health Project on the Public and Biological Security. The study was designed and analyzed by researchers at the Harvard School of Public Health (HSPH). The project director is Robert J. Blendon of the Harvard School of Public Health. The research team also includes John M. Benson and Kathleen J. Weldon of the Harvard School of Public Health, and Melissa J. Herrmann of ICR/International Communications Research. Fieldwork was conducted via telephone for the Project by ICR/International Communications Research of Media (PA) between September 28 and October 5, 2006.
The survey was conducted with a representative national sample of 1,697 adults age 18 and over, including an oversample of adults who had children under age 18 in their households. Altogether 821 such adults with children were interviewed. In the overall results, this group was weighted to its actual proportion (38%) of the total adult population.
The margin of error for the total sample is plus or minus 2.4 percentage points.
Possible sources of non-sampling error include non-response bias, as well as question wording and ordering effects. Non-response in telephone surveys produces some known biases in survey-derived estimates because participation tends to vary for different subgroups of the population. To compensate for these known biases, sample data are weighted to the most recent Census data available from the Current Population Survey for gender, age, race, region, and education. Other techniques, including random-digit dialing, replicate subsamples, callbacks staggered over times of day and days of the week, and systematic respondent selection within households, are used to ensure that the sample is representative.