Spanish Flu

HOST 4114
Spanish Flu
Crisis Management

January 31, 2014

Table of Contents
Introduction Page 2
What is Spanish Flu and what happened during the pandemic? Page 2
How the situation was handled in 1918 Page 2-3
Impacts from the Spanish Flu Page 3-4
Impacts of mass gathering Page 4-5
Crisis Management Page 5
Additional information that may have arose from research Page 5-6
Recommendations Page 6-7
How the Hospitality sector should act Page 7
Hotel Response Plan Page 8-9
Sample Guest Letter Page 9
Conclusion Page 9
References Page 10-11
Appendices Page 12

Introduction Spanish flu in the year 1918 was a pandemic crisis that greatly affected everyone worldwide. To this day researchers are still studying the influenza pandemic and are working to counter future pandemics. When the Spanish flu came it created many negative impacts to the daily lives of the citizens and industries. Learning from the past, there are many recommendations that industries should implement in order to counter the spreading of a future oncoming pandemic. Crisis management is important during such a deadly situation and every business should create a plan. This document talks about what is Spanish flu and how should it affected the hospitality industry. This document also talks about what steps hotels should take during a pandemic.
What is Spanish Flu and what happened during the pandemic?
Spanish flu is an avian flu that occurred in 1918, it was more deadly than the World War that was happening. Initially it was called "the three day fever" and although it was named Spanish flu, the geographical origins of the flu is unknown. It was named Spanish flu after the millions of deaths in Spain including the King of Spain. Spain was the first country to report publically about their health crisis. Some researchers have pointed it may have originated from China while others believe it was from a small town in Kansas. The total number of people that died from this disease were officially estimated to be 147, 114 in 1918, 21,235 in 1919, and 17,825 in the year 1920 (Antoni, Guillen, & Carolyn, 2008). The first wave of the Spanish flu had been extremely contagious while the second wave was not only extremely contagious but also extremely deadly. Once one caught the disease there was a limited amount of help that could have been done to treat it. In case people were suffering from this cyanosis, the most common remedies were aspirin, cinnamon in hot milk, and oxygen ("Spanish flu: historical," 2009). Like any other flu, it began with coughing, headache, chills and a fever up to 104 degrees Fahrenheit. However deep brown spots would appear and thick bloody fluid would fill up the lungs resulting in victims drowning in their own fluid. Faces would turn blue as their circulating blood failed to get oxygenated. Some died within hours of coming down with the first symptoms. The influenza pandemic of 1918 killed an estimated amount of 50 million people all around the world. It targeted the young and healthy, mostly among 20-40 year olds. When hospital was full, tent hospitals were erected. With the World War happening there was a shortage of nurses and doctors so hospitals had to ask for volunteers. No place was immune even though government officials tried to protect their citizens from the pandemic. There were so many deaths in Chicago that the city banned funerals. Spitting and coughing in public were prohibited. The influenza pandemic was so severe it depressed the average lifespan of a U.S. citizen by 10 years.
How the situation was handled in 1918 How they handled the pandemic was more of a prevention strategy in 1918. State schools were shut down in Britain (Trilla, Tralla and Daer, 2008); ports were closed in Alaska with U.S. marshals posted to guard it. Cinemas, theatres and concert halls were restricted to performance length, and had to be ventilated ("Spanish flu: historical," 2009). Church and funeral services were shortened and some towns were sealed off, nobody could go anywhere without a doctor 's note. October of 1918 became the deadliest month in history of United States. When it continued on to November, stores had to cancel holiday sales to prevent crowds; many cities required their citizens to wear face masks in public. Doctors encouraged those that may have contracted the disease to cleanse their respiratory system by gargling and inhaling mixtures such as warm water mixed with carbolic acid and quinine, or boric acid and sodium bicarbonate ("Spanish flu: historical," 2009). The measures that were taken to prevent the disease from spreading further affected the day to day lives of the citizens. Some people accepted the changes, some protested as they felt the changes were unfair and there were people that broke the rules that were made in order to protect them from the disease (Ott, Shaw, Danila, & Lynfield, 2007). Sporting organizations and establishments that served food and alcohol chose to ignore the closing order and continued their regular operations. When regulation regarding elevators came into effect, hotels objected to stopping their elevators as they would lose guests (Ott, Shaw, Danila, & Lynfield, 2007). Not everybody was happy with the changes that had to be made during the pandemic
Impacts from th Spanish Flu
The gene mutation of the Spanish flu has created fear from all around the world. From H1N1, which spread globally in 2009, it mutated to H5N1, an avian flu that was recently brought into Canada by a traveler who had returned from Beijing, China. Now there is H7N9 a new avian flu that is currently spreading in China. The flu pandemic has created major negative impacts on the global economy and to our own lives. The hospitality industry is highly sensitive to negative environmental factors. Until 2007, the global tourism industry had showed steady growth above the anticipated growth rate of 4.1% p.a. until 2020 forecasted by the World Tourism Organization (Arthur D. Little, 2009). Due to the occurrence of H1N1, the industry growth rate was halted. There are numbers of industries that were seriously impacted by the influenza pandemic, such as airlines, retail stores, travel agencies, hotels, banking & insurances, imports and exports industries and more (Asia Case Research Centre, HKU, 2014); most of the impacted industries are under the hospitality sector.
During the outbreak, the travel and tourism industry would be one of the first industries to be affected as it includes travel agencies, airlines, cruise lines, railways and buses. According to the National Business Travel Association (NBTA) a survey and analysis was done regarding the impact of the pandemic on business travel, there were a total of 61% of travel managers who indicated that their travelers were cancelling trips to Mexico and there was 10% of cancelled trips to other infected countries in response to the outbreak (National Business Travel Association, 2009). Airlines and hotels were suffering from cancelled trips and room cancellation. Many attractions, such as cinemas, museums, theatres and more, had to be closed in order to minimize the spread of the virus. The following are the impact reports from H1N1 by different companies (Trubely, J. S., 2009).
JetBlue Airways Corp. said that the H1N1 virus affected demand across its network and reduced revenue to Mexico by 5 million.
United Airlines parent company UAL Corp., and Continental Airlines Inc. both estimated a $50 million H1N1-related revenue hit.
Marriott International Inc. said that the occupancy rate at their 17 hotels in Mexico were low with the RevPAR down 80% while China and other countries in Asia were also impacted.
The flu panic also affected Mexico, Asia and some gateway U.S. markets, where they have lost approximately up to $10 million toll on the company.

From figure 1: Impacts on global tourism, 1996-2009 (Arthur D. Little, 2009), the chart clearly shows that among the many different negative events, the bird flu and SARS of 2003 along with H1N1influenza A were the most severe crisis that hurt the global tourism.

The hospitality industry in Asia especially in China, they are facing a difficult time right now due to the H7N9 avian flu. There are 49 cases of H7N9 infections and 12 deaths in China (Xinhua News, 2014). In addition, there are a few people who were infected by the virus or have sadly deceased outside of China such as in Canada and Taiwan due to traveling to China. Therefore, countries like South Korea has issued a travel advisory warning to its citizens living or travelling to China to take precautions. The Central Epidemic Command Center (CECC) in Taiwan has issued a travel notice of Level 2: Alert for avian influenza to Guangdong Province, Zhejiang Province, Jianxi Province, Jiangsu Province, Hunan Province, Shanghai City, Beijing City and Fujian Province and a travel notice of Level 1: Watch for avian influenza to the other provinces and cities in China, excluding Hong Kong and Macau (Centers for Disease Control, R.O.C. (Taiwan), 2014).
Impacts of mass gathering According to a research that was done by Pengyi, Keskinocak, Swann and Lee, there are potential negative impacts of national and international travel restrictions, for example; border closures or international air travel restrictions. However, it is challenging to cancel or postpone gatherings which are held near largely affected areas. Looking back at the Spanish Flu in 1918, it was difficult to determine the current and predicted future results of an ongoing pandemic. The World Health Organization, disease control and prevention of the United States and many other public health organizations published recommendations suggesting the public to defer from non-essential travel to infected areas and emphasizing appropriate precautions such as hand sanitizing during travel, while attending or hosting events that require mass gathering. Moreover, there are economic and logistic consequences as they are two negative impacts when it comes to changing a planned scheduled event. In some cases, the holidays are essential when it comes to mass gatherings and cannot be subject to change because it is an annual celebration, for example; New Year’s Eve count downs occurs once a year, the day before a new year and it cannot be rescheduled on a later date. Memish Teal is another good example as it is a global religious event called Hajj Grimace celebrated by Muslims in Saudi Arabia, and it attracts more than 2.5 million pilgrims from all around the world every year. Most of these big events are difficult to cancel during a pandemic, decisions regarding canceling or postponing mass gatherings are left to local authorities; travel restraints are generally not recommended. The public health decision makers may use information from previous pandemics situations to help decide whether to postpone, cancel, monitor, or enforce infection control measures during a group gathering or holiday season (Pengyi, Keskinocak, Swann & Lee, 2010).

Crisis Management
One of the articles mentioned that the organizations in the Canadian hospitality industry are not well prepared. Over 80% of respondents indicated that they have no plan or even a minimal plan for disasters that may occur in the future (Gruman, J. A., Chhinzer, N., & Smith, G. W. (2011). There are some legal issues that would occur during the flu outbreak such as Human Resouce/Labour and employment issues, Contract disputes, Shareholder suits and more (Menges, C.L., & McMenamin, J. P., 2006). Even though the chances of catching an avian flu are low in Canada, the Canadian Red Cross organization has shown that during an influenza pandemic, there is a possibility that up to 10.6 millions of Canadian citizens who would require medical attention (The Canadian Red Cross Society, 2007). Canadian Red Cross has advised businesses to develop a business continuity plan because up to 25% of employees may be reported as absent during work if an influenza pandemic starts.
From the year 2003 to December 20th, 2013, 648 laboratory-confirmed human cases of avian influenza A (H5N1) virus infection has been officially reported to World Health Organization from 15 countries. Of these cases, 384 died (W.H.O, 2014). Even though the risk of getting an avian flu remains low, we cannot ignore the fact that there are still people dying because of the virus. As a result, we should plan ahead in order to prevent or manage similar crises that might happen in the future. In the United States, the Department of Homeland Security (DHS) and The Federal Emergency Management Agency (FEMA) launched Ready Business in 2004, which helps businesses to manage their operations during events of emergencies or disasters. It provides guidelines for businesses to plan, implement, test and exercise programs that can minimize the impacts of flu. Moreover, in Canada, the Ministries of Health also provides supports for businesses to establish workplace flu-shot center. There are many resources available online for businesses to educate their employees about the viruses and businesses can work with external organizations like Red Cross Canada to fully educate and communicate the importance of preventing the flu. In the hospitality industry, it is critical for businesses to actively monitor and assess the possibility of the occurrence of a pandemic, because the flu can be easily transmitted from one to another and managers should consider implementing appropriate crisis management systems to control the flu and to prevent future loss of revenues.
Additional information that may have arose from research
During the research, there was information on a problem indicating that, in the hospitality industry, some managers are not afraid of pandemics and are not taking the flu seriously since the virus has not affected Toronto’s hospitality industry as much (comparing the virus in other countries). Just like in 1918 managers of businesses are disregarding sets of rules that were created to protect them. Some managers believe that the flu does not seem as harmful as SARS. Yet, on January 27, 2014, officials from the Chinese Center for Disease Control and Prevention reported 49 H7N9 infections and 12 deaths so far and it will continue in some cities (Xinhua News, 2014). Some experts in China indicate that the H7N9 virus had mutated and spread from human to human. Although H7N9 is currently a problem in Asia there is always a chance that this disease can travel to other countries. This poses as a problem as some managers are not taking the correct precautions against an oncoming pandemic.
Recommendations
Even today, influenza pandemics occur every few years. It is not a matter of "if" but a "when". Since there is a high chance of there being another pandemic, United States and other countries have plans underway on how they will handle the next pandemic. With the help of the past, there can be a better future. To meet the next influenza pandemic, hospitals today should be prepared to meet the surge in pandemic demand. It is important to develop a plan ahead of time that incorporates all levels of government health infrastructure with clear sets of responsibilities and roles that needs to be met (Ott, Shaw, Danila, & Lynfield, 2007). They should be involved in regional planning for flu medical care as they need to be able to provide care for patients while maintaining essential medical services after the pandemic. The relationship between emergency management and public health is crucial as it is important to determine the number of available healthcare workers, to triage, to determine patient flows and to identify suitable organizations that have trained volunteers for healthcare roles (Ducan & Adjunct, 2006). Communities should be prepared with demographic profiles of communities, including population that requires special needs as well as language minorities. There should be a current up to date register of all active and former active healthcare personnel that is available for emergency use. On May 2006, it was announced on CTV that the Canadian government would have 55 million antiviral agents available (Ducan & Adjunct, 2006). Companies should be sure to protect their employees, especially those who are working directly close to the disease. The government should consider reliable crowd control measures, enforcement of quarantine, restriction of travel, use of privately owned building for hospitals and must consider the usage of compulsory vaccination to control the spread of the outbreak. Plans for community containment must be discussed with shareholders and consensus must be achieved (Ott, Shaw, Danila, & Lynfield, 2007). ). A committee should be created (i.e. National Committee chaired by the Minister of Health, Technical Committees at central government level, etc...) in order to manage the threat of an ongoing pandemic (Birchall, 2009). There should also be effective communication mechanisms set up during the pandemic with the public to inform citizens about the risks involved during a pandemic. Communication becomes an important factor when a crisis such as a pandemic occurs. With clear explanations for isolation, generous employer support, providing of food, medicine and social service to those that are in isolation may mitigate fear and increase cooperation (Ott, Shaw, Danila, & Lynfield, 2007). It is important that the public be educated about the reasoning’s behind health measures such as isolation. Messages should be scientifically accurate, understandable, clear and useful (Ott, Shaw, Danila, & Lynfield, 2007). Increased public awareness about the flu pandemic is another way to give everyone a better understanding about the ongoing situation; experts should be encouraged to educate the general public about the virus and what preventive measures that can be taken (Birchall, 2009). Reporting positive information such as an estimated number of recovery rates can help to reduce a citizen’s anxiety. Medical preparedness according to the news from September, 10th of 2009 by Louise Birchall, U.A.E has a stock of five million Tamiflu capsules and swine flu vaccines to arrive in September for the illness prevention during the H1N1 pandemic (Birchall, 2009). Citizens also have a responsibility to keep themselves safe and healthy with a sufficient supply of food and water. They should review public health procedures on how to reduce the risk of contracting or spreading the disease during a pandemic. People should avoid non-essential travel and ensure everything is clean (e.g. countertops and door handles) while also maintain good basic hygiene (e.g. washing hands, using clean tissue when coughing or sneezing) and carefully disposing waste (e.g. dirty tissues and used face masks) (Ducan & Adjunct, 2006).

How the Hospitality sector should act The hospitality sector has a responsibility to keep their customers safe and should be prepared for a crisis such as an influenza pandemic. Hotels and airports should prevent their customers from non-essential travel to prevent the disease from spreading. All staff members should be knowledgeable and trained so they are prepared. There should be easy access to a list of hospital and medical clinic locations while hotel and airport medical centers are prepared and stocked for future ill customers. They should have a procedure plan prepared in case a situation such as a pandemic arises.
Since hospitals are the most impacted areas during an influenza pandemic, hotel management teams have to take action in order to ensure both guest and employee safety. Individuals may be unable to eliminate the illness but they are able to assist in reducing it and preventing it to spread. There are some individual prevention strategies that hotels may take;
1. Hand-hygiene: employers should obligate their employees to wash their hands often with soap and warm water and sometimes use an alcohol-based hand rub of minimum 60% alcohol for maximum effectiveness. Placing hand sanitizer in many different locations ensure that both guest and staff areas have ample tissues and antibacterial hand sanitizer ("What is SARS?", 2013).
2. Keep utensils, towels, bedding, and clothing clean by using warm water to disinfect it.
3. Keep commonly used surfaces disinfected: clean all the surfaces such as door handles, counters and tabletops in the main lobbies, restaurants and recreational areas. This can help to prevent the spread of the virus (Avendra.com, 2011).
4. Consider frequently sanitizing other areas which are high in traffic such as public telephones, restroom doors, stalls, light fixtures, furniture, fitness equipment, vending and ice machines, railings on stairways and elevator buttons (Avendra.com, 2011).
5. Educating both staff and guests about the prevention, encouraging flu vaccinations and hygienic habits would able to help prevent flu symptoms among guests and the health care industry (Avendra.com, 2011).
6. Health education seminars provided for health care institutions and health experts to be stationed in different areas but mainly the lobby of a hotel (Birchall, 2009). 7. Deposit sanitizing and surgical masks in the lobby for those who have signs of being infected by influenza. Prepare an area for isolation, if anyone exhibit flu-like symptoms, send him/her to the area and contact the nearby hospital as soon as possible.
8. Constant contact to the World Health Organization hotline and collaboration with other regional and international health organizations.
Hotel Response Plan
Employee safety is important, Human Resources and managers should monitor employees for any sign of sickness. When an employee shows signs of sickness, local health centers should be contacted and their recommendations should be followed. Policies should be in place for sick employees and communication must be in place to work out scheduling and possible temporary reduction in staff due to the impact of the pandemic. Staff members should be fully informed on any status changes of the property, occupancy and any data that concerns the pandemic as they server as a source for any quarantine instructions or prohibitions mandated by local authorities.
If a staff member appears to have symptoms of the disease, hotel management should be informed right away and they are encouraged to enforce a sick leave policy for employees. Sick employees should stay at home while human resources should be contacted to evaluate sick leave procedures. Sick employees should visit their physician or a local health center.
If a guest of the hotel becomes sick, hotel management should be notified and the pandemic response plan regarding guest health should come into effect. Local health centers should be notified and recommendations should be followed. When a guest is found to be sick they should be kept away from other guests and have them contact their physician. Friends and family of the sick guest who are staying in the same room should also be advised to see their physicians. It is important to prepare an isolation room and record all details for further follow up. When the infected guest checks out or is transported off the property the guest room should be decontaminated properly before any further use. Procedures must be met when a room needs to be decontaminated and items needs to be handled appropriately for possible biohazard contamination. Gloves and masks should be worn by employees when they are performing the following tasks:
1. Linen: bedding and linens should be checked for any sharp objects, blood or bodily fluids. They should then be placed in biohazard bags and washed with an approved disinfectant. Any material that cannot be washed must be disposed of and considered as hazardous waste

2. Sharp Objects: Any sharp contaminated objects should not be touched. Objects such as syringes should be picked up by tongs and placed inside a container or bag that is puncture resistant.

3. Cleaning and Disinfection: Bleach and water solution can be used and is a safe method for decontamination. Additional attention should be given to surfaces that have a high likely chance to have been touched by the guest. And if equipment becomes contaminated then they should be labeled as biohazard and told to staff members.
A list of places to be decontaminated in a hotel has been provided by the article H1N1 Influenza Management in Hotels
Guest Rooms
Lobby, Public Areas and Restaurants
Public Restrooms
Back of House Property
Door handles
Door handles and stair railings
Door handles and stair railings
Door handles and stair railings
Door security latches
Push plates on swing doors
Handles on stall doors
Push plates on swing doors
Desks and chair handles
Elevator buttons
Toilet and faucet handles
Telephone and computer keypads
Dresser and table drawer handles
Tables and chairs
Soap dispenser handles
Computer mouse
Table countertop surfaces
Elevator buttons
Counter surfaces
Food serving scoops and spoons
Telephone keys
Tables and chairs
Towel dispensing handles
Beverage service handles
TV remote control buttons Menus

Refrigerator handles
Toilet and faucet handles
Public telephones

Toilet and faucet handles
Lights and temperature control switches
Counter surfaces at reception and concierge areas

Soap dispenser handles
In-room information resources, such as menus Room keys
Pens used for signing receipts

Towel dispensing handles

Computer keyboards and mouse

Cleaning equipment and tool handles

Ice machines

Bucket and trashcan handles

Beverage service items, such as coffee and tea pot handles Exercise equipment in fitness rooms

Sample Guest Letter
A sample letter to guests was found in the article H1N1 Influenza Management in Hotels that hotels can use to communicate with their guests when a pandemic occurs. When a situation such a pandemic arrives it is always best to inform guests about what the situation is and to let them know what steps they should take to keep themselves safe. This is the sample found which is located in Appendices.
Conclusion
With a proper procedure plan how what the hospitality sector should do when a pandemic occurs it will help protect both employees and guests. The mistakes from the past should be revised and changed so that the future will be better. It is the responsibility of the hotel to keep their employees and guests safe and they should always take precautions even if the chances of catching the disease are small. Everyone should be prepared for when a possible pandemic comes to avoid disastrous situations.

References
Arthur D. Little. (2009). Tourism industry in turbulent times. Retrieved January 27, 2014 from http://www.adlittle.com/downloads/tx_adlreports/ADL_Tourism_industry_in_turbulent_times_01.pdf.
Birchall, L. (2009, February 14). Hospitality industry united against swine flu. HotelierMiddleEast.com. Retrieved January 30, 2014, from http://www.hoteliermiddleeast.com/5660-hospitality-industry-united-against-swine-flu/.
Centers for Disease Control, R.O.C. (Taiwan). (2014). H7N9 influenza infections confirmed in Shanghai City, Guangdong Province and Zhejiang Province in China, CECC for H7N9 influenza advises people traveling overseas to take preventive measures to ward off infection. Retrieved January 27, 2014 from http://www.cdc.gov.tw/english/info.aspx?treeid=BC2D4E89B154059B&nowtreeid=EE0A2987CFBA3222&tid=1ED228EE6990075F.
Choong-Ki, L., Hak-Jun, S., Lawrence J., B., Myung-Ja, K., & Heesup, H. (n.d). The impact of non-pharmaceutical interventions for 2009 H1N1 influenza on travel intentions: A model of goal-directed behavior. Tourism Management, 3389-99. doi:10.1016/j.tourman.2011.02.006 Duncan, K. (n.d.). Important Information About the Public Entity Risk Institute. PERI. Retrieved January 26, 2014, from http://www.riskinstitute.org/peri/component.
Flu prevention for the hospitality industry. (2011, November 30). Flu prevention for the hospitality industry. Retrieved January 24, 2014, from http://www.avendra.com/whatwedo/thoughtleadership. Mu, X. (2014, January 27). China goes on high H7N9 bird flu alert. - Xinhua. Retrieved January 26, 2014, from http://news.xinhuanet.com/english/china/2014-01/27/c_126071190.htm.
Gruman, J. A., Chhinzer, N., & Smith, G. W. (2011). An Exploratory Study of the Level of Disaster Preparedness in the Canadian Hospitality Industry. International Journal Of Hospitality & Tourism Administration, 12(1), 43-59. doi:10.1080/15256480.2011.540980
"H1N1." H1N1 Influence Management in Hotels 9-09 (2009): n. pag. American Hotel & Lodging Association. Web. 26 Jan. 2014.
Jing, M. (2013). Four industries suffer from H7N9 bird flu. China Daily USA. Retrieved from http://usa.chinadaily.com.cn/business/2013-04/08/content_16383294.htm.
National Business Travel Association. (2009). Swine flu outbreak impact on business travel. Retrieved January 27, 2014 from http://www.gbta.org/Lists/Resource%20Library/Swine_Flu_Impact_MAY09.pdf.
Ott, Miles, Shelly F. Shaw, Richard N. Danila, and Ruth Lynfield. "Public Health Reports." Lessons Learned from the 1918–1919 Influenza Pandemic in Minneapolis and St. Paul, Minnesota. N.p., n.d. Web. 22 Jan. 2014.

References: Arthur D. Little. (2009). Tourism industry in turbulent times. Retrieved January 27, 2014 from http://www.adlittle.com/downloads/tx_adlreports/ADL_Tourism_industry_in_turbulent_times_01.pdf. Birchall, L. (2009, February 14). Hospitality industry united against swine flu. HotelierMiddleEast.com. Retrieved January 30, 2014, from http://www.hoteliermiddleeast.com/5660-hospitality-industry-united-against-swine-flu/. Centers for Disease Control, R.O.C. (Taiwan). (2014). H7N9 influenza infections confirmed in Shanghai City, Guangdong Province and Zhejiang Province in China, CECC for H7N9 influenza advises people traveling overseas to take preventive measures to ward off infection. Retrieved January 27, 2014 from http://www.cdc.gov.tw/english/info.aspx?treeid=BC2D4E89B154059B&nowtreeid=EE0A2987CFBA3222&tid=1ED228EE6990075F. Choong-Ki, L., Hak-Jun, S., Lawrence J., B., Myung-Ja, K., & Heesup, H. (n.d). The impact of non-pharmaceutical interventions for 2009 H1N1 influenza on travel intentions: A model of goal-directed behavior. Tourism Management, 3389-99. doi:10.1016/j.tourman.2011.02.006  Duncan, K. (n.d.). Important Information About the Public Entity Risk Institute. PERI. Retrieved January 26, 2014, from http://www.riskinstitute.org/peri/component. Flu prevention for the hospitality industry. (2011, November 30). Flu prevention for the hospitality industry. Retrieved January 24, 2014, from http://www.avendra.com/whatwedo/thoughtleadership. Mu, X. (2014, January 27). China goes on high H7N9 bird flu alert. - Xinhua. Retrieved January 26, 2014, from http://news.xinhuanet.com/english/china/2014-01/27/c_126071190.htm. Gruman, J. A., Chhinzer, N., & Smith, G. W. (2011). An Exploratory Study of the Level of Disaster Preparedness in the Canadian Hospitality Industry. International Journal Of Hospitality & Tourism Administration, 12(1), 43-59. doi:10.1080/15256480.2011.540980  "H1N1." H1N1 Influence Management in Hotels 9-09 (2009): n. pag. American Hotel & Lodging Association. Web. 26 Jan. 2014. Jing, M. (2013). Four industries suffer from H7N9 bird flu.  China Daily USA. Retrieved from http://usa.chinadaily.com.cn/business/2013-04/08/content_16383294.htm.   National Business Travel Association. (2009). Swine flu outbreak impact on business travel. Retrieved January 27, 2014 from http://www.gbta.org/Lists/Resource%20Library/Swine_Flu_Impact_MAY09.pdf.  Ott, Miles, Shelly F. Shaw, Richard N. Danila, and Ruth Lynfield. "Public Health Reports." Lessons Learned from the 1918–1919 Influenza Pandemic in Minneapolis and St. Paul, Minnesota. N.p., n.d. Web. 22 Jan. 2014.