The H1N1 flu pandemic has many business leaders concerned, but the strain of the recession and other worries have them holding back on aggressive, and costly, responses. That could prove disastrous. "There are a lot of companies who might have had generalized discussions about [a pandemic], but when it comes down to it, most don't have big plans," says John Challenger, CEO of Challenger, Gray & Christmas, a Chicago-based outplacement firm. "It's human behavior that until it hits you square between the eyes, you don't really want to deal with it," he says. "And there might be some skepticism that it's just another bird flu or Y2K kind of thing, where nothing really happens." Yet Challenger and other human resources consultants say it's too risky not to take swine flu seriously, especially when many staffs are operating at bare-bones levels. Companies can't afford to brush off a threat that could leave much of their remaining workforce incapacitated, or "to create any more ill will," he says. 1 million and counting The federal Centers for Disease Control and Prevention in Atlanta estimates that the H1N1 virus has infected more than 22 million people in the U.S. since April, and more than 4,000 people nationwide have died of related complications. The proportion of deaths attributed to influenza already has exceeded what is normally expected at this time of year, with the young hit the hardest, the CDC says. At the same time, a survey published in September by the Harvard School of Public Health found that the pandemic and resulting absences could have devastating effects on U.S. businesses. Only one-third reported that they could sustain their businesses without "severe operational problems" if the swine flu kept half their workforces out sick for two weeks, according to the survey. Jennifer Benz, who runs Benz Communications, a San Francisco-based employee benefits communication firm, says many of her clients have begun health education campaigns but have stopped short of analyzing all the issues that could arise from a pandemic. "It's very easy to post communications throughout your company, such as washing your hands when you sneeze, but to really look at changing policies is a much different thing," she says. "It's a tough business environment right now." Many companies may do more if they see absenteeism soar, she says, but by then, it may be too late. "I think a lot of companies have a plan in their back pocket. If their work site gets hit really hard, then they'll look at 'How do we respond?' " The flu pandemic highlights the importance of providing robust health benefits, such as more than one or two sick days a year, she says. But ad hoc solutions, such as allowing employees to work from home, will fail if a company hasn't thought them through by, for instance, providing enough access to laptops and ensuring that computer networks can support large numbers of workers dialing in. Furthermore, just telling employees to stay home doesn't help if the company has a weak sick-leave policy or doesn't provide paid sick time for hourly or part-time workers. "For low-wage workers, missing some days off can mean the difference in paying your rent that month," Benz says. In many cases, businesses are opting against more aggressive efforts because of cost and privacy concerns, says Russell Robbins, a principal and senior clinical consultant in the Connecticut office of HR consulting firm Mercer. Unfortunately, it's easy to dismiss warnings over H1N1 as paranoid or an overreaction, but the truth is that the flu is likely to spread, Robbins says. "I just keep saying that the only way we're going to weather through this is if we're prepared for a crisis," he says. "In other words, make plans now." Medical opinion For some businesses, such as medical facilities, restaurants and food stores, there's often a greater urgency to implementing a response plan. At Northwestern Memorial Hospital, a task force looked at preparations for everything from a minor outbreak to the worst-case scenario resulting in widespread absenteeism, says Dean Manheimer, senior vice president of human resources. In addition to its comprehensive employee communication plan, Northwestern ramped up an immunization program and reached out to temp agencies to ensure replacements are available. It also is encouraging sick employees to stay home. "If you are sick, we will send you home," Manheimer says. "And we have a very robust paid-time-off policy that supports that." For now, Northwestern has not considered increasing employee sick days, but the hospital will continue to monitor the spread of the virus and make decisions accordingly, Manheimer says. Like many large corporations, Chicago-based Boeing Co. started looking at its disaster plans in 2005, after the Asian outbreak of the avian flu caused concern worldwide, says a disaster-planning spokeswoman for the company. One of the most important considerations was ensuring that employees fully understood their health care benefits and options, including those for sick children and other dependents, the spokeswoman says. Boeing leaders mulled over more costly options too, such as installing infrared devices to detect fevers, but opted against them, at least for now, over concerns that the cost wasn't justified. Small-business toll For small businesses, preparing for flu is a particularly difficult challenge. In an operation of a couple dozen or fewer employees, even a few illnesses can shut down operations. Samuel Ko, president of Philos Technologies Inc., has roughly 75 employees scattered at plants nationwide, as well as at the company's Wheeling headquarters. If even a few people are out sick, the metal-surfacing company could be strained. For now, though, Philos offers only one paid sick day a year. Beyond that, employees can try working out an arrangement or provide a doctor's note, but there are no guarantees of extra time off at their regular pay. Ko travels extensively in Europe and Asia for his business and takes the H1N1 threat seriously. To prepare for the flu season here, he is cross-training employees to fill in for those who are ill. Still, he worries about what might happen if the flu spreads through an entire plant or office, and does not have ideas for how to prevent his hourly employees, who have no sick leave, from showing up for work ill. "We need to look at that," Ko says. Other small-business owners are trying to head off that exact scenario by assuring their employees that they will be taken care of. Because his workers butcher and handle meat all day, Bill Begale, owner of Paulina Market, a 22-employee gourmet meat market in Chicago, is taking extra precautions to keep his store sanitary, with frequent hand washing and intensive sanitary procedures. He's also offered to pay the $20 or $30 it would cost nonunion employees to get flu shots. Many of Begale's butchers are covered by union benefits, but he tries to assure the others that they can work things out on a case-by-case basis. Temporary workers are lined up to fill in for ill employees, and Begale says hourly employees who can't afford to lose their pay to sickness can come in on a day off or use vacation days to get paid. "If anyone has a fever, they just can't come in. I'll send them home. We've talked about it a lot here," Begale says. "They just know what kind of person I am and that I'd work something out."