Despite numerous warnings from public officials and thousands of deaths around the world, most American businesses are not prepared for another swine flu outbreak, and small businesses could be among the hardest hit, according to a recent survey conducted by the Harvard School of Public Health.

The survey, which collected data from over 1,000 businesses from July to August, found that many of the businesses surveyed had not discussed the possibility of another swine flu, or H1N1, outbreak. For example, when asked if the company had developed any written emergency plan or revised existing plans, 45 percent reported they did not, and 4 percent did not know if the company even had plans.

"I think what the survey tells us is that there are some vulnerabilities, and we have to start looking at those now," says Gillian SteelFisher, Ph.D., assistant director of the opinion research program. "Unfortunately, we don't usually get a preview of what might happen."

The survey contains data that points to several areas where smaller businesses might be affected by an outbreak, such as the fact that only 27 percent of small businesses said they would be able to avoid severe operational problems if half their employees were absent for a month.

"Three quarters of small businesses are saying they'd really be in trouble," SteelFisher says.

In addition, SteelFisher says the group found that only 67 percent of the small businesses surveyed offer sick leave, compared to 76 percent of large businesses and 82 percent of medium-sized businesses. Without sick leave, some employees might be forced to find work elsewhere during a family member's sickness or child's school closing.

"In such an outbreak you might expect that people would have to take off work to care for themselves or their families," says SteelFisher. "I think that's a challenge for employees of small businesses in particular."

Janet Napolitano, U.S. Secretary of Homeland Security says the government is working to address that challenge, among others. On September 14, Napolitano, along with SBA Administrator Karen Mills and Dr. Daniel Jernigan, Deputy Director for the Influenza Division of the Center for Disease Control, held a conference to announce a guidebook that will be released to small businesses on decreasing exposure to seasonal flu and H1N1, as well as how to manage operations during an outbreak.

"We're already seeing an uptick in cases across the country, and we expect that to continue throughout the fall and winter," says Secretary Napolitano. "Small businesses will have a major role as we work through the H1N1 issue in our country."

According to the officials, the guidebook will outline four key steps for small businesses to prepare:

1. Plan now. With fall already upon us, businesses should now be discussing precautions.

2. Take into account two planning scenarios. Small businesses should prepare for two types of outbreaks: one in which there is a lot of disease, but moderate illness, and another in which the virus changes and illness becomes more severe.

3. Protect your workforce. Encourage the sick to stay at home for at least 24 hours after their last fever without taking any fever reducers. Since the offices of small businesses are often just that -- small -- consider putting physical distance between employees to reduce the potential spread of the virus. Also, encourage rigorous hand-washing hygiene and respiratory techniques, such as sneezing into the sleeves and not into hands.

4. Maintain continuity of operations. Even during high levels of absenteeism, Jernigan says, small businesses can make strides toward keeping things flowing as smoothly as possible. Those who can work from home during the event of an outbreak, should.