Pandemic Risk

Americans Mostly Safe From Ebola, Despite Rapid Spread

As the deadly Ebola virus claims more lives in West Africa, experts say practicing basic hygiene is the best defense.
By: | August 1, 2014 • 5 min read

Since it was first discovered in early March, the Ebola outbreak in West Africa has reportedly taken up to 900 lives and infected about 1,700 others — a number that is likely to grow rapidly as affected countries (Guinea, Liberia, Nigeria and Sierra Leone) struggle to contain the disease.

The disease is increasingly emigrating to other countries, with at least two suspected victims in U.S. hospitals and a suspected Ebola death in the Middle East. Several Middle Eastern countries are reporting suspected infections.

A meeting on August 1 between World Health Organization (WHO) director Dr. Margaret Chan and leaders of Sierra Leone, Guinea and Liberia established a $100 million plan to deploy more medical professionals to the region.


In a transcript of meeting remarks, Chan said, “This outbreak is moving faster than our efforts to control it. If the situation continues to deteriorate, the consequences can be catastrophic in terms of lost lives but also severe socioeconomic disruption and a high risk of spread to other countries.”

Despite these bad omens, though, American business travelers and employees stationed in the region should be at low risk for infection as long as they take basic precautions.

“So long as they avoid heavily populated areas, practice standard universal hygiene precautions like hand washing, and stay out of hospitals and clinics where Ebola patients are treated, their risk should be lower,” said Dr. Robert Quigley, regional medical director and president of medical assistance, Americas region, for International SOS.

Armed gangs are chasing caregivers away from villages, while the infected hide, for fear that aid workers will cart them off to die.

Katherine Harmon, health intelligence director at iJET International, said her company advised that the affected countries and surrounding areas were safe for travel. “If you’re not a health care worker, you have low risk of being exposed. Stay away from large crowds; avoid people who are sick in general; practice good personal hygiene. The risk of contracting Ebola is quite small.”

The rapid spread of disease among these impoverished countries, she said, is mostly due to cultural practices. In burial practices, for example, the bodies are washed, and the deceased’s loved ones customarily touch the body as a sign of reverence.

“They don’t understand that those bodies are still infected, and everyone who touches them is at risk,” she said. “And if somebody tries to come in and take the bodies away to cremate them, they take it as a religious slap in the face.”

Health ministries in the affected countries also separate physician licensing into Western medicine practitioners and homeopathic practitioners. “There’s a very strong community sentiment that does not believe in Western medicine. They believe doctors want to preform experiments on them,” Harmon said. “The biggest risk is from patients who have absconded or are hiding their symptoms, refusing to seek treatment.”

“If you’re not a health care worker, you have low risk of being exposed. Stay away from large crowds; avoid people who are sick in general; practice good personal hygiene. The risk of contracting Ebola is quite small.” — Katherine Harmon, health intelligence director, iJET International

Ebola’s mortality rate is around 90 percent, but early treatment can improve chances of survival by about 30 percent. Police in some countries have started to conduct house-by-house searches to locate infected people.


Harmon also advised U.S. workers or visitors in the region to carry their own medical kits, as supplies and availability of doctors will run low. Self-care may be necessary, she said, since not all third-party medical assistance providers will be able to evacuate employees due to international regulations and individual protocols.

“You may be stuck there,” she said.

The affected countries have ramped up efforts to quarantine the disease over the past few days. Sierra Leone declared a state of emergency, Liberia has sealed its borders, and two major Nigerian airlines will no longer fly into countries where Ebola has been confirmed. The Centers for Disease Control (CDC) has recommended deferring all non-essential travel to the region. WHO, however, has not issued any travel or trade restrictions.

Airports servicing flights in an out of the regions are screening passengers for symptoms, which will help contain the disease, Harmon said. “The best approach is for people to understand what’s going on and be cooperative with these measures.”

Though the Peace Corps and other aid groups have pulled out volunteers, “lots of organizations, such as NGOs, are heading in there anyway,” Quigley said.

“All companies have different thresholds for evacuation and different levels of risk tolerance. They should be looking through their travel tracker processes to identify anyone who is there and potentially at risk. They are having to work with local authorities, who have some control over how and when people can exit.”

“Companies should evaluate their risk tolerance, talk to their insurance people and assistance providers and make sure they’re covered,” Harmon said. “Know what your plan is to get out if something happens.”

Quigley added, “You need to go back to your business continuity plan, which traditionally would include an infectious disease plan and pandemic plan. If you don’t have one, this kind of event should motivate companies to develop one. You can bet there is some exposure there for companies in every industry segment.”

In addition to supplying more nurses and physicians, WHO’s new plan also aims “to increase preparedness systems in neighboring nations and strengthen global capacities.” This should slow the transmission of the Ebola virus within the most affected countries and prevent its spread across borders.


The plan also includes improved communication efforts, advising how to avoid the infection, how to recognize its symptoms, and how to report suspected cases. “Referring people infected with the disease for medical care, as well as psychosocial support, are key,” the statement said.

“It can take 21 days to prove you are Ebola-free if you’ve been quarantined,” Harmon said, “Once these countries have a zero-case level of Ebola patients, it will take up to 42 days for them to be declared Ebola-free. It’s going to be a while before things are back to normal.”


Katie Dwyer is an associate editor at Risk & Insurance®. She can be reached at [email protected]

R&I Profile

Achieving Balance

XL Catlin’s Denise Balan stays calm and focused when faced with crisis.
By: | January 10, 2018 • 6 min read

In the high-stress scenario of kidnap or ransom, the first image that comes to mind isn’t necessarily a yoga mat — at least, not for most.

But Denise Balan, senior VP and head of U.S. kidnap & ransom, XL Catlin, who practices yoga every day, would swear by it.


“I looked at these opposing aspects of my life,” she said. “Yoga is about focus, balance, clarity of intent. In a moment of stress, how do you respond? The more clarity and calmness you maintain, the better positioned you are to provide assistance in moments of crisis.

“Nobody wants to be speaking to a frenetic person when either dealing with a dangerous situation or planning for prevention of a situation,” she added.

“There’s a poem by [Rudyard] Kipling on that,” added Balan’s colleague Ben Tucker. “What it boils down to is: If you can remain calm, you can manage through a crisis a lot better.”

Tucker, who works side by side with Balan as head of U.S. terrorism and political violence, XL Catlin, has seen how yoga influences his colleague.

“The way Denise interacts with stakeholders in this process — she is very professional and calm in the approach she takes.”

Yin and Yang

Sometimes seemingly opposite or contrary forces may actually be complementary and interconnected. In Balan’s life, yoga and K&R have become her yin and yang.

She entered the insurance world after earning a juris doctor degree and practicing law for a few years. The switch came, she said, when Balan realized she wasn’t enjoying her time as a commercial litigator.

Denise Balan, senior VP and head of U.S. kidnap & ransom, XL Catlin

In her new role, she was able to use her legal background to manage litigation at AIG, where her transition from law to insurance took place. She started her insurance career in the environmental sector.

In a chance meeting in 2007, Balan met with crisis management underwriters who told her about kidnap and ransom products.

She was hooked.

Because of her background in yoga, Balan liked the crisis management side of the job. Being able to bring the calmness and clearness of intent she practiced during yoga into assisting clients in planning for crisis management piqued her interest.

She then joined XL Catlin in July 2013, where she built the K&R team.

As she became more immersed in her field, Balan began to notice something: The principles she learned in yoga were the same principles ex-military and ex-law enforcement practiced when called to a K&R-related crisis.

She said, “They have a warrior mentality — focus, purpose, strength and logic — and I would say yoga is quite similar in discipline.”

“K&R responders have a warrior mentality — focus, purpose, strength and logic — and I would say yoga is quite similar in discipline.” — Denise Balan, senior VP and head of U.S. kidnap & ransom, XL Catlin

Many understand yoga to be, in itself, one type of meditation, but yoga actually encompasses a group of physical, mental and spiritual practices. Each is a discipline. Some forms of yoga focus on movement and breathing, others focus on posture and technique. Some yoga is meant to relax the mind and create a sense of calmness; other yoga types make participants sweat.

After having her second child and working full-time, Balan wanted to find something physical and relaxing for herself; a friend suggested yoga. During her first lesson, Balan said she was enamored with it.

“I felt like I’d done it all my life.”

She dove into the philosophy of yoga, adopting the practice into her daily routine. Every morning, whether Balan is in her Long Island home or on a business trip, she pulls out her yoga mat to practice.

“I always travel with my mat,” she said. “Daily practice is the simplest form of connection to routine to maintain my balance — physically and mentally.”


She said the strangest place she has ever practiced was in Lisbon. She was on a very narrow balcony with a bird feeder swarming with sparrows overhead.

After years of studying and practicing, Balan is considered a yogi — someone who is highly proficient in yoga. She attends annual retreats with her yoga group, where she is able to rejuvenate, ready to tackle any K&R event when she returns.

In 2016, Balan visited Tuscany, Italy, where she learned the practice of yoga nidra, a very deep form of meditation. It’s described as the “going-to-sleep stage” — a type of yoga that brings participants to a state of consciousness between waking and sleeping.

“It awakens a different part of your brain,” Balan commented. “Orally describing it doesn’t quite do it justice. One has to practice Nidra to fully understand the effect it has on your being.”

Keeping a level head during a crisis is key in their line of business, Tucker said. He can attest to the benefit of having a yogi on board.

“I’ve seen her run table-top exercises where there is this group of people in a room and they run an exercise, a simulation of a kidnap incident. Denise is very committed to what we’re doing,” said Tucker.

“She brings that energy. She doesn’t get flustered by much.”

Building a K&R Program

When Balan joined XL Catlin, she was tasked with creating the K&R team.

Balan during a retreat in Sicily, Italy, 2017

She spent time researching and analyzing what clients would want in their K&R coverage. What stuck out most to Balan was the fact that, in these situations, the decision to purchase kidnap and ransom cover is rarely made because of desire for reimbursement of money.

“I asked why people buy this type of coverage. The answer was for the security responders,” she said.

“These are the people who sit with the family. They’re similar to psychologists or priests,” Balan further explained. “Corporations can afford to pay ransom. They buy [K&R] because it gives them access to these trained and dedicated professionals who not only provide negotiation advice, but actually sit with a victim’s family, engaging deep levels of emotional investment.”

“I’ve learned to appreciate all moments in life — one at a time. The ability to think clearly and calmly guides my work, my practice and my personal life.” — Denise Balan, senior VP and head of U.S. kidnap & ransom, XL Catlin

Balan described these responders as people having total clarity of purpose, setting their intentions to resolve a crisis — a practice at the very heart of yoga. She knew XL Catlin’s new kidnap program would put stock in their responders.

“I’ve worked closely with the responders to better understand what they can do for our clientele. These are the people who run into danger — warrior hearts married to dedication to our clients’ best interests.”

But K&R is more than fast-paced crisis and quick thinking; Balan also spent a good deal of time writing the K&R form and getting the company’s resources in order. This was a huge task to tackle when creating the program from the ground up.


“A lot of my day-to-day is speaking with brokers and finding ways to enhance our product,” she said.

After a few months, she was able to hire the company’s first K&R underwriter. From there, the program has grown. It’s left her feeling professionally rewarded.

“People don’t often get that opportunity to build something up from scratch,” she said. “It’s been an amazing experience — rewarding and fun.”

“She brings groups of people together,” said Tucker. “She’s created a positive environment.”

Balan’s yogi nature extends beyond the office walls, too. Her pride and joy, she said, are her kids. And while it may seem like two large parts of her life are opposite in nature, Balan’s achieved balance through her passions.

“[Yoga] has given me the ability to see beyond only one aspect of any situation” she said. “I’ve learned to appreciate all moments in life — one at a time. The ability to think clearly and calmly guides my work, my practice and my personal life.” &

Autumn Heisler is a staff writer at Risk & Insurance. She can be reached at [email protected]