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Curing the Ebola Outbreak Confusion

by Arlene Karidis

Ebola preparedness

Local health providers are cautious, but not fearful of this dangerous disease.

In a remote corner of Meritus Medical Center, away from the bustling emergency department, and away from the filled beds upstairs, a medical team slips into boots and protective shields where they “double glove.” Then they disinfectant lab tubes and place them in a biohazard bag. It’s dropped in another clean bag, and sealed up to be whisked away.

These workers are a dedicated task force who have congregated for a routine Ebola preparedness drill. They practice specific Centers for Disease Control (CDC) protocols to avoid contamination — from techniques for disposing hospital gowns to be incinerated, to ways to handle stethoscopes and other medical instruments reserved for isolation rooms.

Five cases of Ebola have been reported in the United States since the fall of 2014 at the time this went to print, with the first being a man who had just returned from West Africa, where the serious disease, spread by bodily fluid, originated. He died in October 2014. As of the end of that month, the World Health Organization (WHO) reported there have been over 13,500 cases, almost all in a few regions in West Africa. In total, there have been more than 6,000 confirmed deaths.

“Still, Ebola is not considered a major public health threat in this country. We have sophisticated infection control, so there is much less chance of contracting it,” says Dr. Mohammed Ali, MD, an infectious disease specialist at Meritus Health. “But as a precaution,” he says, “we are preparing to be ready to fight this if we see a potential case.”

Summit Health also regularly trains an Ebola task force representing each of its entities: Chambersburg Hospital, Waynesboro Hospital, and Summit Physician Services. In addition to these dedicated teams, and the training of Emergency Medical Services (EMS) staff that transport patients to their hospitals, the two health systems have taken the Ebola clamp down further. They have designated triage areas for patients who meet criteria as a “person under investigation.”

Who Is A Person Under Investigation?

Anyone who may have Ebola and who health systems — nationwide — handle according to CDC guidelines can find themself as a person under investigation. The goal is to be ready to immediately diagnose and avoid the spread of the disease, if there is any chance a person could be infected.

While the medical community and CDC say there is no need to panic, they assume nothing and act fast. Though the disease is extremely rare in this country, it is deadly if not treated immediately — and it can be hard to detect initially.

The challenge is that symptoms can mimic the flu and other viral infections like malaria, and typhoid fever, with symptoms including severe headache, muscle pain, diarrhea, vomiting, bleeding, or bruising.

But, says Dr. Ali, “Suspicion starts if a person had contact with someone who may have Ebola, or who had been to West Africa within 21 days. Or if they traveled to West Africa themselves in that timeframe. And if they also have internal bleeding. Then we classify the patient as a person under investigation.” The next step is a blood test available through state labs authorized by CDC, to rule out Ebola or to begin a care plan.

An information-Sharing Flow

Shawn Stoner, Washington County Health Department’s public health emergency planner, is set to typically be the first one in Washington County notified if a resident may be infected. She hears about it whether they come in through a health provider or another source.

“If I learn of someone who could have Ebola, we would send them to the ER if we thought they needed care. And we’d notify the ER in advance so they can prepare. If the patient needed an ambulance, we would call 911, and that response team would contact the ER department,” says Shawn, who adds that the health department also guides schools on how to monitor for, and respond to, potential Ebola cases.

“It’s like a web where we are the first point of contact and are triaging,” says Shawn, who also alerts the state health department if a person may require monitoring or testing.

Ebola is spread through direct contact with bodily fluids of an infected person or objects, like needles, that have been contaminated. It is not spread through the air, by water, or by food. And it is only contagious once symptoms manifest, explains Ericka Kalp, director of epidemiology and infection prevention at Summit Health. “Direct contact means that body fluids from an infected person have touched someone's eyes, nose, or mouth or an open cut, wound, or abrasion,” she says.

Currently, there are no commercially available vaccines against the virus. But there are several therapies under evaluation, with research support from Fort Detrick-based United States Army Medical Research Institute of Infectious Diseases (USAMRIID).

Three of the vaccines are in clinical trials at National Institutes of Health (NIH) and Walter Reed National Military Medical Center. Each vaccine focuses on the specific strain currently active in West Africa. Meanwhile, research is underway to develop a cocktail against several other known Ebola strains. “We are [working on several different vaccines] with the idea that eventually we're going to have to cover all those bases,” John Dye Jr., USAMRIID’s Viral Immunology branch chief told DoD News in October, 2014.

If the vaccines are found safe and effective, they should be available on a large scale in affected areas by mid-2015, says a WHO spokesperson of the program, which will likely start in West Africa.

Other Infections

Despite all the talk of Ebola, influenza will have a much harder impact on this country. It infects thousands of people a year, causes many hospitalizations, and can be fatal. The best prevention against flu is vaccination, says Dr. Ali, who adds that scientists looking at previous outbreak patterns created a vaccine most likely to cover this year’s strains.

Another bad virus hospitals look out for is Methicillin-resistant Staphylococcus aureus (MRSA). It’s a hard-to-treat staph infection, typically acquired in hospitals, that is resistant to common antibiotics. “A lot of people carry MRSA on their skin or in their nose, which is not harmful, so you don’t need to treat it. But if you get ill, have surgeries or cuts, it can get in the blood and go to organs,” says Dr. Ali.

A simple MRSA infection calls for one or two weeks of antibiotics, though complicated cases may require up to six months of drug treatment. Health providers say they are seeing more MRSA outside of the hospital setting, which usually causes boils and abscesses. But this is not serious, and if they are small they resolve themselves. Otherwise the treatment course is drainage and antibiotics, says Dr. Ali.

Another highly contagious infection often caused by ongoing or high-dose antibiotics is C. difficile. Symptoms are severe diarrhea and abdominal pain. “One important measure to try and prevent [MRSA and C. difficile] is to take antibiotics only when needed and exactly as prescribed. This includes continuing them for the prescribed length of time (even if you’re feeling better),” says Ericka, the director of epidemiology and infection prevention at Summit Health.

Minimizing illness from most viruses is quite simple and boils down to good hygiene. “Wash your hands often. Cover your mouth and nose with a tissue when you cough and sneeze. Or sneeze into the crook of your arm,” suggests Ericka. “If you are sick, limit contact with others. All these steps help contain germs and stop the spread of disease.”

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