Erecting medical defenses against Ebola

Though a major outbreak of the dangerous Ebola virus in Kentucky is unlikely, said Kraig Humbaugh, M.D., senior deputy commissioner with the Kentucky Department of Public Health, the DPH, county health departments and hospitals in the state are cooperating and vigilantly monitoring potential risks.

They’ve conducted outreach to the hundreds of Kentucky businesses with international interests whose employees travel abroad. Meanwhile, multilevel protections and protocols are being implemented for military personnel from Fort Campbell who are in Liberia building special new Ebola treatment facilities and training Liberian caregivers.

“We understand that there are public concerns, and we need to address them as the crisis situation evolves in this country and globally,” Humbaugh said.

Kentucky has a collaborative emergency Ebola response system in place among hospitals, local health departments, the Department of Public Health and the CDC.

“The Ebola virus has been studied for over a decade,” Humbaugh said. “Researchers understand the organism, how it spreads and how to control that spread in this country. We have the facilities in this country and state to combat it.”

Patricia Burns, director of infection control at Saint Elizabeth Healthcare in Northern Kentucky, said healthcare systems developed plans with the Northern Kentucky Health Department years ago in response to previous public health crises such as the HIV/AIDS crisis in the 1980s and biological terrorism threats following the 9/11 attacks in 2001.

These events prompted hospitals and local health department to develop emergency response protocols to protect the public health and contain a potential biological threat from spreading, she said.

“This situation [Ebola] is not drastically different from those instances. It is elevated a bit higher because of how quickly the virus attacks the human body,” Burns said. Nevertheless, Burns said that procedures are the same throughout the state.

Kentuckians should understand, Humbaugh said, that much less exotic diseases are far more likely than Ebola virus to be fatal to them in the next several months.

“The flu represents a far more serious health threat to Kentucky,” he said. “We have had more deaths related to influenza and pneumonia in the last few years than we will have from the Ebola virus.”

However, flu vaccines are plentiful, Humbaugh said, encouraging their use.

“Most health departments, pharmacies and doctor’s offices are offering flu vaccines at little to no cost at all.”

Protocols in place, just in case

In the meantime, DPH is monitoring developments with Ebola, which has caused one death on U.S. soil, and disseminating updates from the Centers for Disease Control to healthcare providers across the state, he said. DPH has issued several advisories to the public and Kentucky’s healthcare providers concerning CDC guidelines for safe handling and treatment of potential Ebola patients.

Placards and signs distributed to hospitals throughout the Bluegrass for posting in ERs and doctor’s offices remind providers to inquire about every patient’s recent travel history. And two critical criteria define a patient as high risk for Ebola, Humbaugh said.

First is the presence of symptoms such as high fever, vomiting or diarrhea. Since those symptoms are associated with many illnesses, including other viral infections endemic to West Africa, the second factor is the most critical: having had direct contact with an active Ebola patient.

“If a patient meets both criteria, then that patient should be moved into isolation,” Humbaugh said. However, people should also know that merely being in the presence of someone with the disease is not enough for transmission.

“The virus is spread by contact with an infected person’s bodily fluids. Healthcare workers need to keep this in mind because fluids are contagious even after the subject is dead. But for the average person, just being in the same place as an Ebola patient is not enough to contract the disease,” he said.

Indulging for a moment in possible worst-case scenarios, Humbaugh said it’s difficult to predict where a patient may first present symptoms.

“It could be at home, a hospital, doctor’s office, emergency room or urgent care treatment center. Our message to all providers is to recognize risks and calmly take the steps necessary to get that person into isolation,” Humbaugh said.

“If a situation should occur that a person presents symptoms of the virus and has had contact with an Ebola victim, notification of our local health department would be one of our first steps,” Burns said.

Treating personnel would take measures to reduce the amount of contact a potential patient would have with the general public. It would be the local health department’s job to notify the Kentucky DPH, which would contact the Centers for Disease Control in Atlanta, she said.

“That is how we would work together. That is how the flow would happen if we needed confirmation testing or community resources,” Burns said.

The risk of an Ebola outbreak in Kentucky is low, Humbaugh said, but the specter of a U.S. wave seemed possible in October when nurses Nina Pham and Amber Vinson at Texas Presbyterian Hospital in Dallas contracted Ebola caring for Thomas Eric Duncan, who had just traveled from his native West Africa.

That prompted the CDC to issue more stringent guidelines for nurses and healthcare providers in handling isolated patients with the disease. These focused on people actively treating patients with the disease, but another big source of concern arises from those who may inadvertently come into close contact with an at-risk individual in the course of business or vacation travel.

International commerce and the Ebola virus

According to a New York Times article, the U.S. Department of Homeland Security ordered all incoming international traffic from Ebola-infected areas in western Africa be routed to five major airport hubs in the United States: Kennedy Airport in New York; Newark Liberty International in New Jersey; Washington Dulles International; O’Hare International in Chicago; and Atlanta’s Hartsfield-Jackson International.

Arriving passengers get “Check and Report” Ebola kits with thermometers and instructions on how to monitor themselves, the article said. Homeland Security called for state and local health departments to implement regular checks on these travelers for the 21-day incubation period of the disease. Passengers will be asked to check in daily with their local health departments to report their temperature, any symptoms and future travel plans.

Similar measures are being taken at major airports in Canada as well as in London, Paris, Brussels, Cairo and Hong Kong.

The global response to the Ebola epidemic in Africa has had an effect on international travel and, by logical extension, on global commerce.

International traffic at Louisville International and Northern Kentucky-Greater Cincinnati airports has not, so far, been impacted to a great degree. Neither airport has direct departing or arriving flights with West Africa, according to Emily Gresham Wherle, spokesperson for the Northern Kentucky Health Department.

“Most people traveling to those areas are using major international hubs and, therefore, are already being screened before they ever get to Kentucky,” Wherle said.

An exception, she said, could be travelers in Africa who use an airport in Europe to connect with a direct flight to Louisville or Northern Kentucky. But the various international responses greatly increase the likelihood that people will go through some type of Ebola screening before they would land in the commonwealth, she said.

Beyond the Dallas cases, the only recorded U.S. Ebola patients are physicians who were directly involved in the effort to bring the epidemic under control in Liberia, Sierra Leone and Guinea.

Business travel precautions in place

The DPH recognizes that Kentucky businesses are engaged in international commerce, Humbaugh said, and urges business travelers to inform local health departments and primary care physicians of their upcoming travel plans. This recommendation is good to follow even if the destinations don’t include a stop in West Africa.

The Northern Kentucky Health Department, Wherle said, is receiving cooperation from the large number of corporations in the area with international interests. In conjunction with their counterparts across the Ohio River in Cincinnati, the health departments are providing information to area businesses on the precautions international travelers should take and how to monitor themselves in the unlikely event of exposure to the virus.

“If symptoms present themselves, we emphasize that individuals should call the hospital or health department first with their concerns. We may have specific instructions for them to follow to reduce exposure risks to others,” Wherle said.

If the epidemic were to spread beyond western Africa, it is reasonable to conclude that more aggressive efforts would be enacted to contain the disease. But it is premature to assume a worst-case scenario, Humbaugh said.

“We’re aware that Kentucky has interests around the globe. But few of those interests are likely to be in West Africa,” he said. “The greatest risks are from doctors, nurses, humanitarian aid workers and military personnel who are at work in these high-risk areas. But they are aware of those risks and are constantly taking precautions.”

Fort Campbell, Operation United Assistance

In October 2014, about 1,400 soldiers from the military base at Fort Campbell in Western Kentucky deployed to Liberia as part of Operation United Assistance being managed by the U.S. Agency for  International Development.

Participants are elements from the 101st Headquarters, 101st Sustainment Brigade and the 86th Combat Support Hospital, said Lt. Col. Brian DeSantis, spokesperson for the 101st Division.

Their primary mission is construction of Ebola treatment units near the Liberian capital of Monrovia, DeSantis said.

“When they’re done, healthcare workers will use them to test potential or suspected Ebola patients,” he said, and provide isolation treatment of active cases.

A secondary mission, DeSantis said, is for military specialists to train Liberian healthcare workers who will staff these treatment units in the proper procedures to interact with active Ebola patients and protect themselves.

Soldiers will not have direct contact with Ebola patients, he said, nor will they be stationed in areas Ebola patients are being treated. Army guards will work with the Liberian military to secure the area and ensure that soldiers’ exposure to the virus is minimized.

The mission has no established time frame, DeSantis said, and it is difficult to predict how long soldiers will be in-country. But military personnel are cognizant of the risks when soldiers return home, and protocols are in place to monitor their health for 21 days, he said.

“All the ways to monitor for Ebola will be done when soldiers are released to return to Fort Campbell and their families. We follow the protocols established by the CDC for determining if there are risks,” DeSantis said.

Although there are obvious risks associated with the mission, DeSantis said that many of the soldiers being deployed on this mission appreciate the opportunity to provide humanitarian aid. It’s a welcome change of pace from peacekeeping missions in Afghanistan and Iraq. They understand the risks, he said, but they regard the challenges ahead as personally rewarding.

Josh Shepherd is a correspondent for The Lane Report. He can be reached at editorial@lanereport.com.