Health officials, airport molding Ebola response
KONK LIFE STAFF WRITER
The death of an Ebola patient at a Texas hospital and the adoption of protocols at airports to detect passengers sick with the deadly virus have Keys public officials on their toes.
In the absence of Federal Aviation Administration Ebola protocols for airports the size of Key West International Airport, EYW Director Peter Horton and Monroe County Health Department Director Bob Eadie have worked out procedures for suspected Ebola cases aboard aircraft landing in Key West.
The U.S. airports where most Guinea, Liberia and Sierra Leone passengers land — Newark Liberty, Hartsfield-Jackson in Atlanta, New York’s JFK, Chicago O’Hare, and Washington Dulles — last week launched enhanced screening of passengers based on FAA protocols. The FAA will pass on protocols to smaller airports like Key West eventually, Horton said. The screening at the large airports include hand-held thermometers that look like harmless guns. They also make each passenger fill out a travel questionnaire.
In the meantime, Horton and county health officials will use protocols created for earlier health scares, such as SARS, and swine and bird flu.
“We have a protocol we established for bird flu, and right now it’s the same protocol we would use for Ebola,” he said. “If the airline thinks they have a passenger who has Ebola or Ebola symptoms and land in Key West, we isolate it out on the ramp and call the Monroe County health unit; we’ve already talked to Bob Eadie, the Monroe County Health Department director, about the procedures.”
Under the plan, Horton would contact Monroe County Emergency Management “and await instructions from them while we keep everyone on the aircraft” until the state health unit arrives. The Monroe County Health Department is a state agency.
Using the example set last week by the airline passenger who only joked about having Ebola, EMTs would put on biohazard suits, enter the aircraft and remove the passenger and anyone else showing symptoms.
Only general aviation aircraft land at the airport from overseas, usually from the Bahamas, Cayman Islands, Mexico, and the Caribbean, Horton said. The planes usually clear U.S. Customs, refuel and fly off.
During the interview he paused to explain what sounded like firecrackers in the background. He was handling a more immediate danger to Key West air passengers.
“We’re bird banging,” Horton explained. “We’re using little explosive devices to scare birds off the runway so they don’t collide with aircraft.”
Protocols for securing Ebola test samples
Those responsible for testing people in Key West and the rest of the Keys should have the Florida Department of Health “Ebola Virus Diagnostic Specimen Submission Check List.” The document outlines the procedure for testing humans for Ebola. It also describes procedures for sending the drawn blood to Stephen White at the Bureau of Public Health Laboratories in Miami.
The document was sent out to health departments in August, according to talking points released by Chris Tittel, spokesman for the county health department.
According to “Guidance document number 2014-X,” anyone drawing blood to be tested must first consult with the county health department or state epidemiology office; no specimens will be accepted at the Miami laboratories without approval of an epidemiologist, who must sign the form. The form includes the phone number for the state epidemiologist office.
Using the Ebola Virus Disease Algorithm, the health worker taking the blood must determine the likelihood that the patient has been exposed to Ebola and mark the appropriate box on the form: High Risk Exposure; Low Risk Exposure; or “Travel to the active outbreak countries but no identified exposure.”
Of course, health workers must adhere to OSHA Blood-borne Pathogens Standards and wear appropriate personal protective equipment. “At a minimum,” the protocol states, “standard, contact, and droplet precautions should be utilized while collecting and processing the sample. All sample processing should be completed in a Class 2 Biologic Safety Cabinet or better.”
After the Ebola test sample is contained in basic triple packaging system with a primary watertight container wrapped with absorbent material, a second watertight container and an outer shipping package, the protocol states, an Infection Control Practitioner (ICP or equivalent must approve the packaging before it can be shipped. There’s a separate form to sign that indicates who approved the packaging.
Then it is sent to the Miami Bureau of Public Health lab in Miami using a commercial or local courier, the protocol states.
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I read online yesterday a article about one of the nurses in the Dallas hospital, who had close and frequent contact with the Ebola patient, now is infected with it. She was wearing all the protective gear throughout, but something happened, there was a breach of the safety protocol, details not provided in the article, and she had been monitored since the breach and then she came down with Ebola. Also, she’d had close relations with someone else, now also being closely watched.
Here’s the entire article. I am not left feeling CDC, President Obama, and all points in between and beyond are awake yet. Nor am I left feeling Ebola can be, or will be, contained in west Africa, or in Texas.
(CNN) — A health care worker at Texas Health Presbyterian Hospital in Dallas who had “extensive contact” on “multiple occasions” with Thomas Eric Duncan has tested positive for Ebola after a preliminary test, officials said Sunday.
Confirmatory testing is being conducted by the Centers for Disease Control and Prevention in Atlanta. Test results are expected to be announced later in the day.
The patient is a nurse, an official who is familiar with this case told CNN.
She was involved in Duncan’s second visit to the hospital, when he was admitted for treatment, and was wearing protective gear as prescribed by the CDC: gown, gloves, mask and shield, Texas Health Resources chief clinical officer Dan Varga said.
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She is in stable condition, Varga said. Duncan, the first person to be diagnosed with Ebola in the United States, died Wednesday.
The nurse had “extensive contact” on “multiple occasions,” said Dr. Tom Frieden, the director of the CDC.
“At some point, there was a breach in protocol, and that breach in protocol resulted in this infection,” he said at a news conference Sunday. “The (Ebola treatment) protocols work. … But we know that even a single lapse or breach can result in infection.”
Varga said someone who is a “close contact” of the nurse has been “proactively” placed in isolation.
The hazardous materials unit of the Dallas Fire Department has cleaned up and decontaminated the public areas of the health worker’s apartment complex, Mayor Mike Rawlings said. Police are keeping people out of the area and are talking to residents nearby.
“We have knocked on every door on that block,” the mayor said.
Hazardous materials units have also cleaned out the nurse’s car and will work on her apartment Sunday.
Case was anticipated
“We knew a second case could be a reality, and we’ve been preparing for this possibility,” Dr. David Lakey, commissioner of the Texas Department of State Health Services, said in a statement Sunday morning.
“We are broadening our team in Dallas and working with extreme diligence to prevent further spread.”
The nurse reported a low-grade fever Friday night and was isolated, the health department said. The preliminary test result came in late Saturday.
If confirmed by the CDC, the nurse’s case would mark the first known transmission of Ebola in the United States and the second-ever diagnosis in the country.
A White House official told CNN that Homeland Security Adviser Lisa Monaco briefed President Obama on the second Dallas Ebola case.
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CDC corroboration expected
David Sanders, associate professor of biological sciences at Purdue University, said he thinks the CDC testing will probably support the preliminary results.
“It sounds likely that it’s positive, and it’s going to stay positive.”
The news that a health care worker might have the disease is not completely unexpected, an infectious disease specialist told CNN’s “New Day.”
“I think we’ve always expected that there may be another individual who will come down with the Ebola from the transmission of this one particular person, and we always felt that it was going to likely be one of his close contacts or one of the health care workers, because that’s the way this virus works,” Dr. Frank Esper said.
Esper said Texas officials have been keeping a close eye on people who had contact with Duncan.
“I will tell you that the fact that we identified this individual so quickly is actually to me a sign that the system is working,” he added.
Globally, the disease has wrought catastrophic consequences.
The World Health Organization estimates more than 8,300 people have contracted Ebola during this year’s outbreak. Of those, more than 4,000 have died.
Ebola not very infectious
Ebola is actually difficult to catch. People are at risk if they come into very close contact with the blood, saliva, sweat, feces, semen, vomit or soiled clothing of an Ebola patient, or if they travel to affected areas in West Africa and come into contact with someone who has Ebola.
Those stricken with Ebola suffer ghastly symptoms, including vomiting, diarrhea, muscle pain, fever and unexplained bleeding.
Three countries — Sierra Leone, Guinea and Liberia — have been hardest hit. And many of those who care for the ill have also come down with the disease.
The World Health Organization estimates at least 416 health care workers have contracted Ebola, and at least 233 have died.
In Liberia, health care workers are threatening to strike if their work conditions don’t improve.
The first infection outside of Africa happened in a nurse’s aide in Spain, Teresa Romero Ramos. She became sick after she helped treat an Ebola-stricken Spanish missionary.
Her case has prompted questions from fellow medical professionals about whether they are properly equipped to safely treat Ebola patients.
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Another search begins
For weeks, health officials have been monitoring those who had contact with Duncan before he was hospitalized and isolated.
Duncan left Liberia on September 19 and arrived in Dallas on September 20. Four days later, he began feeling ill; the following night, he went to Texas Health Presbyterian Hospital.
But despite telling a hospital worker that he had arrived from Liberia, Duncan was sent home with antibiotics. He returned a few days later and tested positive for Ebola.
And now, the search begins for all the contacts whom the nurse came in contact with.
“We need a whole new crew of people to do contact tracing,” said Elizabeth Cohen, CNN senior medical correspondent.
Because Ebola’s incubation period can last up to 21 days, the health nurse’s contacts will have to be monitored for three weeks.
The Texas health department said officials have interviewed the patient and are identifying any contacts or potential exposures.
“This is not an easy thing,” Cohen said. “Keeping track of large numbers of people, taking their temperature twice a day, making sure they don’t … leave town, all of that is a lot of work.”