Members of the Richland County Ebola Preparedness Response Team met with local media on Monday afternoon to provide details about the county’s action plan against the disease, as well as answer a few frequently asked questions.
Health Commissioner Martin Tremmel of Richland Public Health as well as representatives from OhioHealth MedCentral and Avita Health System addressed members of the media after the second meeting of the Richland County Ebola Preparedness Response Team. The team met with first responders, elected officials and representatives from local health care systems to discuss and provide updates on the issue of Ebola.
“It’s very important for our large community of Richland County and all of our surrounding metropolitan areas to know that we’re working collectively as two major healthcare systems interfacing with a large public health system to be forward-thinking and proactive in the approach and the way we’re going to deal with Ebola,” said Tremmel.
According to the Centers for Disease Control and Prevention, Ebola, previously known as Ebola hemorrhagic fever, is a rare and deadly disease caused by infection with one of the Ebola virus strains. Symptoms of Ebola include: fever, severe headache, muscle pain, weakness, diarrhea, vomiting, abdominal pain, and unexplained hemorrhage. Symptoms may appear anywhere from two to 21 days after exposure to Ebola, and a person must have symptoms to spread Ebola to others.
President of OhioHealth MedCentral Jean Halpin and Marketing and Community Relations Manager for Avita Health System Kelby King explained both health systems have heightened their awareness and practiced procedures since mid-August. Liz DeHaan, Infection Preventionist at OhioHealth MedCentral, said members of the Richland County Ebola Preparedness Response Team are following the preparedness activities recommended by the CDC.
“We’ve used those to do our risk assessments as to where we were falling in areas of increased improvement,” said DeHaan. “As has been indicated, we’ve been preparing for a biohazard event for many years. It may be targeted towards this Ebola situation, but the infrastructure has been in place for a very long time.”
Because the symptoms of Ebola closely resemble symptoms of influenza, Halpin noted there are two important screening questions asked to determine whether a patient possibly has Ebola.
“Number one, have you been in West Africa within the last 21 days? And number two, have you had direct contact with a patient with Ebola? If the answer is yes to either of those, then we activate the process,” said Halpin. “If the answer is no the patient could still very well be sick with the flu or other viruses and so we will treat that patient accordingly.”
Should a patient in Richland County present with symptoms consistent with Ebola and answer yes to the screening questions, the next step is isolating the patient. Halpin said if the decision were made to keep a patient at OhioHealth MedCentral in Mansfield, the patient would be transferred to a negative airflow room. King stated patients would not be kept at Avita Health System and would instead be transferred to OhioHealth in Columbus or The Ohio State University.
Dr. Michael Patterson, Vice President of Medical Affairs at OhioHealth MedCentral, emphasized the importance of asking the screening questions as soon as possible when dealing with a potential Ebola patient.
“The sooner you know you might have a person under investigation for Ebola, the better,” he said. “The whole goal of this is to limit exposure and to isolate patients that screen positive so as not to contaminate others. With these patients that screen positive, it’s focused on isolation and containment, and limiting that exposure to others. We’re going to treat the patient, we’re proud to be the closest tertiary care system in the area, and we are prepared.”
According to the CDC, Ebola is spread through direct contact (through broken skin or mucous membranes in, for example, the eyes, nose, or mouth) with blood or body fluids (including but not limited to urine, saliva, sweat, feces, vomit, breast milk, and semen) of a person who is sick with Ebola, objects (like needles and syringes) that have been contaminated with the virus, and infected animals. Ebola is not spread through the air or by water, or in general, by food.
The CDC states that “unlike respiratory illnesses like measles or chickenpox, which can be transmitted by virus particles that remain suspended in the air after an infected person coughs or sneezes, Ebola is transmitted by direct contact with body fluids of a person who has symptoms of Ebola disease. Although coughing and sneezing are not common symptoms of Ebola, if a symptomatic patient with Ebola coughs or sneezes on someone, and saliva or mucus come into contact with that person’s eyes, nose or mouth, these fluids may transmit the disease.”
The spread of the Ebola virus through airborne virus particles has not been documented during human Ebola outbreaks in settings such as hospitals or households.
“I feel the misconception of it being airborne is because of the media and what they’re seeing when people are garbed up and treating folks who are suspected or have been diagnosed,” said DeHaan. “What you see going on in Africa and that kind of Personal Protective Equipment (PPE) are really driven around the supply availability. They’re in full garb, they’re being wiped down and sprayed down, and that’s because of the lack of availability of supplies so they have to initiate other processes to have enough PPE around.
“In the United States, the CDC recommendation for protection is around contact precautions and respiratory precautions because of the risk to the mucus membranes, and that’s a point of contact,” DeHaan continued. “To exercise caution, and what we’ve learned historically with communicable disease, in the past it’s always been recommended to use an N95, which is a higher level of respiratory protection. Although there is no confirmation that it is airborne, to give the ultimate amount of protection to the primary caregivers to reduce the risk of potential contamination to the mucus membranes, we are using the highest level of respiratory protection available.”
Patterson added at OhioHealth MedCentral the organization has taken protection a step further by mandating potential patients be treated in a negative airflow room.
“That is above and beyond the current CDC recommendations,” he said.
Reed Richmond, Health Educator for Richland Public Health, noted currently only three cases of Ebola have been identified in the United States. Of those three cases, only one has resulted in a fatality. Two healthcare workers also tested positive for the disease, with the second healthcare worker testing positive for the disease on Oct. 14. The CDC confirmed that the second healthcare worker who tested positive for Ebola traveled from Cleveland to Dallas/Forth Worth on Oct. 13 on Frontier Airlines flight 1143, but did not exhibit any signs or symptoms of illness while on the flight.
The healthcare worker was visiting family in Akron from Oct. 8 to Oct. 13, according to the Ohio Department of Health (ODH). Tremmel stated that health officials in Richland County have looked at the flight manifest from Dallas to Cleveland and then from Cleveland to Dallas, and determined from that data that no Richland County residents were on either flight.
“We are not aware of any other examples of contact with an individual from Richland County with the nurse in question,” said Tremmel. “It would seem that her initial areas of contact would be with family, friends, and, as we know a bridal business. The public health officials in that jurisdiction are monitoring those folks on a tiered basis.”
Tremmel noted local churches, physicians, nurses or healthcare professionals working involved in missionary work that are either currently deployed or planning to deploy to areas of Africa are asked to keep the public health system appraised of their travels. Tremmel said conversations about appropriate quarantine upon return would need to take place, though he added only a handful of conversations have been had up to this point and those conversations have been positive in nature.
Tremmel acknowledged that while the possibility of an Ebola case in Richland County exists, the probability is quite low.
“The good news is there was a traveler from Texas to Ohio that has been taken into the public health and medical systems appropriately, the contacts have been readily identified, and we continue to monitor on at least a twice-daily basis for symptoms of those contacts,” said Tremmel. “Would that lead to other potential? It does exist, hence that’s why we bring together community partners, this is why we collaborate and this is why we train.”
“I feel the misconception of it being airborne is because of the media and what they’re seeing when people are garbed up and treating folks who are suspected or have been diagnosed,” said Liz DeHaan of OhioHealth MedCentral.
Reed Richmond, Health Educator for Richland Public Health, noted currently only three cases of Ebola have been identified in the United States. Of those three cases, only one has resulted in a fatality.
