With concerns mounting over the possibility of an Ebola outbreak expanding beyond West Africa, government and health officials are re-evaluating protocols and procedures — and at the same time, looking to quell public fear.
Gov. Andrew Cuomo yesterday convened a news conference to outline the New York’s plans for Ebola preparedness and assure residents that the state is “taking every precaution to protect their health and safety.”
Cuomo designated eight hospitals statewide to treat Ebola patients, including Stony Brook University Hospital and North Shore/LIJ on Long Island.
The state health commissioner yesterday issued an order to all hospitals, diagnostic and treatment centers, and ambulance services in New York State, requiring that they follow protocols for the identification, isolation and medical evaluation of patients requiring care.
Changing protocols and guidance from CDC
Local hospital administrators, who have been processing new directives and guidance documents from the Centers for Disease Control on an almost daily basis for the past week or so, are working to sort out how protocols and procedures are changing, Eastern Long Island Hospital president and CEO Paul Connor said.
“The challenge is this is an evolving situation. CDC and the Department of Health continue to evolve their perspectives,” Connor said. “We’ve had a lot of big meetings the past couple of days,” he said.
“Like everybody else, we are staying right up to date with whatever the curent requirements are, making sure our training is appropriate, that our screening of patients is immediate and proper — asking if they have been out of the country and where they’ve been. If they have symptoms that could be Ebola and they have been out of the country, we physically move them right into isolation,” Connor said.
“Once you have a patient who’s been diagnosed, the challenge then is to efficiently transfer that person to Stony Brook, to make sure that all happens as seamlessly as possible,” he said.
He noted that diagnosis is not done all that quickly. “The patient’s blood has to go to Wadsworth in Albany,” he said. “The time between presentation and diagnosis and between diagnosis and transfer is critical.” His “greatest fear” is possible contamination that could “disable the hospital,” Connor said.
“God forbid we have a situation where you have to isolate part of the hospital and then can’t use it. That’s what has everybody up at night,” Connor said.
ELIH has been working with Peconic Bay Medical Center in Riverhead on staff training and education, he said. “We are considering outside training as well.”
The current protocols spell out the type of personal protective equipment that should be worn by all health care workers coming into contact with a patient who has both symptoms of infection and specific risk factors within the past 21 days before the onset of symptoms.
According to Terry Glass, director of clinical services at ELIH, additional training for staff on donning and doffing personal protective equipment has been given. In addition, staff has updated and reviewed policies and procedures; drills have been performed in the emergency department. Stop signs, she said, have been posted at the entrance to the emergency room, where patients must call to the ER to come and escort them to the ER, to limit interaction with other patients and staff members.
A “Code E” team has been assembled, especially for situations where a patient presents a positive trail history, signs, or symptoms. Also, an anteroom is located off the hospital’s isolation room, where nurses can change.
“I think we’re all concerned about the issue at hand,” said Pat Pispisa, vice president of patient care. “But we have to do everything in our power to make sure that we protect our staff and to the best we can for the patient, as well. And I think that’s what we are doing.”
Glass said each day, staffers are evaluating equipment, and placing orders for any that’s new and recommended. This week, a meeting was held to discuss a new mask, which staff will be trained to use. Connor, she said, has been having town meetings with staff “covering information to allay fears and provide information as to what we’re doing.”
Symptoms include fever of greater than 101.5 degrees Fahrenheit, and additional symptoms such as severe headache, muscle pain, vomiting, diarrhea, abdominal pain, or unexplained hemorrhage.
Risk factors within the past 21 days before symptom onset include direct contact with blood or other body fluids or human remains of a patient known to have or suspected to have Ebola Virus Disease; residence in — or travel to — an area where EVD transmission is active; or direct handling of bats or non-human primates from disease-endemic areas.
The protocols also detail procedures for EMS systems and public safety dispatchers for identifying and managing patients with known or suspected EVD, and screening procedures in communities where the risk of Ebola is considered elevated — communities where patients with confirmed Ebola are identified in the area.
Cuomo also announced coordination by the Port Authority of procedure and practice between all airports to ensure proper training is in place.
Congressman alarmed by in-flight death on Nigerian flight to JFK
Yesterday, Rep. Peter King (R-Seaford), chairman of the House subcommittee on Homeland Security, wrote to the secretary of the U.S. Dept. of Homeland Security demanding answers regarding the handling of airline passengers from countries affected by the Ebola outbreak.
King was alarmed by the in-flight death of a passenger on a flight from Nigeria to JFK yesterday. The passenger reportedly died after vomiting aboard the plane. King said in the letter he has “very serious concerns” about the handling of the passenger’s remains and the “cursory exam” conducted by a CDC official at JFK before declaring that the passenger did not have Ebola. He said the CDC failed to give adequate instructions to Customs and Border Patrol and Port Authority officers regarding handling the deceased passenger’s remains or the rest of the passengers on the plane. Read King’s letter here.
King said 70 to 100 passengers from countries impacted by Ebola arrive at JFK daily — two-thirds of all passengers of concern entering the U.S. every day.
“These individuals transit the airport with the rest of the traveling population, including using the restrooms,” King wrote. They are segregated from other travelers only after they arrive at the Customs and Border Protection office, he said.
“Given the high volume of travelers at JFK, it is essential that extraordinary measures are taken to intercept possible Ebola-infected passengers while keeping the pubic, CBPOs [Customs and Border Protection Officers] and other first responders safe from exposure,” King wrote.
King demanded answers from the homeland security chief by today.
PBMC chief: Hospital screening systems will be quickly overwhelmed
With Ebola transmissions now documented in the U.S. and Europe — something that never happened before the current Ebola outbreak in Africa, which is the most widespread since the disease was first identified there in the 1976 — health officials worry about “loss of containment.” That worry is not just a concern about the spread of the disease itself, but also for the impact loss of containment will have on the ability of hospital systems and first responders to screen and isolate potential Ebola patients.
As it stands now, screening consists largely of asking patients with certain symptoms whether they’ve lived in or traveled to countries where the virus is active.
When questions about travel to West Africa are no longer relevant — in other words, if more Ebola diagnoses and transmissions are confirmed outside of West Africa — then local screening of patients presenting with known EVD symptoms becomes much more complicated and much more burdensome on local providers, PBMC Health president and CEO Andrew Mitchell said.
“The early symptoms of Ebola are the same as the flu — fever, malaise, nausea, vomiting. If we can no longer rule out patients based on risk factors of travel to West Africa because the disease is active in Europe and the U.S., what happens when patients present with flu symptoms?” Mitchell asked. Flu season is just beginning, he noted. “The system will be quickly overwhelmed.”
Under current CDC guidance, all health care workers handling symptomatic patients with risk factors for EVD must wear extensive protective gear and follow very specific rules for removing and disposing of the protective equipment. If the risk factors change — if containment is lost — following the same protocols for all patients with those flu-like systems will overload the system, Mitchell said.
The prospect of every flu patient having to be ruled out by people wearing all that protective equipment is almost mind-boggling.
“If we lose containment — God forbid — then all bets are off,” Connor said. But he’d rather not speculate on that scenario. “We have individuals in our country whose role is to deal with that. Our role is to do what we need to do here,” he said.
“We’re a small community hospital without the resources of other larger hospitals, but we have to follow the protocols just the same.”
Personal protective equipment is cumbersome and difficult to work in, both hospital chiefs noted. And the availability of the equipment may quickly be depleted, they said.
Tyvek suits are already backordered, Mitchell said.
“We have those moon suits, from the old days when we were more worried about bioterrorism and we could use those,” Connor said, “but they are far from optimal to work in.”
Mitchell said it’s more important than ever for everyone to get a flu shot this year.
“The probability of us getting a confirmed Ebola case is very low. The probability of us getting a suspected case is very high,” Mitchell said — even more so if the limiting risk factor of West African travel is no longer part of the screening equation.
“You don’t want to contribute to the overload of the system and you don’t want to be put into a quarantine.”
Local fire departments are also taking the time to raise awareness regarding Ebola. “We actually went over the protocol Monday at rescue, as well as discussed the protective gear we have and showed new people where it is in case they did not know,’ said Southold Fire Department Chief Peggy Killian. “We went over the signs and symptoms of Ebola, which in itself are vague.”
In addition, she said, the FD set a new policy: “Anyone sick with fever is a no-touch zone, and EMTs must wear gloves, blood borne gear, or Tyvex, as well as cover the patient’s mouth and nose, whether with a non-rebreather mask or a surgical mask. In addition, EMTs plan to give hospital plenty of notice so they can get prepared. ” It is scary,” she siad. “We are trying to protect our community by not spreading the virus, and by asking the proper questions.”
Countywide, officials are also taking action. Suffolk County Executive Steve Bellone and the Suffolk County Health Department hosted a table-top exercise on Ebola this week; the exercise was designed to prepare emergency response personnel in the event an individual within Suffolk County becomes infected. The presentation included an overview of the disease, method of transmission, protective equipment and quarantine protocol. The hemorrhagic fever disease has killed more than 4,000 people this year, mostly in Western Africa, Bellone said.
