By Diane Carman
In the aftermath of the first death of Ebola in the United States, health care providers in Colorado and across the country are redoubling their efforts to identify people at risk for developing the virus, isolate any suspected cases quickly and contain its spread.
“Our main message to providers is to ask questions of patients who have symptoms of Ebola if they have traveled to the affected countries, primarily Liberia, Guinea and Sierra Leone,” said Dr. Wendy Bamberg, medical epidemiologist for the Colorado Department of Public Health and Environment. “We’re working very hard on this right now, trying to communicate this message to providers in hospitals, in communities and local public health agencies.”
Despite frequent alerts from the Centers for Disease Control over the past few months about the risks for the spread of Ebola from West Africa, Texas Health Presbyterian Hospital in Dallas sent Thomas Eric Duncan home after he went to the emergency room feeling ill on Sept. 25. He had told intake nurses of his recent travels to West Africa, but physicians did not identify him as a potential Ebola patient.
He was admitted Sept. 28 after his condition deteriorated, and he died Oct. 8.
No suspected cases of Ebola have been reported in Colorado.
“From a public health perspective, we feel that the hospitals and the health care system are able to handle this,” Bamberg said. “We can identify patients quickly ask the appropriate questions, isolate patients quickly and the system is able to respond quickly to keep our health care workers and others safe.”
The Texas case offers an opportunity to refine protocols, Bamberg said.
“Every time a new situation presents itself, we’re going to learn more,” she said. “We’re observing what is happening in other states. The health department is always in communication with the CDC.”
That’s an understatement.
In the past few months, the CDC has issued frequent bulletins on everything from how to identify the symptoms and risk factors for Ebola, and how to handle laboratory specimens, to the sequence for putting on and removing protective clothing when treating infected patients.
“We are sending the health alerts to providers and public health facilities as we get new CDC guidance,” Bamberg said. “We’re following their recommendations closely.”
She said that hospitals across the state routinely isolate patients to contain outbreaks of such common diseases as TB and Methicillin-resistant Staphylococcus aureus (MRSA).
“Isolating patients is something hospitals do every day,” Bamberg said. It usually involves placing patients in private rooms with their own bathrooms, carefully managing anything contaminated with bodily fluids and requiring all health care workers to wear gowns, face masks, face shields, gloves, shoe covers and other protective clothing.
“Our message is that every hospital must use precautions,” she said, and any suspected cases must be reported to the health department immediately.
The symptoms of Ebola are common to many less serious illnesses and can easily be dismissed by health care workers unless further questions are answered. They include fever, vomiting and diarrhea.
“They are very general symptoms,” Bamberg said, “and as influenza season gets under way are likely to be much more common.
“We are hoping that health care workers will ask appropriate questions of every patient with these symptoms.”
That message is being sent to health care workers from first responders to private physicians, clinical nurse practitioners and emergency room personnel.
Patients who are diagnosed with Ebola must be isolated immediately to curtail the spread of the virus. Treatment is limited to supporting the patient with fluids, respiratory support and dialysis, if necessary, to give the body time to fight the infection. No proven therapies are available to treat the virus.
Ebola is not an airborne virus, Bamberg emphasized. It is spread through contact with bodily fluids, such as blood, vomit or feces.
While the Ebola outbreak has fanned public fears, Bamberg emphasized that the greater risk to Coloradans is influenza, which affects millions of Americans every year.
“Flu season is on the way,” she said. She advised Coloradans concerned about public health is to “get a flu shot and wash your hands frequently.”