Ebola Update: Now in the U.S.

The current Ebola outbreak is the worst one ever recorded. It will likely infect 20,000 people before the virus stops spreading and has prompted the World Health Organization (WHO) to declare the outbreak an international health emergency—one that will require a coordinated global approach if it is to be contained. Now, a game changer: The first case of Ebola to be diagnosed in the U.S. was announced in Dallas, Texas, just a few days ago.

Although Ebola is rare, it is deadly. Since the first outbreak in 1976, Ebola viruses have infected thousands of people, killing roughly 60 percent of them. The current outbreak involves the most deadly of the five Ebola virus strains and, so far, has infected 6,574 people and caused more than 3,000 deaths. Most Ebola outbreaks have occurred in remote African villages in Sierra Leone, Guinea, and Liberia, but one traveler carried the virus to Lagos, Nigeria. Meanwhile, public health experts believe that an additional 15 countries, including Ghana, Liberia, Mozambique, and Malawi, are at risk for Ebola exposure.

Ebola spreads from one human to another through direct contact with the bodily fluids of an infected person or indirect contact with contaminated environments. Symptoms include fever with chills, sore throat, joint and muscle pain, headache, nausea, vomiting, and diarrhea. There may be agitation, confusion, fatigue, seizures, and sometimes coma. As the disease progresses, liver and kidney function can be compromised. When this occurs, bleeding from mucous membranes and puncture sites may occur in up to 50% of cases. Diffuse bleeding is rare. Victims are infectious as long as the virus remains in their blood and secretions. Any patient who exhibits these symptoms and who has either been in one of the infected countries or has had contact with someone who has should be treated as a potential Ebola victim.

Until just a few days ago, the only cases of Ebola to enter the U.S. have been those of four American health workers who contracted the virus in West Africa. Two of them were treated at Emory Hospital in Atlanta and discharged. The third American was treated at the Nebraska Medical Center and is now virus free. A fourth American carrying the Ebola virus arrived at Emory University Hospital a few weeks ago.

Real Risk in the U.S.?
Now that the first case of Ebola virus has been diagnosed in the U.S., public health officials here remain confident that the U.S. isn’t at risk for a major outbreak because of this country’s sophisticated health care delivery system and isolation procedures as well as its well-developed public health infrastructure. Taking every precaution, the CDC has recommended that all care providers evaluate any patient who exhibits symptoms consistent with Ebola virus infection or those who have risk factors—including any who have traveled to an infected area or who have had contact with the blood or bodily fluids of a person who may be infected. When a patient is suspected of having Ebola virus, CDC recommendations include:

  • placing the patient in a single-patient room with a closed door
  • instructing all health care workers who come in contact with the patient to wear gloves, gowns, shoe covers, eye protection, and a facemask
  • avoiding any aerosol-generating procedures or, if they are required, performing them in an airborne isolation room
  • cleaning and disinfecting potentially contaminated materials with hospital-grade quaternary ammonium or phenolic products.

In conjunction with the U.S. Department of Health and Human Services, the CDC has created a detailed Ebola checklist to prepare facilities in the event that they receive Ebola-infected patients. Among other important actions, the CDC’s checklist includes:

  • reviewing emergency department triage procedures.
  • training all frontline clinical staff to recognize the symptoms of Ebola and ensuring that all laboratory technicians understand proper specimen collection, transport, and testing guidelines.
  • designating specific contact persons to communicate with state and local health departments
  • ensuring an adequate supply of personal protective equipment, including gowns, gloves, shoe covers, eye protection and face masks, respirators, hand hygiene supplies, and other infection control supplies.

Security Plays a Role
According to Caroline Ramsey Hamilton, a security risk assessment expert, hospital security planning can also play a part in containing Ebola virus at U.S. hospitals. Specifically, security departments should:

  • reserve the emergency department for regular patients and set up a tent facility or temporary building to treat suspected cases of Ebola.
  • create separate isolation units and entranceways for Ebola patients
  • ensure that adequate supplies, including temporary barriers, food, water, and containment equipment are available
  • put effective communication systems, such as temporary signs and electronic message boards, in place for both internal communications and communication

Read more about Ebola in Ebola: What You Need to Know

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