A week ago, Americans heard the scary news from the CDC that Ebola is here. Unfortunately, the Liberian national who had travelled to Dallas on Sept 20 and became ill four days later finally succumbed to the disease. While we wait anxiously, the patient’s close contacts have been in quarantine and are being monitored for signs and symptoms. So far, none of his close contacts have tested positive for the disease.
The handling of this event has made us all take a second and third look at our preparations for an outbreak of any infectious disease. Are we prepared locally?
Over the past ten years, the San Antonio Metro Health District, Department and State Health Services Region 8 (DSHS), and the South Texas Regional Advisory Council (STRAC) have worked closely together to prepare a coordinated response to any emergency event. This coordinated response has served our community well through multiple hurricanes, a tornado and a pandemic. For the most part, this preparedness has not been obvious to the public. In the public health field we have an old saying “If you do your job right, no one knows about it. If you make one mis-step, it’s disastrous.”
As the Ebola outbreak raged on in West Africa, Metro Health has had weekly meetings with STRAC since August to prepare for an Ebola case in San Antonio. They are coordinating with all other agencies, including fire, police, EMS, hospitals, the medical examiner, and funeral parlors to have policies in place should a case occur here. At the same time, local health officials are working intensively with health care providers to educate staff to recognize risk factors.
“If a patient has a fever of 101.5 degrees fahrenheit, has travelled from Liberia, Sierra Leone, or Guinea in the past three weeks, this triggers immediate isolation and further evaluation for possible Ebola infection,” said Dr. Anil Mangla, assistant director of Metro Health.
We’ve all seen photos of workers in high-level HAZMAT gear. But an important element is often forgotten: how to remove the personal protective equipment (PPE) properly so as to not contaminate yourself or your environment. Officials believe this is how the nurse in a Spanish hospital became infected. So health care workers in San Antonio are receiving updated information on the proper use, removal and disposable of PPE. Hospitals in San Antonio are well stocked and prepared.
Court ordered quarantines for tuberculosis happen often enough that local officials are accustomed to the procedure. Should quarantine become necessary for Ebola or any other disease, the city attorney’s office has reviewed the policies and is prepared to act promptly. Systems are already in place for the clean up and transport of contaminated materials, so there will be no delay in disinfecting the areas in which a patient had been.
Still, there is fear.
Ebola makes us nervous, rightly so, with a fatality rate around 50% in the current outbreak. But the risk of transmission locally is extremely low. Even if a traveller from West Africa arrived in a San Antonio hospital, the likelihood of infecting anyone is slim. The living conditions of most San Antonians, even our poorest residents, are much different than in West Africa. We have running water and soap to clean surfaces; we’re not cleaning up vomit with a dry rag and our hands. We have ready access to bleach. We have, for the most part, ready access to health care facilities that are now acutely aware of the possible arrival of an infected patient.
The only documented transmission in the 38 years since this disease was first identified has been through close contact with body fluids of an infected individual. Dr. C.J. Peters, known as the “Virus Hunter” of the CDC and a world-renowned expert on Ebola virus now working at UTMB in Galveston, will not rule out the possibility of an airborne infection. But let’s take that in context. When dealing with biology, we learn to “never say never.” As epidemiologists we learn that diseases can change and surprise us, so we prepare ourselves for all possibilities. That doesn’t mean they’re likely. It means we’re prepared.
*Featured/top image: Confirmed and probable Ebola cases in West Africa. Map courtesy of the World Health Organization.