Ebola Q & A. # Question Answer Modified

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Tyrone Parrish
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1 Ebola Q & A # Question Answer Modified 1 Are U.S. hospitals ready to care for patients with Ebola virus disease (EVD)? Yes any U.S. hospital that is following CDC's infection control recommendations( and can isolate a patient in a private room is capable of safely managing a patient with EVD. CDC recommends that U.S. hospitals isolate the patient in a private room and implement standard, contact, and droplet precautions. 3:17 PM 2 Why do responders in Africa wear so much personal protective equipment (that can include full body suits) for this Ebola outbreak when CDC says hospitals here could safely manage the care of an Ebola patient without a full body suit? There are important differences between providing care or performing public health tasks in Africa versus in a U.S. hospital. In field medical settings, additional PPE may be necessary to protect healthcare workers. In some places in Africa, workers may not have the ability to prepare for potential exposures. For example, in some places, care may be provided in clinics with limited resources (e.g., no running water, no climate control, no floors, inadequate medical supplies), and workers could be in those areas for several hours with a number of Ebola infected patients. Additionally, certain job responsibilities and tasks, such as attending to dead bodies, may also require different PPE than what is used when providing care for infected patients in a hospital. 9:26 AM 3 What are body fluids? Ebola has been detected in blood and many body fluids. Body fluids include saliva, mucus, vomit, feces, sweat, tears, breast milk, urine, and semen. 9:26 AM 4 Can Ebola spread by coughing? By sneezing? 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. 5 What does direct contact mean? Direct contact means that body fluids (blood, saliva, mucus, vomit, urine, or

2 feces) from an infected person (alive or dead) have touched someone s eyes, nose, or mouth or an open cut, wound, or abrasion. 6 How long does Ebola live outside the body? Ebola is killed with hospital-grade disinfectants (such as household bleach). Ebola on dried on surfaces such as doorknobs and countertops can survive for several hours; however, virus in body fluids (such as blood) can survive up to several days at room temperature. 7 Are patients who recover from Ebola immune for life? Can they get it again - the same or a different strain? Recovery from Ebola depends on good supportive clinical care and a patient s immune response. Available evidence shows that people who recover from Ebola infection develop antibodies that last for at least 10 years, possibly longer. We don t know if people who recover are immune for life or if they can become infected with a different species of Ebola. 8 If someone survives Ebola, can he or she still spread the virus? Once someone recovers from Ebola, they can no longer spread the virus. However, Ebola virus has been found in semen for up to 3 months. People who recover from Ebola are advised to abstain from sex or use condoms for 3 months. 9 Can Ebola be spread through mosquitos? There is no evidence that mosquitos or other insects can transmit Ebola virus. Only mammals (for example, humans, bats, monkeys and apes) have shown the ability to spread and become infected with Ebola virus. 10 I actually have 2: 1. With large amounts of chlorine (bleach) needed to disinfect the room, could this create resp problems along with local irritation to the eyes and mucous membranes for both the patient and healthcare worker, from its caustic nature in close quarters? If so how will this be avoided? 2. If transmittable by bats, is this a certain type of bat? As we have bats in this state, is this seen as an additional concern? If so what is being addressed on a state and national level? Answer to question 1: Fortunately, the Ebola virus is susceptible to standard EPA-registered hospital disinfectants with activity against non-enveloped viruses. We also are fortunate to have the Xenex (pulsed xenon ultraviolet light) disinfection device which can also quickly deactivate the Ebola virus. Large amounts of chlorine bleach will not be necessary. Answer to question 2: Source: CDC Because the natural reservoir host of Ebola has not yet been confirmed, the way in which the virus first appears in a human at the start of an outbreak is unknown. However, scientists believe that the first patient becomes infected through contact with an infected animal, such as a fruit bat or primate (apes and monkeys), which is called a spillover event. Fruit bats in Africa are considered to be a natural reservoir for Ebola. Bats in North America are not known to carry Ebola and so CDC considers the risk of an 9:28 AM

3 Ebola outbreak from bats occurring in the United States to be very low. 11 What is the quickest way to test for Ebola and how long does it take to get the results? Do we have the ability to test for Ebola here at the hospital? I am afraid that if Ebola comes to San Antonio, that our EC will be swamped with people who think they have Ebola and maybe they only have the flu or a stomach virus. It would be good if we could test them on the spot. We do not have the ability to test for Ebola here at the hospital. Diagnostic testing for Ebola virus is performed at a reference lab in Austin, Texas using PCR. A presumptive positive test is confirmed by a secondary test performed by the national CDC lab. The turnaround time depends on transport of specimen and performance of the assays. An estimated turnaround time is probably 48 hours although this time might improve. 3:18 PM 12 Patient teaching question. Should we get any positive ebola patients, we read somewhere that ebola can stay in the semen for 3 months after the patient gets over the infection. What should we teach these patients about that when they are discharged? Source: CDC Once someone recovers from Ebola, they can no longer spread the virus. However, Ebola virus has been found in semen for up to 3 months. People who recover from Ebola are advised to abstain from sex or use condoms for 3 months. 3:18 PM 13 If our hospital treats an Ebola patient, are you going to ask the caregivers to self-quarantine or will there be mandatory quarantine (given what happened to the Dallas nurses). How about quarantine for the person who registers the patient in the EC? 14 What are the main signs/symptoms of those infected with the Ebola virus? If the hospital treats a patient with confirmed Ebola virus disease, we will be working closely with public health authorities to include San Antonio Metropolitan Health District and the CDC. These authorities will be providing guidance on appropriate monitoring of caregivers. Source: CDC Updated 10/21/2014 Symptoms of Ebola include 9:38 AM 10/22/2014 8:38 AM Fever (subjective or greater than F or 38 C) Severe headache Muscle pain Weakness Diarrhea Vomiting Abdominal (stomach) pain Unexplained hemorrhage (bleeding or bruising) Symptoms may appear anywhere from 2 to 21 days after exposure to Ebola, but the average is 8 to 10 days. Recovery from Ebola depends on good supportive clinical care and the patient s immune response. People who recover from Ebola infection develop antibodies that last for at least 10 years. 15 For Nursing staff and those at Call centers: what are their guidelines on how to advise a patient who CALLS - The information on the appropriate screening and response to a patient that meets criteria has been or is being distributed to all areas to have a consistent 3:19 PM

4 especially a HIGH risk individual with travel history. Current script advises them to got to the nearest ER response. The Infectious Diseases consult pager has been identified as the primary contact for these patients to direct care. 16 If a pregnant pt presents with ebola symptoms, delivers her baby and desires to breastfeed, how should this mother be advised? This is a challenging question. Ebola virus is detectable in the breast milk of a person infected with Ebola virus disease. If the pregnant patient were to deliver the baby, the first question would be whether the baby was also infected. This clinical scenario would require careful consultation with clinical experts. 3:20 PM 18 Does UH have the ability to test for Ebola in house or does it have to be sent out? How long does it take to recieved results? 19 It is assumed that the nurses who contracted Ebola in Dallas followed CDC guidelines. What is UHS prepared to do to exceed these obviously inadequate measures. Please see answer to question #11 UHS is implementing the high level personal protective equipment (PPE) protocols used by the University of Nebraska Medical Center which has successfully treated a patient with Ebola virus disease without any secondary transmission to health care personnel. 3:20 PM 3:20 PM 20 Can you give us an update on the Ebola Vaccine that's currently being tested? Source: BBC News (Oct 19, 2014) There is a Canadian vaccine, developed by the public health agency of Canada's National Microbiology Laboratory, which has shown promise in animal studies. However, its safety and effectiveness in humans is unknown. It combines fragments of Ebola virus with a non-fatal virus. It should be enough to trigger the immune system to produce antibodies to attack Ebola, protecting against future infection. Clinical trials have started at the Walter Reed Army Institute of Research in the US but results are not expected until December. The WHO will conduct further tests in Europe and Africa. A separate vaccine is already being trialled in the US, UK and Mali. It is being made by GlaxoSmithKline, which has warned the vaccine will "come too late" for the current epidemic as full safety and effectiveness data would not be ready until late :21 PM 21 For those individuals that recovered from Ebola, can a serum or vaccine be developed for others to use, and or is it based on matching blood type? Serum from individuals that have recovered from Ebola virus disease, known as convalescent serum, has been used to treat other individuals with active disease. Use of convalescent serum does require a matching blood type. The efficacy of this treatment is not entirely clear. 3:21 PM 22 Who will be given the correct PPE? The Units or ONLY EC and GYN EC. PPE is being distributed to all ambulatory intake clinics, Gyn EC, Emergency Department and 5th floor Sky Tower. The 5th floor Sky Tower is the designated 9:39 AM

5 unit for any suspect or confirmed inpatient. 99 Is it true that other hospitals are teaching their staff to screen the patients and any suspecion of Ebola would be transferred to our facility? Would UHS automatically quarantine that staff personnel who completed the intake of a suspected ebola patient? Who will be given the correct PPE? The Units or ONLY EC and GYN EC. Thank You Question 1: Other hospitals instructions to their staff are not available to us. Question 2: Quarantine means to remove a person from the public venue and isolate them at home. There would be no reason to quarantine a staff member based soley on intake of a suspected ebola patient. The patient would need to be confirmed and level of exposure of staff member assessed. Question 3: Select ambulatory clinics, the two Emergency Centers and 5th Sky tower have been provided the correct PPE to manage a suspect or confirmed ebola virus disease patient. 5:40 PM 99 How can we be preventative if we suspect Ebola -> is there a number we can call / give patients to call if Ebola is suspect, to avoid exposing dozens of staff? There is guidance for outpatients that are calling in a meet the screening criteria. Please see Suspect Ebola Patient on Telephone in Call Center of Clinic protocol on the Ambulatory Protocols tab of the Ebola Portal. 4:46 PM 99 What is the protocol for outpatient clinics who have no access to appropriate PPE for a suspect Ebola patients? How can we minimize exposure? Should there be signage to direct patients to a location that IS prepared to care for patients with Ebola? Correct PPE for suspect patient intake was distributed to all ambulatory clinics on October 22, The educators were trained on both the 22nd and 24th of October. The educators will begin training at the individual clinics the week of October 27th. 1:43 PM 99 How is a patient suspected of having EBV tested? And if positive how is it being treated? The test for EVD is done at a reference lab in Austin, Texas using PCR. A presumptive positive test is confirmed by a secondary test performed by the national CDC laboratory. There is no specific treatment for EVD at this time. Convalescent serum has been used to treat some individuals with active disease. Antivirals have been used, but there is little to no data on efficacy. 5:55 PM 99 For the ambulatory setting if we identify a potential Ebola patient and they are placed in a room what does the MA, front desk staff or anyone who had contact with that patient need to do in the interim once the pager has been activated and the team awaits instruction? Does any surveillance need to start happening while the team is enroute? Does the staff need to go and get the Please review the Suspect EVD Patient Intake Plan Ambulatory on the Ambulatory Protocols plan of the Ebola Portal. Please note that San Antonio Metropolitan Health Department will use the clinic sign in sheet to follow-up with patients and families in the waiting areas. The appropriate PPE for the ambulatory clinics was delivered on Wednesday, October 22, The trainers have begun training of correct PPE donning and 8:56 AM

6 names/numbers of the patients/families in the waiting area? doffing. What if the patient needs care while they are placed in the patient room? The providers said they need to have PPE in that case if they have to enter the room if the patient is hypoxic or vomitting etc. They are requesting one PPE kit available in ambulatory or a surgical gown and set up? 99 at what stage of the disease, the patient will have a positive blood test From the CDC's Review of Human-to-Human Transmission of Ebola Virus: Ebola virus is usually detectable in patients blood at the time of fever and symptom onset, 17 although Ebola virus RNA levels at the time of fever and symptom onset are typically low (near the detection threshold limits) and in some patients may not be reliably detectable during the first 3 days of illness (Figure 1). 14 Ebola virus RNA levels in the blood have been shown to increase logarithmically during the acute phase of illness 14 and the bodies of deceased Ebola-infected persons are highly infectious. 3 Among patients who survive, the Ebola virus RNA levels in the blood decrease during clinical recovery. 2:22 PM 99 The National Nurses United call for Ebola are suggesting that if there will be apatient with Ebola, 2 Nurses will take care of the Patient. And no other patient that they will take care of, only the Ebola Pt. Is thie ok with UHS? The current plan at UHS is to have two nurses available to the patient with one standing by ready to assist when needed. The nurses will only be assisgned to the patient suspected of or confirmed for Ebola Virus Disease. 9:34 AM 99 I read an article that EBOLA is not direct contact but it is Airborne according to University of Minnesota Research. They submitted this research to the Center for Infectious Disease Research and Policy. Many people does not believe with the CDC. Do you think we need to follow the Direct contact or Airborne Isolation? We have reviewed the article from the Center for Infectious Disease Research and Policy. At this time there is no direct scientific evidence to suggest transmission by airborne route in the absence of aerosol generating procedures. We will be following the isolation protocols utilized by the University of Nebraska Medical Center which has successfully cared for two patients with active Ebola Virus Disease and had no secondary transmission to providers. 8:46 AM 99 There was alot of new information mentioned in the first town meeting this morning, such as following the Nebraska standards instead of CDC etc.. Can someone be taking notes at these town meetings since all staff can't attend and start including those questions and anwsers on this page? It was mentioned at this mornings town meeting All valid points. The information presented at the town hall meetings is also available on teh portal and through CDC. We are reviewing the questions on the FAQ regularly and updating as needed. 5:26 PM

7 how fluid the situation is and it keeps changing almost daily. Some of the Oct. 20 answers may need updating as well. 99 For the ambulatory setting if we identify a potential Ebola patient and they are placed in a room what does the MA, front desk staff or anyone who had contact with that patient need to do in the interim once the pager has been activated and the team awaits instruction? Please review the Suspect Ebola Patient Intake Plan Ambulatory on the Ambulatory Protocols tab of the Ebola Portal. The plan outlines the duties of the clinic staff and the sequence of events. 8:05 AM 99 What if the patient needs care while they are placed in the patient room? The providers said they need to have PPE in that case if they have to enter the room if the patient is hypoxic or vomitting etc. They are requesting one PPE kit available in ambulatory or a surgical gown and set up? PPE kits containing the required PPE for Ebola Viral Disease were delivered to all ambulatory clinics on October 22, :19 PM 99 Who and where will a log be kept of all the employees attending to a patient dx with Ebola? A monitor with a sign in-sign out sheet will be stationed at the entrance to the room of a suspected or confirmed Ebola patient. 5:18 PM 99 What are the speicific screening assesments for Ebola? The specific sceening assessments are currently (as of October 23, 2014) Does patient complain of fever, headache, joint/muscle aches, weakness, fatigue, diarrhea, vomiting, stomach pain/lack of appetit, bleeding? 5:14 PM AND Resided in or traveled to a country with wide-spread Ebola transmission before illness onset including: Guinea, Liberia, or Sierra Leone within the last 21 days? o OR Have been exposed to someone who has been infected with Ebola within the last 21 days?

Frequently Asked Questions About Ebola Virus Disease

Frequently Asked Questions About Ebola Virus Disease Note that many of the answers below are accurate at an identified point in time. For the most recent information, please visit www.cdc.gov/vhf/ebola.