1 - General FAQs about the Ebola virus (pages 1-3)

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1 EBOLA FAQs This document contains three sections of FAQs: 1 - General FAQs about the Ebola virus (pages 1-3) 2 - FAQ for staff who may be meeting guests arriving from infected areas who ve been invited to BBC premises for interviews (page 4) 3 - Specific health FAQs for those based in or planning to visit infected countries to film or produce programmes (pages 5-8) Ebola virus disease is a serious, usually fatal, disease for which there are no licensed vaccines or treatments; but for people living in countries outside Africa, it remains a very low threat. SECTION 1 GENERAL EBOLA FAQs Q1. How is Ebola Virus spread? A1. Ebola Virus is very difficult to pass from person to person. It is not airborne and so in order to become infected you have to be in contact with the body fluids, blood or organs of an infected person who is showing significant later symptoms of the disease. As far as current knowledge goes there is no risk of contracting Ebola Virus from someone who may be incubating the disease but does not have current symptoms; or indeed from those who have mild symptoms which is common in the early stages of the disease. You need to have very close contact with the source of infection to be at risk. Those most at risk of being infected are those who are caring for infected individuals (relatives and health care workers) either by directly touching the victim's body or by cleaning up blood stained body fluids (stools, urine or vomit) that carry infectious blood. There is also a risk at funerals as in Africa it is common practice for mourners to touch the body of the deceased. They only then need to touch their mouth to become infected. Other possible routes of infection are: touching the soiled clothing of an infected person, then touching their mouth or an area of broken skin having sex with an infected person without using a condom (the virus is present in semen for up to seven weeks after the infected person has recovered) handling unsterilised needles or medical equipment used in the care of the infected person Ebola virus disease is generally not spread through routine social contact (such as shaking hands) with patients who do not have symptoms, however during an outbreak such as this, when in an Ebolainfected area, it is good practice to reduce or eliminate such contact and pay scrupulous attention to infection avoidance measures and especially hand washing. Simply washing hands with soap and water can destroy the virus. Number2_ebola_faq_7November2014.docx 1 of 8 07 Nov. 14

2 Q2. What are the symptoms? A2. An infected person will typically develop a fever, headache, joint and muscle pain, sore throat, and intense muscle weakness. These symptoms start suddenly, between 2 and 21 days after becoming infected, but usually after 5-7 days. Symptoms progress to diarrhoea, vomiting, a rash, stomach pain, followed by internal bleeding and/or bleeding from the ears, eyes, nose or mouth. Ebola virus disease is fatal in the majority of cases. The sooner a person is given care, the better the chances that they will survive. Q3. How is Ebola diagnosed? A3. It's difficult to know if a patient is infected with Ebola virus in the early stages as symptoms such as fever, headache and muscle pain are similar to those of many other infectious diseases. But specialist infection clinicians will make expert judgements on what the most likely diagnosis is based on the patient s history. If Ebola is considered a possibility on this basis, then a person would be tested for the disease. A suspect case would be isolated in a side room so as to minimise contact with other people while they are being tested. It is only if this test is positive that the case is considered to be confirmed. If the test is positive then they will be transferred to a hospital-based high-level isolation unit. It may be necessary to keep the patient in isolation as it is possible to get false negatives (where the virus is not picked up in the blood) to repeat the test up to four or five days later. Q4. How is Ebola Virus treated? A4. There's currently no specific treatment or licensed vaccine for Ebola virus disease, although potential new vaccines and drug therapies are being developed and tested. Patients need to be placed in isolation in intensive care. Dehydration is common, so fluids may be given directly into a vein (intravenously). Blood oxygen levels and blood pressure need to be maintained at the right level and body organs supported while the patient's body fights the disease and any other infections are treated. Q5. Can I catch Ebola Virus from someone who doesn t have symptoms now but develops the disease later on? A5. No. There is no evidence that there is a risk of contracting Ebola Virus from someone who may be incubating the disease but does not have current symptoms. Number2_ebola_faq_7November2014.docx 2 of 8 07 Nov. 14

3 Q6. I ve heard that Ebola virus is fatal in the majority of cases what s the point in going to hospital for treatment? A6. There is growing evidence that those who seek treatment early for Ebola have a better chance of surviving. Although there is no treatment, supportive care significantly improves the outcome of the disease. Q7. Why is the risk of Ebola Virus in the UK low? A7. The likelihood of catching Ebola virus disease is considered very low unless you've travelled to a known infected area and had direct contact with a person with Ebola-like symptoms, or had contact with an infected animal or blood or body fluids Also, Ebola patients are not infectious before they have symptoms, and in the early stages of developing the disease it is highly unlikely that they will pass on the disease. The disease then progresses very rapidly. This means infectious people do not walk around spreading the disease for a long period. It typically takes 5-7 days for symptoms to develop after infection, so there is time to identify people who may have been exposed, put them under surveillance and if they show symptoms, quarantine them. Public Health England has put in measures to screen people travelling into the UK from West Africa. Number2_ebola_faq_7November2014.docx 3 of 8 07 Nov. 14

4 SECTION 2 INTERVIEWING GUESTS OUTSIDE OF EBOLA INFECTED COUNTRIES WHO HAVE BEEN TO AN EBOLA-INFECTED AREA Q1. I want to invite individuals who may have been exposed to Ebola into BBC buildings to conduct interviews. What do I need to do? A1. The WHO have recommended (8/8/14) that close contacts of the disease (which do not include properly protected health workers) should be monitored daily, with restricted national travel and no international travel until 21 days after exposure. Therefore such contacts should not be presenting themselves for interview at BBC buildings and we should not invite individuals to break the rules. At present as there are no restrictions on international travel for individuals who are not direct contacts there is no reason why individuals from infected countries or areas who have no symptoms should not be invited in to BBC building for interviews. However before allowing them on site you need to be assured that they are currently well and asymptomatic. There is a flow chart available to support this, here is the link: Q2. What precautions are we taking to ensure guests who come to an interview in a newsroom or local bureau, who have come from an Ebola-infected area, are not infectious? A2. The flow chart (as above) is to help people screen guests, it is worth reading the addendum to the chart. If you are aware that someone has visited an Ebola affected country they should be asked, before they are formally invited into a BBC building, if they have any symptoms. It would be unlikely that someone suffering from Ebola is going to want to be out and about as they are likely to be feeling very unwell. Once a guest has actually arrived at the BBC premises it would not be unreasonable to ask again if they are well and asymptomatic (without symptoms) as a final reassuring check, especially if the initial screening had been completed some days beforehand. If there are still doubts refer to the box adjacent to the flow chart for further advice or support. Q3. What do I need to do if I am greeting a guest at a BBC building who may have come from an Ebola-infected area? A3. Providing the above checks have been completed and this is a guest who is asymptomatic, and (even if they have been in an affected country within 21 days) are registered with a reputable health authority, such as Public Health England, you should feel free to greet them as you might any other guest to the building. Number2_ebola_faq_7November2014.docx 4 of 8 07 Nov. 14

5 SECTION 3 HEALTH FAQs FOR STAFF PLANNING TO VISIT AN EBLOA-INFECTED AREA Q1. I live or am working in an infected country and I am worried about catching Ebola Virus. A1. Ebola virus disease is generally not spread through routine social contact (such as shaking hands) with people who do not have symptoms, however during an outbreak such as this it is good practice to reduce or eliminate such contact and pay scrupulous attention to infection avoidance measures and especially hand washing. Ebola Virus is very difficult to pass from person to person. It is not airborne and so in order to become infected you have to be in contact with the body fluids, blood or organs of an infected person who is showing symptoms of the disease ie As far as current knowledge goes there is no risk of contracting Ebola Virus from someone who may be incubating the disease but does not have current symptoms. You'd need to have very close contact with the source of infection when they are seriously ill or after death to be at risk. Q2. While deployed to an Ebola-infected country, I would like to film in clinical areas/hospitals where Ebola patients are being treated. A2.This is a very high risk activity and will only be appropriate with careful high level editorial justification, following guidance from the High Risk Team, and scrupulous control measures. Patients with Ebola are cared for in clinics or hospitals where medical staff protect themselves fully from contamination by infected body fluids from patients. Even then we are aware that some medical and nursing staff have caught the disease despite these protective measures so complete safety can never be assured. Any filming would have to be agreed and supervised by a reputable medical or health source in the country such as the WHO, Medicins Sans Frontières etc. Filming in these areas is very high risk, and specialised advice will need to be sought. This will include taking an bio hazard expert with you and adhering to strict infection control protocols. All deployments must be approved through the High Risk Team. The WHO have recommended that individuals who have been in close contact with infected patients (except properly protected healthcare workers) should not travel internationally for 21 days, and if there is any chance that you or one of your team have been a close contact then you must adhere to this advice. Please bear this in mind when planning any such very high risk activity. Q3. While deployed to an Ebola-infected country, I would like to interview patients who have the disease or are suspected of having the disease. A3. This is prohibited as it poses a significant risk of infection. If someone is suspected of having the disease then they should be directed to health care and testing facilities. It is unlikely someone with the disease would be fit enough to be interviewed over the telephone. Q4. While deployed to an Ebola-infected country, I would like to interview families or carers of confirmed Ebola victims. A4. Unless you have the support and oversight of a bio hazard expert actually deployed with you to ensure appropriate control measures are in place you should not conduct face to face interviews if the families have had contact with the patient less than 21 days ago. If this is the case, or there is any doubt, then the interviews can be carried out by phone. If the contact was more than 21 days ago and the Number2_ebola_faq_7November2014.docx 5 of 8 07 Nov. 14

6 family members are well then normal contact is allowed, providing you pay attention to preventative hygiene measures. Q5. While deployed to an Ebola-infected country, I would like to interview health care workers involved in the care of confirmed Ebola victims. A5. This is permitted providing the interview takes place outside the clinical setting, the health care worker has been taking appropriate hygiene precautions in a reputable establishment, and the health care worker is free from any Ebola-like symptoms. You must establish freedom from symptoms before inviting an individual into BBC premises. If there is any doubt about whether someone has symptoms then the interview should be conducted by phone. If you are unsure what to do, please refer to your line managers for approval, who may seek as well advice from the high risk team. Q6. Can I interview those who have had Ebola infection and survived while deployed to an Ebolainfected country? A6. This is permitted providing the interview is not taking place in a clinical establishment or any other area where there is a risk of contact with other symptomatic persons and the interviewee is symptom free and has been declared virus free by a reputable medical practitioner or treating centre. If this declaration is not available, then interviews should be conducted by phone. You must establish freedom from symptoms before inviting an individual into BBC premises. Q7. Can I film in the vicinity of hospitals and clinics that are treating Ebola patients or in areas where there have been cases and deaths in an Ebola-infected country? A7. There is likely to be an exclusion zone imposed around infected areas or clinics or establishments where patients are being assessed or treated and you should observe this. However families are leaving their relatives outside these treatment centres so it will be considered a high risk task to undertake. Filming at a safe/long distance, where there is unlikely to be any close contact with cases or suspected cases is permitted, providing appropriate preventative hygiene measures are taken. Be aware that broadcasters can attract attention and contact with the local population could occur. Refer to your line manager for permission to do so. Q8. What is designated as close contact for Ebola? A8. Ebola Virus close contacts: Someone who has nursed or cared for Ebola patients either by directly touching the victim's body or by cleaning up body fluids (stools, urine or vomit) that carry infectious blood. Health Care Workers in Ebola clinics or treatment centres Laboratory workers handling contaminated specimens Individuals who have attended and participated in funerals where the body has been touched after death. Touching the soiled clothing of an infected person, then touching their mouth Those who have handled unsterilized needles or medical equipment Having sex with an infected person without using a condom. Other workers for example journalists, who in the course of their work may be exposed to a similar risk of contact with symptomatic individuals Number2_ebola_faq_7November2014.docx 6 of 8 07 Nov. 14

7 Q9. What are the recommended Preventative Hygiene measures in infected countries? A9. Avoid contact with individuals who have symptoms Avoid having sex with people in risk areas; use a condom if you do Make sure fruit and veg is washed and peeled before you eat it Wash hands frequently using soap and water (alcohol hand rubs when soap is not available), as this destroys the virus Avoid facial contact such as kissing with others, and if you do shake hands then make sure you wash your hands before you eat, drink, smoke, or touch your face. Don't handle dead animals or their raw meat Don't eat 'bushmeat' Q10. I am planning to return to my home country from an assignment in a high risk country where I could have been exposed to Ebola Virus - what should I do? A10. If you feel you have had unprotected exposure to the Ebola virus you need to seek advice from the WHO or BBC CMO and High Risk Team. You should isolate yourself and seek medical advice without delay. see Q11. Do not travel internationally for 21 days if you have been a close contact of an Ebola patient or bodily fluids. Q11. Why is the BBC not quarantining individuals who have returned from covering stories in Ebola infected areas? A11. The risk of individuals picking up Ebola, unless they have been in close contact with an individual suffering from the disease is extremely low, so an arbitrary quarantine isn t justified, especially as there are currently no general restrictions on travel from infected countries or restrictions on individuals going about their day to day lives. At present we advise that anyone with health symptoms (which actually are most likely to be caused by unrelated infections acquired abroad) who return from Ebola areas to stay away from work, isolate themselves and seek immediate medical advice see Q12. Note that the WHO now advise that those who have been in close contact with an Ebola patient should not travel internationally for 21 days after the contact. Q12. I have been in close contact with known Ebola infected individuals, what should I do? A12. If an individual has had a close contact with an Ebola patient as described in Q8 then they must not travel internationally for 21 days, they need to monitor their symptoms particularly their temperature, and seek advice if they fall ill. Q13. What should I do if I develop symptoms on return to the UK? A13. If you feel unwell with symptoms such as fever, chills, muscle aches, headache, nausea, vomiting, diarrhoea, sore throat or rash within 21 days of coming back from Guinea, Liberia or Sierra Leone, you should stay at home and immediately telephone 111 or 999 (or the appropriate number in your country of domicile) and explain that you have recently visited West Africa. You should also alert the High risk team and / or your line manager. Number2_ebola_faq_7November2014.docx 7 of 8 07 Nov. 14

8 As a member of BBC staff, if you deployed from or are returning to the UK, you will have been registered with Public Health England (PHE), and on your return they will give you a phone number to call if you become unwell and you should call that number first. These services will provide advice and arrange for you to be seen in a hospital if necessary so the cause of your illness can be determined. If you travel in an ambulance the medical staff may be wearing full personal protective equipment when they collect you. There are other illnesses that are much more common in returning travellers than Ebola (such as flu, typhoid fever and malaria) that have similar symptoms in the early stages, and can also be fatal so proper medical assessment is really important to ensure you get the right diagnosis and treatment. Q14. I have returned from an assignment where I have been in a country where there are cases, but have not knowingly been in contact with infected individuals or areas where they have been treated or cared for. A14. The risk of catching Ebola virus in this circumstance is extremely low. Nevertheless it is good practice to monitor your health for 21 days following your return and if you develop any symptoms then follow the advice in Q12. Bear in mind in the UK all passengers returning from Ebola infected areas will undergo a screening on entry to the UK. Q15. I may have been on a flight with someone with Ebola. Am I at risk? A15. No. So far there have been no documented cases of people catching the disease simply by being in the same plane as an Ebola victim. Q16. I have returned from an Ebola-infected area what should I do with my equipment? A16. All crews deploying to affected countries are undergoing training to understand about care and cleaning of equipment. The equipment in country should never have been exposed to the Ebola Virus, nevertheless good practice will include daily cleaning of equipment and a final equipment clean before returning. The equipment can be used as normal. Any equipment that was taken to an Ebola affected country that was exposed or even potentially exposed to the virus will be disposed of in country, rather than risk exposure of staff having to clean it or return it to the home country. Fully revised 7 th November 2014 Number2_ebola_faq_7November2014.docx 8 of 8 07 Nov. 14

Primary Care Guideline for the Management of People Concerned About/Potentially Exposed to Ebola. Provincial Ebola Response Task Force Nov.

Primary Care Guideline for the Management of People Concerned About/Potentially Exposed to Ebola Provincial Ebola Response Task Force Nov. 6, 2014 Primary Care Guidelines for the Management of People Concerned