Chicago Ebola Preparedness Update Suzet McKinney, DrPH, MPH, Deputy Commissioner Stephanie Black, MD, MSc, Medical Director March 18, 2015
Agenda Ebola Overview Crisis in West Africa Symptoms and transmission Chicago Preparedness Efforts Coordinated Effort O Hare Operations Chicago Ebola Resource Network Traveler Monitoring Healthcare Coalition
Graph 1: Total suspected, probable, and confirmed cases of Ebola virus disease in Guinea, Liberia, and Sierra Leone, March 25, 2014 March 1, 2015, by date of WHO Situation Report, n=23934
http://www.nytimes.com/2015/03/01/world/africa/near ly-beaten-in-sierra-leone-ebola-makes-a-comeback-bysea.html?_r=0
Graph 2: Total suspected, probable, and confirmed cases and deaths of Ebola virus disease in Guinea, March 25, 2014 March 1, 2015, by date of WHO Situation Report, n=3219 Graph 3: Total suspected, probable, and confirmed cases and deaths of Ebola virus disease in Liberia, March 25, 2014 March 1, 2015, by date of WHO Situation Report, n=9249 Graph 4: Total suspected, probable, and confirmed cases and deaths of Ebola virus disease in Sierra Leone, March 25, 2014 March 1, 2015, by date of WHO Situation Report, n=11466
Symptom Frequency in Symptom Current Outbreak % of cases (from symptom onset to detection) Fever 87% Fatigue 76% Vomiting 68% Diarrhea 66% Unexplained bleeding Blood in stool 18% 6%
The fluid must have an entry point, like a cut or scrape, or someone touching their nose, mouth, or eyes. Blood, feces, and vomit are the most infectious. Virus usually not found in saliva until patient is severely ill.
Chicago Response O Hare Operations 1. High risk travel hub 2. Traveler Screening 3. Transportation, housing, etc. Chicago Ebola Resource Network 1. Shared Responsibility for Care 2. Evaluation of PUIs Traveler Monitoring 1. Active Monitoring 2. Direct Active Monitoring 3. Inter/Intra State Coordination Healthcare System Preparedness 1. Network of Providers 2. All Area Hospitals and Clinics 3. EMS Providers
Airport Screening All individuals leaving Guinea, Liberia, and Sierra Leone are screened at exit from their country and entry into the US Exit Screening Temperature Questionnaire: Exposures and symptoms Entry Screening in US airports JFK, Dulles, Newark, Atlanta and Chicago O Hare Customs and Border Protection and CDC staff Temperature Questionnaire: Exposures and symptoms
Airport Operations CDPH staff on site daily to support CBP, CDC screening CDPH Role at ORD Issuance of controlled movement orders EMS coordination for transport of PUIs Coordination of housing, transportation, other needs for travel companions Compliance with City s Emergency Operations Plan OEMC DFSS American Red Cross
CDC Care Kit CARE kit introduction How to check and report your health for Ebola Digital thermometer How to use your thermometer to check your temperature Symptom card and log CDC CARE card Phone numbers for State and Local Health Departments
Ebola Contact Card
Risk Level Determination High risk: direct contact of infected body fluids of someone diagnosed with Ebola. This can include needle stick, or splashes to eyes, nose or mouth or handling body fluids in a laboratory, without wearing personal protective equipment (PPE) Some risk: close contact with a person showing symptoms of Ebola such as in a household, health care facility or community Low risk: having been in a country with widespread Ebola transmission within the previous 21 days and having no known exposure OR being in the same room/plane for a brief period of time with a person showing symptoms of Ebola
Arrival screening at O Hare Traveler has fever or other signs/symptoms consistent with Ebola Traveler is asymptomatic (i.e. no fever, no signs or symptoms of illness) but reports an exposure to Ebola during the 21 days before arrival Traveler is asymptomatic, and doesn t report exposure to Ebola during the 21 days before arrival Disposition Medical evaluation required If high risk exposure: Quarantine If some risk exposure: Conditional release If low risk exposure Active daily monitoring required? Possibly, if/when the patient is discharged YES YES YES
Resource Network Where will Symptomatic Travelers receive care? The Chicago Ebola Resource Network Rush University Medical Center, University of Chicago Medical Center, Northwestern Memorial Hospital, Lurie Children s Hospital of Chicago Network of hospitals identified with: Specialty care expertise (infectious disease, intensive care, dialysis), Resources to support usual care as well as care for an Ebola patient Laboratory capacity and systems Advanced infection control systems Waste management systems Willingness to care for Ebola patients CDC team assessed hospital readiness and training needs (10/19-10/23)
Appropriate Referrals Referral Source O Hare Hospitals Clinics ` Exposure Symptoms Provider Verification Guinea, Liberia, Sierra Leone in past 21 days Guinea, Liberia, Sierra Leone in past 21 days Guinea, Liberia, Sierra Leone in past 21 days Fever or any other symptoms consistent with Ebola Fever or any other symptoms consistent with Ebola Fever or any other symptoms consistent with Ebola CDC physician ID physician (in person or via phone) Physician in consultation with CDPH Community Guinea, Liberia, Sierra Leone in past 21 days Fever or any other symptoms consistent with Ebola Paramedics
Hospital Responsibilities Tiered approach: frontline, assessment treatment centers Evaluate patients presenting to ED Travel history Guinea, Liberia, Sierra Leone in past 21 days Identify symptoms consistent with Ebola Consult with ID physician to determine appropriateness to transport to network hospital Participate in inventory management reporting for PPE Make Ebola resources available to staff and train staff
Clinic Responsibilities Evaluate patients presenting to clinic Travel history Guinea, Liberia and Sierra Leone in past 21 days Identify symptoms consistent with Ebola Consult with CDPH physician to determine appropriateness to transport to network hospital Make Ebola resources available to staff and train staff Interim guidance and protocols provided by CDPH
PUIs 8 patients Age range 5-61yo 10/21/14-3/5/15 5 of 8 from O Hare Alternative dx: 3 malaria 1 typhoid fever 3 URI (influenza, coronavirus, non-specific) 1 dehydration
Asymptomatic Travelers
Arrival screening at O Hare Traveler has fever or other signs/symptoms consistent with Ebola Traveler is asymptomatic (i.e. no fever, no signs or symptoms of illness) but reports an exposure to Ebola during the 21 days before arrival Traveler is asymptomatic, and doesn t report exposure to Ebola during the 21 days before arrival Disposition Medical evaluation required If high risk exposure: Quarantine If some risk exposure: Conditional release If low risk exposure Active daily monitoring required? Possibly, if/when the patient is discharged YES YES YES
Monitoring Procedures Asymptomatic with low risk of exposure Allowed to continue traveling Local public health agencies required to monitor these individuals for 21 days following their arrival to final destination In-person visit at start and once/week thereafter Active monitoring with twice daily temp reporting and symptom checks Asymptomatic with some risk of exposure May not continue traveling on public airplanes Local public transit prohibited Local public health agencies required to monitor these individuals for 21 days following their arrival to final destination Direct active monitoring with twice daily temp reporting and symptom checks Daily in-person visit Staffed by PHNs, epidemiologist, med dir, admin assistant
Monitoring procedures Asymptomatic with high risk of exposure Home quarantine required May not continue traveling on public airplanes Local public transit prohibited Local public health agencies required to monitor these individuals for 21 days following their arrival to final destination
Monitored Individuals Chicago 10/17/14 3/17/15 62 individuals with one repeat traveler = 63 monitoring events First individual was a flight attendant, remainder were travelers to W. Africa 8 children (aged 1-17 yrs.) 1 lost to follow up x 1 w
Risk Level Monitored Individuals by Risk Level Chicago 10/17/14 3/17/15 # Comment Some 8 3 family members of a hospitalized person + 5 HCW who worked in W. Africa Low 54 Visiting or joining family, business trip, minister, aid workers, medical researcher Total 62
Healthcare System Preparedness
Healthcare System Preparedness Acquisition of appropriate PPE Guidance and treatment recommendations Frequent situational awareness calls Training Ebola Resource Network staff sent to Emory and University of Nebraska Infection control supplemental training for non- Ebola Resource Network hospitals Funding!
Funding Supplemental funding available via ASPR and CDC $4.8M Ebola Supplemental for AM/DAM (CDC) $145M Ebola Supplemental (CDC) $1M Ebola Supplemental for select cities (ASPR) New funding available for Ebola preparedness and response $106M ELC grant appropriation (CDC) $162M Ebola Preparedness and Response appropriation (ASPR) $32.5M Ebola competitive appropriation for regional Ebola treatment centers (ASPR)
Thank You. Questions.