Expert Briefings & More
U. S. Sen. Lamar Alexander (R-Tenn.), ranking member of the Senate Health Committee, met with infectious diseases experts from Vanderbilt University Medical Center and state health officials on Wednesday, Sept. 24, to ask:
“Do we know what we need to do to prevent an outbreak of the Ebola virus in this country? If we do know, are we prepared to do it?”
Little did Alexander know his questions would come into play a few short hours later as Thomas Eric Duncan headed to the Emergency Department of Texas Health Presbyterian Hospital in Dallas. After initially being sent home, Duncan returned a few days later and was diagnosed with Ebola. By Oct. 8, patient zero was dead.
The Nashville Briefing
At the time Alexander met with Nashville experts, participants were still unaware Ebola would dominate every media outlet in America as the viral threat reached our shores. Despite the new viewpoint, much of the information shared with Alexander in late September is still relevant … perhaps even more so … today.
The Nashville briefing included William Schaffner, MD, a nationally known infectious disease expert and professor 0f Preventive Medicine at Vanderbilt University Medical Center; James Crowe Jr., MD, director of the Vanderbilt Vaccine Center; Thomas Talbot, MD, MPH, chief hospital epidemiologist at Vanderbilt; and other faculty members who take a lead role in emergency preparedness and public health.
Alexander said he came away from the meeting with a clear diagnosis … “We should not panic over Ebola, but we shouldn’t ignore it either.” The senator added, “I believe we should treat the Ebola epidemic as seriously as we treat ISIS … and I’m not given to overstatement.”
In the wake of Ebola arriving in America, the virus certainly hasn’t been ignored. On the other hand, the panic level has varied among stakeholders and the general public.
Although Alexander said he was reassured by Tennessee’s ability to control Ebola, he remained alarmed by CDC predictions that if the often-fatal virus continues to spread in West Africa at its current rate, as many as 1.4 million people could be infected by January. “This could endanger our national security interests,” Alexander warned.
Members of the briefing felt the U.S. government had been slow to react to the disease outbreak. Given the events last month, that assertion now seems particularly prescient.
Cognizant that many Americans were nervous about flying infected aid workers back to the U.S., the expert panel sought to reassure the public that every precaution would be taken during those medical transports. The bigger concern, as is now known, would be undiagnosed individuals arriving from Ebola hotspots. In late October, the CDC announced it would actively monitor travelers from Ebola-affected countries who arrive in the U.S. for a period of 21 days.
“Should Ebola come here via an airplane, we can diagnose it, we can contain it, and we can treat it safely and effectively,” Schaffner said during the briefing. While most believe that is true for Vanderbilt, Emory and a number of other hospitals around the country, it became painfully apparent from lapses in Dallas that not every hospital is well equipped to handle patients presenting with Ebola symptoms.
Crowe called for increased funding for vaccine research and a hastened timeline. Historically, it has taken 25 years to bring a new vaccine to market. Given the current situation, that timing won’t work for Ebola. Crowe and colleagues have isolated monoclonal antibodies from human survivors (see below). “We have them, but they’re not ready for use because they have not been scaled up so we’re working 24/7 here,” he noted of this next generation of treatment.
The experts reminded Alexander and the public that Ebola could only be transmitted through contact with the bodily fluids of someone who is already symptomatic. Although Ebola is mutating into different strains, Crowe said, “The chance of it developing the capacity to be transmitted through the air is very low.”
While the mortality rate of the current outbreak in West Africa is about 50 percent, Schaffner said the death rate could be brought down significantly with basic supportive care, even without a specific drug treatment. “But there has to be more care than sending the patient home with bleach and a mask, which is about all they can do without help from the international community,” he said. Schaffner added, “If we could provide … as we’re now trying to do in West Africa … more supportive care, I think we could move the needle and improve survival in Africa.”
Alexander asked, “What would you say to an American MD about treating the disease?”
The VUMC experts replied there are three critical three steps: the patient should be transported to a dedicated location, evaluated, and put in the care of the medical ICU team. At VUMC, the care team had already begun practicing details of this procedure.
Schaffner noted, “We are functioning on the premise that (Ebola) will come here. We know what to do about infectious disease.” He continued, “We need to be sure that patients are put into a treatment situation where they are attended to by trained and equipped providers, not just people who want to help.”
More on Ebola Drug Therapies
Vanderbilt University researchers have partnered with Mapp Biopharmaceutical Inc. to develop their new human antibody therapies to provide short-term protection for people exposed to the deadly Ebola and Marburg viruses. These hemorrhagic filoviruses kill, in part, by causing massive bleeding.
The San Diego-based company has developed an experimental treatment, called ZMapp, which contains antibodies manufactured in plants. ZMapp has prevented lethal disease in rhesus monkeys but has not yet been tested for safety and efficacy in humans. At Vanderbilt, researchers are using a high-efficiency method to isolate and generate large quantities of human antibodies from the blood of people who have survived Ebola and Marburg infections and are now healthy. No live virus is used in the research.
“We’re the only lab in the world that has a high-efficiency human hybridoma technique for isolating human monoclonal antibodies,” explained James Crow, Jr., MD. He said Vanderbilt has been isolating antibodies to major human pathogens to better understand the basic science of immunity.
“However, with the current urgent medical need for treatments for Ebola infection, we are thrilled to be working with Mapp Biopharmaceutical to produce the antibodies we have discovered as antiviral drugs that may benefit patients and healthcare workers facing this terrible epidemic," Crowe said.
Notes from the TDH
Last month, Tennessee Department of Health Commissioner John Dreyzehner, MD, MPH, FACOEM, led a media briefing regarding the state’s level of preparedness and response to Ebola and followed up with additional guidance.
While stressing there had been no confirmed or suspected cases of the deadly virus in Tennessee, Dreyzehner said should the need arise, “We’re confident we can provide patient care and mitigate transmission to others.”
He added the TDH had been providing guidance to hospitals and facilities for several months … not only on Ebola but on MRSA and other contagions, as well. Dreyzehner noted, “Fear, mistrust and stigma are really thriving with this epidemic.” For that reason, he said it was critically important healthcare providers and media outlets help the public understand the facts about Ebola including that it can’t be spread through the air, by mosquitos, in the water and typically not through food. Instead, it is spread through bodily fluids or on items grossly contaminated by bodily fluids, such as a needle. “Ebola cannot live long outside the human body and is easily killed by common disinfectants,” he said.
Asymptomatic patients and those who have recovered from the disease are not a public health threat. However, once someone shows symptoms, Dreyzehner said the viral load increases as the person becomes sicker. While the incubation period is generally three weeks, days 8-10 are often the time when symptom onset occurs. Some individuals have taken longer than 21 days to test positive for the virus, and Dreyzehner said it appears people are capable of transmitting Ebola for about 90 days through semen.
Since bodily fluids can transmit through open wounds or through the eyes, nose, mouth and skin, it is critically important for healthcare providers to protect themselves. “The most basic thing we can do is washing our hands,” Dreyzehner said. “We touch our faces about 16 times and hour,” he added to emphasize the importance of killing germs through proper hand-washing protocols.
Equally, he said, healthcare providers need to be sure to follow the specific order of putting on and taking off personal protective equipment (PPE). Recently, the CDC (cdc.gov) updated PPE guidelines to more closely match protocols in place by Doctors Without Borders, which has a successful history of fighting Ebola and other contagious diseases around the world.
With cold and flu season approaching, many people across Tennessee will develop fevers and have nausea, which may cause additional concern this year. However State Epidemiologist Tim Jones, MD, pointed out, “If you have not traveled to Liberia, Guinea or Sierra Leone within the last 21 days; and if you have not been exposed to body fluids of a confirmed Ebola virus disease patient, you do not have an appreciable risk for Ebola.”
There is, however, a very real chance Tennesseans who do not get their flu shot could be exposing themselves to that airborne virus. “Flu represents a clear and present danger and every year too many Tennesseans unnecessarily die from this common illness,” Dreyzehner said. “Some incorrectly regard flu as a really bad cold. It’s not; it can and does kill many every flu season. If you have not had your flu shot or nasal spray yet, we urge you to get it now. It could save your life.”
If you or your patients have concerns over Ebola, the TDH announced three new information resources about the disease in late October:
Tennesseans with questions about the disease may call a toll-free number to obtain accurate, timely information: (877) 857-2945.
TDH is providing additional information about Ebola virus disease, including summaries of weekly activities and adding links to other sources of reliable information: health.state.tn.us/Ceds/ebola.htm.
Should a confirmed case occur in Tennessee, the department will make a public announcement and post information to the TDH website: health.state.tn.us.
HCA’s Gift
In late September, HCA made a $1 million cash donation to the CDC Foundation’s Global Disaster Response Fund to help support international Ebola response efforts involving the CDC and their work with partners on the ground in West Africa.
HCA has a long history of supporting relief efforts including those following the earthquake in Haiti, the Indonesian tsunami, Hurricane Katrina and Typhoon Haiyan in the Philippines. The donated funds will be used to provide much-needed supplies and equipment to aid workers including personal protective equipment, infection control tools, ready-to-eat meals, generators, exit screening tools and supplies at airports such as thermal scanners to detect fever.
“Ebola continues to spread rapidly in West Africa, and CDC and others have made it clear that the window of opportunity to contain the virus is closing quickly,” said R. Milton Johnson, president and CEO of HCA. “The time to act is now, and we strongly encourage other companies, particularly those in the healthcare industry, to join us in this important effort to save lives.”
Waller Launches Ebola Legal Resource Site
In late October, Waller Lansden Dortch & Davis, LLP announced the launch of a comprehensive online resource to help healthcare leaders and other organizations impacted by the Ebola virus tnavigate diverse issues pertaining to the arrival of the virus in the United States. The website can be accessed at EbolaLegalResource.com.
“The immediate and long-term legal implications of the Ebola virus on all facets of hospital, clinic and practice management must be seriously considered,” said Mark Peters, a partner in Waller's Labor and Employment practice who works extensively with healthcare employers. “Waller’s Ebola legal resource website comes in response to the many questions we’ve received from clients. Preparation in this situation is important, whether an Ebola patient walks through your doors or if you are simply dealing with the climate it has created.”
The site launched with a compilation of media articles, links to outside resources, and original articles from Waller attorneys including:
The Role of Healthcare Employers during the Ebola Crisis,
Patient Privacy Concerns,
FAQs on Employee Discipline, Discrimination & Harassment,
Workers' Compensation for those Contracting Ebola, and more.
The site, which will be updated as new information becomes available and is analyzed, is tailored to healthcare executives, board members, risk managers, human resources professionals and others who are asking what Ebola means, from a legal perspective, for their organization, employees and patients.
Joint Statement on Ebola from Tennessee Hospital Association, Tennessee Medical Association & Tennessee Nurses Association
Across the country, healthcare providers, workers and citizens share concern on the possible spread of Ebola in the United States. Here in Tennessee, our hospitals, physicians, nurses and other healthcare workers continue to prepare for such an event in our state.
Nothing is more important than the safety of our patients, their families and our colleagues who care for the sick day in and day out. Safely providing high-quality care to our patients in any situation is our chief priority and the healthcare providers of our state are committed to this goal.
In the past few weeks, we have learned much from our colleagues around the nation who have had to deal with actual Ebola cases and have implemented appropriate practices as a result. We are now on heightened awareness for anyone showing up in our emergency rooms and physicians’ offices who exhibit symptoms similar to the Ebola virus.
While we know the threat of Ebola in the U.S. is very different from the reality in West Africa, it is vitally important for healthcare providers to prepare for a worst-case scenario. For this reason, Tennessee Hospital Association, Tennessee Medical Association and Tennessee Nurses Association are working in concert with the Tennessee Department of Health, as well as appropriate federal agencies, to ensure appropriate protocols and policies are in place.
ACEP Calls for More Resources
The arrival of the Ebola virus in the United States has prompted the nation’s emergency physicians to urge policymakers to provide more resources for personal protective equipment (PPE) and training for emergency care workers as they manage the front lines.
“The response to Ebola should be regionalized, with emergency departments screening and identifying patients who are infected, and then transporting them to facilities specially equipped to care for them,” said Alex Rosenau, DO, FACEP, president of the American College of Emergency Physicians (ACEP). “Rapid identification of infected patients combined with a regional response will protect both patients and healthcare workers, in particular emergency physicians and nurses, from spreading the infection.”
Rosenau said the top priorities should be increased funding for emergency department disaster preparedness, increased training, and supplies of PPE for all healthcare workers in emergency departments. Additional resources are needed to train EMS medical staff, including paramedics and emergency medical technicians.
“Emergency physicians are asking Congress to restore funding to the federal Hospital Preparedness Program, a program designed to help hospitals plan for emergencies,” Rosenau stated. “Funding to this program has been cut by 50 percent since 2003. In addition, all emergency departments need rapid “yes/no” testing for the Ebola virus in labs dedicated to identifying Ebola patients.”
RELATED LINKS:
AMA’s Ebola Resource Center for Clinicians
Tennessee Department of Health