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U.S. Health Departments Working Overtime to Prepare for Ebola

Author: Association of State and Territorial Health Officials : Contact:

Published: 2014-10-17


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Since the summer, they have been creating Ebola guidelines and algorithms for their healthcare facilities and providers, collaborating with their West African populations, and communicating with the public about the disease and how to prevent an outbreak.

(Ebola hemorrhagic fever - EHF) is the human disease caused by ebola viruses. Symptoms start 2 days to 3 weeks after contacting the virus with a fever, throat and muscle pains, and headaches. There is then nausea, vomiting and diarrhea along with decreased functioning of the liver and kidneys. At this point some people begin to have problems with bleeding. Ebola first appeared in 1976 in 2 simultaneous outbreaks, in Nzara, Sudan, and in Yambuku, Democratic Republic of Congo. Ebola is introduced into the human population through close contact with the blood, secretions, organs or other bodily fluids of infected animals.

"The biggest thing the states are working on right now for Ebola is communication," says Kathy Talkington, ASTHO's senior director of immunization and infectious disease. "People look to state public health as the honest broker of information as to what's going on, so the health departments are making sure that they fully understand what the procedures are from federal health officials and then communicating those to healthcare providers and facilities, public health labs, disease detectives, and the public."

To improve their preparedness capacity, health departments have produced Ebola guidelines for healthcare providers, public health labs, educators, and other stakeholders, in addition to building out their isolation units and setting up incident command systems. The New York State Department of Health and New York City Department of Health and Mental Hygiene worked together to produce Laboratory Guidelines for Handling Specimens from Patients with Suspected or Confirmed Ebola Virus Disease. The Guam Department of Public Health and Social Services and Guam International Airport Authority are planning to convert one of the airport gates into an isolation unit in case the territory receives potential Ebola cases. The Tennessee Department of Health sent a letter to universities and colleges on how to address possible Ebola cases among students, as well as published several tabletop exercises for healthcare providers and facilities on its Ebola resource page.

These preparations have been especially critical in states with large West African populations, such as Minnesota and Rhode Island, where residents often travel back and forth between their homelands. Both states have set up incident command systems, an organizational system approach designed to help manage emergency responses. "We have a Liberian population of about 15,000, so we watched Ebola closely as the situation evolved," says Michael Fine, director of the Rhode Island Department of Health. "I've also spent some time in Liberia, so I understand the situation on the ground the health infrastructure - and that probably made me conscious early on of what was coming at us."

Rhode Island is working closely with its Liberian community to prevent Ebola transmission in the state and back in Liberia. On Oct. 5, Fine met with hundreds of Liberians in a town hall-style meeting in a local church. During the event, he answered questions about Ebola, collaborating with the pastor and deacons - some of whom have lost family members to the disease. The health department has also partnered with its local United Way and Fox News affiliates to start a campaign that allows members of the Liberian community to call friends and family members in Liberia to teach them about Ebola, which helps counter skepticism of health workers in Liberia and improves the Rhode Island Liberians' knowledge of the disease. "We have been expecting some imported cases of Ebola into the United States, but we are ready," Fine told a local news station earlier this month. "We've been working on this since the summer. Our hospitals are ready, our primary care physicians are ready, our EMS is ready. Everybody's been looking out, paying attention, and being aware."

State and territorial health agencies have been in constant contact with CDC and other federal agencies as well as local health departments and healthcare providers. They have been an integral part in the decision-making process on preparation procedures, including the enhanced screening provisions at several ports of entry and ramping up laboratory capabilities to test for the virus.

The first two cases of Ebola diagnosed in the United States - that of Thomas Eric Duncan, who was diagnosed on Sept. 30 and passed away on Oct. 8, and Texas nurse Nina Pham, who had treated Duncan - demonstrate the enormous complexity of this situation. As soon as the Texas Department of State Health Services was alerted of the first case, the federal, state, and local public health infrastructure acted in concert to contain the threat. That same infrastructure remains ready, with lessons already learned from the Texas cases, to act should another case present itself in the United States.

See ASTHO's new blog for the full article on how states and territories are preparing for Ebola.

ASTHO is the national nonprofit organization representing the public health agencies of the United States, the U.S. territories, and the District of Columbia, as well as the more than 100,000 public health professionals these agencies employ. ASTHO members, the chief health officials of these jurisdictions, are dedicated to formulating and influencing sound public health policy and to ensuring excellence in state-based public health practice.

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