The fear of the casual spread of the Ebola virus was addressed by the State Epidemiologist Friday afternoon after the news that a patient being tested for Ebola at Deaconess Hospital was determined not to have the virus.
Dr. Kristy Bradley, State Epidemiologist at the Oklahoma State Department of Health said that the health care system in Oklahoma does have procedures in place for standard triage and screening protocols, and that the care in Dallas has heightened awareness.
Dallas officials announced Sunday that a health care worker who had attended Thomas Eric Duncan during his second visit to Texas Health Presbyterian Hospital tested positive for the virus. If the preliminary diagnosis is confirmed, it would be the first known case of the disease being contracted or transmitted in the U.S. The health care worker reported a fever Friday night as part of a self-monitoring regimen required by the Atlanta-based Center for Disease Control.
So far, none of the family and associates of Duncan who have been in quarantine since Duncan was positively diagnosed have been identified as having the disease. Duncan died last Wednesday.
The Oklahoma State Department of Health released the Friday afternoon Q&A with Dr. Bradley answering many of the common questions about Ebola and Oklahoma’s preparedness.
Q: How contagious is Ebola in relation to the flu, HIV, measles and other diseases.
Dr. Bradley: Even though you hear the term “flu-like symptoms”, flu-like symptoms really pertain to a person having a fever, body aches, joint aches, headache, and maybe a sore throat. Flu-like symptoms can be found as symptoms of a number of infectious diseases, so we shouldn’t confuse influenza with Ebola – they are quite different.
Influenza is a much more contagious disease than Ebola. It’s a respiratory disease and so one that is spread through respiratory droplets expelled when people cough or laugh or sneeze. Those droplets can spread several feet away from a person and land on another person or on inanimate objects. If a person than touches that contaminated surface and then touches their eyes or nose or mouth, they could then become sick.
That is not the case with Ebola. Ebola is not that contagious. It is more like a blood-borne pathogen, like viral hepatitis B or C or HIV, requiring almost direct with the blood and bodily fluids or items that are freshly contaminated with the blood or bodily fluids for a person to be at risk of exposure to the virus.
Primarily that happens in a health care setting where we have health care workers becoming exposed while caring for patients. We’ve certainly seen that in our humanitarian physicians and nurses who have been over in Liberia or Sierra Leone and caring for numerous patients with Ebola virus, who have an accidental exposure and contract the disease. Exposure to Ebola virus also occurs to family members who are in very close contact with someone who has the disease.
Another very important point with Ebola is that people are only contagious when they are sick with symptoms of the disease -- and actually a couple of days into their illness – when the virus multiplies more in their body. Persons are not contagious with Ebola before they have fever or other symptoms of the disease. In contrast, person with influenza can start to shed the virus up to 24 hours before they are actually ill.
Q. You mentioned people who are in isolation. Could you talk about when we are going to be notified and when we (the public and the press) should be concerned about reporting versus what isolation means and what the difference is?
Dr. Bradley: To be extra cautious during the screening process, health care facilities will immediately put a person who is being screened into an isolation room or area as soon as the health care workers learn the person has some of those early criteria for Ebola screening: being in a country that’s affected with the virus and reporting symptoms that might be consistent with Ebola.
They’re going to be put into isolation very early into the process even before the health care workers have a lot of time to ask them questions about their potential exposures and also to do more examination of the patient and perform some other preliminary diagnostic tests to rule out other causes of illness.
A large proportion of persons who travel to these African Ebola-affected countries and come back with fever, headache and body weakness --and maybe even some bleeding problems-- have malaria as the more likely cause than Ebola, so it’s important that the patient be evaluated for a number of different things that might be causing the signs and symptoms.
Q: The person that caused the recent report today (Friday). What do you know about that patient?
Dr. Bradley: I can’t speak to specifics but I can tell you that the travel exposure history was not consistent with what we would classify as a suspected case. So this is really a time for everyone to learn their African geography! We are planning to disseminate posters displaying the affected countries to more of our urgent care clinics and other medical clinics so that people can see which countries actually are of concern and where the Ebola epidemic is still spreading at very high rates.
Q: So you’re not concerned with the event in Dallas and anyone who may have had contact in the Dallas area?
Dr. Bradley: All of the persons who would be at risk of being exposed to Ebola from the case in Dallas were rapidly identified by the public health officials and epidemiologists working in Dallas County and with the Texas Department of State Health Services. They’ve been under quarantine and being monitored for a number of days now.
They will be monitored for the full incubation period of the disease, which is 21 days, so they’re still in the midst of that.
Q: What lessons have state health departments across the country learned from that event?
Dr. Bradley: I think one of the biggest wake-up calls for everyone is the need to have very sensitive screening protocols and that is what you are seeing happening now. It seems like recently there’s been a pretty large uptick in the number of patients being screened to determine if they may be an Ebola-suspect patient and that’s largely because of what happened in Dallas.
Nobody wants that to happen here -- that an Ebola patient would be overlooked -- so our health care providers are doing an outstanding job in Oklahoma, very much aware of the need to have those standard triage and screening protocols in place. So if they learn of a possible travel history to somewhere in Africa and the patient is having fever or other symptoms of illness that could be consistent with Ebola, they’re appropriately putting them into isolation and beginning to ask those important screening questions.
But just because they are doing their job by doing that triage and screening process that should not be construed as meaning that we’re having an increased risk of Ebola. It just means we’re more on alert, if you will, and doing a better job of screening to detect any cases should they occur here in Oklahoma.
