Written by Dr. Kevin Jensen, M.D.
William Bee Ririe Hospital Emergency Department Director
Recently the diagnosis of two patients in Texas who have contacted the African Ebola Virus has focused media attention on the latest of the “world pandemics”, Ebola Virus Disease (EVD) or Ebola hemorrhagic fever. As the Director of Emergency Medicine for the William B. Ririe Hospital, I was asked to write this article to inform our local population of our own risks for coming in contact with this disease, and what our hospital is doing to be prepared for the arrival of possible Ebola cases to our area.
First, let me put some things in perspective. Over the past 30 years as I have been practicing emergency medicine, it seems like every year a new “world-wide epidemic” has surfaced, sure to kill every one that comes in contact with it in a horrific manner. I can remember, as can most of you, the “Swine Flu”, the “Avian Flu”, Anthrax, Botulism, various biological warfare agents, “flesh eating bacteria”, “Duck Flu”, and AIDS each coming along with great media hype, but gradually losing media attention as they became more known, and less of a threat than they were originally thought to be. Each year, physicians in general, and emergency physicians in particular, have studied up on these illnesses and have found that standard universal precautions which are employed in most hospitals are sufficient to combat the spread of most of these diseases. Protocols have been adopted, vaccines and antibiotics have been developed, and the “epidemics” have been quelled before they became much more than a small fire. We no longer see huge world-wide epidemics such as the “Spanish Flu” of the early 1900’s, small pox or the “Black Plaque” of the middle ages. There are many physicians now days who have never seen a case of measles, mumps, rubella or polio. I suspect most will never see a case of Ebola.
So what do we know about Ebola? The Ebola virus is not new. Most of the following information comes from the article from the US Center for Disease Control, (CDC) in the article, Ebola Fact Sheet, which can be found online at the website, http://www.cdc.gov/vhf/ebola/pdf/ebola-factsheet.pdf . To quote the article “(The Ebola Virus) was first discovered in 1976 near the Ebola River in what is now the Democratic Republic of the Congo. Since then, outbreaks have appeared sporadically in Africa.” The virus seems to be cold intolerant as outbreaks have occurred only in warm, moist tropical areas, usually around the equator in Africa, (hence the first diagnosis in the US occurred in Texas, and as yet, there have been no cases in colder, dry climates such as White Pine County). We don’t know much about the transmission of the virus, but it seems to be found in monkey populations and may be primarily transmitted from animal populations to humans via bats, and secondarily by human contact with raw animal products, especially feces. When the first human in an outbreak becomes infected, it is almost always by contact with an infected animal. Transmission from human to human is by way of direct contact with infected body fluids such as blood, feces, saliva, urine, vomit and semen. The virus in the blood and body fluids can enter another person’s body through broken skin or unprotected mucous membranes in, for example, the eyes, nose, or mouth. There has been no documented transmission by respiratory droplets, such as coughing or sneezing.
The diagnosis of Ebola Virus Disease is difficult at first, as it appears like many other common diseases. Symptoms may include: Fever greater than 101.5°F, severe headache, muscle pain, vomiting, diarrhea, stomach pain, unexplained bleeding or bruising. A person infected with Ebola is not contagious until symptoms appear. The diagnosis should be suspected in persons presenting with those symptoms who have had recent travel (within 21 days) to Africa or contact with the body fluids of a person known to be infected with Ebola.
So how is William B. Ririe Hospital preparing for an outbreak of Ebola, should it occur? First, we practice the universal precautions to prevent the spread of disease, as recommended by the CDC, namely isolation of patients with Ebola, or any other infectious agent, from contact with unprotected persons in a room with reverse isolation precautions. These rooms have an anti-room for healthcare workers entering the room to be able to don protective clothing, which is left in the anti-room upon leaving the patient room, to prevent transmission of any disease to other patients. WBRH has recently undergone a series of health care inspections from the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), the College of American Pathologists, the Federal and Nevada State Center for Medicare and Medicaid Services (CMS) and others, and passed those rigorous inspections with only a few minor discrepancies in infection control, all of which have been corrected. Our infection rate in orthopedic, general surgical, and obstetrical procedures is much lower than many of the large hospitals in Nevada. Also, our infection control nurse, Bethann Kane, and other key personnel have been involved in three panel meetings in the last two weeks, put on by the Nevada Rural Health Partners, in conjunction with the Nevada State Center for Disease Control, specifically addressing the prevention of spread of the Ebola virus. New policies and practices have been developed as a result of those meetings, and I have volunteered to be a member of the state task force for the development of strategies for treatment of Ebola infected patients. Practices and policies are constantly being updated as we learn more about the virus.
In short, though we have contact with travelers who are enjoying our local scenic beauty, I can’t remember any who have recently come from Africa. Our cold, dry climate is protective of transmission of the Ebola virus, and I am not aware of any African monkeys in the area. Though we have bats in the area, most are locals, though some migrate from Mexico, occasionally carrying rabies. We, like most of the US, have a greater chance of being killed by accidents, including motor vehicle accidents, and smoking related diseases, including heart attack, stroke, and cancer. So, we expect the common diseases and prepare for the worst. In the meantime, wear your seatbelts, don’t text and drive, try to cut back or quit smoking, and don’t share needles with, or kiss any African monkeys.