Ebola: Should Americans be worried? No. And yes.

Ebola victim succumbs to disease Wednesday in a Dallas Hospital

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With more than 15,000 reported cases and nearly 7,000 deaths as of Sept. 30, the 2014 Ebola outbreak in West Africa is the largest in history.

The Centers for Disease Control and Prevention (CDC) estimates that without appropriate interventions and major, rapid changes in community behavior, it’s possible there could be more than one million cases of the deadly disease by January 2015.

The number of cases in West Africa, where the outbreak is concentrated, is frightening. But last week, it was another number that made many Americans really start to worry about the deadly virus: One.

That’s the number of confirmed cases here in the United States. Thomas Duncan traveled to Dallas, Texas, from Liberia in West Africa two weeks ago; the CDC confirmed Sept. 30 that he had Ebola. He died Wednesday, Oct. 8, in a Dallas hospital, and the CDC is carefully monitoring nearly 50 people with whom he came into contact since exhibiting signs of illness. Ebola is contagious only if an infected person is experiencing active symptoms.

Should Americans be worried about an Ebola outbreak here? Health officials say no — but it’s a qualified no.

According to information from the CDC, the center “recognizes that even a single case of Ebola diagnosed in the United States raises concerns. Knowing the possibility exists, medical and public health professionals across the country have been preparing to respond … and health care professionals have been reminded to use meticulous infection control at all times.”

In Connecticut

In Connecticut, Gov. Dannel Malloy on Tuesday, Oct. 7, signed an order declaring a public health emergency as a “precautionary and preparatory measure,” while at the same time reassuring residents that the state is well prepared to deal with Ebola.

The governor’s order gives the commissioner of the Department of Public Health the ability to quarantine anyone who may have been exposed or infected with Ebola.

“We are taking this action today to ensure that we are prepared, in advance, to deal with any identified cases,” Mr. Malloy said Tuesday. “Right now, we have no reason to think that anyone in the state is infected or at risk of infection. But it is essential to be prepared and we need to have the authorities in place that will allow us to move quickly to protect public health, if and when that becomes necessary.  Signing this order will allow us to do that.”

Last week, Mr. Malloy reiterated the CDC’s assurances that “the risk of an Ebola outbreak in the United States is very low.”

On Oct. 2, Mr. Malloy said, “CDC Director Dr. Tom Frieden reassured the public that by upholding strong health care infection control measures and public health practices, the U.S. can ‘stop Ebola in its tracks.’ Our state health department has been working and communicating with federal and state partners to ensure those strong measures and practices are in place here in Connecticut.”

State Health Commissioner Dr. Jewel Mullen said acute care hospitals in Connecticut, “by following well-defined, standard infection control measures and with the use of proper personal protection equipment,” are capable of dealing with a case of Ebola if necessary.

However, Dr. Mullen added, “I do not believe that the patient diagnosed in Texas puts Connecticut residents at higher risk.”

On Oct. 7, Dr. Mullen praised Mr. Malloy’s decision to declare the health emergency now and put in place a mechanism to more efficiently respond if necessary.

“…Having this order in place will allow us to have a more coordinated response in the event that someone in Connecticut either tests positive for Ebola or has been identified as someone who is at risk of developing it,” Dr. Mullen said. “We have no reason to believe that anyone in Connecticut is infected or at risk of infection, but if it does happen, we want to be ready.”

Dr. Matthew Miller is the chief medical officer for the Western Connecticut Health Network, which includes Norwalk, Danbury and New Milford hospitals. He confirmed Monday, Oct. 6, that area hospitals are up to the Ebola challenge, should it present itself here.

“As with any potentially transmissible illness, we follow evidence-based clinical protocols and CDC guidelines to ensure the health and safety of our patients and staff,” Dr. Miller said. “We have well-trained staff, as well as the facilities and equipment to isolate and manage potentially infectious patients. We are fully prepared to manage Ebola should we encounter this very serious illness in our community.”

Locally

Monica Wheeler, director of community health for the Westport Weston Health District, said Tuesday that she has been very impressed by the massive outreach efforts from hospitals, the Department of Public Health, and the CDC.

Ms. Wheeler said one of the main things being stressed to health care workers is the importance of immediately identifying and isolating anyone who might be at risk of Ebola exposure.

She said people need to do their part if there is even the slightest chance they have been exposed to Ebola. “There’s a tremendous responsibility on health care workers that may have been exposed, and also on people who travel. If they get a fever, they need to take immediate action,” Ms. Wheeler said.

The recommendation is not to go to an emergency room, Ms. Wheeler said — that would risk widening exposure. Instead, contact a physician, who then may directly admit patients to an isolation room if exposure is suspected. “It’s a lot of responsibility and investigation,” she said.

Ms. Wheeler said health officials are being “very cautious” but are using “known and good techniques for monitoring and limiting” possible health risks.

What is Ebola?

The Ebola virus is native to Africa. It was first discovered near the Ebola River in what’s now the Democratic Republic of the Congo in 1976.

The virus lives in animal hosts — most likely bats — and can cause disease in both humans and other primates, such as monkeys, gorillas and chimpanzees.

Humans can contract the virus through contact with the bodily fluids of infected animals: blood (through butchering, eating, or performing surgery), saliva (through bites) or feces.

Once transmitted, the virus can spread from person to person through contact with body fluids (blood, saliva, vomit, feces, urine) or contaminated needles. [See Causes sidebar.]

Infected people are not contagious until they develop symptoms.

Ebola causes hemorrhagic fever (high body temperature with bleeding). Symptoms include high (over 101 F) fever, severe headache, vomiting, diarrhea, muscle pain, and bleeding, often from the eyes and other orifices. [See Symptoms sidebar.]

There is no medication available to specifically treat Ebola, and so supportive care measures are used to treat symptoms. [See Treatment sidebar.]

Prevention

There is also no vaccine available to prevent the disease. But there are measures people can take to help prevent the spread of Ebola. They are similar to preventive measures for much more common viral illnesses, such as the flu, enterovirus and the common cold: Wash hands with soap or hand sanitizer; avoid contact with body fluids and blood; avoid direct contact with people, animals, or items that may be infected with the virus.

For caregivers and health care workers, or those who are in an area affected by the Ebola virus:

  • Do not handle the body of someone who has died from Ebola.
  • Isolate patients.
  • Wear protective clothing (masks, gloves, gowns, eye protection).
  • Use proper sterilization and infection control measures.
  • Notify health officials immediately if there is contact with the blood or body fluids of a person sick with Ebola.

Stopping the outbreak

The CDC says it knows how to “stop Ebola in its tracks” in the United States. But that’s not happening in Africa.

The CDC says, however, that there are ways to end the current outbreak in Africa — but changes must be made immediately.

“We know how to control and eventually stop the epidemic,” said a CDC statement issued at the end of September. “Halting the epidemic requires placing up to 70% of patients into either an Ebola Treatment Unit or in a community setting in which the risk of disease transmission is reduced and safe burials are provided.”

The statement continues, “The cost of delay will be devastating. The number of cases is doubling about every 20 days. Every month of delay in reaching the 70% target will increase the number of patients, which means more cases and more deaths and the need for even more beds and other resources.”

The CDC recommends the rapid implementation of interventions, including “appropriate disease control methods, communication, changes in community behavior, and adequate resources, such as staff, beds, equipment, supplies.”

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