On Thursday, Dr. Jamie Syrett, the Director of EMS, and Associate Medical Director at Newark Wayne Community Hospital, met first with the Emergency Management and Sheriff’s office, then the LEPC (Local Emergency Planning Committee).
The topic at hand was the Ebola virus, now a sweeping plague in West African countries. The history of the disease was pinpointed from its initial identification, right up to its appearance and effect on the United States over the past months.
Discovered by Belgian doctors in remote, sparsely habitated villages, the first human outbreaks occurred in 1976 — one in northern Zaire (now Democratic Republic of the Congo) in Central Africa: and the other, in southern Sudan (now South Sudan). The virus is named after the Ebola River, where the virus was first recognized, according to the Centers for Disease Control and Prevention.
Dr. Syrett explained that when the disease first cropped up, the death rate wiped out entire villages before outside sources identified the bacterial strains. It also prevented the deadly virus from spreading outside pocket areas. Dead bodies not only rotted under the African equator extreme heat, but the disease liquefied the body tissue. Even days and weeks after death, the bacteria remained active and contagious. “Everybody literally melted away.”
The doctor explained that since its identification, the virus has sprung up 32 times since 1976. So, why is the current outbreak becoming so alarming?
Dr. Syrett explained that travel between villages, towns and cities in Africa has expanded and with air flights of only hours reaching all points of the globe, paired with the 21 day incubation period for the disease, the current strain is spreading like “wildfire”.
With no proven, fully tested treatment, the disease has a mortality rate of about 61%. On October 15th, the CDC confirmed 8973 cases of Ebola with 4484 reported deaths. The CDC also predicts that the case load may be growing exponentially at a rate of 10,0000 cases per week, with a prediction of 1.4 million cases worldwide by January of 2015.
At first, the CDC said the disease was probably spread by contact with bodily fluids of an infected person. In the last several days the federal agency has backed off that statement. Health aid workers, with what were considered more than adequate safe suits and procedures in place, are among the confirmed new cases of Ebola in the United States.
Syrett explained that, without knowing how the disease is spread and just how persistent the bacteria aftermath is, local hospitals are in a quandary on how to prepare. “We know that this one kills people and is highly infectous.” He added that Newark-Wayne has perhaps 8-10 protective suits on hand right now.
How safe are the current suits and standards?
The Doctor explained that a test was run with three surgeons, trying to work within the confines of the bulky suits. Their hands were then covered with chocolate syrup. They were asked to wash up, then remove the suits. Only one doctor successfully was able to remove the suit without contamination showing up somewhere on their bodies.
With the CDC and medical communities ‘learning as they go’, Syrett indicated that answering definitive questions is impossible. “There are no clear state, national, or regional plans in place. We are playing catch-up right now. There are no validated instructions.” He added that, hours after preparing for his talk, new instructions, bulletins and protocols were coming out.
“This will affect every single one of you in a different way,” Syrett warned. He added that the current Zaire Ebola strain may be successfully contained, or run its course. “I don’t know if this is the virus that gets us, but a virus will get us.”
The future?
If a severe outbreak of a bacterial infection does spread, the social implications could be disastrous. Syrett imagined how first responders (ambulance, police, etc.) to an illness call would react if they had to don a protective suit on every call involving some sort of flu-like sickness. “If we had to put all EMS (emergency Medical Services) people into containment suits, nobody would go. He pointed to the nurses unions now questioning the current safety procedures in light of recent nurse infected cases. The CDC has indicated that first responders may have to be somewhat “expendable” in the battle against deadly viruses.
How would the average working class respond at factories and work places, knowing a fellow employee may be diagnosed with a deadly virus, especially if it is uncertain how the disease is spread? What about air flights? This past week a Texas nurse who treated Thomas Eric Duncan until his death, boarded a plane in Dallas and flew to Cleveland, with what was described as a low grade fever. She was later diagnosed with the Ebola strain after arriving back home on a return flight. Duncan, who arrived by plane from West Africa, was the first person to die on U.S. soil from the virus.
The air jet transporting the nurse was used on five successive flights before the CDC notified the airline of a potential problem. The plane was sanitized over and over again, but almost 150 people rode the aircraft before the nurse was to become a confirmed case. What about the 150 people in contact with more and more family and friends.
Governor Andrew M. Cuomo, on Thursday (10/16), convened New York State agency leadership along with regional hospital and healthcare representatives to outline the State’s plans for Ebola preparedness and to assure New Yorkers that the State is taking every precaution to protect their health and safety.
The Governor has designated eight hospitals statewide to treat potential patients with Ebola. Locally, the University of Rochester Medical Center in Rochester has been designated. He said it’s unlikely that Ebola will show up in NYS, but wouldn’t be surprised, given the high level of travel into and through New York.
Additionally, the State Department of Health has issued a Commissioner’s Order to all hospitals, diagnostic and treatment centers, and ambulance services in New York State, requiring that they follow protocols for identification, isolation and medical evaluation of patients requiring care.
Statement from Strong Memorial Hospital on the designation:
“UR Medicine’s Strong Memorial Hospital has been designated as one of eight regional referral centers in New York State that, if necessary, will provide care for patients with the Ebola virus. A team of senior administrative and clinical leaders at Strong has been working since August on a range of activities to ensure our preparedness. Our top priority at every stage of planning has been to ensure the safety of our staff and patients. Our preparations include: The designation of an isolation unit in the hospital that will be used solely for the care of any patient with suspected or confirmed Ebola.”
“We have begun the process of identifying and training a team of “first responders” on our staff who would care for a patient with suspected or confirmed Ebola. This team will be assisted by an expert team from the Centers for Disease Control that will arrive at Strong within hours after a case is confirmed.”
The problem Syrett points out is that, on any day during a flu season, even a small regional hospital such as Newark-Wayne can see as many as 50 cases a day walk into the emergency room complaining of flu-like symptoms. In addition, he added that as many as 50% of the people in the hospital are on some sort of antibiotics. So how will medical personnel identify an Ebola case if it just walked into an emergency room?
Symptoms of Ebola virus disease
The incubation period, that is, the time interval from infection with the virus to onset of symptoms is 2 to 21 days. Humans are not infectious until they develop symptoms.
First symptoms are the sudden onset of fever fatigue, muscle pain, headache and sore throat. This is followed by vomiting, diarrhea, rash, symptoms of impaired kidney and liver function, and in some cases, both internal and external bleeding (e.g. oozing from the gums, blood in the stools). Laboratory findings include low white blood cell and platelet counts and elevated liver enzymes.
Diagnosis
It can be difficult to distinguish EVD from other infectious diseases such as malaria, typhoid fever and meningitis.
Ebola 2014 Jamie Syrett, MD
Timeline
• 1976 – Hemorrhagic Fever outbreak close to the Ebola river in Congo. Since then there have been 32 outbreaks before the current one (2361 cases, 1438 deaths – Case Fatality Rate 61%).
• 3/19 – 23 deaths reported in West African “mystery” hemorrhagic fever.
• 7/27 – Missionary group reports 2 Americans with Ebola while helping in Liberia. (Brantly/Writebol)
• 7/31 – Brantly/Writebol received ZMapp test drug
• 8/2 – Brantly flown to Emory University. (Writebol 8/5)
• 8/19 – Writebol discharged – Negative for Ebola.
• 8/21 – Brantly discharged
• 9/3 – Dr Sacra – Diagnosed with Ebola in Liberia (Not treating Ebola patients)
• 9/5 – Sacra transferred to Nebraska Medical Center and gets a blood transfusion from Brantly. (D/C 9/25)
• 9/9 – Unnamed American Ebola Patient arrives at Emory for treatment. Was in Sierra Leone.
• 9/20 – Tom Duncan arrives from Liberia to visit family.
• 9/26 – Duncan goes to Texas Presby ER and is discharged.
• 9/28 – Duncan returns to the ER by EMS and is isolated
• 9/29 – Duncan becomes the first patient io be diagnosed with Ebola in the US.
• 10/2 – US Cameraman diagnosed with Ebola in Liberia. (Arrives in Nebraska 10/6).
• 10/8 – Duncan dies
• 10/10 – Amber Vinson (RN for Duncan) flies DFW – CLE to prepare for her wedding.
• 10/12 – Nina Pham (RN for Duncan) tests positive for Ebola.
• 10/13 – Vinson returns to Dallas with a fever.
• 10/14 – Vinson goes to Texas Presby ER with a
fever.
• 10/15 – Vinson is diagnosed with Ebola.
• 10/15 – CDC contact Frontier passengers from Cleveland (ongoing).
Current Numbers
• As of 10/15
• 8973 cases confirmed
• 4484 deaths
• CDC prediction expects 10,000 new cases/week
• CDC predicting 1.4million cases by January 2015
Ebola Reston
• October 1989 – 100 monkeys were imported from the Philippines. 2 dead on arrival.
• By November – 29 monkeys dead. (Most in Room F). Blamed on failed AC.
• Diagnosis of Hemorrhagic Fever was made. Tested positive for Ebola Zaire.
• By December 450 dead monkeys.
• Army decontaminated the facility (Level 4 – 3 days)
• Noted NOT to transfer to humans despite exposures.
• Army returned facility after decon
• Jan 1990 – Monkeys in Room C started to die. (Monkeys were from Africa, tested positive for Philippines variant – now called Reston)
• Facility destroyed, land now has a childcare on it!