By Tara Bannow

The Bulletin

Facts about Ebola transmission

• Ebola is not contagious until a patient is showing symptoms of the illness.

• Unlike respiratory illnesses, such as measles or chicken pox, which can be transmitted by virus particles that remain suspended in the air after an infected person coughs or sneezes, Ebola is transmitted by direct contact with body fluids of a person who has Ebola symptoms. Although coughing and sneezing are not common symptoms of Ebola, if a symptomatic patient with Ebola coughs or sneezes on someone and saliva or mucus come into contact with that person’s eyes, nose or mouth, these fluids may transmit the disease.

• Once someone recovers from Ebola, they can no longer spread the virus. However, Ebola virus has been found in semen for up to three months. People who recover from Ebola are advised to abstain from sex or use condoms for three months.

• The evidence that’s available shows that people who recover from Ebola develop antibodies that last for at least 10 years, possibly longer. It’s not clear whether people who recover are immune for life or if they can become infected with a different species of Ebola.

Source: U.S. Centers for Disease Control and Prevention

The threat of Ebola is low in Central Oregon, but leaders with St. Charles Health System say that doesn’t mean they’re cutting any corners in preparing for potential cases here.

St. Charles officials have been actively preparing for a potential patient since May, including designing a series of protocols, identifying teams to oversee cases and taking inventory of the health system’s isolation areas and protective gear.

“Just given our geographic location, I think that we’re unlikely to see an Ebola case here,” said Dr. Rebecca Sherer, St. Charles’ medical director of infection prevention and control. “But that having been said, we want to be absolutely, fully, 100 percent prepared in case there is one or two or three.”

The ongoing epidemic is the worst Ebola outbreak in history, with nearly 9,000 total cases and nearly 4,500 deaths since March, almost all of which have occurred in Sierra Leone, Guinea and Liberia, according to the U.S. Centers for Disease Control and Prevention. Three people in the U.S. have been diagnosed with Ebola, one of whom died Oct. 8. Ebola is a rare disease caused by a virus, for which there are no approved vaccines or medications.

Starting Monday, St. Charles Health System will begin a series of training sessions for its providers on how to properly put on and take off personal protective gear designed to keep them from becoming infected, Sherer said.

St. Charles has protective suits that cover people’s legs and shoes, and hoods to cover their heads. Providers treating Ebola patients would wear two sets of gloves, face shields, smocks and respirators that filter virus particles that may be suspended in the air.

“The most important thing here is actually training our staff how to use this gear correctly and, most importantly, how to take it off without contaminating themselves,” Sherer said.

Those most likely to come into contact with Ebola patients will get the training first, including nurses, physicians, emergency room staff, intensive care unit staff and urgent care staff, she said. A handful of hospitalists — the doctors who would admit patients to the emergency room — have already undergone the training, she said.

The health system already had a stash of protective gear from previous disease outbreaks, such as SARS, MERS and the flu pandemic of 2009, but has since ordered more to ensure it can handle Ebola patients. Although only a few providers would care for an Ebola patient, the protective gear would be discarded each time a provider interacted with the patient, Sherer said.

Limiting exposure

In the event an Ebola patient comes to St. Charles, it would be important to limit the number of staff members who come into contact with him or her, Sherer said. One of the mistakes workers at Texas Health Presbyterian Hospital in Dallas made while caring for an Ebola patient was allowing roughly 70 providers to care for him, she said.

“In our system, we would be using just a few providers going in and out of the room,” Sherer said.

St. Charles would also limit provider exposure by making use of its medical robots. They don’t provide care, but can listen to patients’ hearts and lungs. The remote-controlled machines also have cameras and two-way microphones and speakers.

All St. Charles patients will be asked whether they’ve traveled outside of the country and whether they’ve traveled to West Africa within the past 21 days, Sherer said. If they have and are exhibiting symptoms of the disease, they’ll be admitted to St. Charles’ isolation unit, a negative pressure, intensive-care room, she said.

Every St. Charles clinic, including urgent care and emergency rooms, will have checklists that describe how to handle a patient suspected of having Ebola. The first step, isolating suspected cases, protects other patients and providers, Sherer said.

Bend Memorial Clinic, which operates three urgent care clinics in Central Oregon, is taking similar protocols, including asking patients where they have traveled and teaching providers to evaluate patients for symptoms, Katy Wooderson, a spokeswoman, wrote in an email.

Precautions elsewhere

Salem Hospital isolated a suspected Ebola patient for several hours on Wednesday based on her symptoms and travel history. Officials there later determined she wouldn’t need to be tested for the disease. St. Charles has not isolated any patients, nor has anyone concerned about Ebola shown up in its emergency rooms.

Also on Wednesday, officials in Portland responded to a potential Ebola case. A child from Portland was returning from a trip to Nigeria — a country that has only seen a small number of Ebola cases — and felt sick on the plane trip home. The child was determined not to be at risk, Dr. Paul Lewis, tri-county health officer based in Portland, told reporters in a press conference in Portland. The child’s symptoms were caused by eating junk food on the flights, Lewis said.

A single suspected case was easy to handle quickly, but any more would be difficult, Lewis said.

“If it was multiple cases, we’d begin to stretch our capacity,” he said. “If we had a truly suspected or confirmed case, the challenge to the health care system would be very large.”

Texas Health Presbyterian Hospital is being widely criticized for its handling of its Ebola patient, which led to the infection of two nurses who treated him. A statement released anonymously by nurses at the hospital said they weren’t properly trained to care for Ebola patients, including what kind of protective equipment should be worn.

Here in Oregon, the Oregon Nurses Association and Oregon Association of Hospitals and Health Systems released a joint statement Wednesday assuring that nurses and hospitals in Oregon are taking Ebola preparedness seriously, while also being flexible to new directives from the CDC.

“In the end, hospitals and nurses have the same goals in the face of any Ebola case: to ensure patients are appropriately cared for at the right time and the right place and that all hospital and clinical staff are safe in providing that care,” the statement said.

Despite the precautions being taken in hospitals locally and around the world, a group of infectious disease experts wrote in the Annals of Internal Medicine this week that the enormous amount of work it takes to train staff to prevent the spread of Ebola might be too much to expect from traditional medical centers. Handling a case requires tending to every detail, from the safe donning and doffing of protective gear to waste disposal, and the experts wrote that such work might be better suited for a few, high-level biocontainment facilities.

Five major U.S. airports are checking passengers arriving from West Africa for symptoms of the disease. Jeffrey Tripp, director of the Redmond Municipal Airport, said the airport isn’t taking any such precautions. If the federal government directed the airport to do so, Transportation Security Administration officials would be responsible for carrying out those instructions, he said.

“To the best of my knowledge, nothing has come out of Washington, D.C., to change any policies at this time,” Tripp said.

— Reporter: 541-383-0304,

tbannow@bendbulletin.com

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