As you are all aware, Texas has experienced three cases of Ebola Viral Disease (EVD) in Dallas as a result of the ongoing outbreak in West Africa.
Montgomery County enhanced its preparations over a month ago based upon the growing concern that the outbreak would not be contained to Africa. This included education of our EMS providers and First Responders as well as informational Bulletins distributed to our county health care providers. Since the developments in Dallas, we have initiated additional enhancements within the county and in coordination with the Texas Department of State Health Services (DSHS) and the CDC.
Calls coming in through the 9-1-1 system are screened for symptoms and travel history consistent with EVD. In the circumstance of a positive screen, our first responders are alerted to utilize enhanced personal protective equipment (PPE) and to minimize personnel entry to avoid potential exposure. The Paramedics then perform an additional screen with more specific questions to determine risk. This information is shared with the receiving hospitals that will follow their institutional plan for infection control.
We are coordinating with our hospitals, free-standing emergency rooms, urgent care centers, clinics, and private physician offices to ensure that our plan is comprehensive and inclusive. Additionally, we will be performing drills with simulated Ebola patients to ensure that the system is effective. The success of the plan is dependent on each component of the system practicing in order to ensure the personal safety of the health care providers, as well as to protect the health of the public.
It is important to remember that EVD is spread by close contact with individuals who have EVD and who are ill. In the first several days of symptoms, the viral load is low and the disease is difficult to detect. As the viral load increases, the patient becomes more seriously ill and the disease becomes easier to spread. Even at this stage, close personal contact is required for disease transmission to occur. Due to the difficulty of transmission of the disease, health care workers or family members caring for EVD patients while they are severely ill are more likely to be infected due to the increased exposure.
The United States, Texas, and our region are well prepared to stop any large outbreaks of EVD. However, there is extreme difficulty in preventing small outbreaks involving a few people. This is due to the fact that EVD mimics many other diseases in its early stages. This also means that the overwhelming majority of patients who have a positive initial screen for EVD will have something else, primarily malaria. While we are in this phase of Ebola response, it is important that the public does not over-react to seeing our health care providers in PPE. This practice is routine in order to protect our health care workers for many types of infectious diseases. EVD is rare and unlikely to be the reason for the illness, but even if you are sitting or standing in close proximity, or if you shake the person’s hand, you are unlikely to get EVD.
It is also critical to understand that we must commit to prevention of diseases that we have developed vaccines for, such as Influenza. It will be extremely taxing on our healthcare system to deal with a heavy flu season while we are looking for potential cases of EVD. Please encourage vaccination for flu now.
The two most important ways to prevent the spread of infectious disease, including EVD, are to wash your hands thoroughly and often or use hand sanitizer containing over 70% alcohol, and do not touch your face until your hands have been cleaned.
Dr. Mark E. Escott, MD, MPH, FACEP
