Ebola in Texas 2014 2015 JEFFREY HOOGHEEM TEXAS

Ebola in Texas 2014 - 2015 JEFFREY HOOGHEEM TEXAS DEPARTMENT OF STATE HEALTH SERVICES

Introduction �The 2014 Ebola incident was historic and unlike anything we have faced before �Many of the challenges were not unique to Dallas or the state of Texas �Strategies and practices were implemented that can be used in other states and in other situations

Goals �Present background and history of Ebola Virus Disease �Highlight unique aspects of the response �Discuss challenges and strategies that were implemented �Showcase the success stories and practices that could be used in future responses

Ebola Background 1976 - 2015

Ebola Background • Discovered in 1976 near the Ebola River in what is now the Democratic Republic of the Congo • Causes Ebola hemorrhagic fever • Likely carried by bats; Causes disease in humans and nonhuman primates (monkeys, gorillas, and chimpanzees) • Five identified Ebola virus species, four of which are known to cause disease 1. 2. 3. 4. 5. Ebola virus (Zaire ebolavirus) Sudan virus (Sudan ebolavirus) Taï Forest virus (Taï Forest ebolavirus, formerly Côte d’Ivoire ebolavirus) Bundibugyo virus (Bundibugyo ebolavirus) Reston virus (Reston ebolavirus)

Ebola West Africa 2014 -2015 1976 -2013 Outbreaks 24 previous outbreaks 2, 400 cases 1, 597 deaths, 66% case fatality ratio Largest single outbreak, 2000 -2001, Uganda, 425 Cases, 224 Deaths (53%) 2014 -2015 Outbreak >10 times larger than all previous Ebola outbreaks combined 26, 290 cases 10, 890 deaths, 41% case fatality ratio Data current as of 1 May 2015

Challenges UNITED STATES 2014

Challenges � 911 Centers Receiving & Handling Ebola Calls �EMS Responding to Ebola Calls/Incidents �Handling Remains of Ebola Victims �Waste Management �Pets & Animals �Communications

911 Call Taker Protocol �Assist 911 call takers if contacted by: Monitored (known) Ebola Contact Individual Complaining of Ebola Symptoms �Algorithm for handling Ebola related calls Symptoms? Travel History? Contact with Ebola Patient? Actively monitored? Notify first responders of patient status prior to dispatch �Allowed 911 to handle large number of calls related to Ebola

911 Call Taker Protocol

EMS Practices Protocol �Assist EMS in responding to suspected Ebola patients �Addressed on-scene safety PPE Handling patient Possible patient behaviors Cautions regarding bodily fluids �Patient Assessment �Transport

EMS Practices Protocol

Mortality Planning/Protocol �Planning for potential death of initial case Planning Post Mortem Protocols �Identifying a funeral director to process remains �Control Order for cremation �Coordination between DSHS, CDC & TCEQ �Coordination between Dallas Presbyterian Hospital, Dallas County Sherriff’s Office and Crematory

Post Mortem Checklist

Waste Management - Initial �Cleaning the apartment How to clean Identifying waste �Packaging waste Procedures Supplies & equipment �Transportation DOT Permit Category A Infectious Substance �Destruction Incineration & ash

Pets & Ebola �Pet issues in recent disasters �Poorly understood Ebola risk �Protocols non-existent �Outcry - Spanish nurse’s dog �Dallas Nurse’s small dog Transported to Hensley Field, Decommissioned Naval Air Station 21 day quarantine Texas A&M vet providers �Recommendation: Those monitored for EVD should avoid pets

Communications PERCEPTION IS REALITY

Public Perception

Erroneous Public Beliefs �Inflated Ebola risk �Conspiracy Theories �Overreactions News Headline, “Schools in Ohio, Texas closed over Ebola fears” In Belton, Tex. , on Friday, environmental workers prepared to disinfect North Belton Middle School, which had been closed because of the Ebola scare. Credit Rusty Schramm/The Temple Daily Telegram, via Associated Press

Risk Communication �High media and public interest �Little knowledge about Ebola Virus Disease (EVD) �Response partners interest in Ebola Preparedness Springboard into discussion about infection control �Risk (likelihood vs. severity) �Media images vs. guidance

Conclusion MOVING FORWARD

Countries Affected �Ebola Free (as of May 14, 2015) Nigeria Senegal United States Congo, Democratic Republic Spain Mali United Kingdom Liberia �Active Transmission/Monitoring Guinea Sierra Leone

Current Cases Guinea Sierra Leone � 12 cases reported in the week ending May 24, 2015 Guinea: Sierra Leone: 9 3

Monitoring �Continue to monitor travelers returning from West Africa. �As of May 25, 2015: Texas has monitored total of 742 Travelers 77 travelers currently monitored

Conclusion �Ebola posed unique challenges �Procedures and practices implemented during this incident can inform future responses �What we knew about Ebola Virus Disease going into October 2014 still remains true today �Accurate and consistent information sharing dispels rumors and calms fears �Ebola related activities continue

Questions/Comments JEFF HOOGHEEM JEFF. HOOGHEEM@DSHS. STATE. TX. US (512)563 -4455