© Copyright October 2014 STATE OF PREPARATION: SOUTHERN SLC STATES AND THE EBOLA VIRUS AN ISSUE ALERT FROM THE SLC LEGISLATIVE CONFERENCE OF THE COUNCIL Lauren Greer, Policy Analyst OF STATE Stephanie Noble, Research and Publications Associate OVERNMENTS Southern Legislative Conference G October 2014 Commons License courtesy Creative Photo of NIH NIAID via flickr he World Health Organization reports that it is important for states to remain proactive in emergen- the current outbreak of the Ebola virus dis- cy response and vigilant in mitigating the risks posed by ease (EVD), which is believed to have begun in infected patients. March 2014 in West Africa, is the largest and Tmost complex outbreak of the virus since its discovery in The following provides a brief account of some of the 1976.1 It was not until August 2014, when two American efforts SLC states have taken in reaction to the Ebola vi- missionaries were flown to Emory University Hospital in rus disease, as of October 20, 2014. As governors across Atlanta after contracting the disease in Africa, that most the nation continue to meet with health officials in their Americans became aware of the outbreak. Nearly two states, the policies and efforts to combat this disease, for months later, the first diagnosis of Ebola was reported in which there is no proven treatment, undoubtedly will the United States. continue to evolve. The diagnosis and subsequent death of this patient has Alabama led many states to reevaluate their emergency prepared- Governor Robert Bentley held a press conference on ness strategies. While the Centers for Disease Control and October 8, alongside the Alabama Department of Pub- Prevention (CDC) has issued guidance and recommenda- lic Health and the Alabama Hospital Association, to tions for healthcare providers treating Ebola patients, and announce the measures the state is taking to prepare for standards for public health preparedness in state and local possible Ebola cases.4 In addition to issuing a healthcare emergencies, it lacks the authority to enforce them.2 provider bulletin, the Department has sent toolkits to every hospital in the state, as well as paramedics and doc- Incorporating the recommendations from the CDC, ma- tors’ offices.5 The toolkits include a list of questions to ask ny states have taken steps to offer healthcare providers patients, information on how to protect staff from the with the information and tools needed to care for suspect- disease, and suggestions on the adequate care of patients. ed Ebola patients, limit exposure to others, and to educate Likewise, healthcare workers are being trained on the the public on the disease. proper protocol for isolating patients and donning and doffing protective gear.6 The state also is working to en- The CDC recently announced it would establish a rapid- sure every hospital has the basic gear necessary to stop the response team that will be deployed immediately to assist spread of Ebola, such as face-shields, and monitoring in- U.S. hospitals with a diagnosed case of Ebola.3 However, ternational students who return from West Africa. THE SOUTHERN OFFICE OF THE COUNCIL OF STATE GOVERNMENTS PO Box 98129 | Atlanta, Georgia 30359 SERVING THE SOUTH ph: 404/633-1866 | fx: 404/633-4896 | www.slcatlanta.org Florida Guard and Department of Transportation. Meanwhile, Governor Rick Scott has maintained communication the state’s Department of Health and Hospitals has distrib- with Texas Governor Rick Perry as their states learn uted information on identifying symptoms of Ebola, the lessons on proper containment. Governor Scott’s office Department of Education is circulating guides for schools, also is coordinating preparedness efforts with the De- and the Department of Corrections is briefing wardens on partment of Transportation, the Agency for Healthcare identification, transportation, and containment.12 Administration, and Department of Health. The state’s Department of Health has issued guidelines to business- On October 15, the Board of Secondary and Elementary es, colleges, healthcare facilities, and emergency medical Education approved emergency rules granting local su- services, while the Agency for Healthcare Administration perintendents the authority to close schools in the event has identified hospitals with the appropriate treatment of any actual or imminent threat to public health or safety kits and isolation facilities and has distributed informa- that may result in loss of life, disease, or injury.13 A stu- tion and training on containment protocols.7 dent or staff member also may be removed from a school if reliable evidence or information suggests he or she has a Georgia communicable disease, which may be considered a threat On October 20, Governor Nathan Deal signed an ex- to others in the school. ecutive order to create the Ebola Response Team. The 14-member team, chaired by Public Health Commission- Mississippi er, Dr. Brenda Fitzgerald, comprising health, education, The Department of Health issued an Ebola virus hospital and public safety representatives from around the state, preparedness guide and the head of the State Emergen- including Emory University Hospital. The Ebola Re- cy Operations Center and state health officer, Dr. Mary sponse team is tasked with reviewing the state’s protocols, Currier, briefed the governor on the steps the Depart- and assessing procedures and best practices in prepara- ment has taken to prepare.14 8 tion for the potential spread of the Ebola virus disease. North Carolina Kentucky Joined by Health and Human Services Secretary Aldona The Department for Public Health has developed a pack- Wos, Governor Pat McCroy held a news conference Oc- age of materials, called “Out of Africa,” which is intended tober 13, to discuss the steps the state has taken to prepare to help hospitals, public health agencies, and healthcare for a possible Ebola diagnosis. The Department of Health organizations with Ebola preparedness.9,10 The materi- and Human Services’ Division of Public Health has been als include Guidelines for the Initial Management of Patients working with public health partners and healthcare pro- in Emergency Departments with Suspected Ebola Virus Dis- viders since July to prepare for the possibility of Ebola in ease to help healthcare personnel manage suspected cases their state.15 The Department is actively monitoring the of Ebola and care for those patients in a manner that will state’s largest hospitals for cases of Ebola using a network limit further exposure to the virus by other patients and of hospital-based public health epidemiologists.16 The personnel.11 Carolinas Poison Center has established an Ebola hotline where concerned residents can receive information and Louisiana ask questions about the disease.17 Governor Bobby Jindal met with the Unified Command Group* and the Governor’s Office of Homeland Security On October 11, Durham County Department of Public and Emergency Preparedness (GOHSEP) on October 1 to Health, in conjunction with Diaspora Alliance NC, held an discuss the state’s readiness to deal with a possible Ebola Ebola education event for the West African community outbreak. GOHSEP is coordinating efforts with the Coast in Durham.18 The event was designed to increase aware- ness and encourage communication and trust with public * The state Unified Command Group (UCG) is a strategic decision-mak- health workers. The community was updated on the cur- ing body, established by executive order of Governor Bobby Jindal, to rent situation in West Africa and information was shared establish a unified and coordinated approach to emergency manage- ment in the state for emergencies and in day-to-day operations. The about what is known about the disease, its transmission, role and duties of the UCG are codified in La. Rev. Stat. §29:725.6. and management. Discussions also included the prepared- 2 STATE OF PREPARATION: SLC STATES AND THE EBOLA VIRUS TIMELINE OF SELECTED EVENTS September 25, 2014 1976 Dr. Sacra is released from Nebraska Med- Facts about Ebola ical Center after being deemed virus-free Ebola first discovered in present-day Ebola virus is not spread through Democratic Republic of Congo September 26, 2014 ● Casual contact March 19, 2014 Thomas Eric Duncan goes to Texas Pres- byterian Health Hospital in Dallas with ● Air Ebola outbreak begins in West Africa a reported fever. He is later sent home ● Water July 27, 2014 with antibiotics and Tylenol ● Food grown or legally purchased in American missionaries Dr. Kent Brantly September 28, 2014 and Nancy Writebol are reported to have the U.S. Duncan returns to Texas Presbyterian contracted the virus while while helping Health Hospital by ambulance Ebola patients in Monrovia, Liberia How do you get the Ebola virus? September 30, 2014 July 31, 2014 Direct contact with The CDC confirms that Duncan has been Brantly and Writebol receive a dose of an diagnosed with Ebola experimental drug, which would later be 1 named ZMapp October 2, 2014 sick with or has died from Ebola. (blood, vomit, urine, feces, sweat, August 2, 2014 American cameraman Ashoka Mukpo contracts Ebola while providing free- semen, spit, other uids) Brantly is flown from Liberia to Atlanta, lance work in Liberia for several Ameri- Georgia, for treatment at Emory Univer- Objects contaminated with the can news outlets sity Hospital virus (needles, medical equipment) August 5, 2014 October 6, 2014 Infected animals (by contact with Mukpo arrives at Nebraska Medical Cen- Writebol is flown from Liberia to Atlanta, blood or uids of infected meat) ter in Omaha for Ebola Treatment, for a Georgia, for treatment at Emory Univer- blood transfusion from Dr. Brantly sity Hospital Early Symptoms August 19, 2014 October 8, 2014 Thomas Eric Duncan dies from the Ebo- Writebol is discharged from Emory Uni- Ebola can only be spread to others after la virus at Texas Health Presbyterian Hos- versity Hospital symptoms begin. Symptoms can appear pital in Dallas from 2 to 21 days after exposure.