Ebola: What Colorado physicians need to know

Wednesday, October 15, 2014 01:14 PM
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Updated Nov. 10, 2014

Click here to view CME webinar on-demand: “Ebola Preparedness in the Outpatient Setting” and download the program slides

CME credit available
Attendees can earn up to 1 AMA PRA CATEGORY 1 CREDITS™. See the full CME statement here.

The 2014 Ebola epidemic is the largest in history, affecting multiple countries in West Africa and impacting countries around the world. One travel-associated case was diagnosed in the United States on Sept. 30; the patient, Thomas Eric Duncan, died at Texas Health Presbyterian Hospital in Dallas on Oct. 8. A second case, Nina Pham, an ICU nurse who treated Mr. Duncan, was identified on Oct. 12. And news agencies reported on Oct. 15 that another health care worker in Dallas has tested positive for the virus. National, state, and local public health officials are actively monitoring the situation and taking precautions to prevent the spread of Ebola in the U.S.

While Colorado has no cases of Ebola, the Colorado Department of Public Health and Environment (CDPHE) is working with the Colorado Medical Society, the Colorado Hospital Association, the Colorado Nurses Association and the Colorado Association of Local Public Health Officials, to prepare a state plan. Click here to read our joint statement.

Early recognition of Ebola is important for providing appropriate patient care and preventing the spread of infection. The Centers for Disease Control and Prevention (CDC) and CDPHE recommend that health care providers:

  • Ask
    • All patients if they have traveled to Sierra Leone, Guinea or Liberia within 21 days.
    • About symptoms consistent with Ebola Virus Disease (see symptoms below)
    • Everyone, every time

  • Isolate

    • If both criteria are met, isolate the patient in a single patient room (with private bathroom) with door closed.

  • Call

    • Call hospital leadership, and
    • Call CDPHE at (303) 692-2700 (evenings and weekends: (303) 370-9395). Also notify CDPHE of any patients reporting exposure to Ebola, even if they have no symptoms.

The CDC issued more stringent guidelines on Monday, Oct. 19, directing medical teams to wear protective gear that leaves no skin or hair exposed. Click here to read those guidelines. They released guidelines for evaluation of patients in the ambulatory care setting on Nov. 1. Click here to read those guidelines.

Signs and symptoms of Ebola

  • Fever (greater than 38.6°C or 101.5°F)
  • Severe headache
  • Muscle pain
  • Weakness
  • Diarrhea
  • Vomiting
  • Abdominal (stomach) pain
  • Unexplained hemorrhage (bleeding or bruising)

Symptoms may appear anywhere from two to 21 days after exposure to Ebola, but the average is 8 to 10 days. Recovery from Ebola depends on good supportive clinical care and the patient’s immune response. People who recover from Ebola infection develop antibodies that last for at least 10 years.

Transmission

Ebola is spread through direct contact (through broken skin or mucous membranes) with the body fluids (blood, urine, feces, saliva and other secretions) of a person who is sick with Ebola, or with objects such as needles that have been contaminated with the virus. Ebola is not spread through the air. Ebola is not contagious until symptoms appear. Click here for an infographic from the CDC.

Travel restrictions and screening

Starting Oct. 11, travelers into five major U.S. airports from West Africa will be subjected to increased Ebola screening measures, which includes questioning, observation and checking passengers’ temperatures. The five airports are Washington Dulles, Newark, Chicago O’Hare, Atlanta International and JFK in New York City.

Although Denver International Airport is not on the list, officials at DIA told the Denver Post they are ready to roll out enhanced procedures if necessary. DIA has no direct flights to or from Africa but the airport is a major connection hub for United Airlines flights from Chicago O’Hare. Signs are posted in the DIA international arrivals area advising those who are displaying any Ebola-like symptoms to seek immediate medical attention.

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