If Ebola arrives here, Erie County is ready.
That was the message that hospitals and public health officials offered Tuesday as they outlined their readiness in the event a case of the deadly disease arrives at their doorstep. They also tried to allay concerns about training and equipment for doctors, nurses and other frontline medical staff.
“We are not starting from scratch. We are putting into effect protocols that already exist,” said County Executive Mark C. Poloncarz.
Infection-control experts, hospital medical executives, emergency services personnel and the health commissioner, Dr. Gale R. Burstein, flanked Poloncarz outside his office.
“We train year-round for an array of scenarios, including public health crises,” Burstein said, noting that a robust public health infrastructure exists that has dealt with outbreaks in the past, such as the H1N1 influenza pandemic.
The main job for local hospitals boils down to quickly identifying and then safely isolating a potential Ebola case.
Once that is done, experts from the federal Centers for Disease Control and Prevention would take over, likely in a matter of hours, and transfer a patient to one of eight designated Ebola “supercenters” in the state for longer-term treatment, county and hospital officials said.
“We’re equipped to do the initial assessment and management. The CDC would then send in a team,” said Dr. Brian M. Murray, chief medical officer of Erie County Medical Center.
Burstein said the county has monitored Ebola since August, communicating with hospitals and other health care providers, as well as consulting about patients who present with suspicious signs.
However, Burstein and the doctors acknowledged that Ebola posed a new and unfamiliar threat that requires special attention. And after errors in infection-control protocol became evident in Dallas, where the Ebola virus spread to two nurses who had cared for a patient who died, hospital officials here realized they needed to “step up their game.” Those are the only confirmed cases in the United States.
“The situation with Ebola is fluid. We are learning from the mistakes at other institutions,” said Dr. John A. Sellick Jr., hospital epidemiologist at Kaleida Health and Buffalo Veterans Affairs Medical Center.
He said physicians were gaining better knowledge about a deadly disease new to the United States but widespread especially in West Africa.
“There was a level of protection that we thought was adequate, and it wasn’t. We know that now and are responding,” Sellick said, referring to the national response to Ebola.
The news conference touched on a handful of other key issues:
• Risk to the general population?
The risk of Ebola to the public remains low, but concern is reasonable, especially among health care workers, Burstein said. The virus is transmitted only by direct contact with the blood or body fluids, such as saliva, of an infected person.
To put things in perspective, Poloncarz noted that influenza kills up to 49,000 people a year in the United States, depending on its severity.
“Speculation and fearmongering on the airwaves has led to an atmosphere of uncertainty, suspicion and distrust,” he said.
Nevertheless, he and others said every hospital must be prepared for the possibility of a person presenting with Ebola symptoms. Early detection, isolation and protection of staff are the essential elements of initial management of an infected patient, they said.
• What are hospitals in Buffalo doing?
Steps include “town hall” meetings with employees, creation of special response teams, mandatory training for certain staff, purchase of personal protective equipment for employees who might come into contact with a patient, identification of areas to isolate patients, and drills.
“What we are doing builds on the contingency drilling we have been doing for a long time,” said Brian J. D’Arcy, senior vice president of medical affairs at the Catholic Health hospital system.
As evidence that his facility is prepared, ECMC’s Murray said staff identified and isolated a pretend Ebola patient within a few minutes in a drill conducted little more than a week ago.
• How are potential Ebola patients screened?
Initially, it begins with a handful of questions: Have you traveled to Guinea, Sierra Leone or Liberia in the last 21 days or been in contact with anyone who traveled in those countries, and what symptoms are you experiencing?
Symptoms of Ebola include fever, headache, muscle pain, weakness, diarrhea and vomiting.
“We even have the people who do our valet parking asking questions,” D’Arcy said.
Because the symptoms resemble those of the flu, Burstein strongly encouraged residents to get a flu shot.
• What is the significance of eight Ebola “supercenters” set up to identify and treat patients possibly infected?
The state chose the University of Rochester Medical Center and Upstate University Hospital in Syracuse, but no facility in Buffalo.
Sellick said that it makes sense to centralize the locations where ongoing treatment of Ebola patients would take place.
“This is not about the hospitals in Buffalo not being good enough,” he said. “This is a disease that is rare and that requires a high level of expertise. You need to focus treatment in units that have staff with experience.”
• What about ambulance personnel?
The CDC has issued guidance for medical first responders, and county officials said the recommendations have been relayed to ambulance companies and fire departments.
“The information is being pushed down to the grass roots,” said Daniel J. Neaverth Jr., the county’s commissioner of emergency services
• What else is happening to improve health care worker safety?
The CDC on Monday issued updated Ebola guidelines for protecting health care workers. Doctors, nurses, and others caring for patients with Ebola should wear single-use personal protective equipment that does not expose any skin, and be trained and monitored in how to put it on and take it off, according to the agency.
Nurses across the nation have voiced concern about adequate equipment and training at hospitals. Locally, it’s difficult to gauge the progress of hospitals in meeting the guidelines. But one key group representing workers at Kaleida Health reports positive signs.
“We have been in contact with the hospital daily over this issue,” said Cori A. Gambini, a registered nurse and president of Local 1168, Communications Workers of America, which represents nearly 4,000 Kaleida Health workers.
She said the union has pressed all the employers where its members work to institute protocols, provide equipment and conduct training sessions. Although she has yet to see a written version of Kaleida Health’s Ebola plans and policies, she said it appears from discussions to go beyond CDC mandates.
The Kaleida Health administration has said that it will provide everything needed to keep health workers and the community safe, and that money is not an issue, Gambini said.