Ebola and a headline this New Yorker didn’t want to see…

A CDC report titled ‘Surveillance and Preparedness for Ebola Virus Disease — New York City, 2014’!

Missing word? Prevention!

While it’s true that there has been an extremely limited number of confirmed cases of Ebola that actually were caught in the United States (2), it is also true that we have discovered that our nations preparedness for any potential widespread outbreak is woefully inadequate!

From these two cases we now have hundreds of people being closely watched due extremely limited to non-existent contact with the nurses and other Texas hospital workers, schools having been closed, airplanes taken out of service, cruise ships denied access to ports and in general, what can only be termed fairly significant economic disruption.

We have also discovered that besides those hospitals with designated areas for these types of patients like the one at Emory, our hospital system seems to be unprepared as well.

From two confirmed cases!

Imagine even a limited New York City outbreak (say two cases) given the close proximity of people in so many areas ranging from subways and buses during the morning and afternoon commutes, elevators in office and residential towers and crowded restaurants and clubs at night.

What would happen to the economy of NYC if only two people were infected? Hopefully calm and common sense would be the order of the day but, having observed the scenario as it developed in Texas, that may not be a reasonable expectation.

The economy of New York could be seriously damaged as residents become reluctant to take mass transit or to frequent businesses and tourists become reluctant to travel here.

Bottom-line? Preparedness and a belief by the people who live here that our political and healthcare leaders are prepared in a proactive and not reactive manner is imperative.

Unfortunately I’m not sure if the verbiage in this report from CDC is a good start or just more of the same.

Is prevention even possible?

And, while it has generally become a political football rather than a discussion of prevention, doesn’t a travel ban of flights from Ebola ravaged countries make good common sense?

Of course there are ways that people could work around such a ban as people can typically find ways to get around most anything, but for a disease with as much as a 40-day incubation period, temperature taking and questionnaires at five airports around the United States seems to me to be woefully inadequate!

The CDC Report

From the CDC report:

‘To ensure that NYC is prepared to manage Ebola cases and prevent disease transmission, the NYC Department of Health and Mental Hygiene (DOHMH), in close coordination with local hospitals and clinicians, nongovernmental organizations and community groups, and city, state, and federal agencies, established systems around Ebola surveillance and management of suspected cases and contacts, and built upon existing general protocols for early recognition and management of persons with a viral hemorrhagic fever. Objectives included rapidly identifying Ebola patients in health care settings, implementing infection control precautions, and transporting ill persons to hospitals via emergency medical services, including persons arriving on international flights into John F. Kennedy International Airport. Enhanced planning began immediately after a CDC alert about Ebola on July 28, 2014. Reporting criteria and infection control guidance were developed in collaboration with local hospitals and sent to hospitals and clinicians via an electronic health alert system on August 11. Information also was shared on three citywide conference calls and in oral presentations to target audiences (1). DOHMH developed Ebola-specific data collection forms and triage protocols and trained staff to handle calls.

The guidance instructed clinicians to call DOHMH immediately after identifying any patient meeting the CDC definition for a person under investigation (PUI): a person who traveled to an Ebola-affected area within 21 days of onset of symptoms and had fever >101.5º F [38.5º C] and compatible symptoms such as severe headache, muscle pain, vomiting, diarrhea, abdominal pain, or unexplained bleeding (Figure) (2,3).* The guidance provided a link to the CDC website for information on the current list of affected areas (4). DOHMH also assisted area hospitals in planning for isolation and management of PUIs or confirmed Ebola patients. DOHMH distributed posters for health care facilities to post in emergency departments to encourage patients to report recent travel history to an Ebola-affected country upon arrival.† DOHMH medical epidemiologists were available at all hours to respond to clinician and hospital questions about PUIs or other persons suspected of having Ebola, using guidance largely consistent with CDC’s risk categories. Under the system, patients with high-risk or low-risk exposure to Ebola would be transferred to another hospital if there was concern about the ability of the reporting hospital to manage the patient; Ebola testing, if indicated and after consultation with CDC, could be performed at DOHMH with confirmatory testing at CDC. Patients should also undergo evaluation for alternate diagnoses. The protocol included consideration of laboratory studies such as complete blood count, coagulation studies, liver function tests, and malaria testing, to assist in determining the need for Ebola testing. Patients not needing hospitalization could remain isolated at home, with daily monitoring by telephone by medical epidemiologists until the patient’s symptoms improved such that Ebola was no longer of concern, or until worsening or persistent symptoms prompted repeat evaluation for Ebola or an alternate diagnosis.’

Reassured or would you like to see more?

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Written by Michael Haltman, President of Hallmark Abstract Service, New York.

HAS is a provider of title insurance in New York State for residential and commercial real estate transactions specializing in the areas of New York City, Long Island and Westchester.

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If you have any questions you can reach Michael by email at mhaltman@hallmarkabstractllc.com.