St. Charles prepares for virus outbreaks

Ebola is only a plane ride away as recently demonstrated by an infected person who flew into Dallas from Liberia, was turned away from a hospital, interacted with 20-some people before he was finally diagnosed, isolated and subsequently succumbed to the virus.

Dr. Tom Frieden, director of the Center for Disease Control (CDC) said in an interview with NPR last week that airlines leaving West Africa are now taking the temperature of passengers before they can board a plane and if they have a fever, they will not be allowed to fly.

This was followed by an announcement from the White House that screenings would begin over the weekend at New York's JFK International Airport and then expand to Washington Dulles and the international airports in Atlanta, Chicago and Newark. Arriving passengers will be checked, using high-tech thermometers that don't touch the skin.

The average time for symptoms to start is 8 to 10 days, but it can take from 2 to 21 days before the infected person shows signs of fever, headache, sore throat, muscle pain and weakness. Even then, in the early stages, it can be mistaken for other flu-like diseases. With Ebola, the symptoms then progress to include vomiting, bloody diarrhea, internal and external bleeding, skin rashes and purple spots.

The virus is carried in bodily fluids including blood, saliva, mucus, sweat, tears, semen, vomit, urine and feces. It only enters the body through direct contact such as through skin abrasions, eyes, nose, mouth, throat, and reproductive organs. Once the symptoms set in, the person is contagious and has about 16 days to beat the virus or die. The chance of death is 50 to 90 percent, however those who survive have a 10-year immunity against it. Unfortunately there are other strains of Ebola, and it is unknown whether the immunity extends to them.

In a conversation with The Nugget, Rebecca Sherer, M.D., director of Infectious Disease Prevention & Control at St. Charles Health System, discussed the protocols in place at the hospital. All patients who present for treatment are asked about their recent travel and contacts, and staff is advised of the pertinent questions to ask so potentially infected patients can be quickly identified, isolated and entered into care. Placards with relevant questions will be posted throughout the hospital and provider offices. Healthcare providers and EMS personnel are being given checklists and procedures for identifying patients and protecting themselves.

Deschutes County Health Services is also partnering with St. Charles to get the information out to the public.

Director Jane Smilie says, "The risk of Ebola here in Central Oregon is very low, but the county has systems in place if it gets too close to home."

"The protection and safety of our staff is of great concern," said Dr. Sherer. "If someone suspects they've been exposed to the Ebola virus, we ask that they call ahead so EMS personnel and emergency-room staff will be prepared to transport or receive them wearing protective clothing and quickly transfer them to an isolation room for immediate care with no waiting."

St. Charles has isolation rooms, which are constructed with special doors, airflow systems and a sterile environment for ease in transferring and treating several contagious patients simultaneously. Arrangements have been coordinated with "Ebola hospitals" specifically designated to treat infected patients in case there is an increase. There are 15 in the U.S., with Harborview Medical Center (for adults) and Seattle Children's designated to receive patients by fixed-wing aircraft from Central Oregon.

Dr. Sherer also discussed the emergence of Enterovirus D68 into Central Oregon. This virus causes flu-like symptoms in children, especially those with a history of asthma or wheezing, including fever, cough, body aches, runny nose and sneezing that may become more severe, and include difficulty breathing. In most cases, the prognosis is good with no complications; however, the prognosis worsens as the severity of the infection increases and complications develop.

Avoiding contact with infected individuals, using good hand-washing practices, and disinfecting items contacted by infected individuals can reduce the chance of becoming infected. Like the common cold, it is spread through respiratory secretions, such as coughing, sneezing or touching an infected surface. There are no vaccines or antiviral treatments and it usually runs its course in a week with supportive care, however some cases may require hospitalization.

EV-D68 shows no signs of slowing down, as 594 people in 43 states have been confirmed and five children have died since late September, including one with no symptoms, but later confirmed. St. Charles Heath System has been checking for this virus since September 7, and has positively identified one patient with EV-D68 among 30 patients, 26 adults and four children, who were admitted with flu-type symptoms. Testing has to be done by the CDC, and they will only test patients who have been moved into intensive care. The one child who was moved into ICU tested positive for the virus and has recovered.