Ebola Response and Occupation Health and Safety Protocols

Dr. Joia Mukherjee and Dr. Sara Stulac from Partners in Health recently lead a seminar on the health and safety protocols being followed by frontline workers returning from effected countries in West Africa.

How did Partners in Health get involved in the fight against Ebola?

  • PIH did not have a footprint in West Africa prior to the outbreak, however they serve on the boards of many smaller NGOs who work there. The effected countries, and the World Bank also requested PIH’s help and thus the organization felt the need to do something.
  • It has been a while since PIH has expanded
  • PIH has never been one to enter the conflict, they are about building long term systems; however, the two often collide. It’s not PIH’s goal to get involved with disaster but it sometimes becomes necessary

What they are currently trying to do:

  • Decentralize healthcare, the commute from some of the effected rural areas to the health centers can be an 8-10 hour drive.
    • By mid November they should have some treatment centers up and running.
  • They are trying to open at least 500 beds in each effected area.
  • PIH has recruited about 115 people so far but they’ll need 500 more in the next five to six months.

What are the biggest misconceptions about people returning from West Africa and the spread of Ebola?

“This is both the worst humanitarian issue of our time but at the same time there is no reason to panic”

  • There has not been an unknown case of Ebola transmission; everyone who has contracted virus has had clear, obvious exposure.
    • No one has contracted the virus from someone who was only somewhat symptomatic.
    • At the beginning of illness you have very little of the virus in your system and are not highly contagious.
    • Infectiousness grows linearly with the development of symptoms.
  • Case Study: Eric Duncan
    • Duncan’s entire family, who lived with him while he was initially falling ill, did not contract Ebola.
    • The only people to interact with the patient and contract Ebola were the two nurses caring for him in the later in the virus’ progression.
    • They were not supplied the appropriate safety outfits and were thus exposed.

What are the safety protocols being followed by those returning from the frontlines?

  • The CDC has been working to standardize a stratification of risk which will determine the protocols followed by various travelers based on their level of potential exposure.
  • PIH has adopted their stratification of risk and added a slightly more conservative approach to give people more confidence.
  • The document Dr. Stulac shared that explains categories and protocols is under constant review. Between the time Dr. Stulac put together her presentation the night before and the morning of the #LunchandLearn, the document had been updated again.
  • Protocols include independent group monitoring so it is confidential and everyone feels comfortable.

A brief overview of the risk stratification categories:

  • High Risk – clear, obvious exposure to a highly symptomatic patient in the past 21 days
  • Some Risk – Close contact, within 3 feet of a person with Ebola for an extended period of time in a healthcare unit with a PPE or in a household without a PPE in the last 21 days
  • Low Risk – Being in a country coping with the outbreak, having contact with a minimally symptomatic Ebola patient, being in close proximity with Ebola patient but with no contact

 To read about more the risk categories and specific protocols click here.

Protocol #4 – Risk Categorization and Management of Staff Arriving in the United States from West Africa

Potential issues with the system:

  • It’s based completely on self reporting and there is no practical way to implement external guidelines
  • Denial and desperation to get home could alter health workers’ response
  • Only other way of checking is through an institutional check – every organization is aware of who is doing what job so they know who is at the most risk

PIH is trying to make reporting symptoms as easy and stress free as possible by making themselves 100% accessible. They are also committed to educating those on the realities of an Ebola diagnosis; that it is not a death sentence and the earlier they come forward with any symptoms the better off everyone will be.