Panelist. Ebola: Key Information for Campus Planning & Preparation. Objec5ves. November 18, :00 3:30 PM ET 11/13/14

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1 Ebola: Key Information for Campus Planning & Preparation November 18, :00 3:30 PM ET Follow this webinar at #ppclpwebinar This presenta,on is copyrighted by PaperClip Communica,ons This presenta,on may not be reproduced without permission from PaperClip Communica,ons and its presenters. This presenta,on and all materials provided during the presenta,on may not be altered. This presenta,on is not intended as legal advice and should be considered general informa,on only. The answers to legal ques,ons generally hinge upon the specific facts and circumstances of an ins,tu,on. Individuals with specific ques,ons should contact their ins,tu,on s legal counsel. Panelist Craig Roberts, PA- C, MS Epidemiologist Clinical Assistant Professor University Health Services University of Wisconsin- Madison cmroberts@uhs.wisc.edu The opinions expressed during today s event are not necessarily those of PaperClip Communica;ons Objec5ves Describe Ebola virus disease epidemiology and summary of the current situa,on worldwide Review the planning and emergency preparedness ac,vi,es that colleges and universi,es should undertake for Ebola Explain the basics of Ebola transmission, signs and symptoms to look for, and treatment op,ons Describe essen,al infec,on control prac,ces needed Discuss the appropriate surveillance and public health responses for travelers, exposed persons, and cases Understand how to effec,vely communicate this informa,on to key cons,tuents 1

2 11/13/14 Ebola Virus Disease: Overview Ebola Virus Disease: Overview Ebola virus disease (EVD), previously known as Ebola hemorrhagic fever, is a rare and deadly disease caused by infec,on with one of the Ebola virus species (Zaire, Sudan, Bundibugyo, or Tai Forest) Ebola viruses are found in several African countries. The first Ebola virus was discovered in 1976 near the Ebola River in what is now the Democra,c Republic of the Congo. Since then, outbreaks have appeared sporadically in Africa. Ebola virus disease is animal- borne (zoono,c) and fruit bats are the most likely reservoir. A spillover event from infected wild animals can cause outbreaks in human popula,ons. EVD Situa5on Update: Epidemiology Current outbreak in West Africa is the largest ever reported 14,000+ cases and 5,000+ deaths reported as of Nov 2014 Real incidence is probably much higher Incidence rate is about 1 in 1000 people (es,mate 20K annual cases in popula,on of 21 million) Only 5 cases have occurred outside of West Africa to date, including 4 in the U.S. 8 2

3 2014 Ebola Outbreak, West Africa NB: Nigeria (19-Oct) and Senegal (17-Oct) were declared EVD free. 9 WHO Ebola Response Team. N Engl J Med DOI: /NEJMoa hhp:// 10 Ebola Basics: Transmission Virus is present in high quan,ty in blood, body fluids, and excreta of symptoma;c EVD- infected pa,ents Opportuni,es for human- to- human transmission: Direct contact (through broken skin or unprotected mucous membranes) with an EVD- infected pa,ent s blood or body fluids Sharps injury (with EVD- contaminated needle or other sharp) Direct contact with the corpse of a person who died of EVD Indirect contact with an EVD- infected pa,ent s blood or body fluids via a contaminated object (soiled linens or used utensils) 11 Ebola Virus Transmission Persons with Ebola do not become infec,ous un,l the onset of symptoms Infec,ousness of body fluids (e.g., viral load) increases as pa,ent becomes more ill Healthcare providers caring for Ebola pa,ents and family/friends in close physical contact with Ebola pa,ents are at the highest risk of infec,on Minimal risk of transmission in other seongs NO risk of transmission if no contact 12 3

4 Ebola Basics: Clinical Features Incuba5on: Symptoms may appear anywhere from 2 to 21 days aper exposure to Ebola, but the average is 8 to 10 days Signs and symptoms: Ini,al: Fever, chills, myalgias, malaise, anorexia Aper 5 days: GI symptoms, such as nausea, vomi,ng, watery diarrhea, abdominal pain Other: Headache, conjunc,vi,s, hiccups, rash, chest pain, shortness of breath, confusion, seizures Hemorrhagic symptoms in 18% of cases Recovery: Depends on good suppor,ve clinical care and the pa,ent s immune response 13 Evalua5ng Pa5ents for EVD CDC encourages all U.S. healthcare providers to Ask pa,ents with symptoms about a history of travel to West Africa in the 21 days before illness onset Know the signs and symptoms of EVD Know the ini,al steps to take if a diagnosis of EVD is suspected CDC has developed documents to facilitate these evalua,ons EVD algorithm for the evalua,on of a returned traveler: hhp:// algorithm.pdf EVD algorithm for evalua,on of pa,ents in ambulatory care seongs (appropriate for college health centers): hhp:// care- evalua,on- of- pa,ents- with- possible- ebola.pdf 14 EVD Evaluation Algorithm for Student Health Centers Infec5on Control in Outpa5ent SePngs* Minimum PPE for clinically stable patients: Face shield & surgical mask, Impermeable gown, and Two pairs of gloves Training & Practice Required Before Use! AND *See CDC site for detailed guidance regarding PPE and infection control 4

5 What is the role of the health service? Ø Be prepared to Iden5fy, Isolate and Transfer suspected Ebola pa,ents Ø Have wrihen protocols in place Ø Screen all pa,ents for poten,al Ebola risk Ø Ensure all staff are trained in proper PPE Ø Iden,fy a designated transfer medical facility and establish procedures to transfer pa,ents Ø Know who to call for ID/Ebola advice Ø Minimize the care provided Planning for EVD in Higher Ed The U.S. is unlikely to see sustained transmission or have an outbreak of EVD Sporadic cases, mostly in travelers, will occur Your planning should focus on how to manage a single case event occurring in your community A suspect, rule out Ebola event is even more likely than the real thing but will generate the same ini,al response Planning for EVD in Higher Ed The bad news No comprehensive wrihen guidelines for IHE No single authorita,ve source has all the answers Rapidly evolving situa,on, things will change The good news Lots of excellent guidance that can be adapted Lots of schools are going through the planning you are not alone! One or two people can t do the planning for your institution s response to Ebola. You need a team. Execu,ve leadership Campus health staff Mental health staff Residence Life Communica,ons/Public Affairs Environmental Health and Safety Community and healthcare partners Physical plant Food services Academic departments Human Resources Opera,ons and Finance General Counsel Risk Management Local experts 5

6 American College Health Associa5on Emergency Preparedness Planning Considera5ons 1. Is your campus emergency response plan up to date so it can be ac,vated if needed to respond to a case of Ebola on campus or in the local community? Is it coordinated with the local public health department on a community response to a case of Ebola? 2. Does your campus have a communica,ons plan and team in place to respond to the communica,ons need if a case were to emerge on campus, in the community, or at another ins,tu,on? Is the communica,ons plan coordinated with the local community so that your campus would be informed if a case emerges in the community, allowing communica,on to students and parents? 21 American College Health Associa5on Emergency Preparedness Planning Considera5ons 3. If the public health department orders a quaran,ne for a high risk exposure, does the campus have a loca,on and plan to provide food and clothing to a quaran,ned person? Does the campus have a mechanism (qualified contractor) in place to dispose of waste? 4. Is the student health center screening all pa,ents for travel in the past 21 days? Are there plans in place to quickly respond to an ill student with a travel history from an Ebola affected area? What about other emerging pathogens? 22 American College Health Associa5on Emergency Preparedness Planning Considera5ons 5. Is there a mechanism to iden,fy and contact students, faculty, and staff who are returning to campus from an Ebola affected area and refer appropriately to the public health department for monitoring? 6. Who is responsible for monitoring individual and group ins,tu,onal travelers? Is there a policy and/or mechanism in place to restrict travel based on a CDC travel warning? hhp://wwwnc.cdc.gov/travel/diseases/ebola 23 Surveillance of Travelers Iden,fy a mechanism and/or individual who is responsible for monitoring individual and group ins,tu,onal travelers Consider personal travel how would you know if someone travels to or from an Ebola affected country? implement campus policy compelling all members of the community (students, staff, faculty, visitors) to report at- risk travel Review the campus travel policy Can travel be restricted? For whom? Under what circumstances would it be permihed? See also: hhp://wwwnc.cdc.gov/travel/page/advice- for- colleges- universi,es- and- students- about- ebola- in- west- africa 24 6

7 11/13/14 Surveillance of Travelers Planning: Prepare for Winter Break Contact students from affected countries in advance of winter break Assist students who wish to remain in U.S. with temporary housing Provide students (faculty or staff) considering travel to an affected area with detailed informa,on about risks All travelers arriving from affected countries are screened upon arrival in the U.S. and are required to follow up with the local/state public health department at their final des,na,on Travelers are required to measure their temperature twice daily for 21 days aper departure from an affected country Local/state health department will contact the traveler daily for three weeks to assess health status and monitor temp Get a detailed i,nerary from travelers, with dates Prepare your monitoring approach for when students (faculty or staff) return Ø This could be delegated to the student health service 26 Surveillance of Travelers Students/faculty/staff arriving from affected countries who are asymptoma,c and don t have direct exposure to a person with Ebola are considered to be at low risk for disease. They are not restricted in any way. They may: Ahend class, labs, take exams, go to work Teach, perform research, provide pa,ent care Socialize, travel, congregate, use mass transit Live in a residence hall, ahend spor,ng events, use rec facili,es Travelers with known exposure/contact to a case (e.g. health care workers) are at increased risk; restric,ons on movement and ac,vi,es should be put into place consistent with CDC guidelines: hhp:// and- movement.pdf Contacts of asymptoma,c travelers (e.g. roommates) are at NO RISK and do not need monitoring, quaran,ne, or special ac,on. 28 7

8 EVD Algorithm for Evalua5on of the Returned Traveler EVD Exposure Assessment **CDC Website to check current affected areas: Algorithm available at hhp:// algorithm.pdf Checklist available at hhp:// pa,ents- evaluated- us- evd.pdf **CDC Website to check current affected areas: Active monitoring required; daily check-in and twice daily temperature reporting for 21 days 29 Interim Guidance for Monitoring and Movement of Persons with EVD Exposure RISK LEVEL Monitoring PUBLIC HEALTH ACTION Restricted Public Ac5vi5es HIGH risk Direct Ac,ve Monitoring Yes Yes SOME risk LOW risk Direct Ac,ve Monitoring Ac,ve Monitoring for some; Direct Ac,ve Monitoring for others Case- by- case assessment NO risk No No No No Restricted Travel Case- by- case assessment No EVD: High Risk Percutaneous (e.g., needle s,ck) or mucous membrane exposure to blood or body fluids of a person with Ebola while the person was symptoma,c Exposure to the blood or body fluids (including but not limited to feces, saliva, sweat, urine, vomit, and semen) of a person with Ebola while the person was symptoma,c without appropriate personal protec,ve equipment (PPE) Processing blood or body fluids of a person with Ebola while the person was symptoma,c without appropriate PPE or standard biosafety precau,ons Direct contact with a dead body without appropriate PPE in a country with widespread Ebola virus transmission Having lived in the immediate household and provided direct care to a person with Ebola while the person was symptoma,c hhp:// and- movement- of- persons- with- exposure.html 8

9 EVD: Some Risk Some risk category includes any of the following: In countries with widespread Ebola virus transmission: direct contact while using appropriate PPE with a person with Ebola while the person was symptoma,c Close contact in households, healthcare facili,es, or community seongs with a person with Ebola while the person was symptoma,c Close contact is defined as being for a prolonged period of,me while not wearing appropriate PPE within approximately 3 feet (1 meter) of a person with Ebola while the person was symptoma,c hhp:// and- movement- of- persons- with- exposure.html EVD: Low Risk (asymptoma5c) Low (but not zero) risk includes any of the following: Having been in a country with widespread Ebola virus transmission within the past 21 days and having had no known exposures Having brief direct contact (e.g., shaking hands), while not wearing appropriate PPE, with a person with Ebola while the person was in the early stage of disease Brief proximity, such as being in the same room for a brief period of,me, with a person with Ebola while the person was symptoma,c In countries without widespread Ebola virus transmission: direct contact while using appropriate PPE with a person with Ebola while the person was symptoma,c Traveled on an aircrap with a person with Ebola while the person was symptoma,c hhp:// and- movement- of- persons- with- exposure.html Management of Low Risk Persons Asymptoma5c individuals in the low (but not zero) risk category should be ac,vely monitored un,l 21 days aper the last poten,al exposure. Direct ac,ve monitoring is recommended for some individuals in this category. Individuals in this category do not require separa,on from others or restric,on of movement within the community. For these individuals, CDC recommends that travel, including by commercial conveyances, be permihed provided that they remain asymptoma,c and ac,ve (or direct ac,ve) monitoring con,nues uninterrupted. hhp:// and- movement- of- persons- with- exposure.html No iden5fiable risk includes: EVD: No Risk Contact with an asymptoma,c person who had contact with person with Ebola Contact with a person with Ebola before the person developed symptoms Having been more than 21 days previously in a country with widespread Ebola virus transmission Having been in a country without widespread Ebola virus transmission and not having any other exposures as defined above Individuals in the no iden@fiable risk category do not need monitoring and there are no restric;ons on movement/travel hhp:// and- movement- of- persons- with- exposure.html 9

10 Ebola Risk Summarized EVD is a risk for travelers returning from affected countries, for health care workers who have had contact with Ebola- infected pa,ents, and for family/ friends who have had direct personal contact with someone who has Ebola. Virtually everyone else is at no risk. Community- acquired Ebola is not something you should be worried about. Transmission of the virus does not occur in casual seongs. Quaran5ne vs. Isola5on Quaran5ne Quaran,ne in general means the separa,on of an individual or group reasonably believed to have been exposed to a communicable disease, but who is not yet ill (not presen,ng signs or symptoms), from others who have not been so exposed, to prevent the possible spread of the disease. Quaran@ne applies to people who are well. Isola5on Isola,on means the separa,on of an individual or group who is reasonably believed to be infected with a communicable disease from those who are not infected to prevent spread of the disease. An individual could be reasonably believed to be infected if he or she displays the signs and symptoms of the disease of concern and there is reason to believe that an exposure had occurred. Isola@on applies to people who are ill. More info: S5gma Quaran,ne, isola,on, and monitoring all can result in s,gma and social isola,on of affected persons, and Africans in general Implemen,ng unnecessary restric,ons contrary to public health advice reinforces myths and ignorance about the disease and risk of transmission The psychological impact of a significant Ebola issue on your campus will be both individual and collec,ve; provide counseling resources We should follow na5onal guidelines Ac,ng out of an abundance of cau,on means it's not evidence- based, there's no science to support it, but we're going to do it anyway. Daniel Bausch, Tulane University When ques,oned about our approach and decisions, we should all be able to defend ourselves and our colleges/universi,es by saying that we are following the best, most authorita,ve advice available 10

11 Communica5on is key Messaging Best Prac5ces Campuses have both internal (faculty, staff, students) and external (parents, alumni, general public) audiences. All must be kept con,nually informed (websites, media, etc.) Campuses need to iden,fy spokespersons with exper,se in specific areas and provide them with advanced training. Communica,on needs exist before, during and aper major healthcare issue or biological threat. Phased, pre- planned communica,on messages are needed,,ed to predictable milestones Campuses should establish a means for secure internal communica,ons (intranet, secure website, etc.) to keep key personnel and decision- makers informed Put out a consistent message from a single source/contact Keep messages concise, no more than 3 main points Delegate ques,ons to vehed experts Make sure everyone is on the same page (Admin, Student Health, Public Health) Pa,ent- specific informa,on is responsibility of the hospital, not the school (FERPA/HIPAA) President Obama with the Emory Serious Communicable Diseases Unit (SCDU) clinical team Ebola is a Moving Target Keep up with current recommenda,ons and adjust your campus plans accordingly The best way to win the confidence of your campus is to keep calm and display confidence Some Closing Thoughts 11

12 We need to keep things in perspec,ve 30,000 : 1 The number of Influenza deaths v. the number of Ebola deaths in the United States in the past 12 months 10,000 (20,000) : 2 Total number of new Ebola cases transmitted in West Africa v. the number of new Ebola cases transmitted in the United States And 1,825 : 0 Estimated number of deaths among U.S. college students due to alcohol-related injuries v. the number of deaths of college students due to Ebola in the past 12 months (Data from National Institutes of Health) EVD Summary 1 The 2014 Ebola outbreak in West Africa is the largest in history and has affected mul,ple countries Think Ebola: U.S. healthcare providers should be aware of clinical presenta,on and risk factors for EVD Human- to- human transmission is by direct contact No human- to- human transmission via inhala,on (aerosols) No transmission before symptom onset Early case iden,fica,on, isola,on, treatment and effec,ve infec,on control are essen,al to prevent Ebola transmission EVD Summary 2 Most colleges and universi,es are unlikely to see even a single case of Ebola but must be prepared in the event they do Ins,tu,ons should focus on preparedness planning, medical surveillance, communica,ons, and policy development Risk to travelers, both inbound and outbound, should be a primary focus of campus prepara,on and policy Ac,ons should be guided by the recommenda,ons of local, state and federal public health officials, and decisions should be based on sound science and facts Schools should protect the health of their community as well as promo,ng social jus,ce and compassion. Ins,tu,ons as thought leaders can help mi,gate fear and anxiety both on and off campus

13 Primary Resources Thanks for your par5cipa5on! Key CDC Ebola Pages hhp:// hhp://wwwnc.cdc.gov/travel/page/advice- for- colleges- universi,es- and- students- about- ebola- in- west- africa hhp://wwwnc.cdc.gov/travel/no,ces CIDRAP (U of Minn) hhp:// disease- topics/ebola American College Health Associa,on hhp:// Contact info: Q/A How Do I Call- in with a Ques@on? If you would like to ask a ques,on of our panelist(s) please press *1 and you will be put in a call queue un,l it is your turn to ask your ques,on. OR You can write in a ques,on or comment any,me during the event by clicking on the Chat Bubble in the lep hand corner of your screen. For Ques@ons that Arise AQer the Conference If you have a ques,on that you were unable to ask of our presenter(s), please feel free to us at: Info@paper- clip.com and we will be happy to forward it to our panelists! Feedback We want your feedback on today s event! If you would like to provide sugges,ons for improvement and/or ideas for future event topics, please Laura Beo at: laura@paper- clip.com and she will send you the link to our brief online survey. Thank you for your par,cipa,on, PaperClip Communica;ons 13

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