With the widespread Ebola outbreak in West Africa and yesterday's death of the first patient diagnosed on U.S. soil, Arizona medical authorities are preparing in case an outbreak occurs here.
There have been no diagnoses of Ebola virus infection in the state, and the few scares have not been serious enough to necessitate full-fledged testing, states Dr. Cara Christ, the Arizona Department of Health Services' chief medical officer.
But if an Ebola case is discovered, she says, her department is ready to take charge and keep the public safe.
Three Arizona patients went through a risk-assessment process to determine whether they needed to be tested, Christ says. In such assessments, officials look at whether a patient has been to countries where the virus has proliferated or had contact with any infected people to determine whether a test is needed. None of the three Arizona cases rose to that level.
"The nice thing...is that this is what pubic health does all the time," Christ says. Her department regularly is tasked with assessing sick patients, monitoring their contact with others to track spread of disease, and educating medical providers, caretakers, and the healthcare community generally on infectious diseases. These tasks mirror the steps taken nationally to combat an outbreak of the Ebola virus.
Educating the healthcare community about Ebola is especially important in light of media reports that the now-deceased Dallas patient sought treatment for his symptoms but was sent home un-diagnosed before his eventual diagnosis and death. Christ doesn't have any information on the accuracy of that account, but she says it has served as a lesson regardless. Facilities nationwide are all more cautious, she says, and locally, "almost all of our facilities are screening patients with fever and asking for travel history." Fever is common among patients with Ebola.
The Department of Health Services gives hospitals information on what to do if they suspect a case and will work in collaboration with the national Centers for Disease Control and Prevention (CDC) to test patients when necessary, Christ says. The department also oversees contact tracing, a careful analysis of everyone a sick patient has been in contact with (and an important element of containing Ebola). If any cases should arise in Arizona, the department will keep an eye on those suspected of having come into contact with the disease, asking them to monitor their temperatures and avoid contact with others for at least a 21-day period.
But so far, that's all hypothetical. Christ points out that Ebola does not spread easily--only direct contact with body fluids of a patient sick enough to exhibit symptoms will spread the virus--and says the lack of public-health infrastructure in West Africa has greatly contributed to the disease's spread there.
"We've got a fantastic healthcare infrastructure both in Arizona and in the United States," she says. Domestic systems would easily prevent the rapid spreading that has been seen in international outbreak sites, Christ says. The United States has the financial resources to take proper precautions, the clean water needed for washing hands, and the appropriate infrastructures to allow for follow-up and tracking of the disease, she says.
"It's just not going to spread in the United States like it has there," Christ says.
This week, the CDC and the U.S. Department of Homeland Security's Customs and Border Protection (CBP) announced a joint program to begin more rigorous disease screening at several domestic airports. CBP staff members have been observing incoming passengers for explicit signs of illness, but the new measures will increase CBP staffing at certain major airports, allowing staff to pull aside every passenger whose passport shows travel from Guinea, Liberia, or Sierra Leone, the three major outbreak sites.
Those travelers will be given a verbal assessment not unlike the one used with the three Arizona cases. CBP staff will ask such passengers about possible exposure, take their temperatures, and educate them on self-monitoring for symptoms of the disease. Those who show possible symptoms or whose assessments indicate further monitoring is needed will be referred to public-health authorities. Those who appear to be in the clear will be asked to provide their contact information and to record their temperatures each day in a log.
"We believe these new measures will further protect the health of Americans, understanding that nothing we can do will get us to absolute zero risk until we end the Ebola epidemic in West Africa," said Tom Frieden, CDC Director, in a written statement.
The new screening of incoming passengers will supplement the ongoing screenings of all outbound travelers in affected countries. In the two months since such exit screening began, only 77 of 36,000 screened travelers were denied access to their flights because of possible symptoms. But none of those 77 turned out to have Ebola, the CDC says.
Phoenix Sky Harbor will not be asked to implement incoming passenger screening at this stage, Christ says. That's because the five airports targeted to implement the new program--JFK, Washington-Dulles, Newark, Chicago-O'Hare, and Atlanta--receive more than 94 percent of inbound travelers from the Ebola-affected nations. New York's JFK will roll out the new disease screening on Saturday, and the other four airports will begin next week.
The Department of Health Services' Refugee Health Program seconds Christ in thinking that Arizona isn't likely to see an outbreak. Only two of the 2,400 refugees resettled in the state in 2014 came from countries affected by the Ebola outbreak, the program's website says. "The Ebola virus disease outbreak in West Africa poses no substantial risk to the citizens of Arizona," the program's website says.
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Christ encourages Arizonans to remember that much more common infections like influenza kill many more people than Ebola and spread much more easily. Unlike Ebola, influenza can spread before the sick even show symptoms. And unlike Ebola, influenza has a vaccine.
The most effective ways to stay safe from infectious diseases--from influenza to Ebola--are to take the simplest precautions. It may seem obvious, but the first rule is to stay away from anyone who might be infected, Christ says. Other obvious precautions are: wash your hands regularly with soap and water, and cough into your elbow or sleeve, instead of your hand; stay home when sick, and don't send sick kids to school, she says. "That's how these diseases spread."
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