Even with Ebola out of the public spotlight, public health officials are still preparing for the worst.

By Rose Hoban

For several weeks this past fall, it seemed everyone was focused on the Ebola virus. Members of the media wrote countless articles, people argued on social media sites about quarantine and state and federal health officials held weekly press conferences.

Then, it seems, Ebola dropped off the map.

Even as the epidemic continues to ravage West African countries, with close to 19,000 cases since last year, the U.S. has only had a handful of cases and a single death. The public, apparently, has moved on.

But not public health officials.

At a conference in mid-December, Jennifer MacFarquhar, an epidemiologist with the state Department of Health and Human Services, compared the ongoing preparation for a possible case of Ebola to a swimming duck: calm on the surface but working furiously below the waterline.

Since October, North Carolina officials have had 242 consultations on Ebola with clinicians around the state and tracked dozens of people returning to the state from areas in West Africa where Ebola is epidemic.

“We’re doing a lot of the same stuff, because we have to keep updating everything and make sure it stays current as our federal guidance gets adjusted and the global situation changes,” said state epidemiologist Megan Davies.

Many monitored

According to Davies, well over a thousand people have returned to the U.S. from West Africa and been actively monitored by state and local health departments for 21 days, the maximum length of time it would take for symptoms of Ebola to appear in a potential patient.

“We monitor patients, but these are healthy people, almost all of whom are low risk,” Davies said. “They’ve been in one of the affected countries within the last 21 days, but in that time they did not have any identified exposure.“

Davies declined to say exactly how many people in North Carolina have been monitored by public health officials.

Wake County health director Sue Lynn Ledford said a large number of those people have come back to the Raleigh area and been monitored by local public health nurses from her department.

“There might have been a week [since August] where we didn’t have someone we were monitoring, but we’ve been monitoring pretty steadily,” Ledford said. “One will be ready to roll on and two will roll off. But they’ve all been low risk and very manageable.”

Ledford explained that there are several levels of identified risk for Ebola exposure:

• Low risk is someone who’s been in the country but hasn’t had any direct contact. Because they’ve been in a high-risk country, they’re considered to be low risk, but not zero risk. They could have come in contact unknowingly.
• Medium risk is someone who perhaps was in a work area where they didn’t have direct contact with Ebola patients but were potentially around people who cared for patients.
• High risk is someone who did have direct patient contact, even if they were wearing personal protective equipment. They could potentially have exposure to blood or body fluids of Ebola patients.

“We’ve not had any high-risk [patients] since we’ve been monitoring,” Ledford said. “That’s good. That’s what you want when you look at this from the local level.”

Ledford said a public health nurse conducts an interview and risk assessment with any person who returns to the area from West Africa, even before arriving for a face-to-face interview. Potential patients take their own temperature several times a day and nurses call two or three times each day to ask about symptoms.

“We do have the capacity to quarantine someone,” Ledford said, but that her department has not had the need.

She said she was able to get equipment to handle Skype video calls with potential patients who needed to be quarantined but hasn’t yet needed to use it.

Multitasking

Both Davies and Ledford said there’s been a lot of extra work for their employees getting up to speed with Ebola preparation and staying there. And they haven’t had extra money to do most of it.

“Everything we’ve been doing, we’re doing with existing resources, whether that’s hospitals or health departments,” Davies said.

Ledford pointed out that state lawmakers have been cutting funding to local health departments and the state public health division, and federal lawmakers have cut funding to the National Institutes of Health and the Centers for Disease Control and Prevention for several years.

“We have those initial dollars to do what we needed from an emergency-management perspective, but we don’t have a lot of dollars to maintain it,” she said.

Video prepared by local public health professionals to demonstrate correct use of personal protective equipment. Jennifer MacFarquhar and Billy Fisher have both spent time working in West Africa to prevent the spread of Ebola. MacFarquhar, a member of the CDC Epidemic Intelligence Service, works for DHHS’s Division of Public Health. FIsher is a physician on the staff at the UNC-Chapel Hill School of Medicine and is also a fellow with the World Health Organization.

Congress recently allocated money to cover the costs of all the overtime, personal-protective equipment and additional technology required by state and local public health agencies to be prepared. But that money has yet to trickle down to local agencies.

Both Davies and Ledford said they’re using the training they’ve done and equipment they’ve acquired during their preparation efforts as a way to stay up to date for other potential threats. Public health agencies took a similar approach after the Sept. 11 terrorist attacks and subsequent anthrax scares to beef up infectious disease surveillance.

The money North Carolina received for those efforts in the early 2000s was used as a down payment on the state’s emergency department disease-surveillance system, NC DETECT, and also helped pave the way for building North Carolina’s new public health lab in Raleigh, which opened in 2013.

“From our perspective, even if we had no one coming into Wake County, so much about public health is about being prepared and being able to do early intervention,” said Ledford, who also talked about how preparing for the possibility of Ebola has forged better ties between all of the agencies that would have to respond.

“We’ve made new partners that might have been loosely connected but are now more connected. That’s always good,” she said. “It’s always better to walk into an emergent issue and see familiar faces than see a lot of strangers.”

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