Members of the health care community here have been trying for months to gauge the likelihood of a person infected with Ebola hemorrhagic fever coming to New Jersey. Their predictions range from extremely remote to highly possible. Opinions are also divided on the state’s readiness to handle Ebola, should the disease find its way here.
The spread of the virulent disease, which in the current outbreak had killed more than 4,447 and sickened more than 8,914 people as of mid-October, has been largely limited to a handful of countries in West Africa. However, in recent weeks a man who flew into Dallas from the West African nation of Liberia became the first case of Ebola diagnosed in the United States. He died on October 7. And this week, a nurse who treated the man also was diagnosed.
“It’s only a plane ride away,” says Dr. Manal Youssef-Bessler, founder of the Infectious Disease Center of New Jersey in Livingston.
Youssef-Bessler doubts that New Jersey, or the nation as a whole, is 100 percent prepared. “A lot of questions are being raised about if we have a case here,” she says. “How are we going to handle specimens? Where do these specimens get sent? Do we have a solid protocol in place? I personally don’t believe that we do in every single hospital in New Jersey.”
Dr. Christina Tan, the state’s official epidemiologist, disagrees. “New Jersey’s hospitals,” she declares, “are prepared to deal with the possibility of a case of Ebola or any other emerging viruses coming into the state.”
While stating that “the likelihood of our getting an Ebola case is very low,” Tan, the assistant commissioner for epidemiology, environmental and occupational health at the state’s Department of Health, recognizes that “we can never rule out the possibility of it showing up somewhere, and we understand the precautions that hospitals have to follow.”
Working with the CDC and county health departments, the state has established an emergency response system for screening, reporting and caring for an Ebola patient, not unlike systems put in place during earlier health scares, including anthrax, H1N1, MRSA and SARS, Tan says. The CDC recommends that hospitals and health care workers employ contact and droplet precautions when dealing with a suspected case of Ebola virus. In its current form, Ebola is highly transmittable through bodily fluids, but not through the air around patients. In light of the recent revelation that a nurse treating the Ebola patient in Dallas also contracted the virus, the CDC is currently reviewing its recommendations for handling Ebola patients and reconsidering it’s earlier position that any US hospital with room to isolate a patient should be able to treat an Ebola case.
The World Health Organization (WHO) projected that 20,000 people could be stricken with Ebola worldwide by early November. The Atlanta-based Centers for Disease Control and Prevention predicts about 1.4 million reported cases by January, if the disease is not quickly corralled. With thousands of U.S. military troops and medical personnel traveling to West Africa to lend aid, infectious-disease specialist Dr. Lincoln Miller says that unchecked cases will likely end up Stateside, with New York and New Jersey hospitals being among the places where an infected person might turn up. He disagrees with the assessments of the CDC and the New Jersey Department of Health that any hospital with the ability to quarantine patients can handle such a case.
“I really think they’re downplaying it,” he says. “It would be much more useful to say that [patients] should be sent to places that are really prepared to handle it.”
As co-chief of the infectious-disease department at St. Barnabas Medical Center in Livingston, Miller is taking no chances with the virus, which has a fatality rate around 70 percent, according to the WHO. During a recent assessment of his hospital, Miller identified about a dozen negative-pressure rooms that could handle Ebola patients. These are specially ventilated isolation rooms normally used for tuberculosis sufferers. However, he was concerned that the adjoining rooms, where staff would be decontaminated, may not be sufficient to contain Ebola contaminants. He is looking into getting more space and equipment to handle the threat. He has already ordered better gowns and goggles for the infectious-disease team. “I wouldn’t want anyone to go in there without full protection,” he says.
Similarly, Dr. Henry Fraimow worries about staff at Cooper University Hospital in Camden, where he is the hospital’s epidemiologist. Noting a heightened anxiety among the employees, Fraimow says he is working “to be proactive and educate them so they feel more comfortable.” To that end, he has held weekly staff meetings for discussion of Ebola and enterovirus D68, a respiratory illness sending children to hospitals across the country in recent months.
Adding to the concern about Ebola at Cooper is the sizable Liberian community in Camden and neighboring Philadelphia. Many of these immigrants work in the area’s health care system, according to Fraimow. Liberia has been one of the most severely affected countries in West Africa, along with Guinea and Sierra Leone, and to a lesser extent Nigeria and Senegal.
With a significant West African population in New Brunswick and the surrounding area, St. Peter’s University Hospital faces a similar challenge. In mid-September, the New Brunswick hospital started reaching out to representatives from the state’s Liberian and Sierra Leonian communities to educate them about the disease and warn against unnecessary travel to their home countries, according to hospital director of public relations Phil Hartman.
Like St. Barnabas, St. Peter’s has assessed its equipment needs to be sure it is ready for an Ebola patient. Amy Gram, a registered nurse and director of infection prevention at St. Peter’s, has equipped a cart in the emergency room with disposable leg and shoe coverings, gloves, goggles, gowns, masks and face shields. She also forwarded a host of Ebola alerts from the CDC and the state Health Department to all front-line personnel at the hospital. The alerts provide guidance on identifying symptoms, taking travel histories, handling specimen samples and other matters. The challenge, says Gram, is to make sure people read the dense updates.
“These reports are three and four pages long. Realistically, are people going to wade through all that?” Gram asks. “I send out a summary and try to highlight the important parts.”
Updates on the crisis were being issued so frequently by the CDC that the state Department of Health reduced the flow to weekly reports while referring people to a website for more frequent updates. “We’d be sending out alerts and hospitals would print them out, and everyone thought those were the guidelines,” says Donna Leusner, spokesperson for the Department of Health. “Then they’d be outdated a few days later.”
Dr. Ted Louie of Highland Park Medical Associates is an infectious-disease doctor with a subspecialty in travel medicine. He advises international voyagers what shots they need and what to avoid while traveling abroad. His advice for anyone considering a visit to West Africa right now? Don’t.
“The safest thing would be not to even go there,” Louie says. “But if you have to, be sure to have no physical contact with anyone who appears to be sick. Avoid hunting, or being close to bats or primates. And don’t go to any funerals.” (Ebola is particularly virulent when people touch an infected corpse and can be contracted by contact with bush animals.)
Louie also urges travelers in international airports to keep more than three feet away from anyone who seems sick. Ebola has a 2- to 21-day incubation cycle, but is contagious only when symptoms appear. These include high fever, severe headaches, sore throat, vomiting, diarrhea, abdominal or chest pain and hemorrhaging. Anyone who has traveled to West Africa, even if they were unlikely to have been exposed, should closely monitor their health for 21 days after returning. While there is no approved vaccine or cure for Ebola, patients whose cases are caught early, and who receive plenty of fluids and nutrition, have a better chance of survival.
Fraimow says he would not be surprised if a team from Cooper mobilized to go to West Africa—especially considering the UN resolution urging countries to send medical personnel and supplies then. Such was the case following the Haiti earthquake in 2010. Louie expects some of his colleagues to join the effort, something he says he would have considered “if I was 25 and didn’t have a family.”
“Infectious-disease physicians in general are very interested in what the rest of the world is doing,” Louie says. “They have this very altruistic outlook. So there probably will be no shortage of doctors willing to help out.”
[This story has been updated from the version that will appear in the November 2014 issue of New Jersey Monthly.]