Sunday, April 21, 2019

UW Grand Rounds: Clinical Management of Patients with Ebola -The Nebraska Experience

Another Attack On Ebola Health Workers Announced By WHO


With the situation on the ground in the DRC becoming more perilous (see latest WHO Tweet on today's attack) there are growing concerns that Ebola could spread beyond the currently affected regions, and - as we saw in 2014 - spill over into other countries.
For now, the biggest concern is regional spread, and the threat of spread outside of East Africa is considered very low (see ECDC Rapid Risk Assessment (#4) On Ebola In The DRC).
But very low is not zero, and during the 2014/2015 West African Ebola epidemic several infected individuals either traveled to - or were medically evacuated to - Europe and the United States.

In Europe only 1 secondary infection (a nurse in Spain) was reported, while in the United States two nurses were exposed to and infected in a Texas Hospital. All three survived. 
The very good news is we've learned a great deal since then on how to safely transport, and care for Ebola patients. 
While still not without risks - particularly when dealing with undiagnosed cases showing up unannounced at a hospital - once Ebola cases are identified and isolated, well equipped and properly trained facilities have a good record of safely treating patients.

Some of the training programs designed to prepare healthcare workers to deal with highly infectious patients include:
HHS National Exercise On Moving Infectious Patients
HHS Launches National Ebola Training & Education Center
HHS Selects 9 Regional Ebola & Special Pathogens Treatment Centers
In 2015 Nebraska Medicine - Nebraska Medical Center in Omaha, Nebraska - which successfully treated several medically evacuated Ebola patients in 2014 - became one of 9 the Regional Ebola & Special Pathogens Treatment Centers designated by the HHS, and is part of a larger network Ebola treatment centers around the nation.

All of which brings us to an hour-long video Grand Rounds presentation from the University of Wisconsin - published on Friday on Youtube - which presents Nebraska Medicine's experience dealing with Ebola cases in 2014. 

4/19/19: Clinical Management of Patients with Ebola: The Nebraska Experience

UW Department of Medicine Published on Apr 19, 2019

Angela Hewlett, MD, MS presents a case study about caring for patients with Ebola Virus Disease at Nebraska Medical Center in 2014. Dr. Hewlett is an infectious disease specialist and associate medical director of the Nebraska Biocontainment Unit.
The title of her April 19, 2019 Grand Rounds talk is "Clinical Management of Patients with Ebola: The Nebraska Experience." Dr. Hewlett is one of four Medicine Grand Rounds Dream Speakers visiting this spring. Dream Speakers are invited by University of Wisconsin internal medicine chief residents. University of Wisconsin Department of Medicine Grand Rounds are presented throughout the academic year and are intended for health care professionals and medical researchers. Unless otherwise indicated, Grand Rounds occurs in the William S. Middleton Memorial Veterans Hospital auditorium, Room A1028, Madison, Wisconsin. All faculty and staff are invited and encouraged to attend.
For more information on the Grand Rounds lecture series, visit
Screen shot from Grand Rounds Presentation - Click to Watch

Nebraska Medicine's experience, and track record, show that it is possible for well trained and equipped facilities to safely treat Ebola cases. And the lessons learned along the way are applicable for dealing with other highly infectious diseases, including MERS, Avian Flu, and Virus X - the one we don't know about yet.

In a related topic, this week the  CDC released updated recommendations for agencies and organizations sending responders into the Ebola zone.  I've only included some opening excerpts, so follow the link to read it in its entirety.
Ebola Recommendations for Organizations

Recommendations for organizations sending US-based health care or emergency response workers to areas with Ebola outbreaks and predeparture assessment of any workers traveling from Ebola outbreak areas to the United States
Key Points
  • CDC recommends that organizations sending US-based workers to areas with Ebola outbreaks ensure the health and safety of those workers before, during, and after their deployment.
  • Pre-deployment recommendations include educating workers about Ebola, travel vaccines, healthy behaviors, personal protective equipment, and travel health insurance.
  • During-deployment recommendations include remaining in contact with workers, periodically asking about any symptoms of or exposures to Ebola, and contacting in advance the US state or local health departments that have jurisdiction in the areas where workers will be staying after arrival in the United States.
  • Post-deployment recommendations include staying in contact with workers for 21 days after they leave the outbreak area while they self-monitor for symptoms of Ebola.
CDC recommends that all workers with potential occupational exposure to Ebola virus who are traveling to the United States undergo a health and exposure assessment before their departure from the outbreak area.

The audiences for this document are:
  • Organizations such as nongovernmental, faith-based, academic, or aid organizations that send US-based workers (employees, contractors, or volunteers) to areas where Ebola outbreaks are occurring.
  • Organizations whose non-US-based workers, such as locally employed personnel or US expatriates working in the outbreak area, intend to travel to the United States.
For the purpose of these recommendations, workers include those engaged in Ebola response activities (for example, clinical care or laboratory work in an Ebola treatment unit [ETU], burial work, contact tracing); those providing health care or performing clinical laboratory work in non-Ebola settings in the outbreak area; and anyone else whose duties place them at risk of exposure to Ebola.

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Whether it is Ebola, MERS-CoV, SARS, Avian flu, or something as yet unknown - the odds are that more and more American hospitals and healthcare workers will find themselves faced by high risk pathogens in the future.

Knowledge from programs like the Grand Rounds presentation above can help make that first contact safer for staff, patients, and for the entire community.