Yesterday, we all woke up to the news that the first case of Ebola in the United States had been confirmed in Dallas, Texas. A person recently arrived from Liberia, here to visit family, was admitted to Texas Health Presbyterian Hospital and is currently being treated for the disease. Dr. Tom Frieden, head of the “CDC”, the U.S. Centers for Disease Control and Prevention, has stated that he is confident that this single case will be contained.
The Ebola virus is not air-, water- or food-bourne; it can be transmitted only through direct contact with the bodily fluids of infected people who are already showing symptoms of the disease. Hence, thorough investigations to identify those individuals who have had direct contact with this infected individual, and their subsequent quarantine, should stop any spread of this often fatal virus. Those most likely to be exposed include the patient’s family members, close friends and health care professionals who might have treated him on his first visit to Texas Health Presbyterian Hospital’s emergency room, a visit which, unfortunately, did not, at the time, trigger suspicions of Ebola.
Assuming successful identification of all those having had close physical contact with the patient, it is highly likely that this case will be contained. However, what is of great concern is how this patient, who had informed emergency room personnel that he had recently arrived in the U.S. from Liberia, one of the major West African countries affected by the Ebola virus, and who showed symptoms consonant with Ebola, was ever discharged from this Dallas hospital’s emergency room – only to be readmitted four days later with full-blown Ebola. Until this system failure is understood and addressed, we are all at potential risk as this, the most devastating Ebola outbreak in history, continues.
Our nation’s colleges and universities are sites of particular vulnerability if guidelines promulgated by our public health experts are not followed, as was the case in Dallas. The Dallas hospital’s ER personnel apparently did ask the requisite questions regarding travel history. However, despite the fact that the patient stated that he had just arrived from Liberia and also displayed symptoms resembling early-stage Ebola, nothing was done. Clearly, a breakdown in communications occurred. Such lapses could have dire consequences, depending on the extent of direct contact any infected individual has had with members of the general population. It was recently reported (The Chronicle of Higher Education, September 12, 2014) that some 10,000 students from Guinea, Liberia, Nigeria and Sierra Leone are enrolled in our nation’s colleges and universities. Guidelines have been issued by the CDC in terms of monitoring the health of any students who are from, or who have recently visited, these countries. Such monitoring is to be carried out for 21 days, the maximum incubation period of the Ebola virus. The relatively simple steps of twice-daily temperature readings and the reporting of such flu-like symptoms as fever, chills, muscle pain, nausea and vomiting and weakness are crucial to limiting the spread of Ebola. The isolation and treatment of individuals showing such symptoms, and the identification and 21-day health monitoring and quarantine of all who have had direct physical contact with such individuals, have been extremely successful strategies in Nigeria for stopping the spread of this virulent virus.
While some of our nation’s colleges and universities, including the University at Buffalo, Penn State and the University of Illinois have such protocols in place, others have not yet instituted the precautionary practices being recommended by the CDC. While, indeed, the likelihood of an outbreak is small, the results of such an outbreak would be devastating given the high mortality rate of this hemorrhagic fever – greater than 6500 confirmed cases, with greater than 3,000 deaths according to the World Health Organization, numbers which surely are underestimates of the situation. The American College Health Association has recommended that colleges and universities identify students who have been in affected West African countries and then monitor their temperatures and be alert to possible early-stage Ebola symptoms until the 21-day incubation period has passed. Given that colleges and universities have frequent large gatherings such as major lectures, athletic contests or concerts, and given the close contact possible in student residences, it would seem that an abundance of caution should be exercised… that it would be prudent to follow these relatively simple health -monitoring steps, given the dire consequences of not doing so. College students from West Africa studying here in the U.S. should, I feel, be required to participate in such health checks, as should any members of the university community who have recently visited affected countries. It is a simple process which can be extremely effective in containing the spread of this devastating virus.
I am concerned that many of our colleges and universities have not yet instituted or tested such practices. The time is now, before the kind of lapse which occurred at the hospital in Dallas occurs on one of our nation’s campuses. Protocols need to be established and tested to ensure that all personnel are familiar with the various steps in the process, including the communication channels to be utilized so that all essential participants have the information they require to institute appropriate responses. The consequences of not doing so are just too great.
Dr. Karen Hitchcock, Special Advisor in the consulting firm, Park Strategies, LLC, was President of the University at Albany, State University of New York, from 1996-2004, after which she went on to lead Queen’s University in Kingston, Ontario, Canada. Dr. Hitchcock has received honorary degrees from Albany Medical College and from her alma mater, St. Lawrence University. She has served on numerous regional and national committees and task forces dealing with issues in higher education, research and economic development. While at both the University at Albany and Queen’s University, she co-hosted the popular WAMC program, “The Best of our Knowledge”.
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