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Virginia’s Preparedness for Ebola Virus Disease (EVD)
March 19 2015
Ebola: The Basics
• Ebola virus is a type of viral hemorrhagic fever.• Virus spread person to person mainly by direct contact
with bodily fluids (blood, feces, vomit), less commonly by contaminated items (needles).
• Ebola is a severe and often fatal disease; begins with acute fever, progressing to multi-organ involvement.
• Infected person is contagious only once symptoms develop (2 to 21 days after exposure).
• Persons caring for infected persons (healthcare workers, household members) are at highest risk of disease.
Ebola in Africa and the United States
• Mar 2014: Outbreak began in Guinea• Aug 8: WHO declared international
public health emergency• Sep 30: First case diagnosed in US
(Texas); traveler left Liberia Sep 19, arrived US Sep 20, and became symptomatic Sep 24
• Oct 20: Outbreaks in Guinea, Liberia, Sierra Leone, with limited spread in Nigeria and sporadic detection in 3 other countries, account for 8,973 total reported cases and 4,484 deaths
Image source: CDC (October 10, 2014)
Ebola – Cumulative Cases in West Africa through
03/08/15n=24,247
Confirmed weekly Ebola virus disease cases reported from Sierra Leone (WHO)
EVD Control Measures: Based on Established Core Public Health Actions
• Surveillance• Disease Reporting• Communication
• Investigation
• Implementation of Control Measures
• Risk Communication
Three EVD Scenarios to Considerin Virginia
I. Individual arrives at Virginia airport (Dulles most likely) with symptoms consistent with EVD (or likely exposure) and travel history to affected areas
II. Individual presents to Virginia hospital with symptoms consistent with EVD and a travel history to the affected areas
III. Individual with EVD identified in another state but had contact with Virginians
Quarantine Orders• Legal authority (§ 32.1-43) exists for State
Health Commissioner to issue orders of quarantine for disease threats– If non-compliant with voluntary agreement, or– If such order is necessary to control the disease
• Letters for EVD-related voluntary quarantine and orders for quarantine scenarios have been drafted
State Health Commissioner Actions
• Maintain full situational awareness at local, state, national and international levels
• Inform and regularly update public, healthcare community, legislators and Executive Branch leadership about significant events/developments • Promote hygienic practices and influenza vaccination in
addition• Evaluate each potential EVD case/contact as a
Communicable Disease of Public Health Threat– Determine need for individual orders of isolation or
quarantine
Commissioner (continued)
• Coordinate efforts with neighboring jurisdictions• Direct agency resources to meet local needs• Identify need for interagency assistance• Declare Public Health Emergency if situation
warrants enhanced awareness and communication
• Request Governor declaration of emergency if an affected area needed to be isolated or quarantined
Ebola – Virginia Traveler Active Monitoring
Risk Category Num %Low but not zero risk 631 97.7Some risk 14 2.2High risk 1 0.2
Travelers entered Virginia’s active monitoring program between 10/27/2014 and 2/28/2015
Current Status Num %
Completed monitoring 406 62.8
Transferred out 176 27.2
Released from monitoring 5 0.7
Under monitoring (as of 2/28/15) 59 9.1
554
3429 25 2
Health Planning Region*
Northern Northwest Eastern
Central Southwest
646
*2 travelers were transferred out of Virginia prior to being assigned to a region/health district
VDH Response Activities to Date• Case finding & consultations with hospitals
around the Commonwealth• 5 patients to date tested for Ebola (all
negative)• Airport screening began 10/16 at Dulles • Post-arrival monitoring of all travelers began
10/27
Asymptomatic Travelers from Guinea/Liberia/Sierra Leone that name Virginia as final destination
LOW BUT NOT ZERO TRAVELER
Voluntary Agreement Signed Active Monitoring daily, via phone,
including temp checks for 21 days Movement restrictions: NONE Notify LHD with intent to travel >50
miles
“LOW BUT NOT ZERO” RISK CATEGORY
Notification to VDH via Line Lists to Central Office via CDC Epi-X
Central Office Assigns Travelers to
LHD for ACTIVE MONITORING
“SOME” RISK CATEGORY
Notification to VDH via Phone from CDC Quarantine Station
Released to Virginia-based Final Destination.
Line Lists to Central Office via CDC Epi-X
VDH Central Office Assigns Travelers to LHD
for DIRECT ACTIVE MONITORING
SOME RISK TRAVELER
Voluntary agreement signed Direct Active Monitoring daily, including one in-
person visit for 21 days Movement restrictions: no commercial travel, no
public transport, no large gatherings, no long distance travel by any means, exceptions may be granted.
Work and school generally restricted May interact with family and friends, run routine
errands.
“HIGH” RISK CATEGORY
Met at airport by Local VDH Personnel and Voluntary
Agreement Signed; Order if Necessary.
HIGH RISK TRAVELER
Direct Active Monitoring daily, including once daily in-person visit for 21 days
Movement restrictions: must stay in home/on property for 21 days. No work, school, travel. Essential needs will be supported by family, friends, LHD.
DIRECT Active Monitoring: Public health actively monitors the health of an asymptomatic person as opposed to relying on the person to self-monitor and report symptoms if they develop. Includes public health authority conducting active monitoring through direct observation at least 1x/day
Active Monitoring: Public health assumes responsibility for establishing regular communication with potentially exposed individuals, including checking daily to assess for symptoms or fever, person as opposed to relying on the person to self-monitor and report symptoms if they develop. Can largely be conducted via phone or electronic means.
Governor
Governor’s Cabinet
Ebola Unified Command Group Levine, VDH Stern, VDEM Flaherty, VSP
Trump, Deputy, VDH Burdick, Deputy, VDEM
vJIC / ESF-15 VDH, VDEM, VDSS (2-1-1)
Brewster, VDH Lead Eischen, VDEM Deputy
Geller, VSP Others as required
Liaisons Federal, Local, Private
DMA MWAA
DHS/USCG DHS/CBP
Burket, Port of VA Others as required
Legal Advisor Attorney General’s Office Kurz, OAG, VDH Council
Planning Mauskapf, VDH Chief
Francis, VDEM Dep, Ext Spt Shelton, VDH, Dep, Int Tasking
Operations Trump, VDH Lead
Michael Nelson, VDEM Dep Ext Sp
Finance / Admin Damico, DGS Lead Hill, VDEM Deputy DHRM Rep TBD DOA Rep TBD
Logistics Eaton, VDEM Lead
Buisset, VDEM Deputy
Situation Unit Daily VDH SITREP
Bi-weekly UC SITREP Shelton, VDH
Calkins, VDEM Plans Support Staff, VDEM
Resource Tracking Unit Shelton, VDH
Garnowski, VDEM
Hospital / EMS Readiness Owens, VDH Schitter, VDH Reece, VHHA
6 Regional Hosp Coord’s Giese, DEQ
Future Plans Francis, VDEM
Kelso, DMA
Specialty Teams as req’d Mortuary Affairs, Gormley
Diefenthaler, DBHDS ESF-3 Med Waste, Giese,
DEQ
Public Health Branch Forlano, VDH Deputy Toney, DGS (DCLS)
Law Enforcement Branch
Daniels, VSP Lead Terry, VSP Deputy
ESF-10 Branch Britt VDEM Lead
Giese, DEQ Deputy Hood, VSP
Berry, VDFP
Training & Exercise Branch
Mongold, VDEM Lead Silverstein, VDH Deputy
Estes, VDFP Hanley, VSP
Hospital / EMS Schitter, VDH Lead
Owens, VDH Deputy Reece, Hospital Coalition
Perkins, EMS Reg. Council
Bryan Norwood, MWAA
Safety Officer Rice, DOLI
Multiple State Agency Logistics
Personnel
Intel Unit Vincent, VDEM Lambert, VSP
Regional Coordination King, VDEM Lead Cooling, Magner,
Walker, McCabe (VDH) VSP Rep TBD
EVD 2015 UC Briefing 24 March
Incident CommanderDr. Marissa Levine
Info/Intel ChiefSuzi Silverstein
Sit Awareness UnitJosh Czarda
Planning Chief Bob Mauskapf
Technical Advisors
Four (4) Regional Planners
Operations ChiefDr. David Trump
SNS CoordinatorCindy Shelton
Hospital/MedicalCommunity BranchKevin
Pannell
Fatality ManagementDr. Bill Gormley
Environmental HealthAllen
Knapp
Radiological HealthSteve Harrison
Admin/Logistics/Finance Chief
Richard Corrigan
HRBecky Bynum
FinanceBeth Franklin
Procurement/General ServicesSteve VonCanon
IT Debbie Condrey
VDH All Hazard Incident Management Team3/1/2015
Unified Command EVD Focus• Access to Gov-authorized funding (VDEM / Executive Action)• Coordinate interagency actions (VDH / VDEM)• Coordinate Risk Communications / VA.211 (VDH ORCE / VDEM / JIC)• Coordinate efforts with neighboring jurisdictions (All)• Local preparedness assessments (VDH OEP / VDH CHS)
• Local roles and missions (VDEM)• Pet quarantine / management (VDH +)• Expand /define Unified Command (VDEM / VDH)• Post-arrival tracking (VDH OEpi & Local Health Districts)• Laboratory testing and transportation of samples (DCLS, DGS)• Personal protective equipment status / availability (VDH OEP / VHHA)
• Supply chain status tracking (VDEM)• Function-specific guidance (VDH OEpi)
• Emergency medical services’ patient transport (VDH OEMS)• Medical waste disposition (DEQ)
• Hazmat response in non-healthcare settings (DEQ)• Fatality management (VDH OCME)• Behavioral health (DBHDS)• Healthcare coalition preparedness and response (VDH OEP / VHHA)• Training and Exercises (VDEM +) 1st TTX 2/12 / 2nd planned 5/19
EVD Unified Command Update• Unified Command meets monthly
• Plans, Gap Analyses, & Tabletop Exercises Completed• Regional Coordination Section
• Tiered Hospital Concept• Treatment, Assessment, Frontline Hospitals• Prepared Transport Teams in all EMS Councils
• HHS and CDC Grants• Hospital and Public Health Preparedness ~$11M
• Training and Exercises• Facility, local, regional exercises tracked• 1st Unified Command Exercise conducted 2/12
• Cat A Medical Waste• DEQ regulates and coordinates with facilities
• Communications• Pre-scripted messaging• VDH Website / Dark Site IF EVD case presents in VA.• 211 Call Center• Law Enforcement Video:
http://www.vdh.virginia.gov/epidemiology/ebola/HealthCare.htm
Additional Issues
• W Africa Healthcare Worker Evacuation• Just-in time Logistics / Vendor List(s)• DOD Coordination• Tiered Hospital Response• Situational Awareness
Questions?
Dr. Dave Trump, Chief Deputy Commissioner Public Health and [email protected]
Bob Mauskapf, Director Emergency Preparedness [email protected] 804-864-7035
Cindy Shelton, Assistant Director, Emergency [email protected] 804-864-7486
Jennifer FreelandVDH State Volunteer [email protected] 804-396-0543
Kim Allan, Operations [email protected]
Suzi Silverstein, Director, Risk Communications and Education [email protected]
Kevin Pannell, State Hospital Coordinator [email protected] 804-864-7033
General Info / Contacthttp://www.vdh.virginia.gov/OEP/