NY Times – October 06, 2014
by MARC SANTORA
One week after the first diagnosis of Ebola in a patient in the United States, every person who calls 911 in New York City and relates symptoms such as fever or vomiting is now being asked a new question:
Have you been to West Africa in the last three weeks? If so, did you come into contact with someone sick with the virus?
If the caller has traveled to one of the countries where the disease continues to spread, a series of protocols is supposed to kick in, starting with the emergency medical workers’ donning protective gear to limit their risk of infection.
Taking of a travel history by 911 dispatchers is one of a series of measures the city has been using in recent months to prepare for the arrival of the virus, efforts that have been stepped up since last week, when a man traveling from Liberia was told he had the disease in Dallas.
New York officials are also reaching out to the city’s West Africans, encouraging anyone who may be sick and who has been exposed to Ebola in recent weeks to be checked out at a hospital.
Dr. Thomas R. Frieden, the director of the Centers for Disease Control and Prevention, told reporters on Sunday that fear of the virus was not a bad thing.
“For health care workers, we want them to be scared,” Dr. Frieden said. That fear, he said, ensures a healthy respect for the virus that can be channeled into being “incredibly meticulous” about infection control.
New York City officials said they did not want to repeat mistakes made in Dallas, where the patient was at first sent home from a hospital even though he told health care workers that he had recently been in Liberia.
“Identifying potential Ebola cases is not easy or straightforward,” said Dr. Irwin Redlener, the director of the National Center for Disaster Preparedness at Columbia University and a special adviser to Mayor Bill de Blasio.
He said that while the city had done extraordinary work in preparing, it was possible the virus would still find its way here.
“But it won’t be because this city isn’t doing everything possible to keep any situation under control,” he said.
One vital message that needs to be communicated, he said, is letting New York’s West Africans know they can seek medical care regardless of their immigration status or ability to pay.
Since the city’s emergency rooms are one of the first lines of defense against the spread of the disease, hospitals have stepped up their own preparations.
In addition to increased training and education and emergency drills, test patients simulating someone who might have Ebola are being dispatched to assess the reaction of the staffs.
Dr. Ross Wilson, the chief medical officer at the New York City Health and Hospitals Corporation, said that after each test, there is a full debriefing to evaluate performance.
“We are very reassured that most of our training is working very well,” Dr. Wilson said. One area that needed more work, he said, was ensuring that health care workers who do not frequently put on and remove protective gear know how to do it in the best and safest way.
As hospitals are preparing for the possibility of Ebola cases, the federal government is weighing whether to increase its screening efforts at international airports.
The Obama administration is considering sending more screeners to United States airports to check passengers arriving from West Africa for Ebola, a senior administration official said on Sunday.
Even as American officials publicly express confidence about their ability to contain the disease, they are privately weighing a set of more aggressive steps to prevent Ebola’s spread in the United States.
The news comes on the eve of a meeting President Obama is scheduled to hold at the White House with his national security team and other senior officials to receive an update about the Ebola outbreak in West Africa and the United States’ response.
As recently as Friday, senior officials publicly ruled out expanding the screening of passengers arriving from West Africa or imposing a travel ban, which they said would be ineffective or even harm international efforts to combat the spread of the virus by limiting the mobility of medical workers and others who could assist in the response.
Since August, as the disease spread in West Africa, the city’s hospitals and health care workers have been on high alert.
Over the last six weeks, on average, every day one person has gone to a city emergency room and been placed in isolation because of concern the patient might have Ebola. Last week alone, four people were placed in isolation in city hospitals.
Dr. Mary T. Bassett, the city’s health commissioner, said that the health department had consulted with doctors in more than 80 cases and, of those, 11 raised serious concerns.
No one has been found to have the disease and, in all but one of the suspected cases, doctors were able to rule out Ebola without blood tests.
Since September, the city has been able to perform its own tests for Ebola. By not having to send samples to Atlanta, the headquarters of the Centers for Disease Control and Prevention, the city can get results within four to six hours, Dr. Bassett said.
“We have been dealing with this for a couple of months,” she said. “We are confident that we are ready.”
Emergency medical workers face some of the greatest challenges. Frank Dwyer, a spokesman for the New York Fire Department, said that the department decided last week to have its 911 dispatchers ask about travel, he said, because it helps make sure that emergency medical workers know when they are walking into a high-risk situation.
Julie Hirschfeld Davis contributed reporting.
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