Ebola a Threat Beyond Hospital ERs

Oct. 12--The deadly Ebola virus that has killed thousands in Africa and one confirmed person in the U.S. has created a health concern that goes beyond the emergency rooms at hospitals, health experts said.

Health officials said all facilities, including the urgent care centers and small clinics inside drug and grocery stores that have grown quickly here and throughout the country, are vulnerable.

The quick-care centers allow customers to seek treatment for colds, flu and other minor ailments without enduring a long wait at a doctor's office. But the model was never intended to fight serious illness like Ebola, which raises questions about how effectively clinics can prevent the spread of the deadly virus that has killed nearly 4,000 people worldwide.

"If somebody presented (symptoms) in a clinic, the question would be do they have the capacity and how prepared are they for dealing with that on site. That could be a vulnerability," said Ginger Cameron, an epidemiologist and assistant dean at the Cedarville University School of Pharmacy.

The Centers for Disease Control and Prevention, through state and local health departments, has handed down guidelines for managing patients suspected of carrying the Ebola virus to hospitals and clinics across the country. And heightened awareness after the first case of Ebola ever diagnosed in the United States was confirmed in Dallas late last month has put health care providers on high alert.

"In our 24 local Little Clinic locations, nurse practitioners and physicians assistants are taking all necessary precautions in accordance with CDC and health department guidelines," Cincinnati-based Kroger said in a statement. "We will continue to monitor this situation very closely."

The guidelines call for screening patients exhibiting signs of Ebola, such as fever, headache and vomiting, to find out if they recently traveled to one of the Ebola hot zones, including Liberia, Guinea, and Sierra Leone. Anyone with symptoms fitting the travel profile should be immediately quarantined, according to the CDC.

Therein lies the problem for clinics and urgent care centers that do not have dedicated isolation rooms with attached bathrooms and air filtration systems designed specifically to contain infectious viruses.

In addition, store clinics and urgent care centers are often embedded in retail settings that may make it even more difficult to limit customers' potential exposure to infected clinic patients, Cameron said.

"Ebola is spread through direct contact with infected body fluid, so if you just happened to be shopping at the store you would not be at risk," Cameron said. "But if it's a situation where someone comes in and starts vomiting and there's a lot of body fluid exposure, they (stores) may not be able to deal with it the way we would want them to.

"I think medical staff inside the clinics would be prepared, but grocery store employees may not have the same level of training," she said. "They're not going to work thinking about Ebola, so they may not take the same level of precaution."

Simply cleaning vomit from a store isle -- an unsavory but common task at most retail centers with heavy traffic -- could result in the spread of the disease if it was handled by a store clerk not wearing the recommended protective gear, including masks, gloves, gowns, and eye protection.

Also, it would be difficult to determine with whom or how many people the infected patient came in contact as they worked their way through the store to get to the medical clinic, greatly inhibiting the CDC's protocol of "contact tracing," or trying to find everyone who comes in direct contact with a sick Ebola patient so they can be watched for signs of illness for 21 days -- the incubation period for Ebola.

"The more people that frequent a place where the (infected) person has been, the harder that contact tracing is going to be," said Dr. Thomas Herchline, an infectious disease specialist at Public Health -- Dayton & Montgomery County." But the thing that needs to be emphasized is that this disease is not passed on casually."

Nearly 50 individuals who had direct or indirect contact with Thomas Duncan, the Ebola patient who died earlier this week in Dallas, have been quarantined or are still being monitored by CDC officials -- but none have shown signs of Ebola.

The CDC has said that the chances of contracting Ebola are extremely low unless a person has direct, unprotected contact with blood or other body fluids. And the likelihood of an Ebola outbreak in United States similar to outbreaks in Africa are extremely remote because of the health care infrastructure here that allows Ebola patients to be isolated and treated aggressively with supportive therapy and experimental drugs.

So far, Duncan is the only person known to have died of Ebola in the United States, and he was initially sent home from the hospital where he sought help and wasn't treated until he returned days later.

Unlike Duncan, the handful of Americans to be diagnosed with Ebola in Africa and evacuated to the United States were quickly tested and quarantined at the first sign of the disease, and none has died.

Still, Ebola and other infectious diseases will remain a threat for years to come as people continue to travel to and from countries where many diseases that were eradicated in the United States are still prevalent, experts say.

An outbreak of measles and mumps earlier this year that began on the Ohio State University campus and spread through central Ohio was tied to a group of Amish missionaries who acquired to the disease in the Philippines. A similar outbreak in California was also traced back to the Philippines.

Meanwhile, diseases like Middle East Respiratory Syndrome -- a viral respiratory illness that is new to humans and was first reported in Saudi Arabia in 2012 -- has since spread globally, including into the United States.

The only way to contain the outbreak of such infectious diseases and protect the rest of the world is to concentrate resources in their countries of origin, said Theresa Zink, a professor at the Wright State University Boonshoft School of Medicine, who has volunteered on international aid missions with Doctors Without Borders.

"This (Ebola) is an emergency we are responding to now, however, you can't stop it there," Zink said, referring to U.S.-led efforts to help eradicate Ebola from West Africa. "Many of these countries are poor countries, and they don't have any kind of public health or primary care infrastructure. So what we also need to think about is how wealthier nations can partner with the African nations to begin to build those infrastructures and a plan for a basic public health response.

"We have 911 here," she said. "There's nothing like that over there. The closest thing they have is someone who may walk miles to bring their neighbor to a hospital in a wheelbarrow, unannounced."

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