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 PreparednessDavid.Trump@vdh.virginia.gov804-864-7025

Bob Mauskapf, Director Emergency Preparedness Bob.Mauskapf@vdh.virginia.gov 804-864-7035

Cindy Shelton, Assistant Director, Emergency PreparednessCindy.Shelton@vdh.virginia.gov 804-864-7486

Jennifer FreelandVDH State Volunteer CoordinatorJennifer.freeland@vdh.virginia.gov 804-396-0543

Kim Allan, Operations DirectorKim.Allan@vdh.virginia.gov804-864-7030

Suzi Silverstein, Director, Risk Communications and Education Suzi.Silverstein@vdh.virginia.gov840-864-7538

Kevin Pannell, State Hospital Coordinator kevin.pannell@vdh.virginia.gov 804-864-7033

General Info / Contacthttp://www.vdh.virginia.gov/OEP/