Ebola virus disease Keep Safe, Keep Serving Ebola and the Academic - PDF document

5/22/2015 Ebola virus disease “Keep Safe, Keep Serving” Ebola and the Academic Medical Center Response Disclosures • None 1

5/22/2015 Contributions • Hernando Garzon, MD • Ami Waters, MD • Ethel Wu, MD Roadmap • Background on Ebola • Keep Safe, Keep Serving 2

5/22/2015 Viral Hemorrhagic Fevers 3

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5/22/2015 Transmission – Contact, Droplet, Airborne 5

5/22/2015 How infectious is Ebola, really? 6

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5/22/2015 Clinical course Ebola PCR, and Ab ELISA 8

5/22/2015 Ebola Outbreaks – Key Interventions • Case Identification - Early • Transportation – Safely • Isolation – prevents transmission • Care – Supportive- Can we do more? (Mortality – Africa 60-70%, US/EU 21%) • Contact Tracing – Identifies new cases early • Safe Burials – 50% of infections happen with handling dead bodies • Health Promotion – Outreach and education of prevention measures Care - Supportive • Standing orders – Hydration (ORS vs IV) - >2-3 liters/d – Co-Artem x 3d – Cefixime x 5d – Tylenol, Omeprazole • Limited symptomatic care – Antiemetics, Narcotics, Anxiolytics, etc. • Diagnostics – Ebola PRC – Malaria RDT – iSTAT or lab supported Lytes, CBC, LFTs 9

5/22/2015 Ebola Treatment Units - Structure Ebola Treatment Unit – 80-100 Beds • Human Resources – 80-120 staff (10-15 or more international) • 30-45 clinical staff (MDs, RNs, etc) • 40-80 support staff (hygienists, logistics, psychosocial, drivers, cooks, burial teams, etc) – >100 more peripheral support staff • Water – 100 liters/pp/pd (2500 gallons per day) • Chlorine – 0.7kg/pp/pd (70 Kg per day) (6 tons over 6 months) • PPE – 100 suits, hoods/pd 10

5/22/2015 ETU work environment • Working in full PPE – 45-60 minutes work cycle – High temp and humidity environment – Challenge with hearing, vision, dexterity, documentation, communication – 1.5 liter sweat loss in 60 minutes! • Ave 2 cycles in treatment area per shift • No continuous monitoring or meds (IV) • Very limited monitoring (VS, diagnostics) Treatment outside west Africa 11

5/22/2015 Ebola Mortality West Africa – 60-70% Elsewhere – 21% (5/24) 12

5/22/2015 Non Ebola Consequences of Ebola • Indirect Mortality - Untreated/undiagnosed Medical problems – Estimates of one preventable medical death for every Ebola death • Food Security – Farms abandoned, decrease food availability • Child Protection – >3000 orphaned children • Stigmatization/Distrust – Recovered patients with reintegration issues. Workers shunned by communities • Restricted Travel • Economic collapse – Estimate of $2 Billion lost in trade, commerce, etc Roadmap • Background on Ebola • Keep Safe, Keep Serving 13

5/22/2015 UCSF Global Health Fellowship: Going to the Last Mile 14

5/22/2015 The Canary in the Coal Mine: Ebola Virus “The reasons to shore up health systems between epidemics are both moral and those of vital self- interest. Ebola is signaling a new call to action. We ignore this canary at our own peril. ” --2013-14 UCSF Global Health Fellow Alexandra Stanculescu, MD, blog post May 2014 A Stand in Solidarity “The idea that some lives matter less is the root of all that's wrong with the world .” - Paul Farmer 15

5/22/2015 From Paper to Practice Rivercess County • No ETU • Lack of infrared thermometers, PPE at facilities • Community Disbelief of Ebola and rampant myths of its spread • Lack of trust of healthcare workers • Inadequate community awareness on Ebola Viral Disease (EVD) • Very remote with poor road conditions 16

5/22/2015 Protecting those who Serve: Healthcare workers • In Liberia, 370 health care workers infected • 178 of these died • 28% of workers never trained in IPC • 26% uncomfortable with identification of a suspected Ebola patient Introducing Concepts & Putting into Practice • Ebola Basics and Context of Outbreak • Triage and Isolation Practices • Donning and Doffing PPE • Chlorine Preparation • Waste Management 17

5/22/2015 Small Group Exercises Building Confidence 18

5/22/2015 Taking it one step further Facility Mapping and Action Plans 19

5/22/2015 Keep Safe, Keep Serving • 200 Healthcare workers • 40 health facilities • Two counties • Participants scored 91% on the post-test • Monthly follow-ups • Centralized training is NOT enough, requires ongoing mentorship and supervision “I learned a lot about Ebola I have never learned before. It is my first time.” “I would like to see the training established in all districts.” “I like this training and I want to see change in the “Ebola Virus kills. near future.” We need more training days.” “I would like to see regular supply of equipment for facility such as PPE and constant training on Ebola.” 20

5/22/2015 Applying concepts Identifying limitations 21

5/22/2015 The End of a Mission? Or the Beginning of Another? Questions? 22