The Pertinent Information In regards to the ongoing Ebola outbreak, - - PowerPoint PPT Presentation

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WorldAware Solutions

Ebola

The Pertinent Information

In regards to the ongoing Ebola outbreak, there are four concepts organizations should consider when developing risk mitigation plans:

• Understand the risk: Why Ebola is spreading
• Prepare personnel against risk
• Monitor risks and advise personnel on any changes
• Have a response mechanism in place

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What is Ebola Virus?

• Zoonotic virus – bats the most likely reservoir, although species unknown
• Spillover event from infected wild animals (e.g., fruit bats, monkey, duiker) to

humans, followed by human-human transmission

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What is Ebola Virus?

• Ebola Virus Disease (EVD) or Ebola Hemorraghic Fever (EHF) first emerged in

Sudan and Zaire on the continent of Africa in the 1970’s

• >20 previous Ebola and Marburg virus outbreaks since emerged – NONE as

severe as the current outbreak in West Africa.

• 2014 West Africa Ebola outbreak caused by Zaire ebolavirus species (five

known Ebola virus species)

• 2 separate outbreaks of EVD:

– Western Africa – Dec 2013

• Guinea
• Liberia
• Sierra Leone
• Nigeria (localized transmission)
• Senegal (travel-associated)
• Mali

– Central Africa – Aug 2014

• Democratic Republic of Congo

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Ebola Free?

• 42 DAYS since last case tested negative twice

– 11/21/2014 – Democratic Republic of Congo Ebola free

• Total Case Count: 66
• Laboratory Confirmed Cases: 38
• Total Case Deaths: 49

– West Africa

• Total Cases: 21,206
• Laboratory-Confirmed Cases: 13,430
• Total Deaths: 8,386

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Outbreak Distribution Map: 1976 - 2014

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West Africa Distribution Map

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West Africa Distribution Map

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West Africa Outbreak – Cases Update (Jan 10, 2015)

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Country Total Cases Laboratory- Confirmed Cases Total Deaths Guinea 2,799 2,508 1,807 Liberia 8,278 3,123 3,515 Sierra Leone 10,094 7,766 3,049 Total 21,171 13,397 8,371 Mali 8 7 6 United Kingdom 1 1 Total 9 8 6 Nigeria 20 19 8 Senegal 1 1 Spain 1 1 United States 4 4 1 Total 26 25 9 Countries with Widespread Transmission Countries with Initial Case or Cases and/or Localized Transmission Previously Affected Countries

Why Ebola is Spreading – West Africa

• Lack of Healthcare Infrastructure/Faulty Protocols

– Ebola pathogens are highly concentrated in the blood, vomit, and fecal matter of those infected. Access to basic medical supplies (gloves, gowns, etc.) that aid in reducing risk of spreading the virus is limited in West Africa. Faulty protocols, or the faulty implementation of protocols, have resulted in the spread of the virus outside West Africa (e.g. USA)

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• Lack of Education

– Not understanding how Ebola is spread – Not understanding appropriate quarantine measures

• Cultural Practices

– Burial practices that include ritual bathing of the deceased (handling of infected corpses) – Belief in ‘healers’ and miracle remedies

Ebola – Signs and Symptoms

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Ebola – Signs and Symptoms

• Symptoms appear approximately 2-21 days after exposure

to the virus.

– The average is 8-12 days – For the current outbreak it is 9-11 days

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• Human-to-human

transmission by direct contact

– No human-to-human transmission via inhalation (airborne) – No transmission before symptom

• nset

Ebola – Signs and Symptoms

• A person MUST have signs and symptoms in order to be
• contagious. They are:

– Fever (>100.4˚F)

AND

• Severe headache
• Muscle pain
• Weakness
• Diarrhea
• Vomiting
• Abdominal (stomach) pain
• Unexplained hemorrhage (bleeding or bruising)

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Treatment

• No FDA-approved vaccine or medicine (e.g., antiviral drug) is available

for Ebola.

• Symptoms of Ebola and complications are treated as they appear.

– The following basic interventions, when used early, can significantly improve the chances of survival:

• Providing intravenous fluids (IV) and balancing electrolytes (body salts).
• Maintaining oxygen status and blood pressure.
• Treating other infections if they occur.
• Experimental vaccines and treatments for Ebola are under

development, but they have not yet been fully tested for safety or effectiveness.

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CDC Increasing PPE Supply

• $2.7 million in new personal protective equipment (PPE) to increase

Strategic National Stockpile (SNS)

• Configured into 50 kits that can be rapidly delivered to hospital

– impermeable gowns, coveralls, and aprons; boot covers; gloves; face shields and hoods; N95 respirators; powered-air purifying respirator systems and ancillaries; and disinfecting wipes

• Hospitals coordinate with State Public Health Depts if additional PPE

needed

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Travel Management – Prepare Personnel Against Risk

• Risk Assessment – Establish a risk tolerance as an organization
• Create a safe travel policy
• Determine whether all but essential travel should be deferred
• Create benchmarks for evacuation/relocation
• Establish an Ebola Task Force
• Educate employees on Ebola (e.g. symptoms, methods of transfer,

etc.)

• Establish risk mitigation/prevention measures

– Infectious Disease Protocols / Bloodborne Pathogens – Body heat screening test

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CDC Travel Notice – Ebola affected countries

LEVEL 3

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CDC Travel Notice Definitions

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Warning Level 3, Avoid Nonessential Travel Alert Level 2, Practice Enhanced Precautions Watch Level 1, Practice Usual Precautions

CDC Travel Notice Definitions

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Notice Level Traveler Action Risk to Traveler Outbreak/Event Example Level 1: Watch

Reminder to follow usual precautions for this destination Usual baseline risk

• r slightly above

baseline risk for destination and limited impact to the traveler Dengue in Panama-Outbreak Watch: Because dengue is endemic to Panama, this notice most likely would signify that there is a slightly higher rate of dengue cases than predicted. Travelers are to follow “usual” insect precautions. Olympics in London-Event Watch: There may be possible health conditions in London that could impact travelers during the Olympics, such as measles. Travelers are to follow usual health precautions making sure they are up to date on their measles vaccine, follow traffic safety laws and use sunscreen

Level 2: Alert

Follow enhanced precautions for this destination Increased risk in defined settings or associated with specific risk factors Yellow Fever in Brazil-Outbreak Alert: Because an outbreak of yellow fever was found in areas of Brazil outside of the reported yellow fever risk areas, this would be a change in “usual” precautions. Travelers should follow “enhanced precautions” for that risk area by receiving the yellow fever vaccine. Flooding in El Salvador-Event Alert: There are possible conditions that could affect the health of the traveler and parts of the destination’s infrastructure could be compromised. Travelers are to follow special precautions for flooding

Level 3: Warning

Avoid all non-essential travel to this destination High risk to travelers SARS in Asia-Outbreak Warning: Because SARS spread quickly and had a high case fatality rate, a warning notice signifies there was a high chance a traveler could be infected. Travelers should not travel if possible. Earthquake in Haiti-Event Warning: The destination’s infrastructure (sanitation, transportation, etc.) cannot support travelers at this time.

Have a Response Mechanism in Place

• No response organizations will evacuate a symptomatic person from infected

areas unless coordinated with government approval for immediate treatment

• Most commercial international airlines will not fly into Ebola-infected countries.
• Some response organizations have medical personnel on the ground who can

assist

• Self-Monitor/Quarantine
• Alert Public Health Officials

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Travel Management

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“… international evacuation of patients with Ebola or other Viral Hemorrhagic Fevers is highly complex. International evacuation for patients with active clinical symptoms of Ebola is extremely limited and may not be achievable if patients have any uncontrolled body fluids, such as vomiting, diarrhea or bleeding.”

CDC – Ebola Monitoring Guidelines

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http://www.cdc.gov/vhf/ebola/exposure/monitoring-and-movement-of-persons- with-exposure.html

Travel Management

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• Do you Risk Manage Travel?
• Education and Awareness – reduce risk during travel
• Are communication methods established for travelers?

– Travel alerts and notifications – Recalls / Evacuation Procedures – Emergency Contacts

• Non-US facilities and staff ?
• Key 3rd Parties ?

Travel Management

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Ebola and My Work Place

• Low Risk to US Workforce
• OSHA “at risk industries”:

– Healthcare workers; – Airline and other travel industry personnel; – Mortuary and death care workers; – Laboratory workers; – Border, customs and quarantine workers; – Emergency responders; and – Workers in critical infrastructure/key resource sectors. – Employers in these industries need to immediately review their infectious disease protocols and ensure that such protocols are up to date and are disseminated to all workers. – The Occupational Safety and Health Administration has published extensive guidelines addressing each of these at-risk industries, which can be found at: https://www.osha.gov/SLTC/ebola/control_prevention.html

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My Work Place - Duty of Care

• General Duty Clause of the OSH Act – 29 USC 654(a) – SEC. 5.

Duties (https://www.osha.gov/pls/oshaweb/owadisp.show_document?p_id=3359&p_table=oshact)

– (a) Each employer –

• (1) shall furnish to each of his employees employment and a place of

employment which are free from recognized hazards that are causing or are likely to cause death or serious physical harm to his employees; (2) shall comply with occupational safety and health standards promulgated under this Act. – (b) Each employee shall comply with occupational safety and health standards and all rules, regulations, and orders issued pursuant to this Act which are applicable to his own actions and conduct.

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Duty of Care

• Practical Implications from a Safety Director

– OSHA Guidelines – Infectious Disease – Bloodborne Pathogens – Modify to include Ebola as appropriate – Ensure training is current – Are there employees or duties that should receive additional training

• Monitor government communications and updates

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Response Mechanisms

• Questions or Potential Case Presents

– Contact South Carolina Public Health Dept: 1-803-608-6014 – If Public Health officials can’t be reached call CDC-INFO: 1-800-232-4636

• Internal Protocols

– Ebola Task Force – Travel Management Policy – OSHA Toxic & Hazardous Materials – Bloodborne Pathogens Guidelines: https://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=STANDARDS &p_id=10051

• Decontamination

– Public Health Dept / CDC – potential contamination clean-up requirements – Effective Disinfectant Products (hard, non-porous surfaces): http://www.epa.gov/oppad001/list-l-ebola-virus.html

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Susceptibility to Disinfection / Sterilization

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http://www.cdc.gov/vhf/ebola/prevention/cleaning-and- decontamination.html

Monitor Risks and Advise Personnel on any Change

• Utilize the Ebola Task Force to maintain situational awareness
• Update pertinent Ebola documents on a weekly or bi-weekly basis
• Create and utilize a communication network so key decision-makers are

apprised of any updates to the situation

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Assessing the Risk

• Hard assets in or near affected countries
• Travel exposures

– Essential business travel ?? – Personal travel – mission/volunteer to affected countries for example

• 3rd Parties / Business Associates

– Travelers / Visitors / Customers – Supply chain – business dependencies in affected countries for example

• Employment Issues

– Safe Workplace (OSHA – General Duty Clause - – Privacy – ADA / HIPAA – NLRA or protected activities (http://www.nlrb.gov/resources/national-labor-relations-act)

• Business Risks / Business Continuity

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Insurance Response

• Insurance response

– Workers Compensation – Professional, General & Product Liability – Property Damage – Business Interruption – Environmental / Pollution – Privacy & Security – Directors & Officers Liability

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Workers Compensation - Scenario

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• Jim runs the mailroom at Nobola, Inc. He hasn’t traveled outside Pickens

County, SC in his entire life. He comes to work on Monday and begins having a fever and not feeling well. He eventually goes home with a headache and some body aches. After going to the doctor a couple of days later he is diagnosed with Ebola.

• While Jim was at work he infected another employee?

Workers Compensation - Scenario

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• Sally is Nobola’s Global Director of Supply Chain Quality and Compliance.

She travels globally including Europe, Middle East, Africa and Asia monitoring supply quality and labor standards at Nobola’s suppliers. She recently returned from a trip to Europe where she met with regional suppliers to discuss new quality standards.

Workers Compensation - Scenario

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• A major Nobola supplier from Sierra Leone requests Sally visit them next week

to discuss some supply issues. Nobola decides Sally needs to go. Sally returns and after a couple of weeks she gets a fever and headache.

– Low Risk – Non-direct monitoring but no travel or work restrictions by health dept / CDC

• Employees don’t want to work if Sally comes to work?
• Sally begins to show symptoms?
• Sally is diagnosed with Ebola?
• Sally’s husband get’s Ebola?

Professional, General & Product Liability

A $500 million lawsuit was filed on Wednesday 11/5/14 against Kimberly-Clark alleging the company falsely claimed its surgical gowns protected against Ebola and other infectious diseases. The lawsuit alleges that many of the gowns tested had "catastrophic" failures and that they are aware of individuals that have contracted various diseases while wearing the gowns.

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Property Coverage

Property Damage – “direct physical loss or damage to covered property at the insured premises caused by or resulting from a covered cause of loss.” Business Interruption – loss of business income resulting from covered direct physical loss or damage to the insured’s property Interruption by Civil Authority – may or may not have trigger of physical loss or damage of type insured; other triggers may apply such as where the damage

• ccurred

What constitutes “physical loss or damage”?

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Property Coverage - Example

This Policy Excludes:

loss from enforcement of any law or ordinance: a) regulating the construction, repair, replacement, use or removal, including debris removal, of any property; or b) requiring the demolition of any property, including the cost in removing its debris; except as provided by the DECONTAMINATION COSTS and DEMOLITION AND INCREASED COST OF CONSTRUCTION coverages of this Policy.

This Policy excludes the following unless directly resulting from other physical damage not excluded by this Policy:

contamination, and any cost due to contamination including the inability to use or

• ccupy property or any cost of making property safe or suitable for use or
• ccupancy. If contamination due only to the actual not suspected presence of

contaminant(s) directly results from other physical damage not excluded by this Policy, then only physical damage caused by such contamination may be insured.

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Property Coverage - Example

Decontamination Costs (coverage extension) – If insured property is

contaminated as a direct result of insured physical damage and there is in force at the time

• f the loss any law or ordinance regulating contamination due to the actual not suspected

presence of contaminant(s), then this Policy covers, as a direct result of enforcement of such law or ordinance, the increased cost of decontamination and/or removal of such contaminated insured property in a manner to satisfy such law or ordinance. This Additional Coverage applies only to that part of insured property so contaminated due to the actual not suspected presence of contaminant(s) as a direct result of insured physical damage.

Contamination (definition):

any condition of property due to the actual or suspected presence of any foreign substance, impurity, pollutant, hazardous material, poison, toxin, pathogen or pathogenic organism, bacteria, virus, disease causing or illness causing agent, fungus, mold or mildew.

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Property Coverage - Example Civil or Military Authority – Time Element

This Policy covers the Actual Loss Sustained and Extra Expense incurred by the Insured during the Period of Liability if an order of civil or military authority prohibits access to the insured location provided such order is the direct result of physical damage of the type insured at the insured location or within five statute miles/eight kilometres of it.

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Property Coverage - Example

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• Exclusion
• Definition
• Extension

Healthcare Environmental/Pollution Coverage - Example

“Pollution condition” means:

• 1. The presence of “fungi” or legionella pneumophila;
• 2. “Illicit abandonment”; or
• 3. The discharge, dispersal, release, escape, migration, or seepage of any

solid, liquid, gaseous or thermal irritant, contaminant, or pollutant, including smoke, soot, vapors, fumes, acids, alkalis, chemicals, hazardous substances, hazardous materials, or waste materials, on, in, into, or upon land and structures thereupon, the atmosphere, surface water, or groundwater. For the purpose of this definition, waste materials include, but are not limited to, “low-level radioactive waste”, “mixed waste” and medical, red bag, infectious or pathological wastes.

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Healthcare Environmental/Pollution Coverage - Example

“Facility-borne illness event” means the presence of a facility-borne infectious virus, bacteria or disease at a “covered location”; provided that such facility-borne infectious virus, bacteria or disease is not:

• 1. Naturally occurring in the environment in amounts and concentrations

discovered at the “covered location”; and

• 2. Solely or exclusively the result of communicability through human-to-

human contact

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Privacy – ADA / HIPAA

• Nebraska Medical Center fired two workers for inappropriately accessing the

medical records of Ebola patient

• (CBS Charlotte) Charlotte, N.C. – The Mecklenburg County Health

Department issued a report over the weekend informing the community that a SIM missionary is being monitored for Ebola in Charlotte.

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REMEMBER

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More Americans have been married to Kim Kardashian that have died from Ebola