June Physician Focus: Infectious Disease: Fear vs. Evidence

Posted in Ebola, Flu, H1N1, Physician Focus, Public Health on June 10th, 2016 by MMS Communications – Comments Off on June Physician Focus: Infectious Disease: Fear vs. Evidence

The outbreak of an infectious disease is one of medicine’s most difficult challenges.  At the same time that public health agencies must contain the infection, they must also try to quell the public’s fears – a difficult task in today’s world of instant communication, multiple media channels, and constant media attention.  The experiences of Severe Acute Respiratory Syndrome in 2003, H1N1 Bird Flu in 2009, Ebola in 2014, Middle East Respiratory Syndrome in 2014, and now the Zika virus in 2016, are the most recent examples of threats targeting the public health.

June Physician Focus features Dr. Steven Hatch (r), with host Dr. Bruce Karlin

June Physician Focus features Dr. Steven Hatch (r), with host Dr. Bruce Karlin

The June edition of Physician Focus provides some perspective on the topic of media and public reaction to outbreaks of infectious disease through the experiences of Steven C. Hatch, M.D., an infectious disease specialist at UMass Memorial Medical Center and an Assistant Professor in the Division of Infectious Disease at UMass Medical School in Worcester. Hosting this edition is Bruce Karlin, M.D., a primary care physician in Worcester.

In 2014, Dr. Hatch spent five weeks in Liberia with the International Medical Corps treating patients stricken with Ebola and subsequently returned to that country several times to treat patients. Among the topics of conversation are what public health agencies must consider in reacting to infectious disease outbreaks, comments on how the media covered the Ebola outbreak in the U.S., and Dr. Hatch’s perspective on the latest outbreak of Zika.

Physician Focus is distributed to public access television stations throughout Massachusetts, reaching residents in more than 275 cities and towns. It is also available online at www.massmed.org/physicianfocus, www.physicianfocus.org/disease2016, and on YouTube.


Ebola: New Health Care Worker Guidance on Equipment, Testing, and Personal Protection

Posted in Department of Public Health, Ebola, preparedness on October 21st, 2014 by Erica Noonan – Comments Off on Ebola: New Health Care Worker Guidance on Equipment, Testing, and Personal Protection

MMS has updated its website with new guidance for health care workers related to Ebola Virus Disease from the Massachusetts Department of Public Health and the Centers for Disease Control and Prevention.

Ebola Virus

New guidance from the CDC for Personal Protective Equipment  for health care workers treating Ebola patients:

Both the CDC and MDPH guidance reflect one change to the clinical criteria for a patient under investigation for Ebola Virus Disease having a fever of >100.4 °F. Previous guidance for fever was 101.5°F. (Guidance regarding additional symptoms remains: the patient must also exhibit additional symptoms such as severe headache, muscle pain, vomiting, diarrhea, abdominal pain, or unexplained hemorrhage, AND within the 3 weeks prior to the onset of symptoms, either having contact with the bodily fluids of a patient suspected to have EVD, or having traveled from an EVD-endemic region.)

Links to these resources are available at www.massmed.org/ebola, which is updated as new information and guidance is released.

— Robyn Alie

New Ebola Advice for Massachusetts Health Providers 

Posted in Ebola, Public Health on October 15th, 2014 by Erica Noonan – 1 Comment

Ebola virusCDC officials reiterated this week that chances are quite slim that a patient infected with the Ebola virus will appear at a U.S. health facility in need of care during a conference call to offer preparedness guidance to hospitals, physicians, and other caregivers.

Although patients who have recently returned from Ebola-stricken areas of west Africa with complaints of fever are more likely to be suffering from malaria or some other illness, “every emergency department should be prepared for this,” said Alexander P. Isakov, MD, MPH, Director, Prehospital and Disaster Medicine at Emory Healthcare.

There have been no diagnosed cases of Ebola in Massachusetts, said DPH Commissioner Cheryl Bartlett in a separate call for Massachusetts hospitals on Wednesday, but the reported infections of two Dallas health care workers who cared for an Ebola patient “makes us all anxious,” she said.

The state’s hospitals have been doing well in running drills and implementing proper procedures, she said. “The most important thing we can do is communicate, coordinate our efforts and learn from each other,” Bartlett said.

DPH Medical Director Al DeMaria, MD, said the responsibility for diagnosing and treating Ebola cannot be placed only on large medical centers.  “We have to take care of these patients where they turn up,” he said. The Massachusetts state laboratory is one of 16 labs nationwide equipped to test for Ebola, and results can be obtained in 4-6 hours.

Comprehensive Initial Patient Screening – State and federal officials recommend health providers ask patients who present with possible symptoms of Ebola the following: “In the past three weeks, have you traveled outside the U.S. If so, where?”

If the patient has traveled to a location with an Ebola outbreak, he/she should be moved to a private room, and contact with other patients and staffers limited. Asking about travel history is a useful healthcare routine in general, said Dr. DeMaria “There are lots of diseases where travel can be a component.”

Prepare Your Staff – CDC officials recommend all health care staffers be briefed on proper infection-control procedures, and all facilities designate point persons to handle patients who could be at risk of Ebola. This limits possible protocol breaches, and unnecessary exposure to other staffers and patients.

Obtain Proper Equipment – The CDC recommends all facilities obtain an adequate amount of personal protective gear for staff, and all staff receive training on proper donning and doffing procedures. See CDC links to information on hospital preparedness.

Contact Public Health Officials ­– The DPH said providers with concerns or questions should consult local health authorities, or the DPH directly at its 24/7 Epidemiology Hotline at (617) 983-6800. More DPH Ebola online resources.

Communicate Ahead of Time with Your Vendors – Consider how you would transfer a possibly infectious patient, if needed. Officials recommend providers consider the following questions: Is your ambulance/transport company prepared to handle a patient possibly infected with Ebola?  Are you able to conduct needed procedures safely and do you have a testing company with proper protocols in place?

Is your waste disposal company prepared to dispose of any medical waste related to the patient’s visit? These are questions that should be answered “before the first patient comes through the door” said Bruce S. Ribner, MD, MPH, Director, Emory’s Serious Communicable Disease Unit.

 — Erica Noonan


Ebola Outbreak Underscores the Benefits of Preparedness

Posted in Ebola, preparedness, Public Health on August 26th, 2014 by MMS – Comments Off on Ebola Outbreak Underscores the Benefits of Preparedness

Paul Biddinger, MDBy Dr. Paul Biddinger

The Ebola outbreak currently befalling several West African countries is the most serious outbreak to date.

The outbreak has claimed more than 11,000 lives,* has yet to be contained, and has certainly generated much anxiety, especially among health care workers. While there is no doubt that the Ebola outbreak is serious, it is also important to know the facts about the disease in order keep the threat from Ebola in perspective.

Experts agree that Ebola is not likely to become a pandemic.  In contrast to other viruses such as influenza, SARS and MERS, Ebola is spread only through direct contact with the blood or body fluids from an infected person or animal, not through the air.

Additionally, the virus is only transmitted when patients are symptomatic, making control of the virus more manageable. Unfortunately, the current outbreak is happening in some of the poorest countries in the world with the fewest number of doctors, and in cities with much larger concentrations of people than in previous occurrences, which has made the current situation very difficult to control.

It is very important that clinicians know what to look for and how to manage the virus. Since the initial symptoms are nonspecific, it is essential to obtain a detailed travel history from all patients and additionally ask about potential exposures to infected persons or animals. Early recognition that a patient may be infected with Ebola is critical in order to implement appropriate isolation and personal protective measures.

Understandably, there has been confusion about which facilities can care for patients who may be infected with Ebola. In the modern world, a patient who has been infected with Ebola could present to any hospital.

Therefore, all hospitals must be prepared to recognize potential suspect cases, isolate patients, and teach staff how to properly don and doff personal protective equipment.  Because lab testing and other issues may be complex, hospitals should review the available CDC guidance on how hospitals can safely manage patients with Ebola.

The Ebola epidemic underscores that preparedness efforts are needed every day, and are crucial to responding to any threat to the public health system. The best thing we can do is use this opportunity to review our infection-control measures, strengthen our capacity for detecting and managing infectious disease, and continue to engage the community in proper prevention and containment practices.

* As of May 30, 2015

Paul Biddinger, MD, is chair of the Massachusetts Medical Society’s Committee on Preparedness. He is vice chairman for Emergency Preparedness in the Department of Emergency Medicine at Massachusetts General Hospital, and director of the Emergency Preparedness and Response Exercise Program at the Harvard School of Public Health.