Isles on heightened alert for Ebola despite low risk

Though the state has ruled out what was feared to be Hawaii’s first Ebola case, health officials are on high alert for possible new cases reaching the islands.

"This was sort of a good test run for us," said state Department of Health Director Linda Rosen. "I would predict that we would have another one, but how many people in Hawaii have traveled to Africa?"

State officials contend Hawaii is at low risk for Ebola but are taking precautions to ensure hospitals, doctors, medical hotlines and community health centers screen patients and follow proper procedures if someone who traveled to West Africa and has a fever or other symptoms is identified.

On Thursday the agency determined that a man hospitalized in isolation at the Queen’s Medical Center did not meet the criteria for testing for Ebola.

The Health Department will begin an informational campaign Friday to educate the public about the disease on its website.

"We’re going to be on heightened alert because of what the global community is dealing with and because we do welcome travelers from around the world," said Senate Health Chairman Josh Green (D, Naalehu-Kailua-Kona), an emergency room doctor at Kohala Hospital on Hawaii island. "Many thousands of people will die of the regular flu this year than tragically will die of Ebola. Many individuals in the next few months will have fevers and flu, but obviously they won’t have to be screened for a rare infectious disease unless they have the profile of risk."

One concern is the incubation period for the deadly disease that has killed at least half of those infected is up to 21 days after exposure.

Ebola symptoms include fever, severe headache, muscle pain, weakness, diarrhea, vomiting, stomach pain or unexplained hemorrhaging. The disease is transmitted through direct contact with bodily fluids and is not contagious if a person doesn’t have symptoms, DOH said.

"Primarily the biggest thing about Ebola that’s so concerning is it’s so serious and the fatality rate is so high, and we don’t have effective treatment we can rely on," Rosen said. "We don’t have anything at this point solid besides good, supportive hospital care."

Toby Clairmont, director of emergency services at the Healthcare Association of Hawaii, representing hospitals and long-term care facilities, said the group is working to implement statewide procedures recommended by the Centers for Disease Control and Prevention to identify patients who have recently traveled to Guinea, Liberia, Nigeria or Sierra Leone, the affected African countries.

"The single most important thing they can do is ask the travel history question and, if they do identify a case, immediately put the person into isolation. This is occurring all over the country right now," Clairmont said. "We think the risk is very low, but it’s not nonexistent. The thing about Ebola is it has a relatively long incubation period … which means it can move around the world in airplanes."

Clairmont said his group has accumulated a massive stock of personal protective gear that can be used in an outbreak for an estimated 80,000 health care workers.

Dr. James Ireland, medical director of the state Department of Transportation at Honolulu Airport, said transportation officials have vigilantly screened sick passengers for infectious diseases for more than five years.

If someone on a flight is ill, the airline crew radios the airport even before the plane lands so that paramedics and state firefighters can board the plane before anybody gets off and immediately assess the person.

Paramedics have the ability from the plane to contact the CDC, and at that point the agency would determine whether the person needs to be quarantined, he said.

"Even though this policy’s been in place more than five years, we just re-emphasized travel history, especially coming from Africa,"Ireland said. "Flu, Ebola and many other infectious diseases like malaria all have similar symptoms."

Tai-ho Chen, the CDC’s quarantine medical officer at the airport, said the federal agency is ramping up efforts to educate local airline and U.S. Customs and Border Protection workers on signs of Ebola.

"We have additional guidance that’s gone to airlines and additional training for Customs and Border Protection specifically related to Ebola,"he said. "In addition to the ongoing routine work, we support exercises that help prepare the state for the response for Ebola coming in through the airport."

The CDC has the authority to isolate people for a number of communicable diseases, including Ebola. Local CDC officials are on hand to evaluate potential cases at the airport and take phone consultations for Guam, theMariana Islands and American Samoa.

There’s no cure or vaccine for the disease, and testing for Ebola is only done at the CDC offices in Atlanta. But "Hawaii’s so low in terms of risk," said Melissa Viray, deputy division chief for the DOH’s Disease Outbreak Control Division. "We’re not very high on the list of states very likely to see a true case."

Treatment, not specific to the disease, includes replacing bodily fluids and blood and using medications for conditions that arise such as high blood pressure, she said.

"I really don’t think it is a risk to the public," Rosen added.