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Preparing For Ebola At Vermont's Largest Hospital

A Fletcher Allen employee works under a wall of screens monitoring patients' heart conditions on October 6. Dr. Kemper Alston says the hospital is prepared for the potential arrival of Ebola in Vermont.

By now you are no doubt familiar with the news that several West African countries are suffering from an outbreak of the potentially deadly Ebola virus. That awareness, depending on how you react to media coverage of the epidemic, may have morphed to concern, anxiety, or — hopefully not — panic, after a man in Dallas came down with the virus following his travels to Liberia and back to the U.S.

Dr. Kemper Alston is an infectious disease physician and Medical Director of Infection Prevention at Fletcher Allen Health Care. In a recent blog post, he laid out what Vermonters need to know about Ebola.

“This is unique just because of its sheer size and magnitude,” Alston said. Ebola outbreaks have been documented since 1976, and a lot is known about the virus and how it’s transmitted. What’s different this time, Alston said, is that earlier outbreaks were in rural areas, and this one is in urban areas. “Therefore the potential for transmission has been greater.”

"We're operating under the assumption that we'll get somebody. We might get someone ... who's traveled to those countries [Guinea, Sierra Leone and Liberia], or we might get a U.S. health care worker who is returning ill after volunteering in West Africa." - Dr. Kemper Alston

There’s no specific treatment or vaccine for Ebola, which Alston noted is true for many viruses. But he expects a vaccine to be available within the next year or two.

“The treatment that’s provided is really just supportive care, fluids, electrolytes, temperature control, oxygen. It’s really just basic supportive care. And it’s interesting to see how people will do and how they survive in American hospitals as compared to those facilities in Africa where the resources are just so strictly limited,” Alston said.

Alston said it’s likely that Fletcher Allen will treat an Ebola patient.

“We’re operating under the assumption that we’ll get somebody. We might get someone unexpectedly who shows up with a fever who’s traveled to those countries [Guinea, Sierra Leone, and Liberia], or we might get a U.S. health care worker who is returning ill after volunteering in West Africa. We’re operating under the assumption that this outbreak isn’t going to end anytime soon, and we have to be ready to deal with it.” Hospital staff is having regular meetings, and the hospital has the equipment needed to deal with infected patients. He wrote:

“Preventing transmission does not require high-tech equipment that is not routinely available. Simple barriers, such as gowns, gloves, masks and eye protection are what is required.”

But just because Fletcher Allen is prepared, does not mean people should be overly anxious. Contracting Ebola requires direct contact with someone with the virus, and Alston wrote it is not an airborne disease.

“It is spread by direct contact with the bodily fluids or tissues of a person who is ill. This fact means that widespread transmission in the U.S. is very unlikely to occur. Body fluids include saliva, mucus, vomit, feces, sweat, tears, breast milk, urine, and semen.”

“Passing someone on the street, entering the room they are in, sitting on a bus with them, you’re not going to contract Ebola,” he explained.

This week, the hospital is talking about instituting systematic screening for fever and travel for all emergency room visits. The practice would then spread to all primary care offices.

"For the average Vermonter in the community, this poses absolutely no risk."

“We haven’t done that yet, because we haven’t thought that the risk justified that. But after what happened in Dallas where they missed the travel history or the travel history wasn’t communicated very well, we’re actively talking and we’ll probably this week institute screening all of our emergency room visits with a fever to see if they’ve traveled to West Africa within 21 days,” Alston explained.

While they are prepared for a case of Ebola, an epidemic is very unlikely, Alston wrote:

“The epidemic nature of the disease in West Africa reflects a complex interplay of factors that do not exist in the U.S. An epidemic of Ebola in this country is extremely unlikely. Having said that, with the sheer number of infected persons in West Africa, it is nearly certain that more cases will arrive in the U.S.; they need to be promptly recognized, diagnosed, and isolated.”

Alston said the heightened awareness of Ebola is a good thing, but the price is anxiety. Medical providers at Fletcher Allen have seen that reflected in the questions people ask about the virus. 

“I heard last week that someone was scared to travel to Dallas,” he said. “You have to overcome and be realistic about this. I think the real issues for the health care system within Fletcher Allen if we had to care for a patient like this, we just have to make sure the processes are in place. For the average Vermonter in the community, this poses absolutely no risk.”