Fever to trigger visitor isolation in Ebola plan

(CNS): Following the cruise ship Ebola scare, last week, local officials have now revealed their plan to deal with the possible entry of the deadly virus into Cayman. Although the public health boss had indicated that it may be November before the hospital would be in a position to deal with any cases of the disease, should it find its way to these shores, following the news that a Texas health care worker who may have been exposed to the virus was on board a cruise ship in the region, government has picked up the pace on its plan and says any visitors from the West African region with a fever will be isolated.

Lizzette Yearwood the Health Services Authority’s chief executive officer said travellers arriving from any destination who have fever will be treated as suspect cases, until confirmed positive for Ebola.

“Plans are also in place for the isolation and management of such cases until a full-fledged field unit can be arranged,” she said in release from the health ministry. “We are procuring adequate protective gear for Cayman Islands Hospital staff, and have organised training in all aspects of the management of the virus with the support of an overseas health facility. We are confident we can manage if the need arises,” she added.

Bruce Smith, the Deputy Chief Immigration Officer said his office is actively taking measures to identify passengers by way of a traveller’s questionnaire which asks specifically about travel to West Africa within the past four weeks of their arrival in the Cayman Islands. The department will notify the Health Services Authority (as per protocol), where any have been to Guinea, Sierra Leone, Liberia or Nigeria.

Although the chances of the disease arriving in Cayman are still narrow the movement of healthcare workers in the United States, that have been exposed to the virus since it arrived in Texas, makes the possibility less remote.

The health minister said he was pleased that the cruise ship on which a lab technician who had handled blood samples with the virus was travelling had headed back to Texas. The Carnival Magic which was refused entry into both Belize and Mexico, had been in Cayman just two weeks ago and was due to arrive here this week.

“I am happy that the Carnival ship that was due here next week has gone back to home port, and so far we have not been exposed at any of our ports of entry,” Osbourne Bodden said. “Stakeholders are working hard to ensure that the Cayman Islands remains free of the virus, or that any outbreak is quickly contained. An emphasis has been placed on ensuring that staff at stakeholder agencies are both trained and informed about the disease.

“Government is also monitoring the situation in Guinea, Sierra Leone, Liberia and Nigeria, although the outbreak in that country appears to be contained,” the Minister added.
Officials from 13 agencies are now said to be “working together robustly, to mitigate against the threat of the Ebola virus,” as it has now reached the United States. Members include Public Health, Health Services Authority, Ministry of Health, Ministry of Home Affairs, Hazard Management Cayman Islands, Environmental Health, the Royal Cayman Islands Police Service, the Cayman Islands Airports Authority, the Port Authority, Immigration, Customs, the Department of Tourism and Government Information Services.

Stakeholders have been refining existing preparedness plans and procedures to satisfy the protocols necessary for successful containment of the virus. Some areas under consideration by the Ebola planning committee have included: entry screening protocols; personal protective equipment (PPE); contact tracing; and contingency plans that cover issues such as transportation, isolation/quarantine, case management and infection control measures.

Medical Officer of Health, Dr Kiran Kumar, who heads the committee said the cooperation was extremely productive.  The Health Services Authority team will now check temperatures of travellers and they will be isolated if they have fever or quarantined if there is no fever, whether residents or visitors, for up to 21 days from the date of their departure from the affected countries.

In addition to overseeing local precautions, the Public Health Department is also communicating with international agencies such the Caribbean Public Health Agency, the Pan American Health Organization, the Centers for Disease Control and Public Health England. Should the Ebola virus reach the Cayman Islands, these organisations have promised technical assistance with regards to the deployment of human resources and supplies, Dr Kumar explained.
The premier, who is also the minister of home affairs said the country had a robust system in place.
“Cabinet will meet Tuesday for a briefing and update on Ebola and our efforts on the ground in the Cayman Islands to keep the public safe,” Alden McLaughlin said. “I can assure all that we have a robust communicable disease surveillance system already in place and the Ministry of Health, as well as the Health Services Authority, have already begun work on identifying protocols to deal with the disease should the need arise.”
Officials said the public will receive periodic updates on the global and regional situations with regards to the spread of Ebola, as well as the Cayman Islands’ readiness to cope with any local outbreak.

Despite on-going concerns about the potential for the virus to spread some 60 Dallas residents and health workers who had contact with the first Ebola patient to be treated in the United States were released from quarantine Monday with none of them infected. A nurse who contracted Ebola while caring for two infected West African patients in a Madrid hospital has now tested negative, Spanish authorities have said. The result suggests Teresa Romero, 44, is no longer infected although a second test is required before she can be declared free of Ebola.

However, there are still concerns and speculation that Nina Pham, the Dallas nurse who contracted Ebola last week, may have spread the virus to her boyfriend, according to US media reports.

Meanwhile, with no new cases for more than six weeks, Nigeria has been declaredofficially free of Ebola the World Health Organization (WHO) said Monday. Nigeria won praise for its swift response after a Liberian diplomat brought the disease there in July.
The Ebola outbreak has killed more than 4,500 people in West Africa, mostly in Liberia, Guinea, and Sierra Leone. An estimated 70% of those infected have died in those countries.

Key facts about Ebola
The virus is transmitted to people from wild animals and spreads in the human population through human-to-human transmission. The first Ebola virus disease (EVD) outbreaks occurred in remote villages in Central Africa in the 1970s, near tropical rainforests, but the most recent outbreak in West Africa has involved major urban as well as rural areas.
The average EVD case fatality rate is around 50%. Case fatality rates have varied from 25% to 90% in past outbreaks.
Early supportive care with rehydration and symptomatic treatment improves survival rates.
There is as yet no licensed treatment proven to neutralise the virus but a range of blood, immunological and drug therapies are under development.
There are currently no licensed Ebola vaccines but two potential candidates are undergoing evaluation.
The incubation period, which is, the time interval from infection with the virus to onset of symptoms is 2 to 21 days.
Humans are not infectious until they develop symptoms.
First symptoms are the sudden onset of fever fatigue, muscle pain, headache and sore throat. This is followed by vomiting, diarrhoea, rash, symptoms of impaired kidney and liver function, and in some cases, both internal and external bleeding (e.g. oozing from the gums, blood in the stools). Laboratory findings include low white blood cell and platelet counts and elevated liver enzymes.

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