MIDDLEBURY — Middlebury is a long way from West Africa or even Dallas, Texas, where the deadly Ebola virus has gained a toehold and claimed victims.
But with the town of Middlebury and Middlebury College being popular destinations for international travelers, local health care providers and institutions are taking precautions to minimize the chances of Ebola making its way to Addison County, while also setting up protocols to ensure that any infected patient is segregated from the general population.
Dr. Amanda Young is director of Porter Hospital’s Emergency Department. She has been the hospital’s point person in developing Ebola protocols for the hospital in concert with the Vermont Department of Health, Fletcher Allen Health Care, Middlebury College Health Services and Porter Medical Center’s own Infection Control Department.
“Porter is very aware of (Middlebury’s) status as a hub for travelers,” Young said on Thursday. “We are very interested in getting this right.”
Ebola, previously known as Ebola hemorrhagic fever, is a rare and deadly disease caused by infection with one of the Ebola virus strains. Ebola can cause disease in humans, monkeys, gorillas and chimpanzees.
There are five identified Ebola virus species, four of which are known to cause disease in humans. Ebola was first discovered in 1976 near the Ebola River in what is now the Democratic Republic of the Congo. Since then, outbreaks have appeared sporadically in Africa.
According to the Centers for Disease Control (CDC), Ebola cannot be spread through casual contact, air, water or food grown or legally purchased in the U.S. The virus, according to the CDC, can only be passed to someone who has direct contact with body fluids — blood, sweat, saliva, vomit, urine and tears, for instance — of someone who is sick with, or has died from, the disease. It can also be contracted through contact with contaminated needles or infected animals (blood, fluids or meat).
Ebola can only be spread to others after symptoms begin, and those symptoms can arise two to 21 days after exposure. Those symptoms include fever, headache, diarrhea, stomach pain, unexplained bleeding or bruising, muscle pain and/or vomiting. If an exposed person develops no symptoms after 21 days, they will not become sick with Ebola, according to the CDC.
Ebola arrived stateside late last month when a Dallas hospital treated a U.S. citizen who had contracted the disease while in Liberia. That patient, Thomas Eric Duncan, has since died. Two nurses from that hospital who had contact with Duncan have since been diagnosed with Ebola and are being treated. Meanwhile, the CDC and health authorities have been retracing the infected citizens’ steps to determine who else might have been exposed. Some of Duncan’s friends and relatives are under a quarantine order.
LOCAL PRECAUTIONS
Porter Hospital and Middlebury College officials are working to make sure Addison County’s shire town doesn’t face the same crisis as Dallas. With that in mind, Young outlined a series of steps the hospital is taking to respond to any potential Ebola cases.
It all begins with a simple question to incoming patients.
“A month ago, we instituted a mandatory triage question about travel that has to be answered before (the patient) can go anywhere else in the Emergency Department,” Young said. “Travel is a main determiner in whether a person is at risk or not at risk.”
If the patient is symptomatic and has recently been traveling in West Africa, the Emergency Department physician in charge at the time will be notified and the patient will be taken to one of three isolation rooms in which oxygen is not re-circulated within the hospital. Porter Hospital has the hazmat suits, face shields and other protective gear that is worn by those caring for confirmed Ebola patients. The hospital also has a 55-gallon drum into which all used garments and other waste can be properly packaged and vacuum-sealed for proper disposal.
“We will be current with whatever (the CDC) is recommending,” Young said.
The patient would be interviewed in the isolation room and asked specific questions about their symptoms and travel history. If the responses lead health care workers to suspect Ebola, they would then contact a variety of other officials with organizations like the Department of Health, CDC and Fletcher Allen Health Care, to discuss the case.
Porter is also encouraging individual physician offices to ask travel-related questions by phone with patients booking appointments.
As of this writing, Fletcher Allen hospital had agreed to receive patients suspected to have Ebola, according to Young. The state’s largest hospital, officials reasoned, would be best equipped to perform the blood work, handling of specimens and other delicate tasks associated with Ebola patients.
Young said the state’s hospital representatives are slated to have another phone conference on Friday, Oct. 24, to update any of the current Ebola protocols, if necessary.
“It’s an evolving thing,” she said.
COLLEGE TAKES STEPS
Meanwhile, Middlebury College is also on guard for Ebola. The college’s Parton Center for Health and Wellness has a website that includes the latest information on Ebola and the CDC’s advice on how to avoid contracting the disease. For example, the CDC is urging all U.S. residents to avoid travel to the African nations of Sierra Leone, Guinea and Liberia. The organization has issued a less stringent warning for Nigeria. The nation of Senegal, as of last week, was expected to soon be declared Ebola-free by the World Health Organization. Senegal had one Ebola case several months ago, and the infected patient recovered, noted Middlebury College Public Affairs Director Sarah Ray.
 Middlebury College’s current student body includes 14 students from Africa. That’s 0.6 percent of the institution’s total student population. The college expects to soon welcome back to campus two students currently studying in Africa. One is studying in Senegal, the other in Cameroon, which is not on the CDC’s watch list.
“The staff at (the Parton Center) is monitoring this very carefully,” Ray said, noting close communication with Porter Hospital. “Our goal is to maintain a healthy campus and community.”
State health officials, including Dr. Harry Chen, acting secretary of Human Services, and Acting Health Commissioner Tracy Dolan, stress that the risk to Vermonters of contracting Ebola is very small.
“The plain truth is that until the epidemic is controlled in Africa there will be some risk here, as we have witnessed in Dallas,” Chen and Dolan said in a written statement late last week. “It’s important to understand how very small the risk is in this country. Ebola is not easy to catch. Ebola does not spread easily like the flu or measles. You cannot get it through the air, water or food.”
Ebola is a disease that is unfamiliar in the U.S., but Americans’ expertise and experience in controlling the spread of infectious disease and protecting public health is among the best in the world, they said.
State officials stressed that they are communicating with hospitals and other health care professionals to spread information on best practices in uncovering and treating Ebola. Dolan and Chris Bell, director of emergency preparedness for the Vermont Department of Health, were scheduled to speak this past weekend at the Vermont Healthcare and EMS Preparedness Conference in Killington, which was expected to draw more than 500 healthcare and emergency services professionals from across New England.
“We want to make sure health care providers understand and practice in advance the proper infection control measures, so they are ready to safely identify, isolate, transport and treat Ebola patients — just in case,” Dolan and Chen said.
More information about the state’s guard against Ebola can be found on the Department of Health’s website at http://healthvermont.gov/prevent/ebola/vt_hcp.aspx, or at the Parton Center’s website at www.middlebury.edu/studentlife/services/health.
“The best thing we can do is follow the experts and not follow the panic and the hysteria, and try to learn from any errors that have previously been made,” Young said.
Reporter John Flowers is at [email protected].