Five days after he finished treating Ebola patients in Sierra Leone, a young doctor was back home in New York, and four days after that he was riding the subway, going bowling and coming down with the infection himself.
As New York City scrambles to find people who came into contact with Dr. Craig Spencer — so far his fiancée and two friends have been ordered into quarantine — public health authorities in Georgia are thinking about such a challenge here. If, or when, an Ebola patient surfaces in Atlanta, whether at the airport or at a hospital emergency room, what happens next?
The Georgia Public Health Department would take charge of the response, from tracing the person’s contacts to placing people under quarantine, said Dr. Patrick O’Neal, director of health protection for the department.
O’Neal’s remarks on Friday came as the governors of New York and New Jersey announced that anyone who had direct contact with Ebola patients in West Africa would be automatically quarantined upon arrival at either Kennedy International or Newark’s Liberty International airports.
And New York Gov. Andrew Cuomo publicly chastised Spencer.
“He didn’t follow the guidelines for the quarantine — let’s be honest,” Cuomo said. “It’s too serious a situation to leave it to the honor system.” Cuomo later remarked that the idea of voluntary quarantine is “almost an oxymoron to me,” the New York Times reported.
Two Dallas nurses free of Ebola virus
There was a bit of good news on the Ebola front on Friday. Emory University Hospital announced that Amber Vinson, the nurse who contracted Ebola from the man she was treating at a Dallas hospital, no longer has the virus in her blood. Emory said no discharge date has been set for Vinson.
And in Washington, the second infected nurse from Dallas, Nina Pham, got a hug from the president after she was released, virus-free, from the National Institutes of Health hospital in Bethesda, Md. Both Emory and the NIH hospital have specialized isolation units for treating people with serious communicable diseases.
In Georgia, most hospitals that identify an Ebola patient would send him or her to Emory, O’Neal said. He acknowledged that Emory’s capacity is limited and said other hospitals are taking steps to handle patients on their own.
Once the patient is settled in the hospital, the next challenge is to track anyone he or she came into contact with and decide whether those people are now a threat to the public, O’Neal said.
“The decision will be made by public health as to whether the contact is of such risk that they need to be quarantined,” he said. He noted that the agency’s general counsel has reviewed the state law and confirmed that the public health commissioner, Brenda Fitzgerald, has the legal authority to quarantine people.
The state is divided into 18 health districts, each with a district director. Fitzgerald has delegated quarantine authority to those district directors so that local decisions may be made as quickly as possible, O’Neal said.
CDC takes on a consulting role
Atlanta has two major assets in the fight against Ebola that no other city may claim: Emory University Hospital, with its isolation unit and its experience at curing four patients of Ebola, and the CDC.
CDC officials emphasized on Friday that they act as a consulting agency when an Ebola patient presents at a hospital, and not the agency in charge.
Spokesman Tom Skinner said the CDC performs tests to confirm an Ebola diagnosis and deploys a “go team” to help the hospital, city and county with its response.
A go team was immediately sent to New York on Thursday after Dr. Craig was diagnosed, he said.
“If it happened (in Atlanta), we’d have a team on-site here to assist the state health department with contact tracing and we’d have a team at the hospital,” Skinner said.
‘Fever plus travel equals Ebola’
The state would be calling the shots on quarantines and contact traces, but Atlanta city government has plenty to do, Chief Operating Officer Michael Geisler.
Members of Mayor Kasim Reed’s administration are coordinating with the state and CDC and educating emergency response personnel about how to approach a suspected Ebola patient, he said.
The COO said first responders are being trained to assess whether the person is experiencing the tell-tale symptoms, has traveled to the affected countries or encountered others with possible exposure.
“Fever plus travel equals Ebola until proven otherwise,” Geisler said.
He said the city has equipped police officers with hazmat suits that meet CDC guidelines, and has trained 911 operators to ask a series of questions to assess the possibility of Ebola symptoms.
‘We are happy people are calling’
Also on Friday, more than 100 public safety officials from Fulton County cities, schools and other organizations met to discuss and practice how to handle Ebola cases.
Dr. Matthew McKenna, medical director for the Fulton County Health and Wellness Department, said the most likely way an Ebola patient would be identified is through a screening at Hartsfield-Jackson International Airport. (Travelers from Ebola-stricken countries must enter the U.S. through one of five airports, including Hartsfield-Jackson.)
But McKenna said the county must also prepare for identifying the sick at emergency rooms and other venues.
“It’s our job to worry about that,” he said. “I think we are always looking to try to get better on our preparedness.”
Meanwhile, Dr. Elizabeth Ford, district health director in DeKalb County, said her office has fielded numerous calls about the Ebola scare.
“I have had more media in last two weeks than I had with H1N1,” Ford said. “It has been insane, but we are happy that people are calling and asking questions, rather than making assumptions. It cuts down on the confusion and fear.”
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