Ebola Post-arrival Passenger Monitoring in Virginia Health and Human Resources Subpanel Governor’s Secure Commonwealth Initiative March 2015

Elements of Active Monitoring Entry Airport Screening Risk assignment Active monitoring (State and Local Health Dept) Public health actions when travelers become ill

Airport Entry Screening Conducted by: – Department of Homeland Security’s Customs & Border Protection (CBP) – CDC Division of Global Migration and Quarantine (DGMQ) – In partnership with State and Local Health Departments Entry screening conducted at 5 U.S. airports that are receiving all travelers originating from Guinea, Liberia, Sierra Leone – Passport reviewed – CARE kit provided – Health screening is conducted

Check and Report Ebola (CARE) kit Information on how to check and report Ebola symptoms for 21 days Pictorial description of symptoms A thermometer with instructions A symptom log Information on who to call if they have symptoms

Active Monitoring Traveler is assigned a “risk category” at the airport (High, Some, Low but not zero) If the traveler is symptom free on screening, they are then transferred to the state Active Monitoring program (state of their final destination). The Active Monitoring period lasts 21 days after the last possible Ebola exposure.

Active Post Arrival Monitoring Risk LevelPublic Health Action MonitoringRestricted Public Activities Restricted Travel HighDirect ActiveYes SomeDirect ActiveCase by Case Low but not zeroActive (DAM for some in this category) No

Active vs. Direct Active Monitoring Active Monitoring: Health check 2x/day Contact with health department at least once per day Direct Active Monitoring: Direct observation from state/local health dept at least once/day. A second follow-up can be done by telephone Includes talking about plans to work, travel, public transit, etc.

Active Monitoring In Virginia CDC sends traveler information via a secure system to state health department Monitoring team in the Division of Surveillance and Investigation assigns travelers based on residence Local health department enrolls travelers in the monitoring program

Active Monitoring-Local Health Dept “Intake” interview in to program – Interviews patient and confirms risk information – Provides contact information for LHD – Establishes a plan for how to access care if the traveler becomes ill – Reviews instructions and any relevant travel or activity restrictions – Signs a voluntary traveler agreement based on risk category

Inter-state transfers Active monitoring should be uninterrupted Persons in monitoring program notify health department of travel plans State health departments transfer monitored individuals in between states to ensure consistent monitoring Different methods of notification Very time intensive work

Ebola – Virginia Traveler Active Monitoring Risk CategoryNum% Low but not zero risk Some risk152.0 High risk10.1 Travelers entered Virginia’s active monitoring program between 10/27/2014 and 3/22/2015 Current StatusNum% Completed monitoring Transferred out Released from monitoring70.9 Under monitoring (as of 2/28/15) *2 travelers were transferred out of Virginia prior to being assigned to a region/health district

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Extra Slides

HIGH RISK TRAVELER-MONITORING Direct Active Monitoring: Public health actively monitors the health of an asymptomatic person as opposed to relying on the person to self-monitor and report symptoms if they develop. Direct monitoring includes public health authority conducting active monitoring through direct observation at least 1x/day

HIGH RISK: MOVEMENT A HIGH RISK TRAVELER in Virginia will be asked to sign a voluntary agreement which will include instructions to remain in their home/on their property for the duration of their monitoring period. Family and friends can bring essential needs to the home (groceries) Will not be permitted to work or attend school.

HIGH RISK-TRAVEL No travel will be allowed. Federal travel restrictions (Do Not Board) will be implemented to enforce controlled movement.

SOME RISK-DIRECT ACTIVE MONITORING Public health actively monitors the health of an asymptomatic person as opposed to relying on the person to self-monitor and report symptoms if they develop. Direct monitoring includes public health authority conducting active monitoring through direct observation at least 1x/day

SOME RISK TRAVELER-MOVEMENT Virginia Movement Restrictions: – May NOT attend activities where a 3 foot distance from strangers cannot be maintained (e.g. gym, restaurants, places of worship, etc) – May NOT attend large gatherings where 3 foot distance from strangers cannot be maintained (e.g. concerts, sporting events, movies) – May live in usual home and interact with family and friends. – May run errands for essential needs (grocery, pharmacy, etc). Errands should ideally be handled during off-peak shopping hours.

SOME RISK-WORK/SCHOOL Virginia If a healthcare worker, direct patient care is not allowed Generally restricted but exceptions can be granted on a case-by-case basis depending upon multiple factors (e.g., employer’s approval, ability to maintain 3 feet distance, minimize contacts with strangers) Teleworking from home (with employer’s approval) is encouraged if feasible Children are not allowed to attend school or daycare College/university students are not allowed to attend classes in person

SOME RISK-TRAVEL Virginia Travel on commercial conveyance (e.g., bus, subway, train, plane) is not allowed Travel within community on foot or private vehicle is allowed. Any travel outside of the community (≥50 miles) is generally discouraged; public health may grant exceptions on a case-by-case basis depending on multiple factors (e.g., monitoring compliance, trip duration, continued ability to monitor, timing with respect to incubation period, and access to care if symptoms develop). Federal restrictions may be imposed to restrict commercial conveyance (Federal Do Not Board list)

LOW RISK TRAVELER Monitoring: Active Monitoring, Usually 1x/day check-in (remotely via phone, Facetime, , text, survey, etc). No in-person visits required. * Movement: No restrictions Travel: No restriction, but traveler should notify LHD of travel ≥50 miles from the residence and monitoring should be ensured *Exception is Health Care Worker or Contact to a confirmed case on an airplane.

LOW RISK –US HEALTH CARE WORKER Low Risk (but not zero) Travelers who are health care workers caring for symptomatic Ebola virus disease patients while wearing appropriate PPE will undergo DIRECT ACTIVE MONITORING. They will have no restrictions on their travel, work, public conveyances, or congregate gatherings.