Virginia’s Preparedness for Ebola Virus Disease (EVD) March

Ebola: The Basics Ebola virus is a type of viral hemorrhagic fever. Virus spread person to person mainly by direct contact with bodily fluids (blood, feces, vomit), less commonly by contaminated items (needles). Ebola is a severe and often fatal disease; begins with acute fever, progressing to multi-organ involvement. Infected person is contagious only once symptoms develop (2 to 21 days after exposure). Persons caring for infected persons (healthcare workers, household members) are at highest risk of disease.

Ebola in Africa and the United States Mar 2014: Outbreak began in Guinea Aug 8: WHO declared international public health emergency Sep 30: First case diagnosed in US (Texas); traveler left Liberia Sep 19, arrived US Sep 20, and became symptomatic Sep 24 Oct 20: Outbreaks in Guinea, Liberia, Sierra Leone, with limited spread in Nigeria and sporadic detection in 3 other countries, account for 8,973 total reported cases and 4,484 deaths Image source: CDC (October 10, 2014)

Ebola – Cumulative Cases in West Africa through 03/08/15 n=24,247

Confirmed weekly Ebola virus disease cases reported from Sierra Leone (WHO)

EVD Control Measures: Based on Established Core Public Health Actions Surveillance Disease Reporting Communication Investigation Implementation of Control Measures Risk Communication

Three EVD Scenarios to Consider in Virginia I.Individual arrives at Virginia airport (Dulles most likely) with symptoms consistent with EVD (or likely exposure) and travel history to affected areas II.Individual presents to Virginia hospital with symptoms consistent with EVD and a travel history to the affected areas III.Individual with EVD identified in another state but had contact with Virginians

Quarantine Orders Legal authority (§ ) exists for State Health Commissioner to issue orders of quarantine for disease threats – If non-compliant with voluntary agreement, or – If such order is necessary to control the disease Letters for EVD-related voluntary quarantine and orders for quarantine scenarios have been drafted

State Health Commissioner Actions Maintain full situational awareness at local, state, national and international levels Inform and regularly update public, healthcare community, legislators and Executive Branch leadership about significant events/developments Promote hygienic practices and influenza vaccination in addition Evaluate each potential EVD case/contact as a Communicable Disease of Public Health Threat – Determine need for individual orders of isolation or quarantine

Commissioner (continued) Coordinate efforts with neighboring jurisdictions Direct agency resources to meet local needs Identify need for interagency assistance Declare Public Health Emergency if situation warrants enhanced awareness and communication Request Governor declaration of emergency if an affected area needed to be isolated or quarantined

Ebola – Virginia Traveler Active Monitoring Risk CategoryNum% Low but not zero risk Some risk142.2 High risk10.2 Travelers entered Virginia’s active monitoring program between 10/27/2014 and 2/28/2015 Current StatusNum% Completed monitoring Transferred out Released from monitoring50.7 Under monitoring (as of 2/28/15)599.1 *2 travelers were transferred out of Virginia prior to being assigned to a region/health district

VDH Response Activities to Date Case finding & consultations with hospitals around the Commonwealth 5 patients to date tested for Ebola (all negative) Airport screening began 10/16 at Dulles Post-arrival monitoring of all travelers began 10/27

EVD 2015 UC Briefing 24 March

Incident Commander Dr. Marissa Levine Info/Intel Chief Suzi Silverstein Sit Awareness Unit Josh Czarda Planning Chief Bob Mauskapf Technical Advisors Four (4) Regional Planners Operations Chief Dr. David Trump SNS Coordinator Cindy Shelton Hospital/Medical Community Branch Kevin Pannell EMS Unit Gary Brown ESF3 Drinking Water Branch John Aulbach Fatality Management Dr. Bill Gormley Environmental Health Allen Knapp Radiological Health Steve Harrison CHS Branch Bob Hicks 35 Local Health District Directors Epi Branch Dr. Laurie Forlano Surveillance Unit Dr. Diane Woolard Admin/Logistics/ Finance Chief Richard Corrigan HR Becky Bynum Finance Beth Franklin Procurement/ General Services Steve VonCanon IT Debbie Condrey PIO Maribeth Brewster Liaison Officer Joe Hilbert Safety Officer Dr. Joanne Wakeham VEOC/ESF8 Liaison TBD VDH All Hazard Incident Management Team 3/1/2015

Unified Command EVD Focus Access to Gov-authorized funding (VDEM / Executive Action) Coordinate interagency actions (VDH / VDEM) Coordinate Risk Communications / VA.211 (VDH ORCE / VDEM / JIC) Coordinate efforts with neighboring jurisdictions (All) Local preparedness assessments (VDH OEP / VDH CHS) Local roles and missions (VDEM) Pet quarantine / management (VDH +) Expand /define Unified Command (VDEM / VDH) Post-arrival tracking (VDH OEpi & Local Health Districts) Laboratory testing and transportation of samples (DCLS, DGS) Personal protective equipment status / availability (VDH OEP / VHHA) Supply chain status tracking (VDEM) Function-specific guidance (VDH OEpi) Emergency medical services’ patient transport (VDH OEMS) Medical waste disposition (DEQ) Hazmat response in non-healthcare settings (DEQ) Fatality management (VDH OCME) Behavioral health (DBHDS) Healthcare coalition preparedness and response (VDH OEP / VHHA) Training and Exercises (VDEM +) 1 st TTX 2/12 / 2 nd planned 5/19

EVD Unified Command Update Unified Command meets monthly Plans, Gap Analyses, & Tabletop Exercises Completed Regional Coordination Section Tiered Hospital Concept Treatment, Assessment, Frontline Hospitals Prepared Transport Teams in all EMS Councils HHS and CDC Grants Hospital and Public Health Preparedness ~$11M Training and Exercises Facility, local, regional exercises tracked 1 st Unified Command Exercise conducted 2/12 Cat A Medical Waste DEQ regulates and coordinates with facilities Communications Pre-scripted messaging VDH Website / Dark Site IF EVD case presents in VA. 211 Call Center Law Enforcement Video:

Additional Issues W Africa Healthcare Worker Evacuation Just-in time Logistics / Vendor List(s) DOD Coordination Tiered Hospital Response Situational Awareness

Questions? Dr. Dave Trump, Chief Deputy Commissioner Public Health and Preparedness Bob Mauskapf, Director Emergency Preparedness Cindy Shelton, Assistant Director, Emergency Preparedness Jennifer Freeland VDH State Volunteer Coordinator Kim Allan, Operations Director Suzi Silverstein, Director, Risk Communications and Education Kevin Pannell, State Hospital Coordinator General Info / Contact