Mission to Support Ebola Response Efforts at the New York City Department of Health and Mental Hygiene Paul Livingston, MPH and Jessica Goodell, MPH Public Health Prevention Service Fellows Office for State, Tribal, Local and Territorial Support Centers for Disease Control and Prevention 2015 PHAP Summer Seminar June 2, 2015 Centers for Disease Control and Prevention Office for State, Tribal, Local and Territorial Support

PRESENTATION OUTLINE  Incident Command System:  NYC Index case  Funneling of all air travel originating in W. Africa  Daily Symptom Monitoring:  Healthcare worker monitoring  West African traveler active monitoring  24-hour call center  Database  Quality Assurance and Out of Jurisdiction Notifications  Lessons Learned

* Citations, references, and credits – Calibri, 11pt NYC Ebola Index Case  10/23/14 - Physician volunteer (MSF) positive for Ebola Virus Disease (EVD) following return from Guinea  2 day history of fatigue  low grade fever (100.3°F)  Proper precautions taken  Physician self-monitored  NYC DOHMH contacted EMS and Bellevue Hospital to coordinate transportation and hospitalization of patient

Funneling of all air travel originating in West Africa through five airports, including NYC’s J.F.K. Airport

New York City Department of Health and Mental Hygiene (NYC DOHMH)  SurvEpi  QMB/Countermeasures  Street Team  Health communication  Immigrant communities  Partnership with New York Police Department  Missing Persons

Incident Commander Dr. Jay Varma Emergency Operations Center / Incident Command System EOC / ICS

 Twice daily meetings  Quarantine taskforce  Infection control taskforce  Determine appropriate environmental remediation methods for contaminated premises  Coordinate response planning with other city agencies EOC/ICS

NYC DOHMH Call Center

West African Travelers Active Monitoring  Coming in through JFK-Quarantine Station  Sierra Leone, Liberia, Guinea  Usage of staff and others with language experience  Collaboration with NYPD/Street Team  Out of Jurisdiction notifications  Language/literacy/logistical issues  Called for daily symptom monitoring  As of 11/ travelers under active monitoring

Healthcare Worker (HCW) Active Monitoring  HCW contact with patient or fluids at Bellevue Hospital  Nurses  Doctors  Lab workers  Environmental/waste cleaners  Housekeeping  Contractors  Couriers  Location of exposure  Called for daily symptom monitoring  Outgoing vs. incoming  As of 11/ HCWs under active monitoring

HCWs and Travelers Fields  HCWs  Last Positive Contact  Last Contact Attempt  Best Time to Call  Contact Status  Locator information  Travelers  Arrival date  Arrival city  Ebola affected country  Emergency contact  Language  Out of Jurisdiction Database (MAVEN software)

Data Quality Assurance  Check handwritten daily symptom monitoring (DSM) sheets from call center against entered data in Maven  Interim database with imperfect data entry  Input to IT developers to improve electronic data collection

Out of Jurisdiction Notifications  Lists submitted by federal CDC and JFK quarantine station  Travelers whose ultimate destination lay in jurisdiction outside of NYC  Jurisdictions notified daily and information confidentially transmitted on:  Locator/contact information  Country of exposure  Type of exposure  Risk categorization

Observations  Budget of NYC DOHMH  Complex number of stakeholders  Collaboration with Bellevue Hospital  Evolution of ideas  Evolution of database  Improvements: travelers from 63% (n=218) to 74% to 92% (n=200)  Continual monitoring of HCWs and travelers

Lessons Learned: Monitoring in NYC  Traveler active monitoring and community contact tracing  Split investigation team for healthcare contacts and community contacts with communication between teams  Draw on groups within public health that are used to finding people (Disease Investigation Specialists (DIS), Public Health Nursing (PHN))  Ensure staff is composed of diverse race, gender and nationality (to degree possible) to establish rapport and trust  Some contacts require rapid decision making as to follow-up and approach  Familiarize staff with West African cultural traditions  HCW contact tracing and active monitoring  Set up a system to track all HCWs that have contact with the patient, patient samples or patient waste. In NYC, this was difficult.  Establish system to monitor date of last contact with patient or samples. (Can be difficult with ongoing hospitalization)  Advise hospital to limit number of staff with exposure to patient, samples or waste. (In NYC, large number of lab workers had contact with samples)

Acknowledgements  Elizabeth Schill, Public Health Associate  Alexander Millman, EIS Officer and Supervisor  Dr. Chris Braden- NCEZID  Alison Ridpath, EIS Officer  Kari Yacisin, EIS Officer

For more information, please contact CDC’s Office for State, Tribal, Local and Territorial Support 4770 Buford Highway NE, Mailstop E-70, Atlanta, GA Telephone: CDC-INFO ( )/TTY: The findings and conclusions in this presentation are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. Thank You Any Questions? Paul Livingston, MPH Centers for Disease Control and Prevention Office for State, Tribal, Local and Territorial Support