When Ebola swept her native Uganda in 2000 and 2001, Sacramento County Public Health Officer Dr. Olivia Kasirye watched from afar, concerned about her homeland but already deep into training in the United States for a career here in fighting infectious diseases.
As devastating as the Ugandan outbreak was, Kasirye lost no one close to her. She did, however, benefit from lessons learned by health care workers who brought the virus’ march to a halt with a death rate far lower than in other African countries.
Today, Kasirye is front and center in Sacramento County’s efforts to escalate readiness and response should Ebola gain a foothold in the region.
Joining other emergency response authorities in a briefing Wednesday, Kasirye said in Sacramento County, “the risk is low” that the region would ever see an Ebola case crop up locally.
She also emphasized that there are no known cases of Ebola in the county. Two recent scares at UC Davis Medical Center and Kaiser Permanente South Sacramento turned out to be false alarms.
But, she said, her office is monitoring two patients she described as being “at very low risk” of carrying the virus. “They did visit those (West African) countries,” she said, “but were not in contact with any Ebola patients.”
Those two individuals are required to stay in touch with the public health office, take their temperatures twice daily and call in to report the results.
Unless they show signs of rising temperatures or other symptoms of succumbing to the Ebola virus, they are not being asked to stay out of public places or sequester themselves, she said.
“We will ask them to isolate themselves if we deem they are at higher risk,” she said.
The high-security briefing at the Sacramento Regional Homeland Security and Training Center at the former McClellan Air Force Base was also held to inform residents about measures the county is taking to prepare for a worst-case scenario: the possibility of an Ebola case making its way into the county.
Kasirye – along with representatives from the county department of airports, county emergency medical services, and the California Hospital Association – outlined steps to amp up preparedness to the higher level now dictated by the Centers for Disease Control and Prevention.
That includes following new, tighter guidelines for covering health workers head-to-toe with protective gear, leaving no skin exposed. Though the supply of hazmat suits has dwindled nationwide due to increased demand, a spokeswoman for the California Hospital Association said “every hospital has a minimum supply available.”
As for nurses’ complaints to Gov. Jerry Brown and the public about a lack of training in hospitals, Jan Emerson Shea said the hospitals she represents are developing plans to train their dedicated Ebola response teams first. Preparing other nurses will follow.
“Training is an ongoing process in hospitals,” Shea said. “We are well prepared to screen and treat the virus and any type of contagious disease.”
Because of the overlap of the flu season and the Ebola threat, Shea urged people to get flu shots. Fewer patients with fevers in the community will result in less confusion for health care workers trying to determine who may or may not be a potential Ebola carrier.
At Sacramento International Airport, crews are prepared to respond to reports of ill passengers on incoming planes, said Lance McCasland, deputy director of operations and public safety at the Sacramento County Airport System.
Procedures are in place to isolate potential Ebola carriers, notify health officials, and decontaminate portions of the airport and the planes themselves. McCasland reiterated that the Sacramento airport does not have direct flights to or from the affected West African countries.
In treating patients with the virus, nurses and other health care workers are at highest risk of contamination as the patient approaches five to seven days of infection, experts say.
That’s because the virus multiplies in the blood stream day by day and, at its peak, can produce billions of viral particles in just a fraction of a teaspoon of blood. By comparison, hepatitis C or HIV produce lower viral loads of tens of thousands or millions of particles, respectively.
Essentially, this is what makes Ebola so contagious – and deadly as the patient deteriorates – the hemorrhaging of those high viral loads through bleeding, perspiring feverishly, spewing vomit and expelling diarrhea and urine. Ebola is transmitted through these bodily fluids, including semen, but not through the air, water or food.
Survivors of the virus are thought to be of no risk to others once they recover. Their bodily fluids return to normal, with the exception of semen, which can continue to carry the virus for three months. These patients are advised to abstain from sex during the three-month period.
The CDC’s new recommendations for protection of health care workers put heavy emphasis on laying out explicit, step-by-step instructions for putting on and, most important, taking off protective gear so it does not shed and spread viral particles.
Kasirye, in her role as county health officer, is at the hub of efforts to screen possible Ebola carriers. Her staff is in charge of collecting and shipping to the CDC blood specimens that determine the threat level.
They also play critical roles in tracing patient contacts with others, to make sure everyone stays out of the public and in isolation for the 21-day incubation period of the virus.
Kasirye, who earned her medical degree at Makerere University in Uganda and a master’s degree in epidemiology at UC Davis, said that when Ebola struck Uganda, she kept a close eye on how health workers there were able to eventually bring the outbreak under control.
A study of nurses’ experiences in the field in Central Africa indicated they were not only tasked with infection control measures and caring for patients, but they also needed to be mindful of village customs and superstitions.
Stigmatization, discrimination and belief in sorcery posed added challenges. Often, a nurse would be shunned by her own family, her clothing burned and home destroyed.
Still, a sense of duty propelled them, even when they had to work in conjunction with traditional healers called upon to remove “poisons” from the household of a sickened family.
Spirits or gods were called upon, sacrifices of goats, sheep or other small animals were made and, inevitably, these acts failed to stop the virus from spreading.
Villagers then viewed the illness as being transported to them by a spirit called “gemo” that comes suddenly and rapidly, like the wind, often causing multiple deaths.
Ugandan nurses saw an opportunity to help shape protocols to control Ebola by fighting this spirit and instructed villagers to isolate patients, have survivors with immunity care for the patients, cancel large-scale social gatherings, such as dances, and bury the dead far from the village.
Experts said this resulted in an ideal broad-spectrum approach for battling Ebola that integrated both biomedical and cultural models.
As Kasirye noted, the knowledge of local customs, melded with good medical practices of infection control, contributed to the eventual control of the outbreak.
Call The Bee’s Cynthia H. Craft, (916) 321-1270.