Virginia’s Preparedness for Ebola
Virus Disease (EVD)
March 19 2015
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
Image source: CDC (October 10, 2014)
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
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 (§ 32.1-43) 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
Travelers entered Virginia’s active monitoring program
between 10/27/2014 and 2/28/2015
Health Planning Region*
34
2
29 25
554
Northern
Eastern
Southwest
Northwest
Central
*2 travelers were transferred out of Virginia prior to being assigned to a
region/health district
Risk Category
Num
%
Low but not zero risk
631
97.7
Some risk
14
2.2
High risk
1
0.2
Current Status
Num
%
Completed monitoring
406
62.8
Transferred out
176
27.2
Released from monitoring
5
0.7
Under monitoring (as of 2/28/15)
59
9.1
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
Asymptomatic Travelers from
Guinea/Liberia/Sierra Leone that
name Virginia as final destination
“HIGH” RISK
CATEGORY
“LOW BUT NOT
ZERO” RISK
CATEGORY
“SOME” RISK
CATEGORY
Notification to VDH via
Line Lists to Central
Office via CDC Epi-X
Notification to VDH
via Phone from CDC
Quarantine Station
Central Office
Assigns Travelers to
LHD for ACTIVE
MONITORING
VDH Central Office
Assigns Travelers to LHD
for DIRECT ACTIVE
MONITORING
LOW BUT NOT ZERO TRAVELER


Met at airport by Local VDH
Personnel and Voluntary
Agreement Signed; Order if
Necessary.
Released to Virginia-based Final
Destination.
Line Lists to Central Office via
CDC Epi-X
HIGH RISK TRAVELER


Direct Active Monitoring daily, including once
daily in-person visit for 21 days
Movement restrictions: must stay in home/on
property for 21 days. No work, school, travel.
Essential needs will be supported by family,
friends, LHD.


Voluntary Agreement Signed
Active Monitoring daily, via phone,
including temp checks for 21 days
Movement restrictions: NONE
Notify LHD with intent to travel >50
miles
SOME RISK TRAVELER





Voluntary agreement signed
Direct Active Monitoring daily, including one inperson visit for 21 days
Movement restrictions: no commercial travel, no
public transport, no large gatherings, no long
distance travel by any means, exceptions may be
granted.
Work and school generally restricted
May interact with family and friends, run routine
errands.
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. Includes public health authority conducting active
monitoring through direct observation at least 1x/day
Active Monitoring: Public health assumes responsibility for establishing regular communication with potentially exposed
individuals, including checking daily to assess for symptoms or fever, person as opposed to relying on the person to selfmonitor and report symptoms if they develop. Can largely be conducted via phone or electronic means.
Governor
Governor’s Cabinet
Ebola Unified Command Group
Levine, VDH
Stern, VDEM
Flaherty, VSP
Trump, Deputy, VDH
Burdick, Deputy, VDEM
Liaisons
Federal, Local, Private
DMA
MWAA
DHS/USCG
DHS/CBP
Burket, Port of VA
Others as required
vJIC / ESF-15
VDH, VDEM, VDSS (2-1-1)
Brewster, VDH Lead
Eischen, VDEM Deputy
Geller, VSP
Others as required
Legal Advisor
Attorney General’s Office
Kurz, OAG, VDH Council
Planning
Mauskapf, VDH Chief
Francis, VDEM Dep, Ext Spt
Shelton, VDH, Dep, Int Tasking
Situation Unit
Daily VDH SITREP
Bi-weekly UC SITREP
Shelton, VDH
Calkins, VDEM
Plans Support Staff, VDEM
Resource Tracking Unit
Shelton, VDH
Garnowski, VDEM
Hospital / EMS Readiness
Owens, VDH
Schitter, VDH
Reece, VHHA
6 Regional Hosp Coord’s
Giese, DEQ
Future Plans
Francis, VDEM
Kelso, DMA
Intel Unit
Vincent, VDEM
Lambert, VSP
Specialty Teams as req’d
Mortuary Affairs, Gormley
Diefenthaler, DBHDS
ESF-3 Med Waste, Giese,
DEQ
Safety Officer
Rice, DOLI
Operations
Trump, VDH Lead
Michael Nelson,
VDEM Dep Ext Sp
Public Health Branch
Forlano, VDH Deputy
Toney, DGS (DCLS)
Law Enforcement
Branch
Daniels, VSP Lead
Terry, VSP Deputy
ESF-10 Branch
Britt VDEM Lead
Giese, DEQ Deputy
Hood, VSP
Berry, VDFP
Training & Exercise
Branch
Mongold, VDEM Lead
Silverstein, VDH Deputy
Estes, VDFP
Hanley, VSP
Hospital / EMS
Schitter, VDH Lead
Owens, VDH Deputy
Reece, Hospital Coalition
Perkins, EMS Reg.
Council
Bryan Norwood, MWAA
Regional Coordination
King, VDEM Lead
Cooling, Magner,
Walker, McCabe (VDH)
VSP Rep TBD
Finance / Admin
Damico, DGS Lead
Hill, VDEM Deputy
DHRM Rep TBD
DOA Rep TBD
Logistics
Eaton, VDEM Lead
Buisset, VDEM
Deputy
Multiple State
Agency Logistics
Personnel
EVD 2015 UC Briefing 24 March
VDH All Hazard
Incident Management Team
Incident Commander
3/1/2015
Dr. Marissa Levine
PIO
Liaison Officer
Maribeth Brewster
Joe Hilbert
Safety Officer
Dr. Joanne
Wakeham
VEOC/ESF8 Liaison
TBD
Info/Intel Chief
Planning Chief
Operations Chief
Suzi Silverstein
Bob Mauskapf
Dr. David Trump
Sit Awareness Unit
Josh Czarda
Technical Advisors
Four (4) Regional
Planners
SNS Coordinator
Cindy Shelton
Admin/Logistics/
Finance Chief
Richard Corrigan
CHS Branch
Epi Branch
HR
Bob Hicks
Dr. Laurie Forlano
Becky Bynum
35 Local Health
District Directors
Surveillance Unit
Finance
Dr. Diane Woolard
Beth Franklin
Hospital/Medical
ESF3 Drinking
Community Branch
Water Branch
Fatality
Management
Environmental
Health
Kevin Pannell
John Aulbach
Dr. Bill Gormley
Allen Knapp
Radiological Health
Steve Harrison
Procurement/
General Services
Steve VonCanon
EMS Unit
IT
Gary Brown
Debbie Condrey
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)
•
•
•
•
•
•
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)
•
•
•
•
•
Local roles and missions (VDEM)
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 +) 1st TTX 2/12 / 2nd 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
• 1st 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:
http://www.vdh.virginia.gov/epidemiology/ebola/HealthCare.htm
Additional Issues
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•
•
•
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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
David.Trump@vdh.virginia.gov
804-864-7025
Kim Allan, Operations Director
Kim.Allan@vdh.virginia.gov
804-864-7030
Bob Mauskapf, Director Emergency
Preparedness
Bob.Mauskapf@vdh.virginia.gov
804-864-7035
Suzi Silverstein, Director, Risk
Communications and Education
Suzi.Silverstein@vdh.virginia.gov
840-864-7538
Cindy Shelton, Assistant Director, Emergency
Preparedness
Cindy.Shelton@vdh.virginia.gov
804-864-7486
Kevin Pannell, State Hospital Coordinator
kevin.pannell@vdh.virginia.gov
804-864-7033
Jennifer Freeland
VDH State Volunteer Coordinator
Jennifer.freeland@vdh.virginia.gov
804-396-0543
General Info / Contact
http://www.vdh.virginia.gov/OEP/