Although no cases of Ebola have been detected in Colorado, local health agencies continue to prepare for the possibility. The Larimer County Department of Health and Environment and all local public health departments in Colorado are working with state and federal health authorities to monitor anyone who may have traveled to an Ebola-affected country (currently Sierra Leone, Liberia, Guinea) or cared for an Ebola patient in the United States.
Beginning Nov. 3, anyone visiting or living in Larimer County within 21 days of a potential exposure to Ebola will be monitored twice a day through phone calls and in-person visits by health department staff. Additional restrictions on working or traveling may be imposed, based on a careful assessment of each individual’s potential risk.
“This additional layer of prevention should increase everyone’s confidence that no one in our county will be exposed unknowingly to Ebola,” said Dr. Adrienne LeBailly, health department director. “Anyone being monitored who develops symptoms will quickly be isolated. Health care providers will be able to use appropriate protective equipment when caring for a sick patient, and patients will be hospitalized in a facility that is prepared to care for them.”
Ebola is not transmitted to others before symptoms develop, and it is unlikely to spread during the first few days of symptoms, even within a household. When the disease begins, a patient may experience a general feeling of ill health, fatigue, fever, loss of appetite, and muscle aches, all symptoms that commonly occur with many diseases. Even a highly sensitive blood test may not be able to detect any Ebola virus in the blood until the third day of illness.
Between day 3 and day 6 of the illness, diarrhea, vomiting, and other symptoms may begin, which could increase the risk to care providers as the level of the virus in blood and body fluids increases. While Ebola does not spread through the air, the virus may be present in droplets of body fluids (vomit, blood, diarrhea, etc.) which can travel short distances and could settle in a and unprotected health care provider’s eyes, nose, or mouth. Or such aerosols could land on objects that are touched, and then a person’s contaminated hands can come in contact with eyes, nose, or mouth.
The greatest risk of Ebola being transmitted occurs when a patient is critically ill and virus levels reach their peak, or after the patient dies. This increasing infectiousness over time, especially in patients who die from Ebola, helps explain why two intensive care nurses are the only people who have ever been infected with Ebola in the United States. Household members of the Dallas Ebola patient never became ill despite close contact with the patient in the first stages of illness.
“Better protective equipment for health workers and more thorough training to use it will make infection of hospital staff something that rarely or never occurs,” said LeBailly. “But for the general public, the risk of Ebola is pretty much zero.”
Patients at health care facilities in Larimer County are being asked about travel to the countries currently affected by the Ebola epidemic and about any symptoms they may have that are consistent with Ebola infection.
All hospitals in Colorado have been developing the capability to screen, identify and provide initial care for a patient suspected of having Ebola. Local hospitals have prepared isolation rooms and developed protocols for handling Ebola patients. Staff also have practiced putting on and taking off the personal protective equipment currently recommended by the Centers for Disease Control (CDC).
Three hospitals in Denver – Denver Health Medical Center, Children’s Hospital Colorado and University of Colorado Medical Center – have been designated as specialized Ebola treatment centers for when a higher level of care is needed. The CDC is prepared to deploy rapid response teams immediately to hospitals treating Ebola patients.
Responses to potential Ebola exposures may vary from state to state because their statutes, regulations, and health officials will determine public health interventions in their own jurisdictions. At this time, Colorado is following the recommended CDC guidelines.
“We need to be careful to use the best science available when making decisions about how to deal with travelers from Ebola-affected countries, and use the least restrictive interventions that will still protect the public’s health,” said LeBailly. “We also need to make sure that people who pose no risk of infection to others are not treated unfairly or stigmatized due to mistaken perceptions that they might transmit Ebola.”