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County prepared for Ebola outbreak

Though no confirmed cases of Ebola have been reported in Tennessee, the Washington County-Johnson City Health Department is ready to respond.
“We’re trying to be proactive,” said Director Tim Carson. “We’re constantly tweaking our plan; we had a drill last week.”
In March, seven counties in Northeast Tennessee — Carter, Greene, Hancock, Hawkins, Johnson, Unicoi and Washington — began developing strategies to implement if necessary.
“Each department will come up with its own site-specific plan,” said Chad Bruckman, emergency response coordinator for the Emergency Preparedness Division of the state’s Northeast Tennessee Regional Health Office in Johnson City.
While Bruckman said the pandemic and infectious disease plan is in place for the year, the Centers for Disease Control keeps changing guidelines for the healthcare workers regarding the care of those who are at risk for Ebola.
A meeting was held with first responder agencies such as 911, Emergency Management Agency and Emergency Medical Services at the end of September to discuss the disease, its dynamics and protective patient handling practices.
An exercise with local hospitals and East Tennessee State University on the steps that would be followed should an Ebola case be confirmed was conducted Oct. 3.
In addition, Bruckman said he has held a tabletop exercise with every health department in the region. “We use a mock patient walk-through, and the first question is travel history,” he said, explaining the answers determine the next steps in the care. “Every piece is built on that question.”
The process was very helpful, according to Carson. “When Chad originally asked us where we would put a patient, we changed it in our walk-through,” he said.
During the initial intake, Bruckman said individuals are asked if they have traveled to Sierra Leone, Guinea or Liberia. If the answer is yes, the questions, “Are you ill now?” and “Do you have a fever?” follow.
“We also want to determine the level of exposure,” he said. “We ask, ‘did you attend a funeral when there, did you touch the body, and are you a healthcare worker?’”
If there is reason to suspect a potential case, Bruckman said the individual will be asked to submit to a 21-day voluntary self-quarantine period. If a person determined to be at risk won’t comply, the medical director can step in and legally enforce a quarantine.
“We’re being overly cautious,” he said. “We figure the chances (of contracting the disease) are pretty slim, but we’re providing the same level of training for health department staff as the hospitals.”
In addition, Bruckman said his office is reaching out to ETSU, and Tusculum and Milligan colleges to provide information for international students who plan to travel home for the holidays.
According to Carson, Washington County is the only one of the seven health departments that provides the international travel vaccine for yellow fever and typhoid. “The other closest departments are in Sullivan County and Knoxville,” he said.
With the approaching flu season, which will carry many of the same symptoms, Bruckman said the travel questions will be especially helpful in screening out potential Ebola cases.
Originally, he said, the United States planned to conduct screenings only in the metropolitan area airports, which handle the majority of international flights. Names of those believed to be at risk would be placed on a health watch list, and the health departments in the final destination points would be notified in order to monitor the individuals for a set amount of time following their return.
“It is all very discreet,” he said of the names that are sent to the state health department in Nashville, adding there are only a couple of staff at the regional office who monitor. While Bruckman said it is different for everyone, most people start showing symptoms between five to eight days after exposure.
Sullivan County recently had a meeting with the Tri-Cities Regional Airport and implemented the same plan in place at McGhee Tyson Airport in Knoxville, said Bruckman, who has a counterpart there.
If a local resident experiences symptoms, Bruckman said the state would work with EMA to facilitate a safe transport for the patient from home to a hospital. The hospital would take a blood sample and send it to the state Department of Health. If confirmed when the results are returned within three to five days, family members would be notified.
At that time, the patient would be asked to sign a release. “If the patient refuses (to release his or her name) we would (publicly) announce a confirmed Ebola patient is being treated and the name of the hospital,” he said.
According to Bruckman, both local hospital systems have aggressive infectious disease programs, and are equipped to handle treatment of Ebola.
Anyone experiencing symptoms can call the Tennessee Ebola Hotline at 1-877-857-2945.
“If you don’t report, you’re putting everyone at risk,” he said of fears of a perceived stigma related to the disease.
As far as an end date for the precautions, they won’t stop until the outbreak in Africa is under control. “It will be a long process,” Bruckman said. “The biggest thing we’re worried about are the healthcare workers and the caretakers because we are losing so many of them over there.”
While Bruckman said the State of Tennessee believes it has a handle on protection and response, every precaution possible is being taken. “Ebola doesn’t know skin care, religion, race. It could be anybody,” he said.