6/22/2015 Disclosures Ebola virus disease None Ebola: UCSF in the Hot Zone Contributions Roadmap • Background on Ebola • Keep Safe, Keep Serving • Hernando Garzon, MD • Ami Waters, MD • Phuoc Le, MD 1
6/22/2015 Viral Hemorrhagic Fevers Viral Hemorrhagic Fevers Ebola Species Ebola Transmission 2
6/22/2015 Transmission – Contact, Droplet Airborne? Clinical Course How infectious is Ebola, really? 3
6/22/2015 Ebola PCR and Ab ELISA Ebola Outbreaks – Key Interventions • Early Case Identification • Strict Isolation • Safe Transportation • Care • Supportive – but can we do more? • Contact Tracing • Safe Burials • 50% of infections with handling dead bodies • Health Promotion Outreach & Education Supportive Care Ebola Treatment Units • Standing orders • Human Resources • Hydration - >2-3 liters/d • Co-Artem x 3d • 80-120 staff (10-15 or more international) • Cefixime x 5d • 30-45 clinical staff (MDs, RNs, etc) • Tylenol, Omeprazole • 40-80 support staff (hygienists, logistics, psychosocial, drivers, • Symptomatic care cooks, burial teams, etc) • >100 more peripheral support staff • Antiemetics, Narcotics, • Water – 100 liters/pp/pd (2500 gallons per day) Anxiolytics, etc. • Diagnostics • Chlorine – 0.7kg/pp/pd (70 Kg per day) • Ebola PRC • PPE – 100 suits, hoods/pd • Malaria RDT • iSTAT or lab supported Lytes, CBC, LFTs 4
6/22/2015 ETU work Ebola Treatment Units environment • Full PPE • 45-60 minutes work cycle • High temp and humidity • Sensory & dexterity challenges • 1.5 liter sweat loss in 60 minutes! • Average 2 cycles per shift • No continuous meds (IV) • Very limited monitoring (VS, diagnostics) Non-Ebola Consequences of Ebola This Outbreak in Context • Indirect Mortality • One preventable medical death for every Ebola death • Food Security • Farms abandoned, decrease food availability • Child Protection • >3000 orphaned children • Stigmatization/Distrust • Recovered patients and workers shunned • Economic collapse • Estimate of $2 Billion lost in trade, commerce 5
6/22/2015 Ebola Mortality Ebola Outside West Africa West Africa – 50-60% Elsewhere – 21% (5/24) Health Disparities Ebola Outside West Africa 6
6/22/2015 Global Health Fellowship: The Canary in the Coal Mine: Ebola Virus Going to the Last Mile “The reasons to shore up health systems between epidemics are both moral and those of vital self- interest. Ebola is signaling a new call to action. We ignore this canary at our own peril. ” -Alexandra Stanculescu, MD 2013-14 UCSF Global Health Fellow blog post May 2014 A Stand in Solidarity Last Mile Health in Liberia “The idea that some lives matter less is the root of all that's wrong with the world.”- Paul Farmer 7
6/22/2015 Protecting Those Who Serve Protecting Those Who Serve • 370 health care workers infected in Liberia • 178 of deaths • 28% never trained in IPC • 26% uncomfortable with identification of a suspected Ebola patient Rivercess County Introducing Concepts • Difficult roads • Ebola Basics • remote villages • Context of Outbreak • Lack of supplies • infrared thermometers • Triage and Isolation • PPE at facilities • Donning & Doffing • Community disbelief • Chlorine Preparation • Lack of trust • Waste Management • Inadequate awareness • No ETU 8
6/22/2015 Small Group Exercises Building Confidence Taking It One Step Further Facility Mapping and Action Plans 9
6/22/2015 “I learned a lot about Ebola I have Keep Safe, Keep Serving never learned before. It is my first time.” “I would like to see the training • 200 Healthcare workers established in all districts.” • 40 health facilities “I like this training and I • Two counties want to see change in the • Monthly follow-ups “Ebola Virus near future.” • Ongoing mentorship kills. We need and supervision “I would like to see regular more training supply of equipment for facility days.” such as PPE and constant training on Ebola.” Identifying Limitations Applying Concepts to Practice 10
6/22/2015 The End of a Mission? Questions? Or the Beginning of Another? 11
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