Public Health : Dallas Patient 1st in U.S. to be Diagnosed with Ebola

CDC director vows to “stop Ebola in its tracks” by identifying everyone who came into contact with the patient since he became contagious.

Sherry Jacobson, The Dallas Morning News | October 1, 2014

Tom Frieden, Centers for Disease Control and Prevention director, addresses a congressional subcommittee hearing on the threat of Ebola on Aug. 7, 2014, in Washington. (Alejandro Davila Fragoso/MCT)

(MCT) — The Centers for Disease Control and Prevention confirmed Tuesday that a Dallas patient was the first person in the U.S. to be diagnosed with the Ebola virus.

Federal, state and local officials immediately tried to dampen fears that the patient could trigger an outbreak of the deadly disease.

Dr. Tom Frieden, the CDC director, vowed to “stop Ebola in its tracks” by identifying everyone who came into contact with the patient since he became contagious. Each of those people will be watched for signs of illness, including sudden fever, and if they develop them will be placed in isolation to prevent further spread of the disease.

“This is a tried-and-true protocol. This is what we do,” he said at a nationally broadcast media briefing in Atlanta. “There is no doubt in my mind that we will stop it here.”

The patient, who has not been identified, had traveled by plane from Liberia in West Africa and was visiting family in North Texas. He remains in isolation at Texas Health Presbyterian Hospital, undergoing treatment for symptoms of the dreaded virus. He was described Tuesday as being critically ill.

Presbyterian announced late Monday that the patient could be an Ebola case, based on his recent travel and his symptoms.

The patient’s blood tested positive for the virus Tuesday morning in a state laboratory in Austin, said Dr. David Lakey, commissioner of the Texas Department of State Health Services.

“We have no other suspicious cases in Texas at this time,” he said.

The CDC’s laboratory in Atlanta confirmed the diagnosis later Tuesday and alerted the media at 3:32 p.m. Although the information was embargoed until 4:30 p.m., many news outlets released it immediately.

The virus, named for the Ebola River in the Congo, has had a 90 percent fatality rate in Africa, although the rate for the current outbreak in West Africa is about 60 percent. More than 3,000 deaths have been linked to the disease. There is no vaccine or specific treatment for Ebola.

Frieden said the Dallas patient arrived Sept. 20 in the U.S. He had no Ebola symptoms during the trip, which meant he was not contagious.

On Sept. 24, he developed symptoms, and two days later he sought medical care at Presbyterian’s emergency room. He was sent home but was admitted to the hospital on Sunday. He was placed in isolation and tested for Ebola.

Zachary Thompson, director of Dallas County Health and Human Services, said his staff has begun tracing the patient’s movements from the time he became ill until he was placed in isolation in the hospital.

Every contact will be followed for up to 21 days, which is how long it can take for a person exposed to Ebola to begin showing symptoms. Symptoms include nausea, vomiting, diarrhea and body aches unrelated to any other disease.

Frieden said the contact-tracing effort would “cast a net widely.”

But so far, the people who might have been exposed include “a handful” of family members, whom the patient was visiting, and “a few community members,” he said. The hospital workers who initially treated the patient also will be contacted.

The two-man Dallas Fire-Rescue EMS crew that transported the patient to the hospital Sunday morning also will be monitored, in accordance with CDC and Dallas County health guidelines.

The CDC director declined to reveal the patient’s nationality, age or other identifying characteristics, such as where his relatives live in the Dallas area.

Dr. Edward Goodman, an epidemiologist at Presbyterian, noted that U.S. patient privacy laws prohibit health care providers from identifying the patient further.

Authorities did say, however, that the patient did not appear to have been caring for Ebola victims in Africa. How he became infected is not known.

Although the virus is new to the U.S., hospitals have been preparing for its arrival, and the Presbyterian staff is well prepared to handle “this crisis,” Goodman said.

Frieden stressed that Ebola can only be spread through direct contact with an infected person’s bodily fluids, including saliva, urine or blood.

“Ebola is a scary disease,” he conceded. “We’re all hoping for the recovery of this individual.”

Meanwhile, the effort to stop its spread in Dallas County is just getting started.

The CDC will send a crew of infectious-disease experts to assist local agencies.

Dallas Mayor Mike Rawlings said an emergency operations center has been set up at City Hall, in case it’s needed.

“We’ve spoken to the county, state, and CDC’s on the way,” said Rawlings. “There’s a clear protocol laid out, and everyone’s making sure they are dotting every I and crossing every T.”

TIMELINE

Here’s how the Ebola virus traveled to Dallas:

Sept. 19: The adult male patient leaves Liberia.

Sept. 20: The patient arrives in the United States.

Sept. 24: The patient begins to have symptoms of the virus.

Friday: The patient seeks care at Texas Health Presbyterian Hospital in Dallas either late Thursday night or early Friday morning. His symptoms were not specific enough to identify the virus and he was released.

Sunday: The patient is taken to Presbyterian Hospital by Dallas Fire-Rescue ambulance. He is listed in critical condition in intensive care in isolation.

Tuesday: Positive test results at the Centers for Disease Control and the Texas State Department of Health Services are confirmed. Officials say that a “handful” of family members and two to three others had contact with the patient. Dallas activates its Emergency Operations Center to Level 2 — high readiness — to monitor the case and work with federal, state and county officials.

WHAT’S NEXT

The CDC has convened a team of epidemiologists and will take the lead in the Ebola investigation.

Health care investigators will identify all people who had contact with the patient and monitor them for 21 days. Two Dallas Fire-Rescue crew members who transported the patient are also being monitored.

The CDC said it is possible that someone who came in contact with the patient could develop Ebola.

HIGHLIGHTS

Officials at the federal Centers for Disease Control and Prevention in Atlanta emphasized that the risk of anyone contracting the disease here is extremely small because it requires exposure to the bodily fluids of someone with the virus.

CDC Director Tom Frieden said there is no danger in the United States of a widespread outbreak like the one in West Africa.

“It is certainly possible that someone who has had contact with this patient could develop Ebola,” he said. “But there is no doubt in my mind that we will stop it here.”

Because the man was not sick while on the plane or in the airport, health officials are not contacting fellow passengers. “There is zero risk of transmission on the flight,” Frieden said. “He was checked for fever before getting on the flight.”

Officials at Texas Health Presbyterian said there is no danger for patients, workers or visitors because of rigorous infectious disease control practices.

Staff writers Matthew Watkins and Robert Wilonsky contributed to this report.

©2014 The Dallas Morning News. Distributed by MCT Information Services

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Disaster Preparedness & Recovery : Opinions Divided Over Value of Earthquake Insurance

The number of residential policies has declined in California from 1.2 million in 2004 to 1.1 million last year.

Robert Digitale, The Press Democrat | October 1, 2014

A building sits damaged after a magnitude 6.0 earthquake struck Napa, Calif., in August. Justin Short/Cal OES

(MCT) — Tom Fuller could tell how well folks understood earthquake insurance once he mentioned that he has a policy for his damaged home in Napa.

The uninitiated responded, “Well, you’re lucky.” The more knowledgeable said, “I hope you didn’t hit your deductible.”

Fuller, a public relations consultant, said the repairs from last month’s magnitude-6.0 quake won’t come close to his $48,000 deductible — the amount of structural damage his home must suffer before the insurance company becomes liable for major repairs. That means he will cover virtually all the damage from the Aug. 24 temblor to his 1940s-era home south of downtown.

Even so, his insurance policy still gives him peace of mind that he could rebuild should a massive, 1906-type quake ever level his city.

If needed, Fuller said, “I could afford a $48,000 hit. I can’t afford a $480,000 hit.”

Fuller is a rare breed among Napans, whose city last month suffered one death and an estimated $362 million in damage to its buildings, roads and other infrastructure. Only 6 percent of Napa County homeowners have earthquake insurance, compared to 10 percent of all Sonoma County and California residents, according to the California Earthquake Authority, the public entity that works with private insurers to offer residential coverage.

Only 9 percent of state businesses had quake insurance last year, according to the state Department of Insurance.

The number of residential policies has declined statewide from 1.2 million in 2004 to 1.1 million last year. But with pending changes, more homeowners may begin to consider the coverage.

Even so, earthquake insurance elicits head-jarring differences of opinion among Californians.

Insurance experts say the lack of coverage means that homeowners, businesses and the state as a whole are going to suffer terrible financial harm when a major quake strikes. They consider earthquake coverage similar to other insurance offerings for life, health and automobiles. And they say that other countries take a more sensible approach to managing the risk of catastrophic quakes.

Many homeowners counter that quake insurance is too expensive and the deductibles are too high.

“The premium cost is so prohibitive that it makes no financial sense,” said Lynda Jensen, a Napa resident who lost a chimney and sustained other damage to her 1902 Queen Anne Victorian near downtown.

Jensen, manager of Wine Country Group real estate brokerage on Main Street, said she has yet to encounter anyone in town with earthquake insurance — not neighbors whose homes were red-tagged or fellow business people who scrambled to reopen their doors or the landlord of her reinforced-stone masonry office building, where interior glass windows blew out into diamond-shaped rubble and heavy roof stonework crashed down outside near the back of the building.

Jensen’s own baby blue and white home soon will have a new chimney, and she plans to have a structural engineer look over cracking and slight twisting at its front and back walls. So far the damage amounts to about $30,000, she said.

Despite the losses, she remains uninterested in earthquake insurance. If she had bought such coverage, she said, the deductible level would have been $58,000, meaning she still wouldn’t have received significant help even after a 6.0 quake.

“So what good is it?” she asked.

Another quake coming?

As the Napa temblor showed, California is earthquake country. And Santa Rosa belongs among the communities with tales of loss.

In the 1906 quake, at least 100 people perished here, while the city’s domed courthouse and many downtown structures collapsed. As well, the wreckage from a pair of 5.6 and 5.7 quakes in 1969 led to the remaking of the downtown, including the construction of a modern shopping center atop six blocks of former hotels, theaters and other businesses.

Looking forward, the state has more than a 99 percent chance of experiencing a magnitude 6.7 quake or larger by 2038, the U.S. Geological Survey predicted in 2008. Such a quake would be roughly 20 times greater than Napa’s, said Glenn Pomeroy, CEO of the publicly managed California Earthquake Authority.

In Napa, about 400 homeowners to date have filed claims with insurance companies whose policies are written in cooperation with the earthquake authority, Pomeroy said. The most common payments likely will be $1,500 per home for emergency repairs, followed by living expenses for those who had to temporarily move from their residences. There also could be payments for damaged contents and structures.

While Napa was a moderately strong event, the magnitude-6.7 Northridge earthquake in 1994 showed the nation’s insurance industry how costly such disasters could be.

That quake killed about 60 people and caused $40 billion in damage, including $20 billion to residential properties.

Insurance companies paid $10 billion to homeowners, Pomeroy said, a sizable amount considering that only about 25 to 30 percent of such owners then had earthquake coverage.

The fact that nine out of 10 California homes now lack earthquake insurance is “alarming,” Pomeroy said. His agency is working to offer homeowners new policies “considered to be much more affordable and much more valuable.”

‘Not ready for anything’

Should a major quake devastate a city, many California homeowners with little equity in their homes likely “would choose to walk out of their loans,” said Weili Lu, director of the Center for Insurance Studies and a professor at California State University, Fullerton. Lenders don’t require borrowers to take out earthquake insurance, she explained, but they would share in the losses.

California’s leaders need to give more attention to the danger to the state’s economy from destroyed homes, shuttered businesses and other impacts related to the lack of insurance coverage, Lu said. She called for a task force to bring in key players and researchers to devise a strategy for dealing with such risk.

“At this moment, we’re not ready for anything,” she said. The state could learn lessons from the success of such countries as Japan and New Zealand.

As with homeowners, fewer state businesses have earthquake insurance today. The number declined last year to almost 84,000 from 119,000 in 2004.

Larger companies are much more apt than smaller ones to buy the coverage, said Alex Michon, a senior vice president in Sacramento with Aon Risk Solutions, a global business risk management firm. And those in higher-risk areas can face hefty premiums. A manufacturer in certain areas of Southern California might pay up to $1 million a year for $10 million worth of earthquake coverage.

Evaluating insurance need

In recent years, premiums have become more expensive, and many smaller businesses have decided to go without coverage, Michon said. They’re essentially saying if a big quake hits, “we’re just going to take a bath on it.”

Earthquake premiums and coverage are “on par” with those offered for homeowners who risk damage from hurricanes and tornadoes, said Amy Bach, executive director and co-founder of United Policyholders, a San Francisco-based nonprofit consumer group. The organization doesn’t accept money from insurance companies.

Bach recommends homeowners evaluate the need for quake insurance by considering the style and age of their homes, their compliance with modern building codes, the amount of equity in the properties and their distance from known fault zones.

For the owner of a modern, single-level, ranch-style home in Sebastopol, she said, “it’s probably not worth it” to get coverage. Bach, however, bought insurance for her own 1912-era home with two living levels over a garage in San Francisco’s Inner Sunset neighborhood.

Don’t presume your home is safe because it survived the 1989 Loma Prieta earthquake, Bach said. That reminds her of the people on New York’s Long Island who said their homes had never before flooded but did so in 2012 during Hurricane Sandy. A number of those homes are now in foreclosure because their owners can’t afford to repair them, she said.

Earthquake insurance is meant to protect against a catastrophic event, much like health insurance does for a needed major surgery. “It’s those dollars that the average person could not come up with on their own,” Bach said. “It’s worst-case scenario protection.”

Bach and others cautioned against expecting the government to bail out homeowners. As of Friday, Napa residents were still waiting to learn whether the Federal Emergency Management Agency would designate residents eligible for certain aid, as was previously done for the city’s government. But even if some low-interest loans and small grants are provided, Pomeroy said the federal government is not going to pay to rebuild everyone’s homes.

More coverage options now

More insurance companies in California now offer a choice of deductibles of 10 or 15 percent. Also, the authority recently began to offer policies that set a separate deductible for the home’s contents.

The authority recently asked the Department of Insurance to allow a range of deductibles for contents coverage from as low as 5 percent to as high as 25 percent.

It also sought permission to raise the premium’s discount for those who adequately retrofit homes. That discount now is set at 5 percent, but could go to as much as 20 percent, Pomeroy said.

Another effort seeks to win federal assistance to greatly reduce the more than $200 million the authority now spends each year on “reinsurance,” purchased to make sure it can pay claims from a worst-case quake. About 40 percent of premiums now go to essentially buy insurance for the authority. However, efforts have stalled in Congress to win a federal loan guarantee that could provide a much less costly alternative.

Napa was Northern California’s first large quake in 25 years, and it has once more placed attention on earthquake insurance.

“It does tend to put this back on people’s radar screens,” Pomeroy said. “And it usually shows up in increased policies.”

In Napa, State Farm insurance agent John Cardinale said more clients have been asking him about quake coverage.

“It’s on top of people’s minds,” he said.

Such coverage is just part of the answer to preparing your family, home and community for a major disaster, Cardinale said. But if a 7.0 quake damages your home, “you’re going to thank God you bought earthquake insurance.”

©2014 The Press Democrat (Santa Rosa, Calif.). Distributed by MCT Information Services.

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Training & Education : Intentions to Action: Tips for Creating a Culture of Preparedness

Mary Schoenfeldt, of the Everett, Wash., Office of Emergency Management, shares her decades of expertise on increasing community preparedness.

Jim McKay | September 30, 2014

Mary Schoenfeldt says preparedness is more about a mindset than having an emergency kit. (Photo by Rick Dahms)

Mary Schoenfeldt is the public education coordinator for the Everett, Wash., Office of Emergency Management. She is a 2013 inductee into the International Network of Women in Emergency Management hall of fame and has written numerous books on school safety during her 30 years in the field. 

Schoenfeldt is considered an expert in crisis management, helping communities assess response systems; writing crisis plans; conducting physical site safety audits; and designing school training exercises. She created the community preparedness campaign “Who Depends on You?” This interview has been edited for clarity and length.

Emergency Management: Can you give an overview of the “Who Depends on You?” campaign?

Mary Schoenfeldt: It’s a public education campaign that was really created by a shelter dog, if you will. I’m like everybody else. I’m not as prepared as I should be and I was thinking why that was. I’m at a place in my life that I don’t have anyone I’m directly responsible for. I was walking up the driveway one day and this shelter dog that I’d adopted looked up at me [as if to say], “Now wait a minute — you’re responsible for me and I depend on you.”

That’s where the concept came from. The research tells us that it’s not about education; people are well educated about what they need to do to be prepared. They don’t have the motivation. They have great intentions. So my mantra has been let’s move people from intention to action, and to do that we have to look at what motivates people. What motivates people are responsibility, accountability and peer pressure, and I think back to when H1N1 was sweeping the country and everybody was washing their hands. That’s because the message was right there and everywhere you turned, whether it was on a billboard or on the side of a bus or on TV, and along with that was peer pressure. “If I don’t do it I might put somebody I care about at risk.” It reinforced for me what we were doing with Who Depends on You? 

I have not found anything that I cannot wrap Who Depends on You? around. If I’m talking to a business, it’s their customers, vendors, employees. We can wrap the campaign around young families, that’s just a given. If you have children or elderly parents and they’re looking to you, let’s make sure we’ll be able to be there for them. 

One of the most successful target groups that hear the message is pet owners. They will jump at being prepared because they have this incredible responsibility to whatever their Fluffy is. We’ve done some research and found there are more people who have preparedness plans and kits for their animals than there are people who have them for their families. Part of that is we’ve done a good job of marketing that. 

EM: You hear a lot about getting a kit, but preparedness is much more than that isn’t it?

MS: It’s not about a kit, it’s about a mindset about not wanting to be inconvenienced in some ways because when the power is out we are inconvenienced. For the first hour or so it’s fun and we are camping, but after that it’s no longer fun if we can’t get information or power up something that we’re dependent on or our cellphones go dead and we don’t have a way to charge them. It’s a mindset of preparedness, of being ready for anything. 

The research that we did also found that rural areas were much more prepared than our city dwellers. They confront it all the time. The power goes out more often in rural areas. There might be something that happens with the water supply; you might have to depend on neighbors or yourself because if you’re truly rural you might have a 20- or 30-minute response time to get basic medical or law enforcement. It’s different for those of us who live within a city limit or close to it where we have great government infrastructure — the response time to my house is three to five minutes. So why do I need to prepare? I’m just going to dial 911, and somebody is going to come and fix my problem. 

We [respond] well on a good day, but it’s the bad day we need to prepare for. When I’m out there doing public education, I talk about the difference between an emergency and a disaster. An emergency is bigger than I am, I can’t take care of it and I dial 911; a disaster is I need help and I dial 911 and maybe the phone’s not even working, or the roads are impassable. 

EM: Does preparedness have to start locally? How does it begin?

MS: You start it with conversations. It’s supported locally, and it’s supported by government or the official voice like FEMA, the Department of Homeland Security or a county or state. But I think truly the message comes on a much more personal level. I’m not sure the brochures that we hand out really get people to change and to go from intention to action. It’s more personal relationships, talking to somebody at a safety fair or at work. It’s having kids bring it home from school because the educators talked about it and have developed that relationship with that student and that student comes home and talks about it. 

EM: Can we scare people into it?

MS: I don’t think so. I think we can scare people into being terrified and paralyzed. We have to get their attention sometimes and if you and I are neighbors and I tell you my experience, which was a frightening one, you may say, “What did we learn that may be a lesson for my family?” But I don’t think government can scare people into it. We go at it the wrong way. We need to tell them what works. 

I’m seeing some local campaigns and public service announcements that really try to personalize that message. I’m seeing fewer government entities saying you need to have extra water, etc. We’re going away from that and the messages are becoming more personalized. 

It’s improving but I don’t think everyone can be prepared. Because if we’re prepared and we’re functional in that emergency then it’s just a day-to-day operation. Chaos and confusion are ingredients of a disaster. You can’t have a disaster without chaos and confusion, that’s just an integral part. We can be better prepared but it will never be business as usual. We will always be out of step because physiologically and psychologically we don’t react as quickly as that disaster comes to us. We’re still in shock or denial, and the disaster is there and has turned our world upside-down. 

EM: You mentioned kids. Are we getting to them early enough?

MS: We have a long way to go with that. We sometimes look for easy solutions. It has to be outside of a classroom because of the incredible pressures that they’re under anyway with learning and testing and school safety. If we add another curriculum, we’re fighting an uphill battle. 

There are other organizations. Preparedness is part of the Girl Scout experience, the Lego League has partnered with IAEM and emergency managers across the country, and youth activities — Boys and Girls Clubs, YMCA. There are probably thousands of activities out there that would teach kids emergency preparedness.

EM: You mention school safety and we’re seeing training for active shooter situations. Can you address that?

MS: That’s been my passion. I wrote the first book on school crisis response [School Crisis Response Teams: Lessening the Aftermath] in 1993. Preparedness is needed on a systemic level and a personal level. On a systemic level, I have shied away from focusing on an active shooter for a variety of reasons. If you look at an incident that’s happened on a school campus that involved an active shooter, the challenges to the school system are accounting for everybody; knowing who’s involved; who’s injured; who’s hiding; who didn’t come to school that day. The major challenges in a school shooting incident are accountability and communicating with everybody and that means students, staff and first responders. 

Do we have accountability; do we leave or stay; partnering with those who come to help and connecting families. Those are the issues. They are the same with an industrial explosion or a collapsed roof in a wind storm. It’s all-hazards. 

We’ve got system preparedness but educators and the staff at schools need to be personally prepared for disasters, and that’s not an emphasis I see as much as I would like. The principal, the teacher, bus driver, counselor — they need that same family preparedness plan whether it’s an earthquake or a major storm. You need to have that security that says if I’m at school and the tornado sirens go off I know my elderly mom is going to be OK because we’ve set up those systems and I’ve talked to the care facility where she is and I know their plan. I know my children, who attend another school, are going to be well taken care of. If schools aren’t open, people aren’t getting back to work and the whole economic engine gets disrupted. 

EM: Can you talk about integrating critical incident stress management into training drills?

MS: It’s a key element because the psychological scars and impacts are sometimes far more severe than the physical. The concept of it is trying to provide a safe place for people to make sense of the senseless. You can use whatever model to do that and there are several out there. Emotional impact is truly going to define whether we recover. After Sandy Hook they created what they hoped was a similar image of the elementary school but it was at a neighbor school. It was painted to look like Sandy Hook; it was a recreation of the safe place that Sandy Hook had been. The old school was single-story but the new school was two-story. Some kids were diving under their desks on the first floor every time they heard a startling noise from the floor above. That to me is a clear indicator that we need to support people. It’s not a surprise. 

Another story I heard was a teacher who stopped in the parking lot to call a friend the morning before she went into the new Sandy Hook to face her students. She said to her friend she didn’t sleep the night before and had horrible nightmares and needed a friendly voice. Those are some of the things that are clear indicators that critical incident stress management in a variety of forms is needed.

Jim McKay  |  Editor

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Jim McKay is the editor of Emergency Management. He lives in Orangevale, Calif., with his wife, Christie, daughter, Ellie, and son, Ronan. He relaxes by fly fishing on the Truckee River for big, wild trout. Jim can be reached at jmckay@emergencymgmt.com

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