How well prepared is Australia for an Ebola outbreak, and what steps are being taken to protect the public?
By Sarah Scopelianos and Tim Leslie
The risk of Ebola spreading to Australia is considered low but everywhere from airports to hospitals a wide range of measures are in place to further minimise the risk and plan for a potential outbreak.
The Australian Medical Association has raised questions about the official response, saying it has been chaotic and secretive.
States and territories have their own plans to deal with potential cases but an Ebola tsar has been appointed to oversee Australia’s response and the federal Health Department released national guidelines for public health units to combat the virus.
What’s happening at our airports and borders?
Australia is screening passengers who return from West Africa; biosecurity staff ask people who have been to Liberia, Sierra Leone and Guinea if they have had contact with Ebola patients, and whether they have had a fever in the past 24 hours.
A new system has been set up to alert authorities when Australian healthcare workers leave for Ebola-affected areas and return to Australia.
Officials say 15 to 30 travellers are arriving from Ebola-affected countries each week.
In the two months to late October, authorities screened more than 900 passengers at 10 Australian airports.
Travel restrictions have not been recommended for control of Ebola but the Australian Government’s Smart Traveller website says people should reconsider travel to affected areas and Australians in those areas “should leave while limited commercial options remain available”.
Australia has also suspended its immigration programs from Ebola-affected countries, including its humanitarian program, meaning no visas will be issued to people from those countries wishing to travel to Australia.
The suspension was announced after an 18-year-old woman who had travelled from West Africa to Brisbane was hospitalised with a fever; she tested negative for Ebola.
What are airlines doing to stop the spread?
Airline staff are being advised to watch for ill passengers and report people who are suffering from vomiting and diarrhoea.
Remember: Ebola is spread by direct contact with a person’s bodily fluids.
If a passenger or crew member who has recently travelled in an Ebola-affected country suffers symptoms such as a fever, vomiting or diarrhoea, the sick person should be kept separated from others as much as possible, and the crew is advised to wear impermeable disposable gloves for direct contact with blood or other body fluids, and use an eyemask and/or goggles.
If a person suspected of having Ebola has travelled on a plane, public health authorities will ask the airline for passenger lists and any incident records.
Authorities could contact passengers and crew who were on the flight and cleaners who later cleaned the plane to offer fact sheets, assess the need for medical evaluation and provide advice about self-monitoring their temperature.
But they will focus their attention on tracing any person who reported direct contact with the infected person’s bodily fluids or skin.
According to the Communicable Disease Network Australia’s (CDNA) National Guidelines for Public Health Units, authorities should contact passengers who were sitting one seat away in all directions from the person suspected to be infected.
Using the same toilet as an infected person is not considered a risk.
However, if there have been significant incidents of vomiting and/or diarrhoea in the plane’s toilets, staff should make an effort to identify these toilets, the associated plane section and people who may have been exposed to the case’s bodily fluids, the guidelines say.
If a crew member is the person suspected of having Ebola, authorities will aim to trace passengers seated in the staff member’s area and other staff who had contact with them.
What happens if there’s a suspected case?
- See how Australian doctors and nurses are advised to diagnose and test for Ebola.
Hospital staff will gather information from the patient about symptoms, recent travel and exposure history to Ebola.
The patient will be isolated in a single room and staff will contact the state or territory’s health department. At this stage risk assessments and the need for tests are discussed. The regional department will notify the National Incident Room of the case.
The patient is not allowed to leave hospital unless being transferred.
Should a patient’s tests come back negative and hospital staff can find no alternative diagnosis for the patient’s illness and suspicions remain, the person will kept in isolation and further tests considered.
While there has been some success with experimental medications in the United States, there are currently no antiviral medications to treat Ebola.
The World Health Organisation says supportive care-rehydration with oral or intravenous fluids improves the chances of survival. It says a range of potential treatments including blood products, immune therapies and drug therapies are being evaluated.
While waiting for a diagnosis, treating doctors may decide to start therapy for conditions such as malaria or bacterial sepsis.
If hospital staff find an alternative diagnosis or no longer believe the patient has Ebola, they will be released from isolation and discharged.
They will be given a fact sheet and contact details for the state/territory public health unit to use should they need them.
How is Ebola diagnosed?
A blood test is often the first test, however urine or a swab from the throat or nose can be tested for the virus.
Any sample will be sent to the Victorian Infectious Diseases Reference Laboratory, the only lab of its kind in Australia that tests for hemorrhagic fevers like Ebola.
The lab’s director, Mike Catton, says the facility has the capacity to do hundreds of samples if needed.
It has run exercises to prepare for a “mass casualty event” but Dr Catton says the chances of that happening are “extremely unlikely”.
What about anyone the sick person has come into contact with?
Health staff will interview the suspected Ebola patient to establish facts like when they started feeling sick, what symptoms they have had, the likely source of infection and their contact with other people.
Remember: Ebola is only contagious after the infected person starts feeling sick, not as soon as they get the infection.
Authorities will aim to identify and contact everyone who has had contact with the patient. These people will be given information and monitored for symptoms for 21 days after the last exposure to the case.
People living in the patient’s household are considered to be at a low risk and will be asked to take their temperature twice a daily.
Usually there are no restrictions on work or movement unless symptoms develop, but restrictions might be considered for healthcare workers or people planning to travel to rural or remote areas with limited access to healthcare.
The situation may be different for people who have had a higher exposure to the patient and their bodily fluids.
Should anyone who came in contact with the patient develop symptoms, they must seek medical attention.
What protective clothing do health workers wear?
Health workers are at a much greater risk than the general public as they deal with patients and their bodily fluids in close proximity – and at the end stages of the virus when they are most infectious.
The Communicative Disease Network Australia’s guidelines recommend health workers who are treating suspected or confirmed Ebola patients cover all their skin using appropriate protective clothing, including:
- Hand hygiene
- Gloves, possibly double gloving
- Fluid-resistant long-sleeved gown
- Eye protection, for example goggles
- Fluid-repellent surgical facemask
- P2/N95 respirator for potential aerosol generating or splash procedures
- Face shields
- Leg and shoe coverings
- Overalls
Hospitals like the Royal Melbourne are doing daily emergency drills to prepare staff for the possibility of treating an Ebola patient.
The hospital’s Professor George Braitberg says a buddy system has been introduced where a staff member watches the treating healthcare worker put on and take off their protective clothing to avoid cross-contamination.
Taking off protective clothing has been identified as one of the key risk points for health workers, as they can come into contact with bodily fluids during the process.
“We’re doing daily drills in terms of putting on and off the suits, different sorts of drills on a weekly basis but really not telling our staff how the patient is going to present or what part of the system we’re testing so that we can get their immediate responses,” Dr Braitberg said.
The hospital’s Professor Mike Richards says staff protection has been refined to ensure all skin is covered and headgear includes “Jupiter hoods” that pump filtered air into a hood over the face for specific procedures and prolonged use.
How would hospitals avoid the infection spreading?
Australia’s new Ebola tsar, Professor Lyn Gilbert, is an expert in infectious diseases at the University of Sydney; she will assess and if need be overhaul infection control in all Australian hospitals.
There are 14 units across the county with specialist containment facilities where Ebola patients will be sent. There is some variation between individual hospital responses, but they all are following the principals outlined by the Communicable Disease Network Australia.
The hospital facilities include measures to prevent the spread of infectious diseases, such as negative pressure – which prevents air escaping into other rooms to and reduces the risk of cross-contamination.
Patients presenting with Ebola-like symptoms at hospital should be placed single room with a private bathroom and an anteroom with a door closed, according to the guidelines.
In hospitals where such facilities are not available, other arrangements like the use of commodes in the patient’s room and emptying adjacent rooms will occur.
Sydney University lecturer in communicable diseases Grant Hill-Cawthorne says normal cleaning products like bleach or anything containing chlorine kill the Ebola virus quickly.
Dr Hill-Cawthorne says the handwash solution found on hospital wards would be sufficient for health care workers to use.
“It’s a fragile virus and so normal cleaning methods will get rid of it,” he said.
“We just have to be aware and conscious [that] people do that cleaning before they touch their face and eyes.”
Equipment used will be dedicated to the patient, with disposable equipment and linen to be used wherever possible.
Items stained or containing body fluid will be treated as clinical waste and double-bagged before leaving the patient’s room.
Visitors are to be restricted to a limited number of immediate family members; and only adults who are well.