Get the Facts About Ebola

Q: What is Ebola?
A: Ebola virus is the cause of a viral hemorrhagic fever disease. Symptoms include: fever, headache, joint and muscle aches, weakness, diarrhea, vomiting, stomach pain, lack of appetite, and abnormal bleeding. Symptoms may appear anywhere from two to 21 days after exposure to the Ebola virus, although eight to ten days is most common.

Q: Where is the current outbreak occurring?
A: The current Ebola virus outbreak is centered on three countries in West Africa: Liberia, Guinea, and Sierra Leone; although there is the potential for further spread to neighboring African countries. Ebola does not pose a significant risk to the U.S. public. The standard and rigorous infection control procedures used in major hospitals in the U.S. will prevent the spread of Ebola here. In addition, the New York State Department of Health (NYSDOH) will work with local health departments on contact tracing, isolation, and quarantine.

Q: How is Ebola transmitted?
A: Ebola is transmitted through direct contact with the blood or bodily fluids of an infected symptomatic person or through exposure to objects (such as needles) that have been contaminated with infected secretions.

Q: Can Ebola be transmitted through the air?
A: No. Ebola is not a respiratory disease like the flu, so it is not transmitted through the air.

Q: Can I get Ebola from contaminated food or water?
A: No. Ebola is not a food-borne illness. It is not a water-borne illness.

Q: Can I get Ebola from a person who is infected but doesn't have any symptoms?
A: No. Individuals who are not symptomatic are not contagious. In order for the virus to be transmitted, an individual would have to have direct contact with an individual who is experiencing symptoms.

Q: How has New York State prepared for treating an Ebola patient?
A: NYSDOH has been working with the health care system and continues to do so to ensure that New York's providers are prepared to care for a patient with the Ebola virus. NYSDOH is working with the federal Centers for Disease Control and Prevention (CDC), local health departments, hospitals, and physician organizations statewide. Past emergencies, including September 11, 2001; Middle East Respiratory Syndrome (MERS); Severe Acute Respiratory Syndrome (SARS), and the 2009 H1N1 influenza outbreak have demonstrated the need for hospitals to run practice drills and prepare for the unexpected.

Q: What is the state doing?
A: NYSDOH has purchased supplies to supplement hospitals' stockpiles; conducted drills with hospitals on their ability to quickly identify, isolate, and evaluate a suspect Ebola patient; and developed detailed guidance on lab testing, waste disposal, and other areas of concern. NYSDOH has a department-wide Ebola planning workgroup that meets daily and discusses infection control, laboratory issues, medical waste, emergency transport, personal protective equipment, and hospital planning. The workgroup has issued several advisories and guidance to hospitals and other health care providers. This is in addition to the Ebola planning hospitals have already done. NYSDOH has activated its Incident Management System (IMS), which it uses in emergencies to ensure coordination and communication.

The Department of Health has identified ten hospitals statewide to handle all patients diagnosed with Ebola, with plans to designate additional hospitals going forward. The following ten hospitals have agreed to the designation and are creating isolation units to accept patients:

• Mt. Sinai in Manhattan
• New York Presbyterian in Manhattan
• Bellevue in Manhattan
• Montefiore in the Bronx
• North Shore/LIJ Health System in Nassau County
• Upstate University Hospital in Syracuse
• University of Rochester Medical Center in Rochester
• Stony Brook University Hospital in Suffolk County
• Erie County Medical Center
• Women and Children's Hospital of Buffalo

Q: What are health care providers doing to prepare?
A: Acting State Health Commissioner Dr. Howard Zucker has issued a Commissioner's order to all hospitals, diagnostic and treatment centers and ambulances in New York State, requiring that they follow protocols for identification, isolation and medical evaluation of patients requiring care. The order mandates that all staff receive in-person training in putting on and removing personal protective equipment (PPE). The protocols ensure that New York's hospitals can safely treat patients with Ebola. DOH is also providing guidance to other health professionals and facilities on the proper management of people with potential exposure to Ebola.

Hospitals have established workgroups, identified what type and which rooms would be used for a patient with the Ebola virus; decided what kind of PPE to use; practiced putting PPE on and removing it safely; provided additional staff training; planned for laboratory evaluation of specimens; planned for infection control; coordinated with emergency medical services (EMS), medical waste disposal, and established protocols. NYSDOH is working with the Health Association of New York State (HANYS) and the Greater New York Hospital Association (GNYHA) to ensure that all hospitals in the state are conducting drills with mock patients to test emergency department capacity to quickly identify and isolate suspected Ebola patients.

Hospitals are training and conducting drills. At the request of NYSDOH acting commissioner Zucker, GNYHA, and HANYS, hospitals are drilling their emergency departments on their ability to quickly detect and isolate a patient with suspected Ebola virus. The drills help hospitals evaluate their readiness, identify areas for improvement, execute improvements, and conduct corrective training.

NYSDOH is assessing tertiary care hospitals to determine their level of preparedness to handle Ebola cases and to assess their levels of critical resources, such as isolation rooms, staff identified on all shifts, equipment, supplies, and PPE.

NYSDOH and hospitals have been having regular calls to plan for Ebola. NYSDOH regional offices have met with providers and are addressing hospital questions, providing guidance on issues such as planning, policy, and conducting drills, and planning for and ordering necessary PPE.

NYSDOH has utilized its Health Commerce System to distribute its own CDC, New York City Department of Health and Mental Hygiene (NYCDOHMH), New York City Office of Emergency Management (NYCOEM), and other federal guidance regarding Ebola. NYSDOH has distributed signage; created an Ebola section on its website; provided collaborative guidance between the state, NYCDOHMH, and FDNY on EMS protocols between hospitals and EMS providers; discussed laboratory procedures for hospital testing; and is preparing guidance regarding handling of human remains.

Q: What other agencies are involved in planning?
A: NYSDOH is working with a number of state agencies to prepare, including the Department of Environmental Conservation and Department of Transportation on medical waste disposal issues; county health departments and emergency managers on contact tracing, isolation, and quarantine planning; the State Police to train their personnel, who are often the first to respond and to work local health departments on quarantine planning; and SUNY and CUNY to ensure that colleges and universities adhere to the CDC and NYSDOH guidance; and the State Education Department.

At JFK, the Port Authority is working in coordination with CDC personnel, Customs and Border Protection and the US Coast Guard. There are advanced screenings at JFK using detailed questionnaires for passengers originating in three affected West African nations. In addition, CDC personnel, Customs and Border Protection and the US Public Health Service have conducted practice drilling with the Port Authority Police Department and other Federal, State and local partners for scenarios in which passengers who may have been infected with the virus are handled at JFK. To date, no passengers at JFK arriving from the three West African nations have been identified as having the Ebola virus.

The Metropolitan Transit Authority has developed a protocol to keep its employees and customers safe during this time of heightened awareness. This protocol includes ensuring that at-risk employees have appropriate PPE to guard against infection and are trained in its use, as well as following best practices and recommended standards when cleaning MTA facilities. This protocol was developed in close consultation with DOH regarding symptoms and likelihood of potential exposure. The MTA has met with its labor unions to discuss this protocol and to make sure it is consistent and thorough in its implementation.

The Governor's Office of Public Safety is working with New York State Police, the New York State Chiefs and Sheriff's Associations and SUNY Chiefs to coordinate field advice for police officers regarding recommended equipment and procedures to reduce chance of contamination.

Q: How likely is it that New York State will have more Ebola patients?
A. New York State is a hub for international flights and travelers, and is therefore at risk for having such patients. Hospitals must be in a constant state of readiness. NYSDOH acting commissioner Dr. Howard Zucker is working with the Metropolitan Transit Authority and the Port Authority regarding communication of any concerns at points or ports of entry.

Q: What is being done to prevent ill passengers in West Africa from getting on a plane?
A: CDC is assisting with active screening and education efforts on the ground in West Africa to prevent sick travelers from getting on planes. In addition, airports in Liberia, Guinea, and Sierra Leone, are screening all outbound passengers for Ebola symptoms, including fever, and passengers are required to respond to a health care questionnaire. CDC is also increasing support to the region by deploying 50 additional workers to help build capacity on the ground.

Q: What is CDC doing in the U.S.?
A: The Centers for Disease Control and Prevention (CDC) and the Department of Homeland Security's Customs & Border Protection (CBP) this week will begin new layers of entry screening at five U.S. airports.

The enhanced entry screening is being performed at JFK International Airport in New York and at Washington-Dulles, Newark, Chicago-O'Hare, and Atlanta international airports nationwide.

CDC is sending additional staff to each of the five airports. After passport review:

• Travelers from Guinea, Liberia, and Sierra Leone will be escorted by CBP to an area of the airport set aside for screening.
• Trained CBP staff will observe them for signs of illness, ask them a series of health and exposure questions and provide health information for Ebola and reminders to monitor themselves for symptoms. Trained medical staff will take their temperature with a non-contact thermometer.
• If the travelers have fever, symptoms or the health questionnaire reveals possible Ebola exposure, they will be evaluated by a CDC quarantine station public health officer. The public health officer will again take a temperature reading and make a public health assessment. Travelers, who after this assessment, are determined to require further evaluation or monitoring will be referred to the appropriate public health authority.
• Travelers from these countries who have neither symptoms/fever nor a known history of exposure will receive health information for self-monitoring.

Entry screening is part of a layered process that includes exit screening and standard public health practices such as patient isolation and contact tracing in countries with Ebola outbreaks. Successful containment of the recent Ebola outbreak in Nigeria demonstrates the effectiveness of this approach.

If an ill passenger does enter the U.S., CDC has protocols to protect against further spread of the disease. These include notification to CDC, local transportation authorities and local health authorities if there is an ill passenger on a plane before arrival, investigation of ill travelers, and, if necessary, isolation. CDC has also provided guidance to airlines for managing ill passengers and crew and for disinfecting aircraft. CDC has issued a health alert notice reminding U.S. health care workers of the importance of taking steps to prevent the spread of this virus, how to test and isolate suspected patients, and how they can protect themselves from infection.

Q: What about ill Americans with Ebola who are being brought to the U.S. for treatment? How is CDC protecting the American public?
A: CDC has very well-established protocols in place to ensure the care of patients with infectious diseases and their safe transport back to the U.S. These procedures cover the entire process—from patients leaving their bed in a foreign country to their transport to an airport and boarding a non-commercial airplane equipped with a special transport isolation unit, to their arrival at a medical facility in the U.S. that is appropriately equipped and staffed to handle such cases. CDC's role is to ensure that travel and hospitalization is done to minimize risk of spread of infection and to ensure that the American public is protected. Patients were evacuated in similar ways during SARS.

Q: What does the CDC's Travel Alert Level 3 mean to U.S. travelers?
A: On July 31, the CDC elevated its warning to U.S. citizens, encouraging them to defer unnecessary travel to, Liberia, Guinea, and Sierra Leone over concerns that travelers may not have access to health care facilities and personnel should they need them in those countries.

Q: If an individual with a travel history and any Ebola symptoms is identified at the airport, where are they taken and who is alerted?
A. Individuals from affected countries are identified through their passports and then screened by CDC at the airport. All passengers from Liberia, Guinea, and Sierra Leone have their temperatures taken upon arrival. If a passenger is ill, the individual will be transported to a hospital. If they are at risk, they will be quarantined and the local health department will check in with them twice daily and monitor their temperature. If they are found to have Ebola, they would be transferred to one of the hospitals designated to treat Ebola patients.

New York is the first state to receive a list of travelers from the three affected countries. Working with the CDC, NYSDOH is receiving reports of travelers arriving at JFK International Airport whose destinations are somewhere in New York State. NYSDOH will work with local health departments to contact all incoming travelers to 1) ensure that they have no risk exposure to Ebola; 2) are taking their temperatures for 21 days; 3) have a plan if they get sick; and 4) have contact information at NYSDOH.