On Oct. 20, 2014, Chancellor Joe May talked with Dr. John T. Carlo, a Dallas-area doctor who specializes in infectious diseases, in order to answer questions about Ebola from students and employees of DCCCD.
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Good afternoon, we're doing something a bit different today. About 3 weeks ago we all learned that the first case of the Ebola virus diagnosed in the United States was confirmed in Dallas. This virus has brought national and international attention to our area. The Ebola virus has had far reaching effects on area residents, schools and even our own Allied Health nursing students. Our country and our city already had plans and procedures in place to handle infectious diseases, however like many medical issues Ebola virus has taught us this, what we plan for often changes and as a result what we've seen and heard in the news about the Ebola virus has created confusion and questions for many people. I've spent time in the past few days talking to and meeting with health care professionals from the C.D.C., the Texas Department of Health and Human Services and the Dallas County Health and Human Services.
We want to do all we can to ensure the safety of our students and employees and also as an educational institution we want to provide timely and accurate information. To that end, I've invited an expert to answer some of the questions you sent by email. Dr. John T. Carlo, a Dallas area doctor who specializes in infectious diseases is helping us today with those questions. Dr. Carlo has been interviewed by a number of area news outlets about the Ebola virus, most recently on FOX 4 and he also spent time answering your questions on WFAA TV during a live call in-program. Dr. Carlo has served in a number of leadership positions with medical and health organizations. He is also an active member of the Dallas Medical Society and the Texas Medical Association and a former Medical Director and Health Authority for Dallas County Health and Human Services and has served as a Dallas County Chief Health and Program Director and Principal Investigator for University of Minnesota's Bio Watch Program which is a an initiative funded by the U.S. Department of Homeland Security and he currently serves as C.E.O. for AIDS Arms in Dallas. Dr Carlo, thank you so much for joining us today and sharing information with our DCCCD employees.
It's my pleasure.
First, we've seen in last couple of days some good news in that a number of the individuals that had been under the on the watch list have now been cleared. Can you tell us about them?
Sure we've heard some great news today. First the contacts of Mr. Duncan, in other words, those that were around him before he went to the hospital, in the community, none of them have shown signs and symptoms of Ebola. So they are cleared today and can go back into the community without any risk to other people.
All that really is good news. We have a number of questions that our employees have sent in and I would like to share some of these with you. If you don't mind responding to them. The first one I think is important one. Which countries in Africa are experiencing a major Ebola outbreak or epidemic and which surrounding countries are at risk are OK.
And there is an intense epidemic elsewhere. Keep in mind we're almost at 10,000 cases since this epidemic started which was in December of 2013. So there's three countries right now that are experiencing the highest number of cases and that's Sierra Leone, Junia and Iberia.
And we got some good news today in that some countries that have been on the list, like Nigeria, have been cleared. Is that incorrect?
Right, in some countries we have seen information as of today, and are, quote unquote, Ebola free. But, what that means is that they haven't had any cases since two incubation periods and they're able to make that statement. We have to watch very carefully, because you know, the epidemic does continue to change. But, certainly some good news today, in terms of other countries now kind of coming off the list.
But, one of the things that's been in the news, is air travel. How dangerous is it to travel in an airplane or other forms of public transportation especially when people are traveling to and from countries where there isn't an Ebola outbreak?
Well, you know air travel it is very safe, particularly here in the United States, because we don't have any confirmed cases of Ebola infection and it makes it very very safe to travel on an airplane. Keep in mind if you're traveling around the world, if you're coming from countries that are experiencing cases of Ebola, they're going to ask passengers for signs of fever before they get on the plane and what we know about Ebola is you're not contagious unless you're showing signs and symptoms of an infection. So if you get onto an airplane and you're not you're not symptomatic with fever there's generally no risk that you're going to transmit the infection and somebody else.
Very very good! How many people in Dallas actually have Ebola?
Well today thankfully the answer is zero. We have two nurses, that unfortunately became infected, but they are now in the bio containment hospitals elsewhere outside of Dallas. So we currently have nobody in Dallas with any signs and symptoms of Ebola.
The question reads. Is there a vaccine to protect you from Ebola?
Unfortunately not. You know there's not a vaccine today. That's something we need to work on, and we certainly hope one will come very soon but currently today there is no actual.
I had my flu shot today anyway.
So you know I got mine too. You know and I think that's an important message that there are good vaccines out there and you know we are heading into the flu season. Much more common to get the flu every year. Let's go ahead and get our flu vaccine
How can you tell if you or someone you know might have a Ebola?
Well, you know the initial signs and symptoms are very similar to the flu. You might first experience a fever. Generally people start feeling fatigue and feel pretty sick pretty, pretty quickly. You know the main indicator though and again, as a reminder, it's only that you would .have to be around somebody with Ebola. So today, here in Dallas even if you came down with those signs and symptoms, it's very very unlikely that you have Ebola. Remember travel is the biggest predictor of Ebola risk and we simply do not have a risk here in Dallas.
You know we've seen some caregivers who interact with patients come down with Ebola while others don't seem to catch the disease and this been both true here, but also true in Africa. What kinds of direct contact transmit Ebola from person to person?
You know, we do have a lot to learn about how Ebola is transmitted from person to person, but, what we do know, is that it's the contaminated or infected blood or bodily fluid from somebody who's sick with Ebola and we know that blood or bodily fluid has to go through a break in your skin or has to be ingested to your mouth, nose or eyes . So as a health care worker, you would have an increased risk if you're treating somebody that sick with the Ebola, particularly if they're having a lot of signs of vomiting and diarrhea and you know, are around those fluids and so it's very important in those situations to take those extra precautions and health care workers are doing, that you know, when they're around people that are suspected having Ebola.
You know one of the most frequently asked questions that I hear in the media and people are asking us, is whether or not the ball of viruses airborne.
Can person catch this and you just kind of scratch the way by touching a door knob or toilet seat or other surfaces someone with Ebola might have touched or even someone who's been in contact with an individual who has Ebola. How long can the virus live on a tabletop or a door knob?
We've of course, had a lot of questions about airborne and I think one of the difficulties is that .airborne is a very generic term. So when we talk about airborne viruses, what we're talking about is that the virus actually floats through the air and there are things such as droplets, such as coughs and sneezes. You know the stuff that comes out, but that doesn't travel very far and generally we believe that those types of infectious materials for Ebola would only go about 3 feet or so. We don't call Ebola an airborne virus for that reason, however droplets, if they do contain a virus and they're wet, could be infectious. That's why health care workers are using barrier protection and you see of course, the face shield on the masks and the gloves and the gowns and those sorts of things. You want to make sure that you're protecting yourself from those types of things but, floating through the air, there are viruses that do that. Thankfully Ebola is not one of them.
We also have questions with some conflicting information. is the incubation period really twenty one days? Some sources say essentially thirty one and even was forty two days. Who's right and why does this matter?
Well it's very important, you know, we were using the twenty one day mark as the guideline to say, you know, that's the period of time you need to be weary of a risk free fall. After twenty days we would say that there is no risk, that you're in the incubation period and are eventually going to come down with the infection. You know what I would say is all the data and all the literature around what we know about Ebola and it is emerging but, we have not seen any cases from somebody outside of a twenty one day incubation period come down with an . Now those studies that are showing additional days are using mathematical models to determine probabilities but, I think it's more important to look at the data than of the actual human cases. We've just never seen a case after twenty one days and so that's what we're using as the guidelines
Sort of theory versus what we're actually seeing in real people.
That's right, that's right, and you know, the other thing is most cases and you know are far far higher distribution are going to come down within eight to ten days after exposure. So it's a lot shorter than twenty one days and again twenty one days is a pretty long time for an incubation period so we're fairly comfortable that after that period of time somebody is not going to come down with an infection for good.
Hand sanitizer, will using hand sanitizer help prevent Ebola - what about hand washing and other forms of just good hygiene?
Well you know, and that's really the good news, is Ebola is not a hardy virus. Any sort of detergent soaps that just the household stuff will work just fine. Sanitizers are going to work just great. S,o you know the other thing that you can do when you're using that, it's not really the risk free Ebola but, it'll help you prevent yourself from getting sick from all those other things that we have in our community that we are experiencing every year .
Well that's great, so we should keep doing that regardless?
Absolutely, absolutely keep washing your hands and you know. Also back to the point about the covering your mouth and nose when you sneeze. You know we mention those droplets and you know if you don't cough you know to cover your mouth and nose. Of course you can expel those droplets pretty far and that's another good reason why you want to cover your cough and sneezes is even if you're not sick.
So just kind of elaborate on that, it would be possible to catch Ebola from a sneeze if you were in close proximity to someone.
Theoretically yes, you know, we know that bodily fluids and that would include saliva in the things that would come out of this. What about sweat. Yes, sweat as well, yes so you really want to take the precautions that's why the barrier is the best thing you would want to do. Again we don't have anybody here today in Dallas that is sick with Ebola but, if we did, yes an infected person's sneeze would potentially cause transmission if you were in direct contact with those wet droplets.
Let me ask a related question to that. Can insects like mosquitoes or flies transmit Ebola to humans through bite or landing on your food.
Well thankfully no, there's been no evidence that Ebola can be transmitted by an insect vector, as what we would call the mosquito or anything like that and there's just simply no risk that that could happen. This virus has certain properties that would not make it transmissible through that through that vector .
And another related question is can pets catch a ball and then pass it on to their human host?
Well there has been a lot of concern around pets and there have been studies in dogs and cats that can be carriers for Ebola. However we simply don't have a lot of literature on American pets and whether or not there would be a transmission risk. They're going to do everything they can to rule this situation out of course, and in the nurse's pet. As a whole, remember for a pet to become a carrier or infected it would have to be exposed to that infectious blood in bodily fluid and in even what we had as a result of Mr. Duncan's case there simply is not a risk of environmental contamination so there'd be no way for any of our pets in this community to really acquire that virus.
Very, very good. There was a lot of speaking of I guess Mr. Duncan in the situation there. There's been discussion since then that there are really only a few hospitals across the country that are really equipped to handle Ebola of patients.
Right, well there's for, what we call bio containment hospitals and what these facilities have done they've taken several years and actually up to a decade worth of training so that they can receive not just patients infected with HIV, but really any emerging infectious disease threat and keep in mind this would also be any airborne type viruses that are highly highly infectious viruses. They have the capability to be able to treat people safely in order, you know and prevent any further infections. Now these hospitals are not any different than our normal hospitals in terms of the care they provide. What's different is their infection control practices. So there the risks for the health care workers is lowered through their training but, the care that the patients receive are actually not going to be any different than what you can receive in today's hospitals and this community.
Now the closest one is a Galveston I understand to us.
Right, Galveston does maintain capabilities now and they're going to be ramping up additional capabilities. Galveston has a testing laboratory that can get what's called the B S L 4 which means it has the highest level of bio safety containment and allows you to do any sort of testing on any specimens that might contain an infectious virus or bacteria. They're going to expand that system to allow for hospitalized care at U.T. and be in Galveston. There's more effort to increase that capacity not only across the state but, also across the country, so that we can manage both this situation in any future situations better in the future .
Is it possible to have mobile facilities and go out and take care of some of these crisis and challenges that emerge.
Well you know it would be possible to have some mobile capabilities but keep in mind what we know about Ebola is during the critical phases. Since there is no treatment you're generally very sick and you require quite a bit of, you know, high level, very sophisticated health care. It's very hard to be mobile with all of the things that are typical to our I.C. use in hospitals but, what I think is important is to make sure we have all the necessary personal protective equipment for health care workers in our hospitals so that they can do those critical care functions and do them safely.
Very good. There's been in the media a lot of talk about the cleanup efforts that have gone on in apartments in homes and schools and others. Are those necessary and how effectively?
Well, this has been very tricky, you know, as far as the schools there really is no evidence that would support a clean or anything that schools have been doing we understand that they're doing it out of the abundance of caution into allay fears but, our concern has been that this might be sending the wrong message because there really wasn't any risk in the school in the first place now we might get some reduction of the other things that are passed from children to children in schools through the plane but certainly no nothing different for Ebola what has been challenging is when the apartment of Mr. Duncan needed to be cleaned up they did send out a crew in very full personal protective equipment and did what would be determined as almost a hazmat situation and the reason they did that is because they were working with an unknown and health care workers in people that are involved in the fire department hazmat crews when they work with an unknown there's a certain level of personal protection and equipment that they are familiar with and they're going to use in any of those situations. So while we know this did create an additional amount of fear it really was an occupational method in order to ensure those workers were as safe as possible and you know keep in mind they walked into the apartment it wasn't that they didn't have any knowledge of what they were going to be managing so that that's their training and that's the equipment that they use on the day to day. It makes a lot of sense.
Let's talk about schools and obviously colleges for just a moment. Our folks are asking what kind of procedures should school nurses and really college health care centers follow when they treat sick students. Should we be trying to isolate students from others.
Well I think the first thing is we have to be practical. We know that there is no Ebola risk currently here in Dallas today. We do know that what's going on elsewhere does make us weary, we have to be ready and I think that the first, thing we have to do in any health care situation, if it's a clinic or doctor's office. If somebody comes in with fever you have to ask about travel history and that is the simplest way to at least start guiding the clinician through the decision making as to whether or not this could be ebola or any of the other more common other infectious diseases that we have in our community you know every day. So it's really the travel history is the big piece that has to start.
Some of our locations within the Dallas County Community College District don't have health centers there and particularly in our community campuses and some of the satellite locations. If we suspect someone of showing some type of infectious disease symptoms what should we recommend to them that they do?
Well ,my recommendation would be first let your symptoms be your guide and what would you do normally so if you were sick enough that needed immediate attention, of course, where you would go would be the emergency room, right and if it was not that you were sick enough that needed that attention you would find.
Your doctor saw this and it's really letting the symptoms be the guide as to where you would first access your health care. You know, keep in mind that the main piece if you are sick with fever is that question on travel history and bigger than just the travel history it's the twenty first day period between the time you know that you have the fever to the time that you would have been potentially exposed. So let's say for example you don't come down with a fever and you've been in Sierra Leone before but, it was three months ago no risk and so you know you really have to lay out that timeline in that incubation period and be very thoughtful in making that determination. Unfortunately there's a lot of other tropical diseases and illnesses that you can get while being in these countries so we really follow the incubation period very very carefully.
Now that makes a lot of sense. Something that has a hit close to home I think as being community colleges we have nursing programs that provide a large percentage of the nurses working in hospitals throughout the Dallas-Fort Worth area and I think we're all concerned when we saw that there were 2 nurses that are health care workers that team came down with Ebola of how did they catch it when they were wearing protective gear.
Well that's one of the questions we don't know right now. We certainly want to find the answer to this situation was, you know, one of a couple of things number one the personal protective equipment that was used that was simply not sufficient that's one option. Number two. There was some break the either you know in terms of how personal protective equipment was used maybe the way it was taken off or some other situation happened that that you know caused the infections or there's really something we're not sure that happened you know. Keep in mind Mr. Duncan was very sick and they did a lot, you know, a lot of critical care measures. There certainly was a high risk situation and I think what's important and I hope what we do is really learn from this so we can answer that question but today what we are doing and what we do practice in medicine is a normal infection control protocol in every health care system and keep in mind we have a lot of other infectious diseases that we contend with every day and you know the general Infection Control guidelines that we use everything from the gloves, the gowns, the goggles and everything else you know these are the measures tried and true that we know prevent infectious diseases. So I do think we're going to come around and figure out more information related to this case and hopefully a little direct better personal protective equipment guidelines but, until that time, I know we have a good system in place that really is protecting our workers from a wide variety of infectious disease threats in our community.
You know right now, as you mentioned, the two individuals infected with Ebola are no longer in Dallas or in Texas. They've been transferred to hospitals in other states and yet it really is not over for Dallas or for Texas. When will this be all right?
It's not over just yet we're certainly getting better each day that goes by we get closer and closer to that end. It will be over when everybody is outside of the twenty one day incubation period from when they were last around somebody that had Ebola so we're going to be counting that down and of course right now it's around the health care workers at Presbyterian Hospital. Thankfully we haven't had any additional cases but we're going to have to continue to monitor those health care workers and we will get through this once everyone is outside of that twenty one day patient incubation period.
Right, so let's be monitored as we speak and very carefully. A number of you sent in questions that were directed at me. Let me read some of these questions that have come in and respond to them and you're welcome Dr Carlo, to jump in as well but, the DCCCD colleges have many international students on campus right now. Some may travel to and from affected countries with twenty semesters or during holidays. What about new students from affected countries that are planning to enroll? What can we do to ensure the safety of our students, faculty and staff? While spent a great deal of time on the phone talking with individuals not only about Dr. Carlo but individuals at the Center for Disease Control. Experts within the Texas Department of Health and Human Services and certainly that's something that I'm concerned about and wanting to make sure that we're paying a lot of attention to what's going on with our student body. Nearly five percent of the students we enroll in the Dallas County Community College district are international, so we do have a large number of students that come from around the world. In one of our colleges alone we have over one hundred and forty four countries represented in our student body and we know that we have over one hundred students from West African countries enroll for the spring semester starting January 5, 2015, we know that sixty five are coming from Nigeria. We just said earlier Nigeria is one of the countries that today are going to incubation cycles. Right? no cases and so what we're seeing the language change and really reporting that those countries are relatively low and that's the thing this situation is evolving and it's continuing to unfold. Great news two countries are now technically off the list and I think that you know we do know that there is a risk from the three countries, but it's also individualized. So you know there's more to that than just coming from one of these countries that would put you in immediate risk. You really want to, you know, ask to make sure number one they're not sick or showing any signs and symptoms and then before they leave where they are around anybody themselves that was sick and you know that's how you would use as a measure to determine risk. It's not just that they came from the countries that are currently being impacted .
Right we have forty coming from the Congo we have one from Guinea which is still on the list. So on the list and you know the other thing that we know is in these countries there are certain areas that are not impacted at all and so it's highly intensified in certain regions of these countries so it's really important to learn more about where they are truly coming from before making any over assumptions that they might be at risk.
One of the questions we've been asked which is really a national issue, I guess, should there be a way of limiting the number of incoming students from West Africa? We don't really have a way to limit that certainly once they've gone through the application process their rights are protected just like every other citizen and then and again the President of the United States has said there's not going to be travel restrictions going on. However there are things we can do to work with these individuals once they're here. The students we have arriving right now aren't due to actually start classes until 2015 therefore, we can pay attention to when they arrive, certainly screen up on arrival before they get to our college campus and ensure that they wait out that twenty one day period before they come on our campuses and start interacting with our faculty and staff and students.
Does that assure us that we're taking the profits cautions here?
Yeah, I think so, you know, we're a global community and the globalization of our world doesn't just affect the community college here. This is going on around the planet and we cannot close our doors, we cannot create a wall, we cannot do that successfully and it wouldn't be effective in my opinion. It is preventing disease transmission, it only would create more fear, more panic and more concern unnecessarily.
So I think you're absolutely right we have to continue to receive people from all over the world and be ever ready to respond like we did here in Dallas but, we're going to be monitoring that very closely with all of our students and certainly those that are from countries that are safe where we're going to welcome those that may still be from infected countries, we're going to follow up on the screening again.
Dr.Carlo has agreed to work with us and advise us in this process and then make sure that they don't pass that twenty one day period and that will help ensure that we've really taken the proper precautions.
Another question directed to me is a number of the DCCCD nursing and allied health students were involved in clinicals at Texas Health Presbyterian Hospital. Were any of them on the Presbyterian campus when an Ebola patient was there and were they in turn interacting with people on their own campuses during that time? One, we did have a number of certainly of our nursing students in clinicals at the hospital were there students on campus when Mr. Duncan arrived? They were not involved in any way in the treatment of Mr. Duncan nor were they in a situation that they could be exposed. Certainly those students were not on any watch list, they were not part of any efforts to really limit their travel, limit their exposure either at home with family or back on our campuses. However, as a precaution we did remove all students from clinicals back on Monday a week ago just to ensure as an extra precaution that our students are safe.
Dr. Carlo thank you so much for spending time with us today and I have to tell you how much I really appreciate your own responses to our questions.
We will post this video interview on the District's web site at DCCCD.edu in the new section. You can click on the link to DCCCD's public health emergency plans where you will find additional information that may answer some of the questions you have that we didn't cover today. Please continue to send your questions to email@example.com.
Our staff members who will respond with answers from qualified health care sources who are well versed about the Ebola virus and the situation in our area
Thank you for your participation and Dr Carlos thank you for answering our questions today.