Stony Brook University Hospital is one of two Long Island hospitals and one of eight New York State hospitals declared “Ebola-ready” by Gov. Andrew M. Cuomo. In an effort to ensure the safety and protection of SUNY students and their neighbors, SUNY Chancellor Nancy L. Zimpher set forth a memo for the 64 State University campuses, outlining the precautionary actions that will be taken in response to a possible Ebola outbreak in New York.
The eight “Ebola-ready” hospitals are University of Rochester Medical Center, Upstate University Hospital, Mt. Sinai, New York Presbyterian, Bellevue, Montefiore, North Shore/LIJ, and Stony Brook University Hospital.
The SUNY system’s measures, according to Zimpher, include the expansion of the system-wide Ebola Working Group, the intended designation of a primary contact person for each campus, along with multiple other precautions intended to keep the disease as contained as possible.
First, Zimpher mentioned the expansion of the system-wide Ebola Working Group, a group set forth by President Obama that is inclusive of scientists and officials from the National Institutes of Health (NIH) and Centers for Disease Control and Prevention (CDC), according to Reuters.
Furthermore, the chairman of the Steering Committee for the working group—Dr. John F. Williams, the President of SUNY Downstate Medical Center—as well as other members of the committee have been identified.
“The committee will convene regularly, monitor the situation locally and beyond, and work to ensure that you [students and staff] have access to the latest available information,” Zimpher said. She said that SUNY and its campuses will also be designating a primary contact person “for Ebola-related issues” to aid communication between the Working Group and those involved.
A more serious approach being taken is the continued prohibition of “campus sponsored or approved travel to countries with current CDC Level 3 travel warnings,” the memo stated.
“At this point, those countries are Liberia, Guinea, and Sierra Leone,” Zimpher said in the memo. “This travel ban applies to all campus-related or funded activities, such as study abroad, Research Foundation grant activity, and other travel.”
The CDC and the New York State Department of Health regulations are expected to be in continual compliance with, as is the guidance of local public health authorities.
“All campuses are to continue to work to identify potential travelers from affected areas,” Zimpher said. “Student Health Services or other appropriate offices at each campus should contact these students and offer education and support self-monitoring.”
The same applies for staff and faculty who have traveled to these regions. Zimpher stressed that all campuses review their public health emergency plans, conduct simulated emergency drills and provide the campus community with information on Ebola and Ebola-related procedures.
The Stony Brook University website has designated a separate section for “Ebola Information,” under which students, staff, faculty and the like can find a list of common signs and symptoms, contraction methods, information on what to do if they feel sick and a few other related messages, including one from Dr. Kenneth Kaushansky, dean of the School of Medicine and senior vice president of health sciences at Stony Brook University.
According to the Stony Brook University Student Health Services Office of Affairs, “The virus is transmitted through direct contact with the blood or bodily fluids of an infected symptomatic person; for the virus to be transmitted, an individual would have to have direct contact with an individual who is experiencing symptoms, exposure to needles, medical equipment, or other objects that have been contaminated with infected secretions, [and] exposure to infected animals (through blood, fluids, or meat).”
SBU is closely monitoring the CDC for any new information regarding the outbreak of the virus, affected countries other than those in West Africa and new suggestions to combat the virus.
“Ebola hemorrhagic fever (Ebola HF) is one of numerous Viral Hemorrhagic Fevers,” the university’s website says on its “About Ebola” page. “It is a severe, often fatal disease in humans and nonhuman primates (such as monkeys, gorillas, and chimpanzees).”
“Even long before Chancellor Zimpher’s memo, we took the bull by the horns and decided that we should be prepared for a myriad of reasons,” Kaushansky, treasurer of the Greater New York Hospital Association, said. “We are the only tertiary care academic medical center in Suffolk County. We have the very best of intensive care unit physicians, the very best of emergency physicians; all of the staff that we need to be diligent in our care of patients in Ebola, we have, on our team, ready to go at a moment’s notice.”
“As the only State University hospital in all of Long Island, we feel it’s our mission to care for not just colds and the flu and pneumonia and cardiac surgery but every disease that comes our way,” he said. “We felt sort of morally responsible for doing this.”
Kaushansky, who volunteered Stony Brook University Hospital to be considered “Ebola-ready,” said that it was a vote of confidence because he knew the university was up for the challenge, as did the State Department of Health.
In his decision to put SBU forward, he said that the Greater New York Hospital Association, including his colleagues and representatives from other hospitals, learned early on about the importance of the buddy system. He said that everybody watches everybody else to make sure they’re taking off and taking care of their protective equipment.
“We made the pledge that we would buy the very best equipment available for isolation and for the protection of our staff workers, and we went on a road show, so to speak, with this,” Kaushansky said.
“We have purchased the very best isolation equipment so if someone who comes in appears to be at risk for Ebola, we can isolate that person to protect our other patients, our staff, and everybody else,” he said. “We began very carefully informing our staff members so that people knew where we were. I made a pledge, a personal pledge to everybody, that we would not say anything that we did not know was 100 percent accurate.”
The hospital has now rigorously trained 300 staff members, who engage in drills and practice before they are tested on how to protect themselves and how to best take care of patients, according to Kaushansky.
He explained that the hospital has had its Ethics Consultation team thinking about difficult questions, like whether to put breathing tubes on Ebola patients, whether to put patients on dialysis, whether to perform CPR on patients if needed and so on.
The hospital has devoted a few hospital rooms and emergency rooms to potential Ebola patients, as well as having set aside an isolation room (i.e., critical care room four), in which there is negative pressure. He said that even though it is known that Ebola is not an airborne virus, it is better to be safe than sorry.
He reflected positively on the fact that the Ebola death rate in the United States is so miniscule, saying that this fact has taken a good deal of anxiety out of the situation. Still, he admits to a necessary level of anxiety and caution.
“I feel scared, but I can’t help it,” Christy Siu, a freshman biology major, said. “I hope that the patients get cured, but I’m kind of scared that they might spread it to me.”
Chemical engineering major Anthony Salonia said he feels safe and protected in knowing that Stony Brook University Hospital “would be able to deal with Ebola if it were an imminent threat, but I don’t feel like it’s going to be coming here.”
“I’m actually okay with some people being anxious about this because when you’re anxious you take special precautions,” Kaushansky said. “You know, in my medical training, there are things that I still get anxious about which I think is good, because it means you are heightened. You don’t take things for granted. You check and you double check, make sure you get it right. So I’m okay with people being a little bit anxious about it.”
Kaushansky said the hospital is not making any adjustments in terms of who treats which patient.
“If you’re up for the next patient, you’re taking the next patient,” he said, “because I know we have trained you to use the protective gear and someone will back you up. You don’t get to choose whether you’re going to take care of the Ebola patient or not. It’s part of being a Stony Brook physician or a Stony Brook nurse or a Stony Brook respiratory therapist.”
“We think we have thought through everything that can sort of go wrong and figure out how to fix it, but it’s medicine,” he said. “It’s not mathematics. There still are some unknowns that we’re going to have to be clever about if they arise, should we see a patient with Ebola here.”
The newly-updated signage is another procedural policy set in place to allow for greater access to information. In the hospital’s lobby, emergency room and delivery rooms there are now multi-language signs catering to all ethnicities—especially those who speak French, Kaushansky said, because of the French colonized parts of Western Africa. Hospital questionnaires have also been updated to ensure that all risks are contained, and information is readily available.
Perhaps most important, Kaushansky said, was differentiating that “Ebola is highly infectious, but not very contagious.”
“Contagious means it can spread from me to you, and this ‘fella who died with Ebola in Dallas, was in close contact with 45 people and none of them got it,” he said.
With infections, there only needs to be one viral particle in your blood and you will have a full-blown infection, he explained. This doesn’t happen with influenza, pneumonia, or most other infections, as you usually need thousands of viral particles or hundreds of bacterial particles.
“With Ebola, one particle could do it,” he said.
SBU Hospital has a primary contact person just like Zimpher recommended: Leo J. DeBobes, the assistant administrator for emergency management and regulatory compliance.
“Leo is there when we have power outages, hurricanes, etc,” Kaushansky said. “He’s our lead person, and he’s set up a 24/7 call rotation, so we always have people there to answer questions.”
Kaushansky said he and hospital spokespersons are constantly in touch with colleagues and representatives from other hospitals, in addition to the CDC and Department of Health.
While experimental vaccines and treatments for Ebola are currently underway, there is no single FDA-approved vaccine or medication available as yet, according to the CDC.
“The following basic interventions, when used early, can significantly improve the chances of survival,” according to the CDC website. “These interventions include: “providing intravenous fluids and balancing electrolytes (body salts), maintaining oxygen status and blood pressure, and treating other infections if they occur.”
“We’re a university,” Kaushansky said. “We are all students and we are all always learning, and that’s one of the fun things about being a university hospital and being at a medical school. We are all learning from these experiences.”
As for public health measures, he mentioned his statement at the Greater New York Hospitals Association.
“There really is a silver lining to this cloud that we call Ebola, and the silver lining is that it has forced us all to reacquaint ourselves with good, old fashioned public health measures,” he said. “Ebola has sort of forced us, because we don’t have the specific treatmentsto reacquaint ourselves with good public health—and if nothing else, it forces us to make sure we wash our hands, make sure we do all of the good things that we do anyway.”