With the World Health Organization declaring the Zika virus a “public health emergency of international concern,” U.S. hospitals are scrambling to learn what they can about the disease and how to handle an outbreak. So far, 31 domestic cases have been reported, all contracted outside the U.S. However, as warm weather approaches, the odds could be that local transmission of the mosquito-borne disease will begin to be seen.
On Jan. 26, President Obama called for accelerated development of tests, vaccines and treatments for the mosquito-born Zika virus, which has been linked to a brain defect in infants and Guillain-Barre syndrome in adults. The same day, the Centers for Disease Control and Prevention issued interim guidelines for healthcare providers caring for infants born to mothers who traveled to a country where Zika was active during her pregnancy.
The guidelines also require all Zika cases be reported to state and territorial health departments.
The major concern is for women who become infected while pregnant, because of an as-yet-unconfirmed link to microcephaly.
, an emergency panel convened to discuss the virus. WHO Director-General Dr. Margaret Chan stated in a prepared statement, "[Eighteen] experts agreed that a causal relationship between Zika infection during pregnancy and microcephaly is strongly suspected, though not yet scientifically proven. All agreed on the urgent need to coordinate international efforts to investigate and understand this relationship better."
In light of the rapidly evolving situation, how can hospitals prepare for a Zika outbreak, and what can they learn from previous public health threats, such as the Ebola virus? With Ebola, the CDC issued comprehensive guidelines for assessing and treating the disease and certified 55 hospitals to serve as treatment centers.
For now, most of the focus is on communication. Unlike Ebola, Zika cannot be passed from person to person. The only way someone can get the virus is to be bitten by an infected mosquito, and the mosquito has to get it from an infected person. That eliminates the need for hospitals to ramp up isolation procedures and stock up on protective gear for providers.
Moreover, most cases are mild and there is no treatment if someone is infected. Hospitals aren’t expecting a major influx of patients with Zika virus, said Patricia LaFaro, director of infection prevention at Robert Wood Johnson University Hospital in New Jersey. “It’s really very much keeping everybody up to date with what’s happening, what countries people who are pregnant should avoid, any testing and treatment modalities,” said LaFaro. “So any information we can blast, we blast it out by email to them.”
At Robert Wood Johnson, information from the health department and the CDC is sent directly to all ER physicians and doctors that admit to the hospital. A link to the CDC’s Zika updates and resources has also been added to the hospital’s website.
The New Jersey Hospital Association is also helping to coordinate information on the virus. “It’s very important that the information being pushed out is consistent, especially in a situation that’s very fluid,” said spokesman Kerry McKean.
The group has created a Zika website to provide the latest guidance to healthcare professionals, plus downloadable public information. “During Ebola, we provided daily dispatches to our members with new developments. We also provided a great deal of member education, much of it via webinar,” added McKean. “That worked well, and we’ll be ready to use both approaches with Zika.”
On Jan. 29, the New Jersey Department of Health conducted two conference calls to bring providers and local health officials up to speed on the disease’s symptoms, travel guidance, guidelines for testing pregnant women and infants and critical preventive measures. The latest one had 400 participants, said Donna Leusner, the department's director of communications.
The department has also emphasized with clinicians the importance of taking a thorough travel history of patients, and provided contact information for its communicable disease program to help providers as they manage patients. All CDC information, guidance and alerts are shared via the state’s Local Information Network and Communications System’s alert system and posted on a dedicated website for healthcare providers, Leusner said.
Sandra DiVarco, a partner with McDermott Will & Emery, recommends the following core principles be considered by any hospital or healthcare facility in managing its internal risk management strategy in the event of a major viral outbreak:
- Establish a multidisciplinary framework that demonstrates compliance with best practices and available guidance.
- Be prepared to deal with concerns of staff – healthcare workers are regularly exposed to blood borne pathogens, but media and public attention to a specific viral illness or outbreak can increase concerns and stress for caregivers.
- In addition, HIPAA and other federal and state and federal laws regarding confidentiality and privacy, remain in full force. Consider refresher education on the need to maintain patient confidentiality – even where the matter is novel or of interest.
- Consider an internal Infectious Disease Task Force (comprised of clinicians and representatives from non-clinical areas), or utilizing existing infectious disease committees, to help identify risks and ways to address them, and to ensure updated, consistent communications are made with staff to ensure they are fully aware of any special aspects of care for patients exposed to or with confirmed Zika infection.
- Avoid getting in over your head – identify what your facility can and cannot handle. Consider a SWOT analysis (evaluating Strengths, Weaknesses, Opportunities and Threats) of both physical and human resources available in the case of any viral or other disease occurrence.