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County takes a hard look at Ebola

Every seat at the table was filled at the quarterly meeting of the Carlton County Public Health and Human ServicesEmergency Preparedness Advisory Committee Monday. The main topic that drew many of the 30 attendees — Ebola.

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Facilitator Joanne Erspamer of Carlton County Public Health and Human Services commented that although the risk of the spread of Ebola to the Northeast region in Minnesota remains low, it is a community-wide concern and the county wants to make certain that all elements of the population are prepared for just such an eventuality.

On hand for Monday’s meeting were representatives of the faith community, the National Guard, local hospitals, law enforcement, public health and human services, emergency response and the Fond du Lac Reservation.

Pete Neumann, Carlton County emergency management coordinator, commented that the Advisory Committee represents the type of “whole community partnership” vital to dealing with emergency issues such as Ebola, adding that the goal is now to include business, industry, and other elements of the population at large in the conversation.

“We want to get more people involved in the future, get people talking, begin to understand the threats, assess the equipment on hand, and practice our training and exercises,” he said.

Hospital Preparedness Coordinator Jo Thomson of Northeast Regional Healthcare Coalition admitted there has been “a lot of push and pull of information” regarding the Ebola scare and just how prepared people and institutions in the Upper Midwest need to be. She said her office is now receiving information updates from the state several times a day, and she and others are faced with just what, and how much of it, to disseminate to staff.

“The risk of Ebola is so slight, we don’t want to overdo it at the risk of [preparing for] other diseases,” she stated.

She said staff has voiced concerns over Personal Protective Equipment (PPE) such as masks, gowns and gloves, wondering if there will be adequate access to it and/or funding to obtain additional equipment on the outside chance that Ebola should come to Carlton County.

“We all want to make sure that they have what they need,” said Thomson, “and my understanding is that the state is currently looking at loosening up how it spends money in that regard.

“We don’t want to lose sight of what’s happening in our region,” she said, “but that’s not likely to be Ebola.”

Thomson added that the focus is not as much on identifying one facility where any potential Ebola patients can be sent, but making sure everyone in the area has to be prepared to house those patients for at least a short time.

Marilyn Cluka, regional public health emergency preparedness consultant with MDH, reminded the Advisory Committee that Minnesota has the highest population of Liberians in the United States, primarily in the Twin Cities area. She said the Minnesota Department of Health (MDH) is urging those people not to go home to Liberia to check on family, but rather to stay here instead and focus on those living here in the United States.

Ellen Hill, Northeast Minnesota epidemiologist for the MDH, said Governor Dayton has contacted the CDC to see if the Minneapolis/St. Paul Airport can be listed among the airports slated for “intense screening” of international flights coming in from Africa, given the large population of Liberians living in the state.

On a related note, Hill reported the port of Duluth has been in touch with the Division of Global Migration and Quarantine regarding citizen concerns over a ship or ships reportedly entering the Duluth harbor bearing Liberian registry. She explained that a Liberian registry doesn’t mean the ship itself has come from Liberia and that shipping companies from other countries can register their ships through Liberia as well. She added that it would take a ship at least three weeks or more to reach Duluth even if it came directly from Liberia, which would be inside the Ebola incubation period, so any possible victims would have surfaced before ever reaching the port of Duluth.

In addition, if international staff members from any ship in the Duluth harbor want to come ashore, they first have to obtain permission from immigration authorities, so Hill pointed out that a screening process is already in place to pick up on any potential medical conditions they may be experiencing.

Hill said Governor Dayton has been meeting with legislators to urge that hospitals and clinics statewide be prepared to identify and isolate any potential cases of Ebola as well talk about designating a facility in the area to receive such patients. Carlton County has already begun that process.

At least one local hospital — Community Memorial (CMH) in Cloquet — has come to an agreement with St. Luke’s in Duluth to receive any potential Ebola patients after they are first stabilized at CMH, according to Carolyn Olson, emergency department director. Hill said CMH is being “very proactive” in focusing on training staff and certifying its employees on PPE. She said the hospital already has two of the required negative pressure rooms that would be required for anyone with a contagious disease such as Ebola, one of them right outside the hospital emergency room.

“I don’t want to be the hospital responsible for spreading anything,” she summed up.

Shelly Demers, infection control specialist at CMH, said although many staff members still believe they will need full containment suits like everyone has seen on television, she said the standard PPE is the standard and efforts will be made to upgrade according to the just-released standards of the CDC. She added efforts should be concentrated on proper “donning and doffing” procedures to make certain there is no cross contamination and added the hospital is planning an Ebola drill to walk staff members through the proper procedures.

Cheryl Fischer, nurse coordinator at Raiter Clinic, said the clinic is starting to examine a process of screening its incoming phone calls to find out if potential patients are suffering from a fever, have traveled anywhere recently, and if so, where. She said the clinic is also educating the nurses and staff at the appointment desk on similar procedures.

Carolyn Olson, director of emergency services at CMH, said the next step will be to reach out to the area ambulance services to make certain their personnel is also up to speed on proper procedures of transporting and/or treating possible Ebola patients.

Debra Wolf, RN/IP of Mercy Hospital in Moose Lake, reported that facility is still in the stage of answering questions about Ebola preparedness and procedures, especially from employees and front line staff as well as emergency room workers. She said more education will be needed as well as possible acquisition of additional PPE.

Hill reported the Minnesota Department of Health is currently receiving some 25-30 calls a day regarding Ebola, about 50 percent of which are from the “worried well” — folks who aren’t currently ill or experiencing symptoms but who are merely wondering about what is being done in case Ebola should show up in Minnesota.

The MDH announced on Tuesday that it will be opening up an Ebola Public Information Line this week to field such questions and concerns from the public. The number is 1-800-657-3903.


There was some discussion of proper isolation and quarantine procedures, led by Erspamer. She explained isolation is a method of restricting those who ill with a communicable disease disease in order to prevent further transmission, and quarantine applies to restricting those who are have been exposed to a communicable disease. She said quarantine procedures were used during the SARS outbreak in 2003, the H1N1 outbreak in 2009 and the measles outbreak in 2011.

Erspamer said state statute dictates that the Commissioner of Health has the authority to initiate isolation/quarantine procedures, providing that it’s done in the least restrictive means possible and that the health status of the person or persons involved is monitored to make certain they have adequate food, shelter, sanitation and access to health care, medications and transportation to medical care. She added that employers are not allowed to discriminate against any employee who is placed in enforced isolation or quarantine.

For anyone having further questions about Ebola or the local response to it, contact Carlton County Public Health and Human Services at 218-879-4511.

Symptoms of Ebola

Symptoms of Ebola most commonly start 8-10 days after coming into contact with Ebola virus but can occur as early as two days or up to 21 days after exposure.

Symptoms include:

  • Fever
  • Headache
  • Joint and muscle aches
  • Weakness
  • Diarrhea
  • Vomiting
  • Stomach pain
  • Lack of appetite
  • Abnormal bleeding