Months have passed since the Ebola outbreak surged and fears of its spread in the United States dominated headlines, and most of us likely aren’t giving much thought to the deadly disease.
But every morning, public-health nurses across the state continue to check in with travelers who must take their temperatures and report any suspicious symptoms for 21 days after returning from western Africa. As of now, there’s no projected end date for this precautionary monitoring, which includes low-risk travelers who had no contact with any sick people.
Columbus Public Health has handled the bulk of Ohio’s travelers (almost 250 as of last week), at an estimated cost of $397,000 in staff time and other resources, including electronic tablets, said city Health Commissioner Dr. Teresa Long.
Monitoring travelers for an unlikely but potentially devastating illness is an important job for public health, but it has come at a cost, she said. In addition to the financial hit, nurses who otherwise would have been vaccinating schoolchildren against flu over the winter or visiting community events to offer free blood-pressure checks have been diverted in the interest of monitoring Ebola.
All of the Columbus travelers so far have been considered low-risk for Ebola, meaning they can go about their daily lives but must take their temperature twice a day and report the results to public-health nurses.
In six cases, there was enough concern to set a more-complicated process in motion. In all but one instance, an individual spiked a fever that required hospitalization but proved to be unrelated to Ebola, said Columbus Public Health spokesman Jose Rodriguez.
That case was a hoax and triggered a response that wasted multiple city resources.
After an initial home visit, people who have traveled from western Africa, including visitors and new immigrants, report in daily with computer tablets that allow face-to-face conversations with public-health nurses.
On Thursday morning, nurses Vicki Kovarik and Susan Walline fielded calls from 34 travelers and new residents on the active-monitoring list. At its highest, that list has included 45 people.
Kovarik and Walline sat in front of hot-pink tablets that displayed the faces (and thermometers) of travelers throughout the city and asked about headaches, muscle aches, weakness, diarrhea, abdominal pain, vomiting and bleeding. They asked for the person’s temperature the night before and looked at thermometers to record the reading for that morning.
A high temperature triggers a public-health response, including hospitalization. Other symptoms result in closer monitoring, Walline said, and a particularly intense effort if the traveler is in the eight to 10-day window after return — a more likely time for Ebola symptoms to emerge.
Columbus hasn’t met resistance from travelers, the nurses said.
“People really appreciate that they have been monitored,” Walline said. “By the end, they’re happy that we did it.”
Kovarik said travelers who’ve seen Ebola’s ravages are thankful for the local effort “They’ve seen what’s going on. A lot of them are appreciative. They say, ‘God bless you.’ ”
Monitoring has been a bigger issue for areas of the state with a significant immigrant population, said Beth Bickford, executive director of the Association of Ohio Health Commissioners. “In those areas that are hardest hit, they’ve had to divert resources away from their normal activities, including other infectious diseases.”
There’s some money in the proposed state budget to reimburse departments, but it’s less than $100,000 — a fraction of what Columbus alone has spent in resources and manpower, Long said.
Is this level of monitoring still appropriate?
“It really will be the call of the (Centers for Disease Control and Prevention) and the state,” she said.
An Ohio Department of Health spokeswoman said in an email that there is no indication when monitoring requirements might change or cease.
The federal government continues to advise against non-essential trips to Sierra Leone or Guinea due to ongoing outbreaks and recommends enhanced precautions when traveling to Liberia.
Kelly Yotebieng, a public-health consultant who has worked on Ebola efforts in Congo and, most recently, in Guinea in February, said the monitoring she underwent was simple and not time-consuming.
“They were very flexible. There was a window — if you didn’t call by 11, they would try to track you down,” said Yotebieng, who lives on the Northwest Side.
She said she did not come in contact with anyone with the disease while working with journalists, epidemiologists and government officials to improve communication and surveillance related to Ebola.
Yotebieng said she was grateful that nobody else in her family contracted a stomach bug that hit her young son before she spent the week in Guinea.
Had someone fallen ill during her 21-day monitoring window, she said, “There could have been a little bit of unnecessary fear.”
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