Below is the HillCo client report from the October 7 Senate Health and Human Services Committee hearing.
The committee met to discuss the state's public health preparedness and response to infectious disease threats. The hearing is intended to provide an overview of the ongoing local, state, and federal response to the confirmed Ebola case in Dallas, evaluate the potential threat to Texas citizens, assess Texas’ ability to respond to public health emergencies, and identify any actions or statutory changes necessary to improve the state's ability to protect the public from infectious disease outbreaks.
Opening remarks included the importance of this discussion in the light of other infectious diseases in addition to Ebola, such as Tuberculosis and enterovirus 68.
Kyle Janek, HHSC Executive Commissioner
- Doing everything we can to address but it is a human process
- Treatment is primarily supportive
- Methods in place to help ensure containment efforts in place
- Virtually no risk for passengers on airline to be impacted from man flying in from Liberia due to the fact that he did not have symptoms/fever
- Timeline of events were provided to the committee
- Only past 21 days do you have certainty that an individual is not susceptible to the disease
- Committee Chair Schwertner asked about Incident Command Structure (ICS) set up coordinating between federal, state, local
- By statute – county judge is lead individual in ICS
- Sen. Huffman would temporary visa bans while Ebola is issue be beneficial
- With complexities of modern travel, lack of direct travel – it might not help
- Better screening at airports or point of entry might be better recourse
- Sen. West noted President Obama has put forth some steps but not sure how far into implementation
- History of where a patient has been and people who have been in contact with patient is critical step
- West asked about risk to patients sharing waiting room area with infected and symptomatic Ebola patient
- Not airborne but if sitting next to person who came in contact with bodily fluids would be at risk for direct transmission – must be very direct
- Did any individuals in the net include individuals in the waiting room?
- No – but checking on it to confirm
- Follow up – ambulance and those in ER were on contact list
- Being in the same room is not a risk if there is not a direct contact
- West asked what is average quarantine capacity of average hospital
- It depends on disease
- If airborne want person in negative pressure room and there are hospitals that have those
- People can be quarantined at home or at hospital if spread by direct contact (ie not airborne)
- There is enough capacity in the state hospital system
- Quarantine can be shelter in place
- It depends on disease
- Schwertner said there are a lot of successes on the way it has been handled and Texas can continue to lead by finding a path forward – in regards to possible statutory and regulatory changes, etc
- Sen. Nelson – what authority does state have to quarantine
- Authority given to commissioner of State Health Services
- Does not think authority extends to person just here with no symptoms, etc
- Nelson noted there is a quarantine facility at DFW
- Yes
- In Interim of 2002 discussion on preparedness of all variations and talked about improvements to health alert network – Nelson would like status update and do they anticipate any request for exceptional items in the budget
- The best infectious disease surveillance is low tech and mostly passive
- Nelson – are there any improvements that need to be made to reporting systems
- Can’t think of thing in LAR to make improvements – maybe on the ground need better information
- Nelson – are we communicating – staying up with things?
- We are but nothing compares with the current heighten awareness
- Schwertner wanted to know how to make process more streamlined and better
- Default is that responsibility falls to local health authorities
- Will defer to next panel to answer – noted Task Force the Governor has called
- Schwertner noted HHSC Sunset Report issue of HHSC being decentralized and need for improvement in chain of command and collaboration
- Janek stated in closing remarks
- Until a patient is symptomatic there is no risk of spreading virus and only would occur with direct contact in case of Ebola
- Nelson wanted to know what information is being given to schools, parents, etc
- Janek said getting information out through education channels is a good way to handle fears
- Nelson wants to make sure there is a good way to communicate quickly to schools and parents
Gary Weinstein, Texas Health Presbyterian Hospital in Dallas
- Currently treating patient with Ebola
- Events preceding his current admission are being thoroughly reviewed and will be made available as soon as they are completed
- Several challenges in giving care – so many people involved in communicating his care and ongoing care planning discussion
- Cleared an entire intensive care unit for this case – so could only handle three of those types of cases
- Aggressive supportive therapy is the main treatment – no real specific treatment has been identified
- Anything that goes into patient room does not leave area without proper disposing procedures
- West asked if there is something the state needs to deal with in regards to disposable waste
- No
- West asked who is paying for this
- Charity, the hospital is
- It is expected there will be lessons learned
Dr. Eastman, Parkland Hospital and Texas Hospital Association
- Implemented enhanced Ebola screening system in August
- 32,697 patients seeking care have been screened and 599 answered yes to travel outside of area but not to Ebola affected area and none of them required subsequent screening
- Screening is two simple questions – have you traveled outside the U.S. or been in contact with patient in Dallas?
- Patient record is then alerted and health care providers will see alert and then physician will need to remove it after asking follow up questions
- Schwertner asked if Parkland initiatives are being taken up on a more global level
- Other hospitals are stepping up because unsure of where next patient could present
Dr. Brett P. Giroir, Director of Texas Task Force on Infectious Disease Preparedness and Response
- Identified six categories of issues among them:
- Hospital preparedness and improved diagnostics (advisories are out there and being adequately followed and implemented)
- Command and control issues (activations of ICS and integrate assets)
- Decontamination and waste disposal
- Patient care issues – supportive care is key (iv fluids, oxygen, ventilator, dialysis to support kidney function)
- Care of patients being monitored (may need social health, mental health, cultural competency)
- December 1 deadline to deliver 1st report of recommendations
- Will also work on comprehensive plan to complement state emergency plan
- Want to be objective source of science based information
- Schwertner asked about putting screening methods in place – how to emphasize prevention and education component
- Starts with individual citizens – all need to understand risks and take basic precautions
- Health care is about more than doctor and patient to make sure there is good inter-professional education
- Schwertner asked if they would have any recommendations for the federal government (ie travel)
- Could be possible but focus of task force is what can be done for the state
- Available today in limited scale and limited quantities – there is an investigative vaccine available under experimental protocol with limited evidence it could be given to a health care worker
- FDA does have ability for emergency use authorization – for widespread basis approval
Dr. Thomas Ksiazek, Texas Task Force on Infectious Disease Preparedness and Response, UTMB, CDC
- Schwertner asked how is Ebola transmitted
- Very direct personal contact – direct transmission
- Schwertner – indirect transmission how long can it live outside body
- Limited period of time on its own – hours
- Not airborne? – it can be made into droplets and would be infectious but would not suggest that process is going on
- West asked about transmission by cough
- May increase the possibility of putting out droplets or small droplets
- Does not seem part of process to date
- Schwertner asked about common sense precautions
- In this instance mostly common sense, transmission does depend on direct contact
- Avoid bodies and direct contact with people that are sick
- Schwertner then asked about vaccine progress
Dr. James LeDuc, Ph.D.: Director, Galveston National Laboratory & Pharmacist also working at laboratory
- Doing pre-clinical test with the real pathogens
- Challenge is to scale up production
- Goal was to develop vaccine by eliminating needles
- This has been a 7 year international effort
- There is a phase one study of several candidates
Q&A of Panel
Huffman said take away for public is that Galveston National Lab has wonderful group of scientist working on this on a daily basis
- Dr. Giroir public health measures are needed right now – but for those that already have it then vaccine would be of use to those patients
- Dr. Ksiazek expects hurdle will be lowered in regards to outbreak (1.5 million cases in West Africa)
- Dr. Giroir explains process of getting doses to the public – but no proven therapies just a lot of experimental therapies in various stages
Schwertner – is federal government effort to stem spread sufficient
- Dr. Ksiazek – focus is on Liberia putting beds in place to help isolate patients and have seen screening in place at ports
- In regards to screening Ebola patient didn’t answer questions truthfully
- Thinks more can be done
- Thermal screening and information ticket that if a person becomes ill they need to follow certain procedures
Sen. Taylor asked if there is a concern of people intentionally bypassing screens
- There were people he saw that were screened out
- But there are people who are intent on leaving
- The way we currently operate cannot address those instances
Nelson again thanked the task force to make sure Texas is prepared to handle infectious diseases – would love to see Texas as role model for nation on contain and control