In Conversation With…features an interview between a leader or figure involved in public education and a representative of the Kentucky School Advocate. Dr. Kraig Humbaugh is senior deputy commissioner and director of the Division of Epidemiology and Health Planning in the Kentucky Department for Public Health. His division coordinates public health responses to communicable diseases and disasters.
A pediatrician by training, Dr. Humbaugh is well acquainted with the public health challenges among children in public schools. Note: this interview took place Oct. 30.
Q: In light of the Ebola scare, enterovirus cases and the flu season, has your office been fielding calls from school districts?
A: To be honest, we haven’t had as many questions as I thought we would from school districts. But we have had a few.
It is understandable that folks are concerned about Ebola. It is a disease that we are unfamiliar with and that has, at least in Africa, a 50 percent fatality rate. On the other hand, it is important to educate educators and students that there are a very few people in Kentucky, at least right now, who are at risk for Ebola. Only those who have traveled in the last 21 days to Sierra Leone, Guinea or Liberia, the countries in western Africa where the outbreak is ongoing, are at risk, or someone – and this is really rare – who has had contact with someone with Ebola here in the United States or in another country where transmission is not ongoing.
It is also important to realize that this is a disease that is spread from person to person through direct contact. It is not like tuberculosis, which you can get through the air. You can’t, at least in the United States, get Ebola through food or water. You have to have direct contact with bodily secretions: blood, sweat, vomit, diarrhea.
Ebola is still transmissible after death, which is one reason the outbreak has spread in Africa, where cultural practices around funeral rites are different than here.
Another reason is that in the past, Ebola has been associated with isolated pockets of outbreaks primarily in rural parts of the continent. This, the largest outbreak to date, has spread to urban areas.
Q: What about other contagious diseases?
A: In regard to enterovirus, it is spread much like influenza – via secretions from the nose and mouth. It normally circulates in the spring and the fall. The strain enterovirus D-68, which is more active this year, tends to cause more respiratory symptoms than other types of enteroviruses, many of which cause gastrointestinal problems. It seems to be affecting more children, although it can affect adults. Most people have coldlike symptoms and recover on their own. However, adults and children who have chronic diseases, especially pulmonary issues like asthma, might be at higher risk for this viral disease.
Q: At what point should a school start to ask questions about a student or staff member who has traveled or whose family has traveled, to the African nations with Ebola outbreaks?
A: Most who have just traveled to the affected countries are at low risk if they have not had known contact with an Ebola patient or they are not health care workers who have had direct contact with Ebola patients, but it is important to ask.
What is happening now is that not only are people who are leaving these three countries screened upon exit, but they are being screened at airports upon entering the United States. They are all being routed through five airports and at the airport their temperature is being taken and they are asked a series of questions about their risk before they depart for their final destination.
So I think that at the very minimum, people who are returning from travel from these countries are undergoing monitoring for a 21-day period by public health. It may be that they are just checking in every day with public health authorities about what their temperature is or if they have had any symptoms, but, again, schools should be aware and should be working with their local health departments if they have any children or staff like this. They should be aware that these people will be monitoring themselves for symptoms. If they do note that the person is having early symptoms of Ebola, such as fever, diarrhea or vomiting, they should put that person in a separate area and call the local health department to advise them on the situation.
Q: Is there any reason to be concerned if the African nation involved is not one of those with Ebola cases?
A: Those folks are not at risk. Another group that is not at risk are people who have been in contact with someone who has traveled to the three affected countries. If the person who has traveled is perfectly healthy and has no symptoms, that person is not a risk factor. You only transmit the disease when you are showing symptoms.
Q: Your office recently issued a one-page fact sheet for schools about Ebola. What are the key points that school districts and school personnel need to know?
A: Our one-pager talks about much of what I have already discussed: who is at risk, symptoms, what questions to ask about exposure and what to do if you suspect someone has been exposed to Ebola. It emphasizes that we have not seen any cases of Ebola in Kentucky. The CDC website (www.cdc.gov/vhd/ebola/about.html) has some of the best information for the general public. Other good sources of information are health-care providers and state or local health departments.
Q: What should school personnel tell students to minimize any fears they have, particularly about Ebola?
A: Education is key. At least at this stage, very few people are at risk for Ebola and the vast majority of Kentuckians are not at risk, at least not currently.
Q: What are some general precautions schools can take to keep viruses from spreading?
A: The most important thing is that everyone 6 months of age or older get a flu shot.
One reason to have flu vaccination every year is that the circulating strains often change from year to year. The antibodies you build up also need to be boosted on a yearly basis. Early in the flu season is a great time to get a flu shot as it does take a couple of weeks for the body to produce antibodies that fight the flu.
Q: How about precautions in the schools?
A: Schools should have adequate hand-washing facilities with warm water, regular soap and paper towels. People should spend about 20 seconds washing their hands, which is longer than you think. It doesn’t have to be fancy soap, just plain soap and warm water. Make sure to wash under the fingernails and dry the hands with paper towels or hand dryer. Wash your hands after going to the bathroom and before meals. An alcohol-based hand sanitizer is a good alternative when soap and warm water aren’t available, as on a sports field.
Another preventive action is to cough or sneeze into the elbow so germs can dry out on clothing without being spread.
One of the hardest things to do is to stay home if you are sick, but staying home is a great way to isolate yourself and prevent the spread of disease.
Q: If there is a virus in a school, what are recommendations for cleaning the building to stop the spread?
A: Most schools do a good job of sanitizing and disinfecting using Environmental Protection Agency-approved products. The EPA’s website has good information about to how to disinfect for different viruses, because the way to disinfect can vary depending on the virus. For example, the norovirus can spread on the surface of inanimate objects so it is harder to disinfect for. Schools can also consult with the epidemiologist at the local health department about what product would be effective against certain types of viruses.
Q: What kinds of plans should school districts have in place to deal with disease outbreaks?
A: The main thing is to have a good relationship with local health department and call them early on when there is an outbreak. The health department can advise on the types of disinfectant to use to clean and what to do for particular illnesses. Illnesses are spread in different ways so there might different ways to prevent the spread. The health department also can help investigate the source of an outbreak.
Q: What resources on Ebola and other viruses would be appropriate for schools?
A: The CDC website is probably the best place to go. Also, the Hennepin County (Minnesota) Health Department publishes manuals used by a lot of schools around the country. It is online at www.hennepin.us/childcaremanual. It covers different illnesses, how they are spread and how to prevent their spread. Because there is a lot of misinformation on the Internet, I recommend the Hennepin County site, the local health department, state public health department or the CDC’s site.
Q: What kind of information does your office have that would benefit school districts during outbreaks of communicable disease?
A: We can help the local health department and schools craft a letter in the case of outbreaks or unusual diseases to send to parents to let them know what is going on, what the plans are and how to prevent the spread.