News today that a fourth case of Ebola has been diagnosed in the United States underscores the urgent need to have health workers not just ready, but also willing to treat patients with the illness. Next Wednesday, the National Coordinating Center on Public Health Systems and Services Research (PHSSR) will be hosting a webinar on legal protections to help facilitate health worker willingness. Daniel Barnett, MD, an Associate Professor in the Department of Environmental Health Sciences at the Johns Hopkins Bloomberg School of Public Health, will be the main presenter. Barnett and three Bloomberg colleagues, Leonie Ratko, JD, PhD, MPH, Jon S. Enrick, JD, MPH Carol B. Thompson, MS, MBA received funding from the Robert Wood Johnson Foundation and PHSSR to study the issue. PHSSR's Center is funded by RWJF and based at the University of Kentucky.
NewPublicHealth recently spoke with Barnett.
NewPublicHealth: What are the concerns with respect to health workers being prepared to take some risks in order to protect the public?
Daniel Barnett: There’s been a longstanding tacit dysfunction about preparedness trainings: That if you train someone in knowledge and skills in terms of how to respond, that will necessarily translate into a willingness to do so. But our work has shown that “training to knowledge equals training to willingness” is a false assumption. In other words, I can teach someone how to recognize anthrax or some other infectious disease agent under a microscope, but that in no way ensures that that individual will be willing to come to work to look at anthrax or another infectious disease agent under a microscope, and by analogy, any other type of frontline public health or health care response.
That’s been, frankly, a missing piece in public health preparedness training nationally and internationally, and I think that we need to really rethink paradigms of preparedness training and education to take a more holistic approach. In other words, an approach that recognizes that frontline healthcare workers and public health workers have fears and concerns attached to a whole variety of aspects of the events at hand.
Just about every think tank, school of public health and infectious disease association has held a conference on Ebola in the last few weeks, but two coming up are still absolutely worth tracking.
Now that New York City has seen is first diagnosis of Ebola, an already scheduled conference next week at Columbia University’s Mailman School of Public Health has taken on added importance. Presenters include ABC News Chief Health and Medical editor and former acting U.S. Centers for Disease Control and Prevention director Richard Besser, MD, as well as Irwin Redlener, MD, director of the National Center for Disaster Preparedness at Columbia University's Earth Institute. While the conversation surrounding the Ebola cases in Dallas focused on the need for health care workers to receive better guidance and training, hours into the first case in New York City the focus is on the challenge of containing the disease in a huge urban setting—a topic the presenters will discuss at length.
And on November 7, the White House Office of Science and Technology Policy will host a simulcast workshop together with Texas A&M, the Worcester Polytechnic Institute and the University of California, Berkeley to discuss proposals to dispatch robots to aid in the care of Ebola patients and people who have succumbed to the disease. The idea is to augment — and not replace — health workers. Robots could spray disinfectant, respond to commands given by health workers in a remote location and even help bury the dead.
The conference will include not just engineers, but also public health officials and health care personnel who can speak to the human needs that need to be considered when design the robots. For example, Texas A&M engineering students are working on a robotic attachment that would pick up a dead body in movements that mimic compassion, rather than in another way that may be efficient but does not show sensitivity for the dead and their families.
>>Bonus Link: Read an interview with the conference conveners.
EBOLA UPDATE: Medical Aid Worker Tests Positive in New York City
(NewPublicHealth is monitoring the public health crisis in West Africa.)
A hospitalized medical worker has tested positive for Ebola in New York City, according to the U.S. Centers for Disease Control and Prevention (CDC). The medical aid worker had volunteered in Guinea. The patient is currently in isolation in Bellevue Hospital—one of eight New York State hospitals that Governor Cuomo designated to treat Ebola patients—as the CDC’s laboratory performs confirmation testing. Read more on Ebola.
HHS: $840M to Improve Patient Care While Reducing Costs
The U.S. Department of Health and Human Services has announced an $840 million initiative to improve patient care while also reducing costs, which will encourage patients to seek early preventive care more often. The initiative “will fund successful applicants who work directly with medical providers to rethink and redesign their practices, moving from systems driven by quantity of care to ones focused on patients’ health outcomes, and coordinated health care systems,” according to a release. Potential strategies include:
- Giving doctors better access to patient information, such as information on prescription drug use to help patients take their medications properly
- Expanding the number of ways patients are able communicate with the team of clinicians taking care of them
- Improving the coordination of patient care by primary care providers, specialists, and the broader medical community
- Using electronic health records on a daily basis to examine data on quality and efficiency
Read more on prevention.
EPA Announces $3M to Reduce Diesel Emissions from School Buses
The Environmental Protection Agency (EPA) has announced approximately $3 million in funding to reduce diesel emissions from school buses. Through the EPA’s National Clean Diesel Rebate program, eligible public and private school bus fleet owners can apply for funding to replace school buses that have “older, dirtier” diesel engines, which will in turn improve air quality. "School buses are the safest and most environmentally friendly way to transport children to and from school," said Janet McCabe, acting assistant administrator for EPA’s Office of Air and Radiation, in a release. “The rebates to retrofit older bus engines will provide healthier rides for the 25 million children across the country who ride them on a daily basis.” Read more on air and water quality.
In the wake of the Ebola outbreak in West Africa and cases diagnosed in the United States, NewPublicHealth has been looking at the toll of other infectious diseases in need of new prevention and treatment efforts. Earlier this week, the Kaiser Family Foundation released a series of infographics that compare Ebola to twelve other infectious diseases, including SARS, malaria and HIV, which are all current public health challenges.
The infographics are an important teaching tool for explaining how Ebola is spread and for reminding public health professionals about the need for vigilance when it comes to other diseases.
The series of infographics touch on topics including:
- Transmission routes
- Vaccines, treatments and cures
- Fatality rates
- Key characteristics such as immunity after infection and number of cases worldwide each year
Below is one of the Kaiser Family Foundation’s infographics. Click through to view the additional educational tools.
EBOLA UPDATE: Drugmakers Seeking Indemnity to Protect Against Potential Losses, Claims
(NewPublicHealth is monitoring the public health crisis in West Africa.)
Drug manufacturers working to develop Ebola treatments are also looking for indemnity from governments or multilateral agencies to protect themselves from potential losses or claims related to their work. The issues is expected to be discussed today at a meeting in Geneva that will be chaired by World Health Organization Director-General Margaret Chan. "I think it is reasonable that there should be some level of indemnification because the vaccine is essentially being used in an emergency situation before we've all had the chance to confirm its absolute profile," said GlaxoSmithKline Chief Executive Andrew Witty to BBC radio. "That's a situation where we would look for some kind of indemnification, either from governments or from multilateral agencies." Read more on Ebola.
NIH: $31M in Grants to Enhance Diversity in the Biomedical Research Workforce
The National Institutes of Health (NIH) has announced almost $31 in grants to enhance diversity in the biomedical research workforce. The grants are part of a larger five-year program to support more than 50 awardees and partnering institutions in establishing a national consortium to “develop, implement and evaluate approaches to encourage individuals to start and stay in biomedical research careers,” according to a release. “At the Department of Health and Human Services [HHS] we believe that delivering impact begins with building strong teams that have the talent and focus necessary to get results,” said HHS Secretary Sylvia M. Burwell. “These awards will leverage the power of our country’s diversity so that together, we can continue to advance biomedical research and unlock the cures to some of the great health challenges of our times.” Read more on research.
Study: Conflict at Home or School Affects Teens in Both
Conflict at home can lead to a teen experiencing a greater risk of problems at school for up to two days, while issues at school can also cause problems at home, according to a new study in the journal Child Development. In a study of more than 100 teens ages 13-17 and their parents, researchers also determined that bad moods and mental health symptoms such as depression and anxiety are factors in what’s known as the “spillover effect.” "Spillover processes have been recognized, but are not well understood," wrote Adela Timmons, a doctoral student, and Gayla Margolin, professor of psychology. "Evidence of spillover for as long as two days suggests that some teens get caught in a reverberating cycle of negative events.” The research could be used to help teens learn to better manage stress and difficult situations. Read more on mental health.
Bruce Katz, vice president and director of the Metropolitan Policy Program at the Brookings Institution, recently spoke at the Mailman School of Public Health at Columbia University about his thesis that in the absence of federal leadership, cities are taking the lead on public health innovation in many ways including passing new laws that address public health concerns and partnering with university research centers.
Mailman recently published an interview with Katz about belief that cities are driving public health changes and improvements. One topic Katz addressed was cities working together to improve population health:
Cities watch each other closely. When one innovates, others replicate the innovation or adapt and tailor it to their own circumstances. We used to think if you were going to have dramatic change in a country on any number of issues, you needed the scale of the national government. Today it's more likely that a city will innovate in such a way that other cities can say, “We can do that, and maybe we can do it better.”
For example, when Portland, Oregon, finds a way to promote itself as the place that builds green cities and exports sustainable products and services to growing cities in Latin America or Asia, other cities begin to think, "Wait a second, we have our own clusters of clean energy or clean economy. Perhaps we can do the same branding and marketing and export promotion.”
The success of individual cities, or what Michael Bloomberg has done with C40 [a city-centric climate leadership group] rests on this notion that cities can learn from each other, share with each other, and then replicate the best innovations to have impact in their locales. That's a very different, 21st century model of how society goes about solving its major problems.
Read the full interview.
EBOLA UPDATE: WHO Plans on Ebola Vaccine Tests in January
(NewPublicHealth is monitoring the public health crisis in West Africa.)
The World Health Organization plans to begin testing two experimental Ebola vaccines in West Africa by January. The vaccines will likely be tested on more than 20,000 frontline health care workers and others in the region. The global health agency also announced that a blood serum treatment could be available for use in Liberia within two weeks. Read more on Ebola.
Study: Automated Tracking Improves Vaccine Compliance in Health Care Workers
Automated tracking of influenza vaccinations increases vaccination compliance in health care personnel while also reducing the workload burden on human resources and occupational health staff, according to a new study in the journal Infection Control and Hospital Epidemiology. Researchers analyzed data on nearly 7,000 people including in a mandatory vaccination program, finding that “automated reminders and tracking accounted for more than 98 percent of compliance among healthcare personnel.” "Mandatory vaccination programs help protect vulnerable patients, but can be tremendously time and resource dependent," said Susan Huang, MD, MPH, an author of the study, in a release. "By successfully automating a system to track and provide feedback to healthcare personnel who have not received their seasonal flu vaccine, we are providing safer places for care and reducing the administrative burden of our mandatory vaccination program." Read more on vaccines.
Study: Living with a Smoker is as Bad as Living in a Highly Polluted City
Living with a smoker is the same as living in a smoke-free home in a heavily polluted city such as Beijing or London, with the non-smokers exposed to three times the World Health Organization’s officially recommend safe levels of damaging air particles, according to a new study in the journal Tobacco Control. In a collection of four studies, researchers determined that the concentration of fine particulate matter was approximately 10 times higher in smoking homes than it was in non-smoking homes. “Smokers often express the view that outdoor air pollution is just as much a concern as the second-hand smoke in their home,” said Sean Semple, MD, of University of Aberdeen, in a release. “These measurements show that second-hand tobacco smoke can produce very high levels of toxic particles in your home: much higher than anything experienced outside in most towns and cities in the UK. Making your home smoke-free is the most effective way of dramatically reducing the amount of damaging fine particles you inhale.” Read more on air quality.
Over the weekend, NewPublicHealth conducted an email interview with Tarik Jasarevic, a spokesperson for the World Health Organization (WHO), on Ebola efforts on the ground in West Africa and the impact on the global effort of the cases recently diagnosed in the United States.
NewPublicHealth: Is there concern among global health leaders that the attention on a handful of cases is taking away attention from the thousands of cases in West Africa?
Tarik Jasarevic: While countries need to be vigilant and prepared for a possible case of Ebola, we need to focus on getting all possible resources—trained health workers, medical facilities with beds and money—to the affected countries in West Africa.
NPH: Several weeks ago global health leaders had a checklist of things, including money and personnel, needed to stem the outbreaks in the various countries. Where do things stand now, and what is still needed?
Jasarevic: We need a lot of resources if we’re going to get the virus under control. WHO and partners constructed 12 Ebola Treatment Centers in Liberia, 15 in Sierra Leone and 3 in Guinea—30 out of the 50 that are needed. These facilities contain more than 1,100 beds for patients, out of the more than 4,000 needed. There are more than 2,500 beds becoming available in the next few weeks, but we still need more. We also need international health workers to come work alongside national health workers to manage and run the health facilities. WHO has set up “training academies” in each of the affected countries to train more local health workers, but more are needed.
NPH: What is the current fatality rate?
Jasarevic: The fatality rate for this particular outbreak has always been approximately 70 percent. We are seeing higher numbers of cases and deaths because of the geographic spread of the disease, from urban city centers to rural, hard to reach villages. There is also significant under reporting of cases in the three countries, especially Liberia.
CDC Updates Guidelines on Health Worker Protective Gear when Treating Ebola Patients
The U.S. Centers for Disease Control and Prevention (CDC) announced last night that it is tightening its infection control guidance for health care workers caring for patients with Ebola, with a specific focus on several key steps:
- All health care workers must undergo rigorous training and become practiced and competent with protective equipment, including taking it on and off in a systemic manner.
- No skin exposure is allowed when the equipment is worn.
- All workers must be supervised by a trained monitor who watches each worker taking the equipment on and off.
The CDC is recommending all of the same equipment in its earlier guidance, with the addition of coveralls and single-use, disposable hoods. Single-use face shields are now recommended instead of goggles. Read more on Ebola.
Most People Polled Don’t Know New ACA Enrollment Period Begins in November
A poll just released from the Kaiser Family Foundation finds few people know that open enrollment for 2015 health insurance coverage under the Affordable Care Act begins next month. Other findings of the poll:
- Two-thirds of responders say they know “only a little” or “nothing at all” about the marketplaces where people who don’t get coverage through their employers can shop for insurance.
- Just over half say they know that financial assistance is available to help low- and moderate-income individuals purchase insurance.
Risk Factors for Sexual Assault Need to be Included in Prevention Efforts
Researchers who conducted a Danish study on sexual assault say that certain risk factors for the attacks—including the age of the victim and their prior relationship with the attacker—must be considered when developing strategies to help prevent sexual assaults. The researchers looked at data from more than 250 women who sought help at a Danish center for sexual assault victims between 2001 and 2010. The researchers found that 66 percent of the women were 15-24 years old and 75 percent had met their attacker before the assault. Nearly half of the women reported that the attacker was a current or former boyfriend, a family member or someone they considered a friend. Women who did not know their attacker previously were more likely to report the assault to the police. “We need to raise awareness of the fact that most sexual assaults are perpetrated by someone known to the woman, often in familiar surroundings ... in order to change the general attitudes towards sexual assault, this information should not only target young people, but also the police, health care professionals and the general public,” said Mie-Louise Larsen, of the Centre for Victims of Sexual Assault and the University of Copenhagen and a coauthor of the study, which appeared in BJOG: An International Journal of Obstetrics and Gynaecology. Read more on injury prevention.
Positive Images Improve Function in Older Adults
Older individuals who are subliminally exposed to positive stereotypes about aging showed improved physical functioning that can last for several weeks, according to work done by researchers at the Yale School of Public Health. The study, which will be published in Psychological Science, included 100 older individuals with an average age of 81 years. Some participants saw positive age stereotypes on a computer screen that flashed words such as “spry” and “creative.” Those participants who were exposed to positive messaging displayed both psychological and physical improvements but control participants did not. Read more on aging.
Parents know how difficult it can be to find kid-friendly supermarket checkout counters without candy or magazines. Now a new mobile-friendly website from the Campaign for Tobacco-Free Kids offers parents a way to find retailers who don’t sell tobacco. Public health experts applaud its debut:
- Tobacco companies spend more than 90 percent of their annual $8.8 billion marketing budget at the point-of-sale in stores, and this marketing has been shown to increase youth tobacco use.
- Every day, more than 2,800 U.S. kids try their first cigarette. That’s more than one million kids who take their first puff each year.
- 5.6 million children alive today will die prematurely from smoking unless current trends are reversed.
- An estimated 375,000 U.S. retail stores sell tobacco products. That sends a terrible message to kids that tobacco use is normal, acceptable and appealing.
The new website includes an interactive map that shows the locations of Tobacco-Free Retailers across the country. All CVS Pharmacies have just gone tobacco-free and other retailers who don’t sell tobacco include Wegmans and Target. As part of a new national campaign, stores that are tobacco-free can also display stickers from Tobacco-Free Kids.