What You Can Do To Prepare For Ebola

If ebola spreads to your region -- if people are presenting in your area with symptoms and there is a great deal of fear and uncertainty -- there are some very simple steps you and your community can take to ensure your survival.

Who am I to give this advice? I was tapped to do design on a simulation to train hospitals to deal with medical resource management during pandemic events. I've done a lot of historical research and I've worked with these people. This said, you need to listen to public health officials and authoritative sources over myself in any contradiction. Now on with it...

Take Some Time Off (Self-Isolate)
A very simple and effective way to fight the spread of ebola is to simply avoid contact with others. Pretty straightforward. The more you can avoid others, the more you avoid the disease, the higher your chances of surviving. It's something simple and proactive you can do to stay alive and reassure yourself and your family.

If ebola cases are appearing in your area, and the work you do is not vital to the upkeep of society, stay home. Self-isolate for a few weeks. Download that TV series you've always wanted to watch. Catch up with your reading. Spend some quality time with your family. Do some errands. Take up a new hobby. It's a good way to stay alive. Public health officials will guide you on this.

If you're afraid of losing your job, of missing a month's pay or a month's rent, or losing that new contract, et cetera, you may find that your government very quickly enacts sweeping legislation to protect your ability to self-isolate. This might involve literally nationalizing one month's rent, or something to that effect. If the choice is between that or having a die-off of 50% of the population, I think you'll see the former option taken very quickly, so I wouldn't worry about those things. Keep your priorities straight: living is more important than losing a month's production.

What If You Must Go To Work?
Now, this said, some of you will have jobs vital to the upkeep of society so won't be able to self-isolate. If you work to maintain the infrastructure of society -- if you're involved in the distribution of food, fuel, medicine (etc); if you keep powerplants, water or other utilities running; if you're a first responder, et cetera -- you'll probably need to go to work. Public health officials will likely announce who needs to keep working and who needs to stay home. But here too you can take steps to mitigate risk:

• Workplaces may consider running only "skeleton crews" -- staffing the minimum number  to continue basic-level operations.
• Skeleton crews may be required to self-isolate at their workplaces: bring cots and so forth to camp out at work for a few weeks. This maintains your isolation.
• If you have any contact with the public you may need to wear some level of personal protective equipment (PPE -- more on that below).

Getting Your Basic Living Needs Met
Staying at home is fine, in theory, but we all need basic things like food, medicine and so forth. How do we deal with these needs?

• Gather information. Listen to the radio, go on the internet, etc, for information and directives from public health officials in your area.
• Organize your community (see my article on this here). You're safer working with your neighbours than working alone.
• Control access to your community. Again, you're trying to minimize contact with others. Do these people who want to visit really need to visit? Public health officials will guide you on this.
• Postpone or cancel any trip outside that isn't absolutely necessary.
• You will need to send out volunteers to conduct supply or errand runs. It's best if you organize "shopping lists" or "to do lists" for your entire community, then send a small number of  volunteers to deal with those, rather than having everyone do their own shopping. This minimizes contact with the potentially infected and keeps your community safe.
• If you do leave home you may need to wear some protective equipment (PPE -- see below). It's unlikely you'll need a full-blown biolevel 4 setup, but you may need to wear some basics.
• When on errands, minimize contact with others. Go from point A to point B, do the errand, then return home.
• If you have non-ebola medical needs -- if you need to go to any sort of healthcare setting for a non-ebola issue -- you'll need to pay attention to public health authorities. They will have specific instructions about this.

Many of these things are common sense, when you think about it.

What If You Think You Have Ebola?
Here are the symptoms of ebola.

First, self-isolate! Then seek immediate medical help! If you can maintain isolation while you seek medical help, that will limit the spread.

If you have mild symptoms and are uncertain you have the disease, public health officials will probably ask you to telephone in for a pre-screening. Here, in the Province of Ontario, we have Telehealth (1-866-797-0000 TTY 1-866-797-0007) which enables you to talk to a nurse over the phone.

If you have blatant symptoms public health may want an ambulance to go to your location to get you to a hospital. The ambulance will be equipped to help you and to minimize spread of the disease to others.

If you can't get through and you still need a visit, try phoning your doctor for an appointment.

Using Personal Protective Equipment
Here are some basic principles for using PPE:

• The closer you are to the hot zone, the more PPE you must wear (and vice-versa -- the farther away you are, the less). Here's a good link on biosafety levels. Most of us will not need to wear full biolevel-4 PPE -- that'll only be necessary for healthcare workers. Volunteers doing community errands in ebola-present areas may need to only wear surgical gloves. If things are a little warmer -- if you have a vital job that requires contact with the public -- you might need to add a gown, an ordinary surgical mask and some light goggles. In the unlikely event you are close to the hot zone, you may need to put on smocks or chem suits, outer rubber gloves (over top of your surgical gloves), N95 masks, goggles, boots and lots of duct tape to seal openings. The authorities will guide you on this.
• Pay attention to how you put on and take off your PPE! This is critical. You don't want to leave gaps as you put on PPE. You don't want to infect yourself as you remove your PPE. Here's a link on this. You need others to help you (those helping you remove PPE will themselves be wearing a slightly lower level of PPE).
• Working in high-level PPE is exhausting. It is hot to wear a sealed plastic suit. It's also difficult and claustrophic to wear a full filtration mask. If you have any doubts, hand the job to someone else. (But then again, the knowledge that this stuff can be all that stands between you and ebola is very inspiring to keep it on and use it correctly.)
• Duct tape, plastic sheeting and bleach are your friends. Use lots of it. Use bleach to clean this stuff as it will likely be in short supply.

What Your Hospitals Will Be Doing
If ebola hits your area this is what your hospitals will likely be doing:

Public health officials are going to set aside specific wards of hospitals, or possibly entire hospitals, to be "pandemic response centers". (This is why it's important not to just show up at a hospital -- you may infect yourself, or you may go to the wrong hospital and infect others there.)

If you want to find out more, here is an excellent article that describes how one hospital (North York General Hospital) handled the SARS crisis in 2003.

How Can You Volunteer To Help? 
There may be some things you can do to actually help meet medical capacity to respond to this event. Here are some tips in volunteering with this:

First, be prepared to NOT help! What often gums up the works in any disaster is too many people trying to help. This causes confusion and mayhem. If you want to help, you need to offer your services to your local authorities and then WAIT for them to call on you. They may not tap you, and you'll need to accept that. But, on the other hand, they might need you, depending on your capabilities. Here are some ways you can help:

You may be asked to help your neighbours get needs met, while minimizing spread of the disease. As I detailed above, you may be tapped to do errands, or to run your business, while wearing PPE and minimizing contact with others.

Retired medical staff are the marines! If you are a retired doctor or nurse or other healthcare worker, public health officials will likely already have arranged to tap you to deal with an overload of cases. From my limited knowledge, ebola is not a complex disease to deal with (though we can't definitively treat it): it needs caregivers who have courage more than anything else to confront it.

Housekeeping will be a huge issue. Those of you who have the courage to face the disease, and are willing to wear PPE and follow instructions, can provide housekeeping and other support work.

SARS-event improvised isolation facilities

You may be able to help build improvised pandemic wards. In the event of a major spread of the disease we will need lots of pandemic surge capacity. Read this article on North York General Hospital's response to SARS. They quickly turned ordinary hospital wards into isolation wards. They built an assessment area in the parking lot using tents, plastic sheeting, flexible ventilation hoses and lots of duct tape. Here are the core things that you need to build an isolation ward:

• You can build an improvised isolation ward away from the disease. A crew of skilled volunteer workers can make such a facility in a safe zone, working under healthcare supervision, then turn it over to medical staff for later use.
• You need rooms with beds and nearby washrooms. Think of all the places that you could turn into improvised isolation. Obviously mothballed hospitals work. But what other places might work? Tents? Hotels or motels? Abandoned warehouses? Old schools or other institutions?
• Each room needs 5 core things: isolation, negative pressure, suction, cleanable surfaces and oxygen.
• Isolation means one patient per room, the room sealed. It can be achieved with weather-stripping, etc. If you have a large open space, you can do this with plastic sheeting (double-layered perhap). Healthcare officials may decide to "cohort" large numbers of a later-stage patients together (in large rooms, not actually isolated). (Isolation is critical with any sort of pandemic where the symptoms may be deceptive: you don't want to put patients with ordinary flu into the same room as those with ebola.)
• Negative pressure means that a ventilation system is sucking air out of the room, then venting this air through a filtration unit for exhaust elsewhere. Volunteers with HVAC capability, working under medical supervision, can provide this. You want to create a situation where the air will be sucked into the room anytime someone enters -- this will minimize spread of the disease (it will suck virus particles back into the room when the door is opened). If your building has any sort of ventilation or forced-air heating, you can reverse the flow of this air, seal up the cracks with duct tape, and vent it accordingly. Failing that, you can use flexible hosing to jury-rig such a system, suspending this hosing from the ceiling. (If you need to do any maintenance work on this system, mid-event, you MUST wear PPE!)
• Suction can be improvised through basic plumbing. Patients with ebola have all sorts of nasty fluids that need to be suctioned away. Simple copper pipe, with a flexible hose in the room, can be used to make this. You need to suction this material to a boiling tank, where it can be boiled and sterilized, then washed into the wastewater system. Obviously those with plumbing capability can help out here. (If you need to do any maintenance work on this system, mid-event, you MUST wear PPE!)
• Cleanable surfaces means ideally tiled or linoleum floors and baseboards -- surfaces that can withstand constant hosing down with bleach. Carpeting will have to be ripped out.
• Oxygen is a little more complicated. To improvise a system that pipes oxygen into rooms will require some expert capability. Simple oxygen bottles become highly prized assets in these events.

What Is Ebola?
Ebola is an ancient "filovirus" that evolved to kill primates, specifically, millions of years ago. It lay dormant within the Congo for all that time, living inside its "reservoir" (an animal host which is immune to it, believed to be a species of monkey, ape or fruit bat). In the meantime, mankind spread throughout the globe.

The Trans-Congo highway penetrated through that jungle area, and it is one of the routes of travel by which ebola has re-entered our modern world. (The same route has also carried HIV/AIDS - it too is an ancient disease we are vulnerable to.)

The overall global spread of ebola (as well as HIV) coincides with the spread of civlization and the increase in traffic in Africa and around the world.

Getting Through This
Hopefully, the disease will be contained and all of this advice will get filed under "for-future-use". (Please don't beat me up if ebola doesn't spread here. I'll be just as happy as everyone else.) But either way, it always feels better to focus on what we have working for us, what we can do, and to take steps to further the safety of ourselves and our loved ones.