1st Place

Covid, Ebola,Monkeypox, seasonal flu —Who needs Halloween?

— Paul Hughes-Cromwick

Inspiration: 24/7 ghosts, goblins, and pathogens

2nd Place

Surprise billing curbs,Like the famed headless horseman,Remain incomplete.

— Michael L. Millenson

Inspiration: “How to Avoid Surprise Bills — And the Pitfalls in the New Law”Ìý

3rd Place

Ghastly, grotesque, sick!You mask up to trick-or-treat,But not for covid?

— Micki Jackson

Inspiration: The ongoing mask-or-not masquerade

While Halloween may be coming to an end, KHN reporting continues year-round. Send us your haikus at any time for possible inclusion in our Morning Briefing:Ìý/contact-haiku/

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Dr. Shannon Novosad was on a plane to Utah the next day, one of 10 detectives looking for answers about this case to help other professionals deal with this rapidly growing health problem.

Novosad is a critical care pulmonologist by training, but she is also in a two-year fellowship at the Centers for Disease Control and Prevention’sÌý. Her colleagues in the program include about 80 medical and scientific professionals who study disease prevalence, patterns and control. The group includes dentists, doctors, veterinarians and entomologists.

The teams include not only epidemiologists but also scientists with backgrounds in a particular disease itself, such asÌý. Entomologists, vector technicians, communications specialists and public health scientists have been part of the Zika teams.

They rush to areas where the disease is reported and help with local efforts to identify other patients and health care workers who may have been in contact with an infected person. They also provide extra hands in the collection and analysis of blood samples. And, in the Salt Lake City case over the summer, two entomologists who are vector-borne disease specialists helped local authorities trap mosquitoes to see if they were transmitting Zika.Ìý

These medical SWAT teams Ìýhave also deployed to Texas and the Miami area. Nearly 800 people have been diagnosed in Florida with Zika, at least 64 of them having been infected locally. The size of the teams vary.

Novosad said that she hopes people know “that we have these mechanisms in place” to send in experts to deal with these outbreaks. “That’s why public health is there … and we do have a strong public health workforce.”

CDC Plan For Outbreak

Zika, which can be transmitted by mosquito bites, sexual contact or from mother to fetus, typically causes mild symptoms, including a rash, fever, joint pain and bloodshot eyes. It has also in rare cases been associated with Guillan-Barre syndrome, which includes temporary muscle weakness and paralysis.

However, the effect that has brought the greatest concerns involves pregnant women. The infection sometimes causesÌý, a birth defect in which a baby’s head is unusually small. That can result in developmental delays, intellectual disabilities, problems with balance and with swallowing, according to the CDC.

CDC officials developed a detailed,ÌýÌýfor handling Zika outbreaks, which called for epidemiologists to study outbreak patterns; doctors to interview and treat health care workers and other who may have been in contact with people who had the disease; entomologists to trap and study mosquitoes in the outbreak area; and communications officers to coordinate getting information out to the public.

The Zika plan drew from lessons in the Ebola outbreak, in which health care workers who contracted that deadly virus at first were not interviewed about their exposure to Ebola and precautions for their health and those of others not taken. That led to sharp criticism of the CDC. The agency broadened its teams of epidemiologists normally sent to investigate disease outbreaks to include other experts, such as the vector-born specialists sent in response to Zika.

Behind the scenes in Miami, the disease detectives are interviewing people, collecting data and trapping mosquitoes, all the while working not only to contain the disease but also to quell growing concerns about its reach, said Nordlund.

“Our teams have been well-received and helped contribute to the response.ÌýThe states and local health departments have done a lot of work to get prepared for Zika and are putting in tremendous effort in the Zika response,” the CDC’s director, Dr. Thomas Frieden, said in an email.

The much-publicized logjam in Congress overÌýÌýhas not hampered the CDC efforts, Frieden said, but he added that a shortage of funding could impair response efforts going forward.

Frieden said money for the teams has come from $222 million in repurposed funds.ÌýThe administration earlier this year redirected funding for Ebola research and prevention to help pay for its efforts on Zika.

“We’re in peak mosquito season right now and if more states see local transmission, CDC’s resources will be stretched thin as we help respond in multiple areas,” Frieden wrote in the email. Ìý“But it’s not too late, and we are hopeful that Congress will do the right thing, as they have with Ebola, for example.”

An Urgent Call

The call from the Utah Department of Public Health to the CDC came in on July 12. “We were all on a plane July 13,” said Novosad. “We took whatever plane that could get us there fastest.”

Once there, Novosad said the first job was to identify all health care workers who had come into contact with the patient.

“We started by contacting the employees, and we administered surveys,” she said. “I think people were just really interested in helping, given the unusual nature of this outbreak.”

The team of epidemiologists talked to family members to see if any others were infected.

A lab team helped make sure all necessary blood samples had been taken and were accounted for. A communications group coordinated information among the teams. Each morning at 6 a.m., the entire crew assembled to talk with experts in Atlanta.

The team Tuesday. It did not name the man or his son. Although they did not determine how the son became ill, the investigators noted that he had close contact with his father, who had a very high virus level. The son had hugged and kissed his father, as well as assisted medical workers in caring for him. The report noted that health care workers and family members “should be aware that blood and body fluids of severely ill patients might be infectious.”

Nordlund said she understands why people become unnerved and impatient when disease outbreaks occur.

People typically do not pay attention to the work of public health agencies when no immediate outbreaks are occurring, she said.

“When public health is doing its job, you don’t see it,” she said. When a crisis occurs, it’s suddenly news, she said.

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During his stay at Texas Presbyterian Hospital in Dallas, two nurses also contracted Ebola. Duncan died, but the nurses survived, as did a handful of Americans who fell ill in West Africa but were transported back to the U.S. for care.

The Ebola outbreak in West Africa, and its spillover into the U.S., launched a national media frenzy and forced hospital officials to take a hard look at their readiness for a serious epidemic.

By February, four months after Duncan died, the CDC had designated 55 hospitals nationwide as future “Ebola treatment centers.” Two are in Texas: and Texas Children’s Hospital in Houston. Many of the 55 hospitals renovated rooms and increased training and simulations for staff in case of an outbreak.

“After the case in Dallas a year ago, we knew there would be a need,” said , medical director for infection control and prevention at Texas Children’s. Campbell helped design the isolation unit, which the hospital began planning to build last fall after Duncan’s death. The $16 million project was paid for out of the hospital’s capital funds and $1 million in donations.

“A year ago in the United States, there were only twelve beds for the entire country for patients that had a need to be isolated in a biocontainment unit. And not surprisingly, zero of those beds were designated for children,” she added.

In the special pediatric unit, each of the eight patient rooms has an antechamber, where doctors and nurses put on protective gear, gloves and ventilated hoods. After treating the child inside the room, they will leave through a separate door and enter a third room, where they strip the equipment off.

The whole time, nurses will observe through large glass windows.

“So if there’s any question they can say ‘Wait, stop. You need to clean your hands again.’ Or ‘Wait, stop. Let’s take this glove off more carefully,’” Campbell explained.

The unit has its own biosafety laboratory, so infected blood samples never have to be carried to other parts of the hospital. There’s also a separate medical waste room, where carts full of used clothing and equipment can be wheeled inside six-foot autoclaves. There’s also a locker room with showers. After every shift, medical workers will shower before leaving the unit.

TCH officials say Ebola was the catalyst for the decision to build the unit, but it is designed to handle any globe-trotting superbug.

“These rooms are equipped to take care of TB, MERS, pandemic influenza, bird flu and even a pathogen that we might not know what it is yet,” Campbell said. “That’s why we wanted to build something with the highest level of isolation ability.”

Before designing the unit, teams from Texas Children’s visited adult biocontainment units at hospitals in Atlanta and Omaha. , a pediatric intensive care specialist, said the medical architecture in the new unit is impressive, but none of it will work without proper training protocols and motivated staffers.

The initial training for working on the biocontainment unit included eight hours of general orientation, followed by 16 hours of learning how to don, doff and maneuver in the biocontainment suits.

“I describe it as a space suit,” Arrington said. “It’s a full-body suit that you put on, that has footies and arm holes and covers you up completely.”

Doctors and nurses who volunteered to work on the unit undertook simulations and mock drills, relearning skills such as inserting IVs while wearing the suit.

“When you put three pairs of gloves on, you [can] lose sensation in your hands because they’re so tight,” said Arrington, “But you really lose that tactile feel that, as physicians and nurses, is really important in taking care of any patient, let alone a child,” Arrington said.

Children have always been especially vulnerable to infectious diseases. During the Ebola outbreak in West Africa, children died at a higher rate than adults.

As pediatricians – and parents – know, sick children need close monitoring. They need encouragement to eat and drink, and comfort when they are scared and confused.

And that’s the drawback to a pediatric biocontainment room – the parents of a very sick child will probably not be allowed inside.

But Campbell says Texas Children’s Hospital is ready for that challenge. At least six doctors or nurses will be assigned to each child, and one of them will act as a family liaison. The kids can also use tablets and video chat to talk with their families, and can see them through the large windows.

And the hospital is developing a special doll — one that will wear the same biocontainment suit as the doctors and nurses.

“So that when the health care providers come in, they understand that, yes, we’re dressed up a little differently but that their little doll has similar attire on,” she said.

The pediatric isolation unit will be ready for patients in late October, with a formal ribbon-cutting expected in November.

This story is part of a reporting partnership that includes , and Kaiser Health News. Ìý

ºÚÁϳԹÏÍø News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about .

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