Guidance for UCSF Faculty, Staff and Trainees Planning to Assist in the Response to the Ebola Epidemic in West Africa
Several countries in West Africa, including Guinea-Conakry, Liberia, Mali and Sierra Leone, are experiencing the worst Ebola outbreak in history, and President Barack Obama has asked volunteers experienced in the clinical care of critically ill patients, hospital management and logistics, and public health to travel to the area to help contain the epidemic. We know that many in the UCSF community would like to respond to this crisis, but as they do, volunteers should keep in mind the personal risks of becoming infected and the dangers of spreading the disease. Additionally, as the response mounts, UCSF faculty and staff will be travelling to the epidemic area as part of their jobs.
UCSF believes that we, as an institution, have a societal obligation to protect the people of California from Ebola virus disease and that the best way to do this is to control the epidemic at its source. To that end, UCSF is creating a system to facilitate faculty and staff volunteers’ participation in care, treatment, and disease control activities in West Africa.
To ensure that those who choose to respond have as much training and support as possible, all UCSF-affiliated travelers to affected West Africa countries (whether providing direct patient care or not) must complete (1) a “UCSF Ebola Response Traveler Checklist” (2) register their travel with “uctrips”, and (3) meet with the UCSF Occupational Health Program (OHP).
Travelers on University-approved leave will be eligible to receive donated leave via the Emergency Vacation Leave Sharing Program (EVLSP). For questions, please refer to the information, contacts and links below. You may also send questions to [email protected], a dedicated email account that will be monitored by members of the UCSF Ebola response task force, including George Rutherford, MD, professor of Epidemiology and Pediatrics and campus lead for UCSF’s Ebola response efforts, and Terri O’Brien, PhD, associate chancellor.
New as of November 2015:See note for travelers who will be performing certain ophthalmologic surgical procedures.
CDC has outlined criteria for humanitarian aid workers, limiting eligibility to licensed medical doctors (MD, DO degrees), licensed nurses (RN, NP, etc.), or other licensed clinical care providers (e.g., paramedics, physician assistants, laboratory scientists, and other clinical providers) who have had recent (current or within the past 2 years) relevant experience providing direct care to patients. UCSF will only review requests for University-approved leave from licensed clinical providers who are not enrolled in an academic or training program (academic or training programs include degree candidates, interns, residents and clinical fellows) who meet the CDC criteria.
In addition to volunteers to provide direct clinical care, volunteers are being sought to assist with hospital administration, logistics, the public health response and various research activities. UCSF will review requests for leave from individuals who are not enrolled in an academic or training program (including residents and clinical fellows). Additionally, UCSF faculty and staff who are travelling to affected West African countries as part of their employment will also need appropriate approvals.
Trainees (Clinical and Non-Clinical)
To protect our students and trainees from extraordinary risk, UCSF, by policy, does not approve or sponsor international academic programs for students, residents or clinical fellows from any school or program to any international site for which the US State Department has issued a travel warning or IJET has issued a Level 5 Security Warning. Requests for UCSF sponsorship of an academic program in a high-risk environment as an exception to this campus policy may only be approved by the Dean of the relevant school or the Graduate Division. Because of the risks involved in providing direct care for Ebola patients and from working in an epidemic situation, such exceptions will be rarely granted and only in circumstances where the student’s or trainee’s graduation requirements cannot be met otherwise. Deans of the Schools and the Graduate Division are responsible for ensuring that students and trainees are aware of this policy, and Department Chairs and institute/ORU directors are responsible for ensuring that their faculties are aware of and adhere to this policy. Currently, the US State Department has issued a travel advisory for US citizens considering travel to Guinea, Liberia, or Sierra Leone for any reason. In the future, other countries may be affected by this epidemic and added to the US State Department Ebola Travel Warning List.
Alternatively, students who wish to travel to these countries as private citizens, without formal UCSF sponsorship, must still request and be granted a written leave of absence from the Vice Dean for Education in the School of Medicine and Dean of their school. Residents and clinical fellows must similarly be granted a written leave of absence from their program director and then by their department chair and Dean. In these circumstances, the travel will not be as part of a UCSF-sponsored educational or training program, and all requirements must nonetheless be met (see FAQ “What if I travel to West Africa to assist with the response without being on UCSF-approved leave?”).
The UC Office of the President has issued guidance stating that all travelers should work under the auspices of a recognized governmental or non-governmental organization with the experience and resources to ensure the safety of its staff. Clinical volunteers can identify an organization in need by registering with USAID: http://www.usaid.gov/ebola/volunteers. Other volunteers can identify organizations responding to the Ebola outbreak: http://www.cidi.org/ebola-ngos/#.VHQAuYvF-Sp.
When completing the “UCSF Ebola Response Traveler Checklist”, travelers will be asked to identify and provide contact information for the recognized organization under which they will be working. Please note that UCSF may establish specific requirements for organizations under which UCSF-affiliated travelers can volunteer. For questions, please contact [email protected].
If, for some reason, CDC training is not available for a clinical traveler, the UCSF Ebola Response Task Force may approve an alternative training course. For questions, please contact [email protected] and [email protected].
Planning Your Travel
1. Department Approval (all travelers): All travelers must obtain approval from their department or appropriate supervisor and determine their travel status. There are five potential travel statuses:
Travel as normal business: faculty or staff who will be traveling in accordance with their normal responsibilities at UCSF (approved by the department; not eligible for EVLSP)
Dean-approved Travel for Trainee: student, resident or clinical fellow who receives an exception to the policy prohibiting travel to countries for which the US State Department has issued a travel warning (approved by the Dean; considered UCSF-sponsored educational or training program)
Trainee Leave-of-Absence: student, resident or clinical fellow who is granted a leave-of-absence from their training program (approved by the Vice Dean of Education in the School of Medicine and the relevant school Dean; not considered UCSF-sponsored educational or training program and not eligible for EVLSP)
UCSF-affiliated travel: faculty, staff, or trainee (student, resident, or clinical fellow) who does not qualify for any of the status above.
2. Requesting University-Approved Leave (if applicable): Appropriate departmental approval must be obtained (e.g. manager, Department Chair or administrative officer) for University-approved leave. Academic leaves are subject to APM 700, 758, and 759. Staff leaves are subject to PPSM 2.210 and PPSM 46. The process for obtaining Department approval can be found at the following links:
3. Emergency Vacation Leave Sharing Program (EVLSP) (if applicable): Travelers on University-Approved leave who do not have sufficient accrued vacation leave hours to cover their leave period may be eligible to request hours from the Emergency Vacation Leave Sharing Program (EVLSP). This program was implemented to specifically support employees taking action during this crisis. Go to the UCSF EVLSP page to initiate your request.
5. Occupational Health Program (all travelers): All travelers must meet with OHP to ensure that they have the necessary vaccinations, special immunizations, and malaria prophylaxis for safe travel, and to be counseled about chronic health conditions that can be exacerbated by working under the difficult conditions in West Africa. OHP will also instruct travelers how to keep travel diaries recording any potential Ebola exposures. OHP will liaise with the San Francisco Department of Public Health or other local health department based on the travelers’ city or country of residence to coordinate any restrictions upon return.
New: Because of the persistence of Ebola virus in the anterior chamber of the eye in some Ebola survivors, certain ophthalmologic surgical procedures may involve exposure to virus. If the traveler is planning to perform these procedures, please inform OHP. The traveler may be required to undergo additional quarantine measures. Reference: Varkey JB, Shantha JG, Crozier I, et al. Persistence of Ebola virus in ocular fluid during convalescence. N Engl J Med 2015 Jun 18; 372(25):2423-27.
*Vice Dean for Education in the School of Medicine & Dean; **Program Director, Department Chair & Dean
Trainee leave of absence
Yes for clinical providers
*Vice Dean for Education in the School of Medicine & Dean; **Program Director, Department Chair & Dean
Other UCSF-affiliated travel
Yes for clinical providers
**Residents and clinical fellows
Travel Diary: OHP will review recommended procedures for keeping a travel diary while you are away. For more information, please contact: (415) 885-7580 or [email protected].
Itinerary Changes: You should contact your department supervisor and [email protected] with any changes to your travel plans.
Airport Screening: All travelers to the U.S. from Guinea, Liberia, Mali and Sierra Leone are required to enter the U.S. through five airports – New York JFK, Newark, Washington Dulles, Atlanta or Chicago O’Hare. After passport review:
Travelers from Guinea, Liberia, Mai and Sierra Leone will be escorted by Customs and Border Protection (CBP) officers to an area of the airport set aside for screening.
Trained CBP staff will observe travelers for signs of illness, ask them a series of health and exposure questions, and provide health information for Ebola and reminders to monitor themselves for symptoms. Trained medical staff will take their temperature with a non-contact thermometer.
If the travelers have fever or symptoms consistent with Ebola virus disease or the health questionnaire reveals possible Ebola exposure, they will be evaluated by a CDC quarantine station public health officer. The public health officer will again take a temperature reading and make a public health assessment. Travelers, who after this assessment, are determined to require further evaluation or monitoring will be referred to the appropriate public health authority.
Travelers from these countries who have neither symptoms/fever nor a known history of exposure will receive health information for self-monitoring.
The type of exposures that the traveler has had will determine the type of public health action. In general most health care workers who have been in direct contact with patients with known Ebola virus disease while wearing personal protective equipment (PPE) are considered to be at “some” risk, while people who have been in the affected countries but have not had direct patient care will be considered to be a “low” risk. Health care workers who have had needle-stick injuries or direct exposure to symptomatic Ebola patients without PPE will be considered at “high” risk.
There are four possible public health actions that may be undertaken to prevent spread of Ebola in the U.S. These include:
Isolation for those who are febrile and symptomatic. Although not specifically stated in CDC’s guidance, this would most likely be at health facilities prepared to care for Ebola patients.
Travel restrictions means that people must NOT travel by airplane, ship, or long-distance bus or train, even if they are NOT sick. The reason for this is to prevent possible spread of Ebola if the person develops fever or other symptoms during travel. People on travel restrictions might be allowed to travel by private plane or car as long as they continue to be monitored during travel. This will definitely apply to returning travelers who have been at high risk. Taking local public transport should be discussed with the traveler’s local health department.
Direct active monitoring means that public health officials conduct active monitoring by directly observing the person being monitored. This means that a public health official directly observes the individual at least once a day to review symptoms and check temperature; a second follow-up per day can be done by telephone instead of being directly observed. Direct active monitoring should include discussion of plans to work, travel, take public transportation, or go to busy public places to determine whether these activities are allowed. This will apply to travelers at high risk and possibly to those at some risk.
Active monitoring means that public health officials are responsible for checking at least once a day to see if people have a fever or other symptoms of Ebola. People being monitored must take their temperature twice daily, watch themselves for symptoms, report as directed to public health officials, and immediately tell public health officials if they have a fever or other symptoms. Active monitoring must take place until 21 days after the last possible exposure and can occur on a voluntary basis or be required by public health order. This will apply to travelers at low risk.
Employees who have traveled to Guinea, Liberia, Mali and Sierra Leone will be subject to the following restrictions when returning to UCSF campuses or affiliated sites depending on their level of risk, as defined by the CDC:
Travelers (employees, faculty, students and trainees) must self-monitor for symptoms of Ebola and report the results to UCSF Occupational Health Services (OHP) and to their local health department, as well) for 21 days from the last potential Ebola contact after they return from countries with widespread transmission of Ebola and should follow these guidelines:
All asymptomatic UCSF staff returning from travel to countries with widespread transmission of Ebola who visited /worked in health care facilities (“high” or “some” risk) must remain off work at UCSF campuses or affiliated sites for 21 days from the last potential Ebola contact, or
All asymptomatic UCSF staff returning from travel to countries with widespread transmission of Ebola who did not enter health care facilities (“low” risk) will be permitted to return to work at UCSF campuses or affiliated sites upon return.
Travelers (employees, faculty, and trainees) must be aware of and comply with the Ebola Virus Disease protocols for:
The health care facilities where they are working; and
The local health department in their city or county of residence, including daily monitoring, restrictions of movements, and immediately reporting positive symptoms to that authority.
UCSF faculty and staff in UCSF housing and in the CDC "some risk" or the "high risk" CDC categories and who are asymptomatic must comply with the restrictions of movements ordered by the San Francisco Department of Public Health, including interactions with family members or avoidance of public places and gatherings at UCSF. All UCSF staff in UCSF housing can continue to reside in their residence as long as they are asymptomatic and approved by the San Francisco Department of Public Health. Those in the "some risk" and "high risk" categories may be allowed to undertake limited public activities while maintaining a 3-foot distance from other (e.g. jogging in the park).
CDC Guidance regarding “high”, “some”, and “low” risk categories and additional traveler advice may be reviewed at: http://www.cdc.gov/vhf/ebola/.
For patients with “some” risk of exposure, which includes health care workers who have cared for patients with Ebola virus disease and have used PPE, CDC, the California Department of Public Health, and the local health department where the health care worker lives will require direct active monitoring by the local health department and will assess on a case-by-case basis the need for additional restrictions on public activities and restrictions on travel, including onward travel from one of the five airports. Full CDC guidance can be found on its website.
Post-Travel Phone Call: Within 24 hours of returning to the United States, travelers must have a post-travel phone call with OHP. This call will cover general health status and discuss any unprotected contact with individuals with infectious diseases, blood-borne pathogen exposures or traumatic injuries, as well as the traveler’s return to work. To schedule a call, contact: (415) 885-7580 or [email protected]. For more information: http://www.occupationalhealthprogram.ucsf.edu/.
Work Restrictions: In addition to the restrictions described above, travelers and their supervisors may arrange for a traveler to work remotely during the 21-day period after return. These work arrangements should be approved by the volunteer’s supervisor and OHP before departing for West Africa.