The outbreak of Ebola in West Africa has slowed considerably, but Minnesota continues to vigorously monitor travelers from the region.
For four months, the Minnesota Department of Health has monitored all people arriving from Liberia, Sierra Leone and Guinea for signs of Ebola for 21 days.
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The program coordinated by the Centers for Disease Control and Prevention has brought a sense of control to what had been a very unpredictable situation for states. But it has also strained public agency budgets. The Minnesota Department of Health has spent more than $2 million since the program began last fall, and the extra work likely will continue until the outbreak is officially declared over, perhaps many months from now. Hospitals in the state also have spent millions on Ebola preparations.
Monitoring travelers for signs of Ebola can take as little as five minutes on the phone. Typically, that's all the time that health officials need to make sure that a traveler doesn't have a fever or other signs of the disease. In cases where a traveler was exposed to someone with Ebola, an in-person, home visit by a public health worker is required every day for three weeks. But Minnesota has only had four travelers in that slightly higher-risk category.
Still, colds, flu and other health issues can turn what would have been a quick monitoring call into a much more complicated situation.
"There are these situations that we need to deal with and address and you know, they're never simple," said Kris Ehresmann, director of the Infectious Disease Epidemiology and Control division at the Minnesota Department of Health.
In a recent case, a pregnant traveler arriving from West Africa wasn't sure about her due date because she hadn't received any prenatal care. State health officials considered the woman a low risk for Ebola because as far as she knew, she hadn't been in close contact with anyone who had the disease.
Ehresmann said health officials decided to find the woman a doctor, but the task was more challenging than usual.
"The medical system obviously has some trepidation, thinking 'whoa, these people, we know they've traveled. They're not zero risk; they're in that low-risk category,'" she said. "So we spend a fair amount of time kind of being the go-between."
When the doctor who treated the woman discovered that the birth of the baby was imminent, that set off a harried search for a hospital where the woman could deliver.
Ultimately, one of Minnesota's four designated Ebola treatment centers agreed to admit the woman and a week later she delivered her baby at that hospital.
The new mother never did develop Ebola. Nor have any of the 323 travelers who have completed the state's 21-day monitoring program.
But four travelers have been tested for the disease so far, after reporting possible Ebola symptoms. Ehresmann said each of those occasions sparked an intense, behind-the-scenes response.
"They were treated as if they had Ebola in terms of staff wearing personal protective equipment and those sorts of things while they were being evaluated," she said. "But we have not had a case in Minnesota. All of them have tested negative."
State health officials did not quarantine the four travelers, but they were required to complete their 21 days of monitoring.
Public health officials readily acknowledge that the work of the monitoring program is as demanding as ever.
At the Hennepin County Public Health Department, Dave Johnson, supervisor of epidemiology and health assessment, has trained a few more people in the past month to make monitoring calls. The additional staff will give his existing team more breaks from making calls on weekends and holidays.
Johnson said the extra workers also will help deal with unexpected surges in travelers that occasionally swamp his office.
"It's hard to plan for. We don't know exactly what causes changes in the number of people who are traveling," Johnson said. "So I think that's kind of the biggest unknown for us."
Hennepin County is preparing to keep its Ebola monitoring response going for a year, if needed.
Ehresmann, of the state Department of Health, said her agency also is working with that timeline, assuming that state and federal funding hold out.
A bill in the Legislature would reimburse the state health department and a handful of hospitals for some Ebola-related costs they have already incurred. Federal grants have covered other expenses.
"I think if there were no resources available we'd have to do some serious thinking about what can we realistically commit," Ehresmann said.