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Published in Print: October 29, 2014, as As Educators Respond to Ebola, Threat to Schools Remains Low
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Ebola Risk to Schools Low, Experts Say

Custodial workers clean inside Schrade Middle School in Rowlett, Texas, last week. The parents of four students at two Rowlett-area schools  were aboard a plane with healthcare worker, Amber Joy Vinson, who was diagnosed with the Ebola virus and traveled on a flight from Cleveland to Dallas.
Custodial workers clean inside Schrade Middle School in Rowlett, Texas, last week. The parents of four students at two Rowlett-area schools were aboard a plane with healthcare worker, Amber Joy Vinson, who was diagnosed with the Ebola virus and traveled on a flight from Cleveland to Dallas.
—Nathan Hunsinger/The Dallas Morning News/AP
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Even as worries about Ebola have prompted school closings and other K-12 precautions in recent weeks, medical experts are advising school officials to take a measured approach in response to the handful of U.S. cases of the virus.

Districts in Solon, Ohio, and Belton, Texas, closed several schools after learning that students, parents, or staff members were either on the same flight or had flown on the same plane as one of two Dallas nurses who became sick with the virus this month after treating the United States’ first Ebola patient. The nurse had not yet shown symptoms or been diagnosed with the virus.

And the Akron, Ohio, district closed one elementary school after learning that a student’s parent may have had contact with the nurse while she was in the area.

But infectious-disease experts and public-health officials say those closings, and steps taken elsewhere by education officials to approve emergency-closure protocols for schools far from any Ebola cases, go beyond what is necessary.

Ebola patients must show symptoms to be contagious, and leaders in the districts, which reopened the schools after cleaning them, said none of the potentially exposed people showed any signs of the virus.

“You’re talking about hypothetical risks that are almost too low to measure,” said Dr. Robert L. Murphy, the director of the Center for Global Health at Northwestern University’s Institute for Public Health and Medicine. “It’s almost riskier being in schools where they don’t have mandated regular preventative vaccines [for other illnesses]. Some of that stuff can be lethal.”

People can contract Ebola only by making contact with the bodily fluids of a person who has the virus and is demonstrating symptoms, including a fever, the federal Centers for Disease Control and Prevention has said. If a person is infected, those symptoms will appear within 21 days, the incubation period of the virus, the agency said.

And while health officials work to contain the largest ever outbreak of the virus in West Africa—where about 9,200 cases have been reported, about half of them fatal—they say the likelihood of Ebola spreading beyond a few, isolated cases in the United States is low.

Akron, Ohio, Mayor Don Plusquellic, left, and Akron schools superintendent David James talk before an Ebola media update last week. The Akron district shut down one of its elementary schools for several days after learning that a student's parent had contact with healthcare worker Amber Joy Vinson, who was diagnosed with the Ebola virus.
Akron, Ohio, Mayor Don Plusquellic, left, and Akron schools superintendent David James talk before an Ebola media update last week. The Akron district shut down one of its elementary schools for several days after learning that a student's parent had contact with healthcare worker Amber Joy Vinson, who was diagnosed with the Ebola virus.
—Phil Masturzo/Akron Beacon Journal/AP

The two nurses who were infected had assisted in treatment that included invasive medical procedures, including dialysis, and had contact with fluids such as vomit, CDC officials said. Their hospital followed protocols that have since been updated to provide more thorough protection during such exposure.

“For the individuals who are potentially exposed to either of the two patients in Dallas, you need to monitor intensively for that 21-day period,” CDC Director Thomas Frieden said in a call with reporters last week. “For everyone else, there’s no risk of exposure to Ebola unless you go to West Africa. That’s why we’re going to West Africa to stop that risk there.”

Schools’ Actions

But those assurances haven’t stopped some schools from responding, many acting well beyond the recommendations of national public-health officials and epidemiology experts.

In Maple Shade, N.J., for example, a family that had recently come to the United States from Rwanda—which is roughly 3,000 miles from countries where Ebola has spread and which has no documented cases—agreed to keep their children home for 21 days before enrolling them in school. The school changed course after a flood of media criticism and offered to enroll the children sooner.

The school district in Phillips, Maine, put a teacher on paid administrative leave for 21 days after parents “expressed concern” that the teacher had recently traveled to Dallas.

“At this time, we have no information to suggest that this staff member has been in contact with anyone who has been exposed to Ebola,” said a statement posted on the district’s website. “However, the district and the staff member understand the parents’ concerns.”

A handful of other districts have taken similar steps, such as rescinding invitations to guest speakers who had recently traveled to Africa or holding emergency evacuations after students became sick with other illnesses.

And the Louisiana state school board approved emergency-closure procedures that give local administrators authority to close quickly in cases of Ebola exposure.

State officials said they wanted to set procedures early to give schools guidelines for how to respond should it become necessary.

Appropriate Questions

Ebola: Key Facts

The Centers for Disease Control and Prevention has not released specific guidance for schools related to the Ebola virus. The agency says health care workers in all settings should consider these factors if they suspect a patient has been exposed to the virus.

Exposure to bodily fluids: The virus can only be transmitted through contact with the bodily fluids of a symptomatic patient, infected animals, or items like needles that have been exposed to infected bodily fluids. Those who have been exposed to Ebola, but are not showing symptoms are not contagious.

Fever: The first symptom of the Ebola virus is usually a fever. Other early symptoms include diarrhea, vomiting, stomach pain, and unexplained bleeding or bruising.

Time of exposure: Ebola’s incubation period can be between 2 and 21 days, but the average patient shows symptoms 8 to 10 days after exposure. Nurses should ask patients who have a fever or other symptoms if they have traveled to an affected area within the last 21 days.

On the advice of health officials, schools around the country have also been taking more routine precautionary measures. Those include asking new students about their travel history upon enrollment or if they are sick with symptoms like those of Ebola. The virus can eventually lead to extreme exhaustion, severe muscle pain, and excessive vomiting and diarrhea. There is no approved medicine to treat Ebola. Patients have recovered after medical monitoring and administration of intravenous fluids.

If school nurses see students who have fevers, they should ask them if they have traveled to Guinea, Liberia, or Sierra Leone within the past 21 days, Dr. Murphy of Northwestern University said. If the answer is yes, he said, the nurse should assume the student “has Ebola until proven otherwise.”

That means the school should isolate the student and call the local health department, but a full evacuation would still not be necessary, Dr. Murphy said.

The CDC has monitored dozens of people who were exposed to the initial U.S. patient in non-health-care settings, and none of them has tested positive for Ebola, he noted. They include family members, who were quarantined in an apartment with the patient’s dirty bed linens for several days before being transferred to a clean place.

That family recently passed the 21-day threshold virus-free, and the children in the family were allowed to return to Dallas schools.

“That whole family was living with that sick guy, and they’re all fine,” Dr. Murphy said. “That puts it all in perspective.”

‘Stick With the Facts’

The CDC’s directions to health-care providers have largely focused on hospitals, where public-health officials say the threat of transmission is the greatest.

Nursing organizations have asked the agency to release more specific guidance for nurses in all practice settings, including schools, said Carolyn Duff, the president of the Silver Spring, Md.-based National Association of School Nurses.

“School nurses—there’s no question that we’re all on high alert, but we’re educated in surveillance of infectious disease,” Ms. Duff said.

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School nurses are trained in universal precautions and containing contagious illnesses, she said.

Should schools consider closing if they suspect a student has been exposed to Ebola?

“That really is up to school administrators,” Ms. Duff said. “They are under pressure from their communities to do something. And most schools stay in contact with local health departments, who are in contact with the CDC.”

Polling data show that public concern about Ebola is growing. In a survey conducted Oct. 15-20 by the Pew Research Center, 41 percent of 2,000 respondents said they were "very worried" or "somewhat worried" that "you or someone in your family will be exposed to the Ebola virus." Fifty-four percent of respondents said they had "a great deal" or a "fair amount" of confidence in the federal government's ability to prevent an Ebola outbreak.

Dr. Murphy urged administrators to take only steps recommended by health officials as schools respond to concerns about Ebola.

“I think it’s very important that we stick with the facts and try to reduce the hysteria,” he said.

Vol. 34, Issue 10, Pages 1,13

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