United States: Ebola Back In The News: What Employers Need To Know About The Ongoing Outbreak

The World Health Organization (WHO) has recently declared a global health emergency due to an outbreak of Ebola in the Democratic Republic of Congo. WHO officials made the declaration after the virus recently spread to Goma, a densely populated city and the "gateway to the rest of the [country] and the world."1 The WHO hopes to raise awareness and increase resources for the global response.

According to the WHO, the outbreak has a low risk of spreading worldwide, but risks for expansion nationally and regionally remain high. Therefore, employers with workers who travel to the Democratic Republic of Congo or within the region may need to consider taking some additional precautions to protect the health and safety of employees. Should the emergency worsen, employers may need to consider issues such as restricting international travel; medical inquiries and potential quarantines for employees who have traveled; leave from work; and educating management and employees.

Ebola Virus Disease

Ebola Virus Disease (EVD) is a severe illness in humans. It can be fatal without proper treatment and care.

Sudden onset of fever, intense weakness, muscle pain, headache and sore throat are typical signs and symptoms. These symptoms are followed by vomiting, diarrhea, rash, impaired kidney and liver function and, in some cases, both internal and external bleeding.

The incubation period, or the time interval from infection to onset of symptoms, is from two to 21 days. Patients become contagious once they begin to show symptoms. They are not contagious during the incubation period.

Other diseases can have similar symptoms, such as malaria, typhoid fever, shigellosis, cholera, leptospirosis, plague, rickettsiosis, relapsing fever, meningitis, hepatitis and other viral hemorrhagic fevers.

Transmission of the Disease

According to guidance from the U.S. Centers for Disease Control (CDC), Ebola is transmitted only through contact with blood and other bodily fluids of an infected person.  People can also become infected from indirect contact by having broken skin or mucous membranes come in contact with materials or utensils contaminated with the body fluids of an infected person.  Transmission is generally not through casual contact, and the expectation for spreading to the United States is very low. 

Since the most recent global Ebola emergency in 2014, a highly effective vaccine has been developed to stop new infectious symptoms.  While the supply of the vaccine is not abundant, it is being used to slow the spread of Ebola in and around the Democratic Republic of Congo. Currently, no cases have been reported in the United States.

Occupational Health and Safety Risks

At this point, U.S. employers should at least monitor the situation to see if the disease begins to spread internationally.  Should it reach the U.S., workplaces will generally fall into two areas of concern—healthcare workplaces and all other workplaces.  

Within the United States, healthcare workers are at the greatest risk of infection.  Because their workers may come into direct contact with EVD, healthcare employers need to review their infectious disease protocols to ensure they are prepared for the specific risks associated with the virus. 

The risk of business travelers becoming infected with the Ebola virus during a visit to the affected areas and developing the disease after returning is extremely low, even if the visit includes travel to the local areas in which primary cases have been reported.  Indeed, although the U.S. Department of State has issued warnings not to travel to two provinces in the Democratic Republic of Congo, travel to the country has not been banned.2

Preventing EVD in the Workplace

Healthcare workers at all levels of the health system—hospitals, clinics, laboratories, health posts, laundries and transport—should be alerted to the situation and should be briefed (or re-briefed) on the nature of the disease and how it is transmitted. Workers should strictly follow recommended infection control precautions.  All staff handling suspected or confirmed cases of EVD or contaminated specimens and materials should use special personal protective equipment for working with biohazards, and apply hand hygiene measures according to WHO recommendations. If the recommended level of precaution is implemented, transmission of the disease should be prevented.  Because other infectious diseases may have symptoms compatible with EVD, it is important to apply standard measures of precaution in all healthcare facilities—such as prevention of needle sticks and sharps injuries, safe phlebotomy, hand hygiene, use of personal protective equipment, regular and rigorous environmental cleaning, decontamination of surfaces and equipment, and safe management of soiled linen and healthcare waste.

For all other workplaces, returning travelers are the primary concern.  Affected countries may conduct exit medical screenings of all persons at international airports, seaports and major land crossings for unexplained febrile illness consistent with potential Ebola infection.  Nevertheless, returning business travelers from the affected areas should be notified of the symptoms and asked to watch for any signs of the disease surfacing within 21 days after return.

Rights, Duties and Responsibilities of Workers and Employers

In the event any EVD cases are reported in the United States, employers, workers, and their organizations should collaborate with health authorities in the prevention and control of an EVD outbreak.  Healthcare workers will have the greatest responsibilities in this area.  Current U.S. Occupational Safety and Health Administration (OSHA) requirements for for bloodborne pathogens should be considered,3 and the Agency also provides an overview and summary of relevant authorities and links.4

Under the Americans with Disabilities Act (ADA), U.S. employers may make inquiries into medical conditions only where they are job-related and consistent with business necessity.  Because there currently are no international travel restrictions and because the risk of transmission is very low, requiring a medical examination for returning travelers would likely not be considered a necessity. Employers should be aware that the public health department in each locality will be involved in tracking any illnesses and exposures and employers should reach out to their local public health department as the situation develops. 

Footnotes

1 WHO, News Release, Ebola outbreak in the Democratic Republic of the Congo declared a Public Health Emergency of International Concern (July 17, 2019).

2 U.S. Dep't of State, Democratic Republic of the Congo Travel Advisory (Apr. 9, 2019).

3 29 C.F.R. § 1910.1030.

4 U.S. Dep't of Labor, OSHA, Standards, Safety and Health Topics: Ebola.

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