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Ebola screening trickles down to doctors' offices, care clinics

Efforts to screen for possible cases of Ebola are moving from airports and hospitals to doctors' offices and urgent-care clinics.

While the chance of a widespread outbreak in the United States is considered extremely unlikely, patients making appointments with an eye doctor or gynecologist may be questioned about their travel histories and about symptoms related to Ebola. Receptionists and physicians in many local clinics and medical practices are now asking patients such questions to gauge potential exposure.

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Ebola his killed nearly 5,000 people in West Africa, but there have only been a handful of cases in the United States.

The state Department of Health and Mental Hygiene recently sent guidelines to all Maryland care providers to help identify possible Ebola patients. They are encouraged — but not required — to follow the guidelines, which include a flow chart of questions, starting with: "Ask if patient has traveled to affected country or had contact with a known Ebola patient in past 21 days."

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"This is guidance from the state. Each facility has to tailor it to their particular physical setup and personnel," said Chris Garrett, a spokesman for the health department.

State health officials have also provided posters to hang in waiting rooms, urging patients who have traveled to Guinea, Liberia or Sierra Leone to notify the staff immediately. Officials also have encouraged medical practices to have protective gear for health care workers, including fluid-resistant gowns, masks, face shields and proper gloves.

Health care providers are required to notify a local health department if they have a patient who may be infected with Ebola, Garrett said.

The steps are the latest taken by state and public health officials in response to concerns about Ebola. This week, Gov. Martin O'Malley announced that health care workers and others who arrive in Maryland from the three Ebola-stricken countries in West Africa will be monitored for signs of the virus.

Those most at risk — including health workers who treated Ebola patients without wearing protective equipment — may be required to stay home and keep in close contact with health officials. Others at lower risk may be asked to avoid public transit, large gatherings and public travel.

Last week, the state designated Johns Hopkins Hospital, the University of Maryland Medical Center and MedStar Washington Hospital Center to care for any Ebola patients in Maryland if federal facilities such as the National Institutes of Health can't admit them. University of Maryland Medical Center officials said Monday that a patient who was referred there by the U.S. Centers for Disease Control and Prevention tested negative for Ebola in a blood test.

No one has been diagnosed with Ebola in Maryland. One person was treated for Ebola in the state: Texas nurse Nina Pham, who contracted the virus after treating a patient in Dallas. She was treated at the NIH Clinical Center in Bethesda and was released Oct. 24.

Nonetheless, screening for potential cases has expanded.

At Baltimore's Mercy Medical Center, evaluations to pinpoint potential Ebola exposures are carried out for "all patients seen in all settings," according to spokesman Dan Collins. The questions cover travel history and symptoms, and are in line with recommendations from the CDC, he said.

The University of Maryland Medical System has also provided screening tools for its hospitals and physician offices, said Mary Lynn Carver, senior vice president for the system. The goal is to quickly triage patients who may have Ebola so they can be isolated and cared for properly, while also protecting other patients and health care workers, Carver said.

Private practitioners have begun screening for Ebola in routine communications with patients. Katzen Eye Group, which has six locations in the Baltimore area, sent an email message to patients this week urging them to reschedule appointments if they are sick with symptoms associated with the flu, enterovirus or Ebola.

A Katzen spokeswoman said the email went out "as a reminder for patients to be mindful of other patients and reschedule their appointment if they are exhibiting symptoms for any illness."

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Righttime Medical Care, a private company that operates 13 urgent-care clinics in Central Maryland, including Howard, Anne Arundel and Baltimore counties, has already seen two patients who were at risk of Ebola based on symptoms and recent travel to West Africa, said Dr. Robert G. Graw Jr., Righttime's founder and medical director.

Both were transferred to appropriate medical facilities, Graw said, and further testing and treatment showed that neither had Ebola.

More than 80 percent of Righttime's patients make appointments through a call center, where operators are now asking patients who report symptoms that could be related to Ebola — fever, headache, diarrhea, vomiting — about their recent travel. Operators aren't initially asking all patients about travel to Africa, so as not to alarm them, Graw said.

"We ease into it," he said.

In Righttime's clinics, signs are posted asking any patient who recently traveled to West Africa to wear a mask and report immediately to the receptionist, Graw said. Those patients would be seen right away in a private room.

"Our goal is not to frighten our staff, not to frighten the public. We're here to help them," Graw said.

Graw said there has been some confusion in getting information from public health agencies about how to handle possible Ebola cases. But he said experience with previous public health issues, such as the H1N1 flu virus and anthrax, has made it easier for staff to adapt to Ebola screening.

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