Update on Ebola For Colleges and Universities
October 20, 2014
• Fever (greater than 38.6°C or 101.5°F) • Severe headache • Muscle pain • Vomiting • Diarrhea • Stomach pain • Unexplained bleeding or bruising
Diagnosing Ebola in a person who has been infected for only a few days is difficult because the early symptoms, such as fever, are not specific to Ebola infection. However, if a person has symptoms of Ebola and had contact with blood or body fluids of a person sick with Ebola, contact with objects that have been contaminated with blood or body fluids of a person sick with Ebola or contact with infected animals, the individual should be isolated and public health professionals notified. Samples from the individual can then be collected and tested to confirm infection. The CDC’s recommendations for student health centers in responding to potential Ebola exposure and managing individuals presenting with symptoms consistent with Ebola disease are the same as those for other US health care workers and settings. As a planning step, colleges and universities should review and consider utilizing the American College Health Association Emergency Preparedness Planning Considerations for College Health Centers Regarding Ebola Virus Disease:1. Is your campus emergency response plan up to date so it can be activated if needed to respond to a case of Ebola on campus or in the local community? Is it coordinated with the local public health department on a community response to a case of Ebola? Â
2. Does your campus have a communications plan and team in place to respond to the communications need if a case were to emerge on campus, in the community, or at another institution? Is the communications plan coordinated with the local community so that your campus would be informed if a case emerges in the community, allowing communication to students and parents? Â
3. If the public health department orders a quarantine for a high risk exposure, does the campus have a location and plan to provide food and clothing to a quarantined person? Does the campus have a mechanism (qualified contractor) in place to dispose of waste?
 4. Is the student health center screening all patients for travel in the past 21 days? Are there plans in place to quickly respond to an ill student with a travel history from an Ebola affected area? What about other emerging pathogens?
 5. Is there a mechanism to identify and contact students, faculty, and staff who are returning to campus from an Ebola affected area and refer appropriately to the public health department for monitoring?
 6. Who is responsible for monitoring individual and group institutional travelers? Is there a policy and/or mechanism in place to restrict travel based on the CDC travel warning?
In keeping with these recommended planning steps, institutions should consider the following actions:- Ensure that student health center staff are aware of exposure risks, signs and symptoms     of Ebola and are prepared to follow recommendations in the CDC Health Advisory: Guidelines for Evaluation of US Patients Suspected of Having Ebola Virus Disease.
- Consider providing information to the campus community with recommendations for people who have recently arrived from countries where Ebola outbreaks are occurring and provide specific Ebola education to all people who have recently arrived from countries where outbreaks are occurring in accordance with the screening procedures.
- Continue to monitor the countries of concern in terms of Ebola outbreak. Here are the current CDC travel notices related to Ebola     even if travelers do not plan to be in contact with people infected with the virus:
Warning - Avoid nonessential travel:Â Ebola in Liberia, Guinea and Sierra Leone Alert - Practice enhanced precautions:Â Ebola in Democratic Republic of the Congo Watch - Practice usual precautions:Â Ebola in Nigeria
- Based on current travel notices consider making adjustments to programs for the current semester and upcoming spring semester which would involve travel by students and faculty to these regions.
- Identify students, faculty, and staff who have been in countries where Ebola outbreaks are occurring within the past 21 days and conduct a risk     assessment with each identified person to determine his or her level of risk exposure (high- or low-risk exposures, or no known exposure). Consult     the CDC’s algorithm for evaluation of a returned traveler:
The following steps are consistent with current CDC guidance:
- If the student, faculty, or  staff member has had NO symptoms of Ebola for 21 days since leaving a West African country with Ebola outbreaks, they do NOT have Ebola. No further assessment is needed.
- If the student, faculty, or staff member has had a high or low-risk exposure, state or local public health authorities should be notified, and school officials should consult with public health authorities for guidance about how that person should be monitored. Anyone with a potential exposure should receive thorough education about immediately reporting symptoms and staying away from other people if symptoms develop.
- In the event that a student, faculty, or staff member who has had a high or low-risk exposure develops symptoms consistent with Ebola, the person should be medically evaluated while following recommended infection control precautions. Guidance is available in the CDC Ebola Virus Disease Information for Clinicians in U.S. Healthcare Settings. Public health authorities should be notified.
- If the student, faculty, or staff member displays no symptoms and presents no known exposure risk, institutions are advised to instruct the individual to self-monitor through temperature and symptom reporting until the end of the 21 day period, and to report immediately if symptoms appear.
Note that the CDC is still not recommending that colleges and universities quarantine individuals based solely on travel history. The system presently relies on individuals, including college students, to self-monitor for the onset of symptoms and to take immediate steps to self-report. This raises the questions as to whether the self-monitoring/reporting system is reliable enough or whether other steps should be considered to protect the campus community. Reasonable minds may differ as to whether all return travelers are reliable enough to self-monitor without some other level of mandatory oversight. One option, for example, may be for the Campus Health Center to actively participate in the monitoring of individuals to ensure accurate assessments and timely reporting and action if the individual develops symptoms.
- In the event that a potential case is identified, isolate the individual pending diagnostic testing.
- Although not a full list of precautions, student health center clinicians should be sure to follow these steps when caring for someone who is sick or may be sick with Ebola:
- Separate the sick individual in a private room with its own bathroom.
- Use proper infection prevention and control measures; standard, contact, and droplet precautions are recommended if Ebola is suspected.
- Wear the right personal protective equipment (PPE), including masks, gloves, gowns, facemask and eye protection, when entering the patient care area. Before leaving the patient area, carefully remove PPE and make sure not to contaminate skin and clothing. Dispose of PPE as biohazard waste.
- After removing PPE, wash hands using soap and water (preferred) or an alcohol-based hand sanitizer containing at least 60% alcohol. Use soap and water when hands are visibly dirty.
- Notify local or state health department immediately if Ebola is suspected. The health department can provide additional guidance regarding medical evaluation or testing, if indicated.
- Follow protocols for cleaning and disinfecting reusable medical equipment and proper disposal of needles and other disposable equipment.

The United States Court of Appeals for the Eleventh Circuit issued a long-awaited decision in the Georgia State e-reserves copyright case on October 17, 2014. The Court of Appeals reversed and remanded to the District Court for reconsideration in light of its opinion rejecting that court’s formulaic fair use analysis. In 2008, three publishers (Cambridge University Press, Oxford University Press, and Sage Publications) filed suit in the Northern District of Georgia, alleging that Georgia State University’s e-reserves system – through which students could access electronic content posted by faculty – infringed copyrights held by the publishers. In 2012, the District Court issued an order finding that the university had infringed the publisher’s copyrights in several instances, but that the fair use defense applied to the majority of the alleged infringements. The court applied the four factors of a fair use defense: (1) the purpose and character of the use; (2) the nature of the copyrighted work; (3) the amount and substantiality of the portion taken; and (4) the effect of the use upon the potential market. The court granted declaratory and injunctive relief to the publishers, but ultimately found that the University was the prevailing party and awarded costs and attorneys’ fees. On appeal, the Court of Appeals reviewed the District Court’s application of the four factors, as well as the District Court’s balancing of the outcome of the four factors, noting that because of the circumstances of this case some of the factors weigh more heavily on the fair use determination than others. Regarding the first (the purpose and character of the use) and fourth (the effect of the use upon the potential market for or value of the copyrighted work) fair use factors, the Court of Appeals affirmed the District Court’s holdings that these weighed in favor of a fair use defense. On the second factor, the nature of the copyrighted work, the Court of Appeals reversed, holding that the District Court should have evaluated each work copied to determine whether it contained “evaluative, analytical, or subjectively descriptive material that surpasses the bare facts necessary to communicate information.” If the work contained more than was necessary, then it should have weighed in favor of the publishers or been neutral, although the Court noted that this factor is largely unimportant since the works at issue are not fictional works. On the third factor, the District Court had utilized a quantitative test with respect to the “amount and substantiality taken” in relation to the copyrighted work as a whole, relying on the 10% or one chapter approach set forth in the “Classroom Guidelines” which form part of the legislative history of the Copyright Act. In rejecting that type of blanket approach, Court of Appeals found that the lower court should have applied a more individualized fair use analysis, “considering the quantity and quality of the material taken, including whether the material taken constituted the heart of the work.” The Court of Appeals emphasized that the Classroom Guidelines have never been codified and are too formulaic for a balanced fair use analysis. The Court of Appeals vacated the injunction, declaratory relief, and award of attorney's fees and costs, and remanded to the lower court for further proceedings. The Way Forward for Universities Even though this case will continue, the Court of Appeal’s ruling provides useful guidance to institutions of higher education. Specifically, a formulaic approach to fair use rather than a case-by-case inquiry opens a fair use analysis to criticism and attack. As a result, copyright policies or guidelines should require an individualized analysis of the amount taken of a copyrighted work in relation to the work as a whole, rather than simply relying on the 10% or one chapter rubric set forth in the “Classroom Guidelines.” Both the quantity and the quality of the material taken must be considered under the third factor, including whether the material taken constitutes “the heart of the work,” and whether the material used is excessive in light of the purpose of the use and the threat of market substitution.
On July 14, 2014, the United States Department of Education issued a