Ebola Virus Disease and the Nursing Workforce

August 2014
David Vlahov

The World Health Organization reported that as of August 11, 2014, the number of cases attributed to Ebola virus disease (EVD) in four West African countries stood at 1,848, with 1,013 deaths. More than 145 health care workers who have provided care to Ebola patients have also become infected, with 80 deaths so far.

Concern has spread to the United States, as two American health care workers who contracted the disease were flown here and are under care. Tom Frieden, director of the Centers for Disease Control and Prevention, has assured the public that the probability of EVD spreading within the US is remote. Nevertheless, both here and around the world, the virulence of the disease, some misunderstanding of how it is transmitted and a failure to have proper protections in place in some health care settings have caused alarm among those charged with treating EVD’s victims.

Those fears recall memories of when I was an infection control nurse in Baltimore, caring for patients with AIDS early in the HIV epidemic. I remember seeing an AIDS patient placed into full isolation, with nurses and physicians congregated outside the room expressing anxiety about whether they should go in at all. As the Health Resources and Services Administration’s Ryan White HIV/AIDS Program history project noted, some physicians and nursing staffs even refused to provide treatment to those with AIDS symptoms. As people died, stigma and willful ignorance kept many funeral homes from accepting bodies for burial. In 1987, the New York Times published an article titled “When Doctors Refuse to Treat AIDS.” As the country faced a new and highly fatal disease, fear was palpable.

With today’s Ebola outbreak – just as with HIV and other viral outbreaks, such as SARS (severe acute respiratory syndrome) and H1N1 influenza (swine flu) – some health care workers have volunteered to be at the front lines, but others have been reluctant. Such reluctance is understandably highest in the earliest days, especially if the routes of transmission are not well understood, health care workers don’t know how best to protect themselves – and don’t trust their employers to provide them with all of the appropriate protections. That appears to be what’s behind reports of nurses going on strike in the affected West African nations.

Given the dire need for treating EVD patients and containing future outbreaks of the disease, we must:

  • Strengthen the global nursing workforce with increased clinical and public health training.
  • Establish an adequate inventory of equipment and supplies.
  • Provide a public health infrastructure for rapid and effective monitoring and response to emerging events.
  • Train governments to lead efforts in public health preparedness and response.

This is what we eventually did with HIV/AIDS and did more quickly with SARS and H1N1. Such preparedness builds a reservoir of trust and confidence that otherwise can be tested and undermined during emergencies such as the one we are currently witnessing.

Nurses play a crucial role in establishing that trust – not just by our presence at the bedside, but through use of our public health expertise to develop policies and lead and organize our communities. By addressing understandable concerns for our own safety and that of our colleagues and communities, we can help ensure patients receive the care they so desperately need.

 

Comments

Once again UCSF School of Nursing, this time Dean Vlahov, is on the front line to address a major health problem, i.e., ebola. Thank you.

Yes, good for UCSF with this timely message...I too recall the fear generated in the hearts of some nurses when it came to the early days of hospitalized HIV/AIDS patients...one staff nurse went so far as to sit on the floor, repeatedly pounding her feet/legs up and down as she cried out her refusal to take on a care assignment of an AIDS person. Let us hope your message goes beyond the UCSF connection for I hear a lot of misinformation over the radio and TV in regard to EBOLA...Thanks for the message...I shall forward it...

Thank you for sharing your experiences during the HIV early days. I was a young ICU nurse, witnessing one of the first cases of AIDs in our SF hospital late 1970s, early 1980s. Thankfully, for us, we had 2 tremendously informed and educated Infectious Disease Physicians who helped us set up a protected treatment plan of care. Yet, I also witnessed others who refused to care for patients because of their fears and lack of knowledge. Florence Nightingale was probably shaking her finger then and now at us for forgetting about the grass roots of Nursing. We are the compassionate workforce, which we should not forget these roots. Yet, we need to be informed about highly infectious disease and the best protection to avoid putting ourselves in harms way. When we do this, we should not walk away from those who are suffering and need the care we can deliver.

What are the appropriate safeguards and how is it transmitted?

The Centers for Disease Control and Prevention (CDC) is an excellent resource: http://www.cdc.gov/vhf/ebola/prevention/

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