Nursing at the Front Lines of Ebola – and Beyond

October 2014
David Vlahov

This month we learned about yet another case of Ebola in the US, where a second Dallas nurse became infected after treating a patient who flew here from Liberia.

We can only imagine what these infected nurses are experiencing. Our thoughts and prayers go out to them and to the others infected in the US, Europe and West Africa. We feel the caution, anxiety and fear of the nurses and other workers who are at the front lines. From a distance we sense the rising level of alarm. Yet as a profession, as colleagues in arms, we can take steps to address this threat.

The first is to put the threat into proper perspective and to not mince words: Ebola is a very dangerous virus. The Centers for Disease Control and Prevention (CDC) and the US Department of Agriculture classify possible infectious agents into levels of threat. Those agents in the highest level (Category A) can result in high mortality rates, might cause public panic and social disruption and require special action for public health preparedness. Category A includes viral hemorrhagic fevers, one of which is the Ebola virus. Given its high rate of mortality (around 50 percent; mortality rates of past outbreaks have varied from 25 percent to 90 percent), it is handled only in the most secure, Biosafety Level-4 laboratory settings. (A note: While the categorization framework was developed for planning around bioterrorism, there is no suggestion or hint of that here. What we are witnessing is an outbreak turned into an epidemic, with the potential to spread through global travel.)

With no vaccine yet and treatment limited to supportive care, step two involves health care workers making sure we can protect ourselves, so we can not just help contain the epidemic, but also address the accompanying public panic and social disruption. Guidelines for prevention are available at

Next, as nurses, we have a role that begins with professional screening, identification and care of the individual patient, family and co-workers, but we must go beyond that. We have a crucial role in educating the communities where we live and the wider community throughout the country and the world. Preventing public panic and minimizing social disruption depends on individuals and communities having information and a sense of support, rather than stigmatization. This will be especially important as the fever and headaches of flu season kick into gear, and as people interact with friends, neighbors and family members who have come from overseas – even those who arrived here long ago. Even as I write this morning, there was a report of a community college in Texas that refused to admit a student from Nigeria.

The first law of epidemics is that whatever goes up must come down. We can make the number of cases and the anxiety surrounding them come down faster if we stick to our training and work together. By conducting objective assessments, making appropriate referrals, providing care with appropriate precautions, and calming others even in the worst of circumstances – this will be yet another time when nursing will be absolutely central to an effective public health response.


The couple of cases in Dallas are hardly the "front lines" of Ebola. Of course it's difficult to imagine what infected US nurses might be feeling, but how about we consider what the nations of West Africa might be feeling, given the 8000 cases and 4000 deaths?

I think it would be a good idea to institute a standard for video surveillance over the staff donning and doffing areas in the care of ebola patients. This could help to identify any untoward exposure that even the buddy system might miss and also be valuable in making any needed changes. Laura McIntosh, MS, RN (UCSF Alumni)

I believe the best way to prepare for this outbreak is to treat it as we do our isolation cases- TB etc . We are required to have yearly FIT testing to make sure we have the necessary equipment and demonstrate how to use it. The CDC is our experts and we need to take their advice on preparing a packet of necessary PPE that is ready and available in adequate numbers. Each and every employee needs to don/doff this equipment to be familiar with its handling. Several days ago, we had a drill for ICU/ ER to work through how they would handle the Ebola patient who walked in our door. Sonia Smith. RN ANP UCSF alumni. Berkeley.

Thank you! You could not have provided a more realistic approach for nurses to put this disease into perspective. I fear we are ignoring our much larger enemy of Influenza that seems to be ignored due to all of the national attention Ebola has created.

With Ebola starting with flu-like symptoms, influenza immunization may improve specificity for detection; yet another reason for getting immunized.

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