Nursing at the Front Lines of Ebola – and Beyond
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 http://www.cdc.gov/vhf/ebola/hcp/infection-prevention-and-control-recommendations.html.
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.