Would you treat someone with Marburg Virus?

Tweety, BSN, RN · Apr 10, 2005

I think it's great that there are those willing to take care of others in dire circumstances. My point really was simply that until you actually do it, it is a hypothetical, no offense intended.

I took you point well. We're human beings, but we can't imagine the circumstances, so it's easy to say what we would do, knowing we're not in that situation. But one has to look back on the AIDS crisis and remember how many nurses refused to go into patients rooms with AIDS to see how American nurses might behave in a similar situation. (Mind you there were thousands upon thousands, indeed most nurses, that didn't do that.)

IMustBeCrazy · Apr 10, 2005

I think it all boils down to using our best scientific judgement of the situation with the facts we have or can research at the time. As of now, and as others in this thread have stated, there is about a 90% rapid mortality with this particular virus. That is what I base my decision on. Like others have mentioned, like it or no, it does come down to a utilitarian approach - where is the best use of my care/time/resources?

Furthermore, and most importantly, who would take care of my family if something were to happen to me? The best advocate for them is...me!

Aneroo, LPN · Apr 10, 2005

I think it all boils down to using our best scientific judgement of the situation with the facts we have or can research at the time. As of now, and as others in this thread have stated, there is about a 90% rapid mortality with this particular virus. That is what I base my decision on. Like others have mentioned, like it or no, it does come down to a utilitarian approach - where is the best use of my care/time/resources?
Furthermore, and most importantly, who would take care of my family if something were to happen to me? The best advocate for them is...me!

Thank you. I am a big believer in the whole "take care of yourself first" motto. Ever ridden in an airplane? When the O2 bag pops out of the ceiling, put yours on first, then help others around you. How can you help others if you are too sick? I have a feeling this is going to be one of those really long debate threads. :sofahider :deadhorse

IMustBeCrazy · Apr 10, 2005

Actually Tweety, that brings up an interesting question. I wonder what scientific evidence was actually available during that AIDS scare? Obviously not as much as we now know, but still, it would be interesting if the panic was more hysteria-related hype or resulting from poor nursing knowledge of the actual facts available at that time? Or alternately the possibility was that there just really *wasn't* info available? Good research topic!

Blackcat99 · Apr 10, 2005

No I would not want to treat someone with Marburg Virus. I need to stay alive to take care of my 83 year old mother who has Alzheimer's. If I died my brother would put her into a nursing home I'm sure.

caroladybelle, BSN, RN · Apr 11, 2005

If proper precautions were in place, sure. That's not being a martyr. But I certainly am not going to put my life in danger for a disease with 90% mortality. The chances of both myself and patient dying too to great to waste that kind of effort.
To be totally honest, if they said "we can't afford precautions" and in my poor African areas the precautions may be prohibitive, I would struggle between letting the patient die alone without care, but in the end I wouldn't kill myself.

Some issues.

Per the CDC, Marburg generally only has a 25%-28% mortality rate in and of itself. It can go higher in relation to other factors.

However, the most recent outbreak in Angola, the mortality was high. One can easily figure out why. Angola has been in the midst of one after another civil wars and guerrilla warfare. There are few if any usable roads, supply lines and safe passageways throughout the area. Infrastructure, such as clean dependable water sources are few to be found. Reliable communication lines for ordering supplies are in short supply, either.

75% of the dead were children. African children have extremely high mortality rates from any disease, due to poor nutrition and no access to health care. In addition, in Africa, depending on the specific area, between 20% to 65% of the population is HIV positive, and few have access to appropriate antiretrovirals. As such, immunosuppression is a big factor.

There are areas that are considered relatively(?) safe to do mission nursing in...Angola is definitely not one of them! Most health care workers that would venture into Angola are aware that you are risking your life in a very real way. There are serious risks of being kidnapped and held hostage or for ransom, murdered outright or raped and tortured. While Marburg is a threat, it pales in comparison to the myriad threats in Angola to non-native healthcare workers

Amazingly, Angola is not a "poor" country. It holds a great deal of valuable resources...in Oil, Diamonds and other commodities. But you find few investors willing to risk anything there, due to extreme civil unrest. It is not lack of money that holds them back but internal strife.

Thus, a high death toll could pretty much be expected, especially among children in this population.

With some African mission groups (not to Angola), one of the big things done was screen the windows ......as in they didn't have any/or were damaged beyond repair. So imagine Marburg (a bodily fluid bourne pathogen that can live for several days on surfaces) in a facility without window screens. Flies go from body to body leaving traces in wounds. Animals go from dead bodies to wounded leaving traces. Also, eliminate supportive care...the primary treatment for Marburg...limited if any access to IV fluids, electrolyte supplements, etc.

In addition, bodies should be cremated promptly with no embalming. This interferes with local cultural customs that have been found to spread the disease.

Contrast that to the US, where would not have such worries, less malnutrition, less immunosuppression. Ability to wash hands properly, access to supportive care, even clean water to drink makes a big difference.

While the CDC has not pinpointed transmission routes from animal to mankind (Marburg is a Zoonotic infection), from person to person is generally bodily fluid mediated (no known cases of airborne person to person transmission). CDC advises contact and droplet precautions.

And chances are if Marburg is a causitive agent of disease, you will not know it until either you escape being infected or get infected. So hypotheticals really are not relevant. Especially if you are not going to Africa soon.

Tweety, BSN, RN · Apr 11, 2005

So hypotheticals really are not relevant. Especially if you are not going to Africa soon.

Relevant or not, the op did get us thinking. But it's important to have some facts. Thanks.

Tweety, BSN, RN · Apr 11, 2005

Actually Tweety, that brings up an interesting question. I wonder what scientific evidence was actually available during that AIDS scare? Obviously not as much as we now know, but still, it would be interesting if the panic was more hysteria-related hype or resulting from poor nursing knowledge of the actual facts available at that time? Or alternately the possibility was that there just really *wasn't* info available? Good research topic!

I think that if nurses, or the general public, could have got AIDS by being near an AIDS infected person that fact would have come out very early. People paniced under the "we really don't know for sure" guise. But if one stopped to think logically, they could have figured out if it was that contageous, it wouldn't have been so specific to gay men, and the other groups it infected at the time.

caroladybelle, BSN, RN · Apr 11, 2005

There were a few announcements in mass media that HIV (GRID at that time) might be passed by casual contact. They involved mistaken interpretation of data and studies that were later discredited - some involved infant children diagnosed prior to their parents/mother. And, yes, many people did decline to care for AIDs patients.

Part of this was moot, as many AIDs patients were in protective isolation, due to their immunocrompromised status. Staff/visitors were having to gown/glove and or mask depending on facility to "protect" the patient.

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Small addition on Angola:

Another danger in Angola is landmines. This is one of the major sites where landmines have been used recently. Acres and acres of land that is boobytrapped...the creators of which, have long since died, maps lost or never kept....cannot be farmed or turned back into usable roads, And no really good ways to get rid of them.

An acquaintance of mine described Angola as Afghanistan or Iraq .....if the war lasted 25 years or more.....and Saddam and his sons had not been captured.....without any coalition forces to keep order.....and without any major nation assisting with rebuilding efforts.

PennyLane, RN · Apr 11, 2005

The Hot Zone scared the **** out of me. I would only care for a pt with Marburg if I got to wear one of those biohazard suits with the piped in O2 supply. Sorry, I didn't get into nursing for this. I'm a nurse by profession, but it doesn't define me.

Marie_LPN, RN, LPN, RN · Apr 11, 2005

I love that book though.

joyfull888 · May 8, 2005

Despite the fear and unknown risks and the fact that nurses were succumbing to the SARS virus, many nurses in Canada volunteered to work in isolation SARS units fully knowing that they could become a victim. A great number were asked to continue to wear their masks at home to prevent possible transmission to their family. Many nurses became sick and some died. The attached link describes the response of nurses in Toronto to the SARS crisis:

http://ca.geocities.com/ipromiseposter/

As the pledge from the International Council of Nurses in Geneva indicates on the nursing poster in the link, the nurses in Toronto lived up to ideals within the profession without hesitation. That pledge, in part reads as follows:

"In the full knowledge of the task I am undertaking,

I Promise to take care of the sick

with all the skill and understanding I possess,

without regard to race, creed, colour, politics,

or social status, sparing no effort to conserve life,

to alleviate suffering, and promote health."

It is quite a profession.