Nursing and the Ebola Virus

[0.adamantite]

For those of us in unaffected countries, are you concerned about the ebola virus spreading? Would you care for ebola patients? I live in an area with a very high density of African immigrants and come into contact with these individuals regularly. We have a lot of African immigrants who bring back tuberculosis from their home countries and at my unit we end up caring for them. We take care of a lot of rare infectious diseases. I was reading an article and it dawned on me how plausible it would be for me to encounter this virus. And I admit, it's terrifying and I might refuse that assignment. Many healthcare workers in Africa are dying because of caring for the ill.

[studentnursemon86]

Working in the ER, we have screening questions to ask patients regarding travel.

I'm not sure on the legality of refusing to take care of patients with infectious diseases. I think unless you were immunocompromised yourself, or pregnant, then there aren't many other valid reasons not to care for a sick patient:

From what I've read from news articles and the cdc website, EBV had a varying incubation period of 7-21 days before symptoms arise, at which point they are contagious. It is spread from human to human contact (ie blood, feces, mucous membranes) and the virus can live outside the body or even after the infected is deceased. It is very scary, but as healthcare workers, basic PPE can help protect you, as well as basic screening questions in the ER.

I have contracted TB already, caring for a patient before they were diagnosed. Thankfully, my immune system has kept it in check as latent TB, rather than active.

It just goes to show, healthcare workers are at greater risk than anyone when it comes to these diseases.

[MassED, BSN, RN]

just seeing what's in the headlines today:

This one is particularly frightening. I can't imagine those conditions.

http://rt.com/news/180748-ebola-msf-six-months/

http://www.nytimes.com/2014/08/16/world/africa/ebola-epidemic-who-health-crisis-west-africa.html?_r=0

this next one is interesting... another example of downplaying the crisis and telling US ER's just some simple PPE is all that's needed....

http://www.nytimes.com/2014/08/16/health/hospitals-in-the-us-get-ready-for-ebola.html

[MassED, BSN, RN]

"High death toll among healthcare workers."

and yet this is not the front page headline....

[OCNRN63, RN]

Droplets are too long to remain airborne for long periods of time. Airborne viruses can survive for a long time, are smaller, and can attach to dust particles and travel through ventilation systems. Droplet organisms cannot do this.

ETA:

Droplets are too large to be transmitted in the same manner that airborne diseases are, and they tend to dry more quickly than an airborne illness, which is extremely resistant to drying.

Edited due to forgetting additional information.

[0.adamantite]

I have contracted TB already, caring for a patient before they were diagnosed. Thankfully, my immune system has kept it in check as latent TB, rather than active.

It just goes to show, healthcare workers are at greater risk than anyone when it comes to these diseases.

So sorry for your diagnosis. I am keeping all of the front line staff (ER, EMS, etc) in my thoughts at this time. I guess my fear is not that the disease will spread like crazy through the general population but that we as healthcare workers are particularly vulnerable. Would you give your life for your job?

[amycamilledenton]

I'm concerned our hospitals are not prepared with effective personal protective equipment and for strictly following CDC recommendations for patients with diarrhea. Leg covers, gown, mask face covers, shield. Would this patient be placed in an isolation with a nurse who was still responsible for caring for uninfected patients?

[MassED, BSN, RN]

Update.

Ebola airborne: A nightmare that could happen - CNN.com

"It's the single greatest concern I've ever had in my 40-year public health career," said Dr. Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota."I can't imagine anything in my career -- and this includes HIV -- that would be more devastating to the world than a respiratory transmissible Ebola virus."

[duskyjewel]

I saw that headline. I looked at my husband and said, "If that's true, we're f*****."

[herring_RN, ASN, BSN]

Some hopeful healthcare professionals in Bong County, Liberia:

[fetch, BSN, RN]

Update.

Ebola airborne: A nightmare that could happen - CNN.com

"It's the single greatest concern I've ever had in my 40-year public health career," said Dr. Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota."I can't imagine anything in my career -- and this includes HIV -- that would be more devastating to the world than a respiratory transmissible Ebola virus."

And then the very next paragraph says . . .

Osterholm and other experts couldn't think of another virus that has made the transition from non-airborne to airborne in humans. They say the chances are relatively small that Ebola will make thatjump. But as the virus spreads, they warned, the likelihood increases.

Basically it's click-bait. If it happens, we're all screwed, but until then it's just a boogeyman.

[herring_RN, ASN, BSN]

Nurses Arrange Huge Donation of 1,000 Hazmat Suits For RNs, Health Workers Fighting Ebola

17 Sep 2014

... Lack of protective suits is a major problem slowing efforts to contain the spread of Ebola as thousands of nurses, doctors and other health workers have been infected, and many have died, in what has been called an "unprecedented" rate.

In addition to Kappler, NNU is in contact with other manufacturers to contribute personal protective suits, and with a variety of international relief organizations to arrange delivery of the suits as quickly as possible at a time when international commerce to the affected countries has been slowed due to the outbreak.

"Today's wonderful contribution of 1,000 protective suits by Kappler is just a down payment and a start on what we know is needed," said Bonnie Castillo, RN, director of NNU's Registered Nurse Response Network.

"Tragically, the Ebola outbreak is only getting worse and spreading to more countries. All of us have a responsibility to support the humanitarian effort and assist the heroic nurses, doctors, and other healthcare workers who are on the frontlines risking their lives to heal the thousands of infected patients in West Africa. This is only the beginning of a stepped up effort in the U.S. We must act before it is too late," said Castillo...

http://www.enewspf.com/latest-news/health-and-fitness/55539-nurses-arrange-huge-donation-of-1-000-hazmat-suits-for-rns-health-workers-fighting-ebola.html

[Queen Tiye, CNA]

[COLOR=#ff00ff]From Pigs to Monkeys, Ebola Goes Airborne | HealthMap

[COLOR=#ff00ff]

From Pigs to Monkeys, Ebola Goes AirborneNov 21, 2012 | Jane Huston | Research & Policy

by rubber bullets 2010, via flickrWhen news broke that the Ebola virus had resurfaced in Uganda, investigators in Canada were making headlines of their own with research indicating the deadly virus may spread between species, through the air.

The team, comprised of researchers from the National Centre for Foreign Animal Disease, the University of Manitoba, and the Public Health Agency of Canada, observed transmission of Ebola from pigs to monkeys. They first inoculated a number of piglets with the Zaire strain of the Ebola virus. Ebola-Zaire is the deadliest strain, with mortality rates up to 90 percent. The piglets were then placed in a room with four cynomolgus macaques, a species of monkey commonly used in laboratories. The animals were separated by wire cages to prevent direct contact between the species.

Within a few days, the inoculated piglets showed clinical signs of infection indicative of Ebola infection. In pigs, Ebola generally causes respiratory illness and increased temperature. Nine days after infection, all piglets appeared to have recovered from the disease.

Within eight days of exposure, two of the four monkeys showed signs of Ebola infection. Four days later, the remaining two monkeys were sick too. It is possible that the first two monkeys infected the other two, but transmission between non-human primates has never before been observed in a lab setting.

While the study provided evidence that transmission of Ebola between species is possible, researchers still cannot say for certain how that transmission actually occurred. There are three likely candidates for the route of transmission: airborne, droplet, or fomites.

Airborne and droplet transmission both technically travel through the air to infect others; the difference lies in the size of the infective particles. Smaller droplets persist in the air longer and are able to travel farther- these droplets are truly “airborne.” Larger droplets can neither travel as far nor persist for very long. Fomites are inanimate objects that can transmit disease if they are contaminated with infectious agents. In this study, a monkey’s cage could have been contaminated when workers were cleaning a nearby pig cage. If the monkey touched the contaminated cage surface and then its mouth or eyes, it could have been infected.

Author Dr. Gary Kobinger suspects that the virus is transmitted through droplets, not fomites, because evidence of infection in the lungs of the monkeys indicated that the virus was inhaled.

What do these findings mean? First and foremost, Ebola is not suddenly an airborne disease. As expert commentators at ProMED stated, the experiments “demonstrate the susceptibility of pigs to Zaire Ebolavirus and that the virus from infected pigs can be transmitted to macaques under experimental conditions… they fall short of establishing that this is a normal route of transmission in the natural environment.” Furthermore, because human Ebola outbreaks have historically been locally contained, it is unlikely that Ebola can spread between humans via airborne transmission.

However, the study does raise the possibility that pigs are a host for Ebola. If this proves to be true in the wild, there are direct ramifications for prevention and control measures. It is still unclear what role pigs play in the chain of transmission. To continue work on answering this question, the team plans to take samples from pigs in areas known to have recently experienced Ebola outbreaks.

The Disease Daily has previously reported on Dr. Kobinger’s work on the Ebola vaccine.

- See more at: From Pigs to Monkeys, Ebola Goes Airborne | HealthMap