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.

[Queen Tiye, CNA]

Ebola is spread by means other than body fluids, or else the American experts who were working over-seas would have never caught the disease. HIV is spread via body fluids, and even the lay person knows how to avoid contracting HIV. So why aren't medical personnel in Liberia, Sierra Leone, or Guinea contracting HIV, or other pathogens that spread via body fluids, at an alarming rate?

[Queen Tiye, CNA]

[h=1]First diagnosed case of Ebola in the U.S.[/h]By Dana Ford, CNN

updated 8:04 PM EDT, Tue September 30, 2014

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STORY HIGHLIGHTS

• NEW: Crew that transported the patient to the hospital has been isolated
  
• "I have no doubt that we'll stop this in its tracks in the U.S," CDC director says
  
• Ebola is spread by direct contact with someone sick with the virus
  
• The patient recently arrived in the United States from Liberia
  

Atlanta (CNN) -- A patient being treated at a Dallas hospital is the first person diagnosed with Ebola in the United States, health officials announced Tuesday.

The unidentified man left Liberia on September 19 and arrived in the United States on September 20, said Dr. Thomas Frieden, director of the Centers for Disease Control and Prevention.

At that time, the individual did not have symptoms. "But four or five days later," he began to exhibit them, Frieden said. The individual was hospitalized and isolated Sunday at Texas Health Presbyterian Hospital.

Citing privacy concerns, health officials declined to release any details about how the patient contracted the virus, what he was doing in Liberia or how he was being treated.

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"I can say he is ill. He is under intensive care," Dr. Edward Goodman of the hospital told reporters.

The patient is believed to have had a handful of contacts with people after showing symptoms of the virus, and before being isolated, Frieden said. A CDC team was en route to Texas to help investigate those contacts.

The crew that transported the patient to the hospital has been isolated, the chief of staff for Dallas Mayor Mike Rawlings told CNN.

At the same time, Frieden sought to play down the risk to public health. There are currently no other suspected cases of Ebola in Texas.

"It's a severe disease, which has a high-case fatality rate, even with the best of care, but there are core, tried and true public health interventions that stop it," Frieden said.

"The bottom line here is that I have no doubt that we will control this importation or this case of Ebola so that it does not spread widely in this country," he said.

According to the CDC, Ebola causes viral hemorrhagic fever, which can affect multiple organ systems in the body and is often accompanied by bleeding.

Early symptoms include sudden onset of fever, weakness, muscle pain, headaches and a sore throat, each of which can be easily mistaken early on for other ailments like malaria, typhoid fever and meningitis.

Ebola is spread by direct contact with someone sick with the virus. That means people on the patient's flight are not thought to be at risk, as he did not begin to show symptoms until several days after arriving in the United States, Frieden said.

"The issue is not that Ebola is highly infectious. The issue with Ebola is that the stakes are so high," he told reporters.

How the virus spreads

The director declined to answer whether the patient is a U.S. citizen, saying just that he was in Texas to visit family.

Frieden also declined to say, clearly, whether the patient is a man, although he referred to the person as "he" on multiple occasions.

A number of other Americans have been diagnosed with the disease in West Africa and then brought to the United States for treatment.

Ebola virus: 9 things to know about the killer disease

The Ebola outbreak has been centered in the West African countries of Guinea, Sierra Leone and Liberia, though there have been concerns about international air travel and other factors -- including the fact the symptoms might not appear until two to 21 days after one is infected -- may contribute to its spread.

More than 3,000 people in West Africa have died after being infected with Ebola, according to a World Health Organization report from last week. The same report stated that there had been 6,553 cases of the virus overall, though the number is suspected to be much higher, given difficulties in tracking and reporting the disease.

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"I have no doubt that we'll stop this in its tracks in the U.S. But I also have no doubt that as long as the outbreak continues in Africa, we need to be on our guard," said Frieden.

[FLAlleycat]

Ebola: Woman saves three relatives from death - CNN.com

[Chaotika]

Ebola: Woman saves three relatives from death - CNN.com

So if she can do that, in such close proximity to those infected and not die herself, why are the healthcare workers getting infected and dying from treating the sick? Is it the sheer number of infected? Is it fatigue? It can't be said that it's poor equipment. This girl saved her family minus 1 and didn't get herself infected using trashbags and stockings and gloves, far from the moonsuits and space gear that the actual healthcare workers sent there are getting. And good for her, she's a nursing student! Even though 1 died and things were very trying for her, she pulled through and so did the majority of her family. Pretty uplifting, hopefully they can learn a thing or two from her!

[sistrmoon, BSN, RN]

What disturbs me is the patient in Dallas went in to the ER and was discharged home initially and wandered around symptomatic for 2 days. Were they not screening for recent travel to Africa?

[classicdame, MSN, EdD]

I hope Dr. Brantly does not take unneccessary chances.

I returned from Europe in August and re-entered the States thru a large airport where several hundred people had to present passports, visa, etc. all at once. One of the agents wore thick gloves. I asked why and he said to prevent contamination while handling documentation from so many people. He said they were not allowed to wear masks because it "looked bad" to the public. He was particularly concerned with passengers from Liberia. I told him I had boarded in Amsterdam along with many people who had come from all over the world. Just because the plane was from the Netherlands did not mean the people on board were. I recommended he wear surgical gloves and tell his boss he had a hand infection and did not want to spread it. Really? This should be REQUIRED of them.

[firstinfamily, RN]

It was in the news this am that the first case on USA shores is in Texas, someone who had traveled from Liberia. So, it is here!! It will only be a matter of time before it spreads in our country as well. And with flu season upon us it will be hard to detect. I do no understand why the people on the plane from Liberia were allowed to depart without some form of ebola testing. Is the testing that inaccurate?? Shouldn't we be testing anyone who comes from the infected countries?? Remember Ellis Island, all the immigrants coming through were tested for a variety of diseases before they were cleared to come ashore. It is a virus, it has probably already mutated at some point, so we may not be doing what is needed to contain it. Jump on board with all the pharmaceutical companies looking for a vaccine to be developed. Where do we draw the line in risking our own lives with those of the patients??

[FLAlleycat]

Sad to say, a nurse didn't think it was important enough to notify the other healthcare providers that the pt came from Liberia. If it spreads in TX, we have her/him to thank. Testing everyone coming from W Africa is not at all practical as it takes four days for the results to get back. Where would all these people hang around while waiting? Remember the American who flew to Nigeria from Liberia via another country and introduced ebola to Nigeria? He was puking everywhere and had diarrhea on the plane flying into Nigeria and even after landing, was not isolated for four yours. This 3rd-world country managed to contain ebola with 20 infected of which 8 died. I'm not too concerned unless hospitals keep turning away high-risk patients they really need to admit!

[Go-GetterRN]

We should have stopped all travel between the infected parts of Africa and the US. We shouldn't have to be worrying about an outbreak in the US, it's kind of a ridiculous situation. Anyways, I'm not going to get into the politics, we need to focus on the nursing. As far as us nurses having to worry about caring for these pts, and potentially contracting the disease, I think we better start gathering the necessary equipment and precautions to protect ourselves. If we get one of these cases in my unit, you better bet the hospital is going to supply me with a full hazmat suit, or I will be refusing to care for this pt. We NEED to make sure we have all the proper equipment to contain this virus before we start caring for these patients or else we will be spreading it to our families and friends. I dont literally mean a hazmat suit, but you get the point.

It will be interesting to see how many nurses and doctors in the us come up with the disease as compared to those caring for the pts in Africa. I am not aware of any in Atlanta, and they have been caring for ebola victims since early september. Not people who caught it in the US, but people who volunteered in Africa and brought ebola back. (Shouldnt medical volunteers be required to sign a waiver saying they HAVE TO STAY where they are if they catch the infection?!? I wish nothing but the best to those docs/nurses that volunteered, but I find it kind of strange that we would risk spreading it here by bringing them back so soon. Even if ebola was spread via droplet, I dont think anyone is capable of sneezing the ebola virus across the Atlantic ocean..) Anyways, we need to learn from how these pts in Atlnata are being cared for. What precautions are medical staff using? Are these precautions effective in preventing the staff from getting ebola? Would we benefit from creating a minimum standard that ALL facilities would have to use if they cared for an ebola pt? I personally think we would. Hospitals want to save money, and not all of them would be willing to provide all the necessary equipment needed unless they were forced to. "Oh, you need a full suit to protect yourself from ebola? Here, use this thin contact gown for your body and tape a tissue to your face to protect your mouth."

Good luck to everyone out there, and props to all you nurses that have been caring for ebola victims.

[SandyB]

I wonder if lack of insurance played any role in not keeping him to test him the first time. Would not be the first time that thought came in to play in an ER for an uninsured patient.

[Chaotika]

So I've been doing some digging. Trying to remain factual, but I'm not going to lie, my head can't help but to do the "what if" dance, every time I see someone from over there dying, who's traveled. I'll try to lay it all out without jumping all over the place, please bear with me.

9/16- Duncan's sister dies from Ebola

9/19- Duncan leaves Liberia, and goes to Brussels, then Washington, headed for Dallas

9/20- Duncan arrives in Dallas

9/26- Duncan goes to an ER and complains he's not feeling well and has come from Liberia (nurse fails to communicate) Duncan sent home

9/28- Duncan is picked up by ambulance and taken back to the same hospital he went to previously.

9/30- Is proven to have Ebola

So this guy was flying while infected. They say that because he was showing no symptoms he wasn't contagious, so people on the planes are fine. It's only the time from 9/26-9/28 that we need to worry about according to the news and CDC. They say there was about 18 people he came into contact with, and they're all being monitored. Schools have sent out letters to parents, schools are being wiped down and cleaned. Now some news sites are saying that United Airlines is trying to get in contact with people who flew on the same flights as this man because it is now released that he flew in from Brussels to Washington Dulles on his way to Dallas. Why are they trying to find the passengers who flew with him if he wasn't symptomatic? Just to make sure? That's great but they have repeatedly said it's not a droplet transmission and there's no risk until symptoms show. Weird.

There's absolutely 0 reason that we should be accepting flights from affected countries. The world is too mobile these days, and as such much smaller than it used to be. This sort of thing while we can possibly deal with in a correct and safe manner in trickles, does not lend itself well with the shape our hospitals are in when it comes to people being infected in droves. In my mind it's a recipe for disaster, and that's not being a sensationalist. There's 0 reason we should be risking the lives of the people here at home, and our already overworked medical professionals. While our level of care here is better than a third world country obviously, we're just not ready to take on the kind of numbers that something like this could possibly bring if it gets out. So why bother even testing the waters? They wanna bring back sick workers being monitored from Liberia to here and expecting them and knowing where they're going to put them and preparing for them beforehand? Fine. That I'm not crazy about, but I can handle that a whole lot better than the idea of every sick African who thinks the USA is now a magical place of ZMAPP cures and lollipops hopping a plane to our shores because they think their life is worth risking millions and our government agreeing with them.

I just don't understand.

[MassED, BSN, RN]

Sad to say, a nurse didn't think it was important enough to notify the other healthcare providers that the pt came from Liberia. If it spreads in TX, we have her/him to thank. Testing everyone coming from W Africa is not at all practical as it takes four days for the results to get back. Where would all these people hang around while waiting? Remember the American who flew to Nigeria from Liberia via another country and introduced ebola to Nigeria? He was puking everywhere and had diarrhea on the plane flying into Nigeria and even after landing, was not isolated for four yours. This 3rd-world country managed to contain ebola with 20 infected of which 8 died. I'm not too concerned unless hospitals keep turning away high-risk patients they really need to admit!

we have no idea that "a nurse" didn't notify the provider. Often times the provider disregards pertinent info in their hastiness to dispo patients.