In September, a man who traveled from Liberia to Texas was diagnosed with the Ebola virus at Texas Health Presbyterian Hospital Dallas, marking the first time Ebola was diagnosed in the United States. The patient, Thomas Duncan, was initially sent home after presenting with fever and abdominal pain; two days later, his symptoms worsening, he returned to the hospital. He died shortly thereafter.
The circumstances around Ebola's arrival in this country revealed that, despite the millions of dollars already spent, we still have much to do with regard to preparedness for biological events. Following Duncan's diagnosis and death, hospital and public health officials issued scores of press releases reassuring the public that the U.S. health care system is equipped to deal with such a virulent disease and that an epidemic like the one in West Africa, where more than 10,000 people have been sickened, couldn't happen here. Then two nurses who had cared for Duncan, Nina Pham and Amber Vinson, were diagnosed with Ebola. A firestorm of media coverage ensued, especially after it was learned that one of the nurses had traveled on a commercial airliner just before she became symptomatic. There were calls for banning travel to and from West African countries, and for quarantining new arrivals from those countries. In late October, the Centers for Disease Control and Prevention (CDC) announced that all travelers from Sierra Leone, Liberia, and Guinea would be routed through five U.S. airports, and that such travelers would be actively monitored after arrival for 21 days by local and state health departments. A Texas university went so far as to refuse admission to two Nigerian students, even though that country had contained the disease.
As I write this, there have been no new cases of Ebola linked to Duncan, the two nurses who contracted the disease while caring for him, or their family members. Yet all rational explanations about how the disease is transmitted (through direct contact with body fluids once symptoms appear) and the general public's very low risk of infection have been overshadowed by fears of a widespread U.S. outbreak.
The public's confusion and concern is understandable. This deadly disease is new to us. At first mixed messages abounded, and rules and policies kept changing; the very agencies we rely on for information seemed not to know what to tell us. If fully gowned and gloved nurses practicing according to CDC infection control protocols could contract the disease, what did this mean for the unknowing public? And we've all been primed by movies like Outbreak, a sci-fi thriller in which someone with a fictional Ebola-like illness infects an entire theater through a sneeze. In reality, the most contagious aspect of Ebola is the fear it has engendered.
I can't help but wonder why we weren't better prepared, not only with equipment but with an action plan and a communication strategy—after all, the current epidemic in West Africa has been escalating since March. In this era of widespread global travel, why didn't it occur to us that at some point a traveler would bring Ebola into this country? Why didn't we realize sooner that, given the virulence of the disease in West Africa, the “usual” protective measures wouldn't suffice?
Since Duncan's death many nurses’ unions and associations, as well as other health care organizations—and even one brave nurse, Briana Aguirre, who cared for one of her two stricken colleagues at Texas Health Presbyterian Hospital Dallas—have decried the lack of appropriate protective garb and training available to staff. The outcry has put pressure on health officials to issue new recommendations for stronger worker protections and guidelines, and it's working. The CDC has issued a guidance document outlining more stringent protective measures to be used when transporting and managing patients infected with Ebola.
As nurses, we have a long history of providing care to patients despite the personal risks. AJN’s archives are replete with stories about nurses who died following workplace exposure to illnesses such as yellow fever, influenza, typhoid fever, AIDS, and severe acute respiratory syndrome. In West Africa, scores of our colleagues have died from Ebola because they chose professional duty over personal safety, knowing they lacked proper equipment. That's a choice no nurse should have to make.