What’s Next: The Ebola epidemic and the U.S. nurses

Written by Lisa Dickey, CNN

“The nurse is the first line of defense, the hardest-hit emergency response worker,” said Henry Bayer, a neuropsychologist who has worked in the emergency departments of Johns Hopkins Hospital in Baltimore, where he directs the hospital’s nurse disaster training and worked with Save the Children during the Ebola outbreak in West Africa. “And it’s one of the reasons this notion of a nurse as hero and as the first medical person to treat someone with Ebola is so deeply important in the U.S.”

Two-thirds of Ebola patients diagnosed in Africa between December 2013 and December 2014 lived with a third party, like a caregiver or neighbor. A nurse provides much of the care in this scenario — nursing the patient while minimizing transmission to others. Given that Ebola can spread through contact with the person’s sweat, saliva or other bodily fluids, “The door to the house is completely open,” Bayer said. “If the Ebola patient doesn’t pass, the other person will be much more vulnerable.”

In the case of the Dallas nurse, Amber Vinson, who first tested positive for Ebola on August 10, 2015, it took her until October 18 to be fully discharged from the hospital and returned to her job at ProHealth.

This tension between a nation’s nurses, exposed to the death of a life, and the American public’s lack of confidence in their ability to diagnose and treat these kinds of diseases, requires a deliberate response, Bayer said.

“You have to deal with that directly and honestly. You have to let the public know what you see happening,” he said. In the midst of the Ebola crisis, the Obama administration left it up to the U.S. Centers for Disease Control and Prevention (CDC) to raise the alarm and initiate the relief effort, according to a 2012 internal memo obtained by CNN. But the CDC at the time only had 53 staff specialists working in its Ebola response center, which made an “unacceptable” level of resources available.

In the end, despite these tensions, the Ebola crisis began as a local threat, without resources at all to effectively screen people in Dallas.

In the school nurse case, school administrators have been able to take swift and effective action, because this nurse — all American students — were in an isolated circumstance, where they would not have been cross-contaminated with anyone else, Bayer said.

To the “enemy” in this case, education needs to be designed for both genders, Bayer said.

When students walk into school in October, they already know about signs and symptoms of flu. When they enter the doctor’s office, the routine medical visits come on as a given.

But when it comes to understanding the threat of Ebola, the same levels of understanding are lacking, the pediatrician said. Because of this, public school administrators need to start to raise their heads above the ranks of nurses and remind all employees how to recognize Ebola signs and immediately call 911 or a doctor. “If there was a nurse with Ebola inside a school, if a student sees the teacher with Ebola, students would know, ‘We better go get someone else because we’re in trouble here. We’re in a catastrophic moment.”

Yet clearly Ebola needs not even get past America’s train of thought. In France, a doctor has admitted himself to a medical facility for testing negative for Ebola. That seems to be the default response of France for infectious diseases. This is what happened with flu at the start of the current season, when school closed at the first sign of flu, and what the CDC said happened in Dallas.

Karen Koch, communications director for Save the Children, says America needs a larger public awareness effort to teach young Americans how to prevent and respond to Ebola, much like the one the World Health Organization in 2000 launched with the “Know Your Neighbor” campaign — the organization told every one of the world’s 5 million people to track someone who might have Ebola. This message is used today by many national health organizations in every country, including Save the Children.

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