Ebola: Impossible Choices Leave Nurses in Tears

After caring for Thomas Eric Duncan, the only American to die from Ebola, many nurses at the Dallas hospital ended up sleeping at the facility for three weeks. They were afraid to go home and risk infecting their children. Ebola has forced healthcare workers to make difficult choices. On the one hand, doctors and nurses swear an oath to care for the sick. On the other, fear for themselves and their families strikes deep. Ebola presents a real dilemma that has literally brought some nurses to tears.

ebolaPandemics are all about the likelihood of infection and the number of chances to infect. Fortunately, in the case of Ebola, the likelihood of infection is relatively low. Our best available data suggests that the virus requires contact with bodily fluids, particularly when the patient has become truly ill. Although the early fever-only stage is troublesome, it’s only later, when the patient is visibly sick, that the number of viral particles increases and the chance for infection becomes a real concern. If sick patients could be isolated, the pandemic would quickly end. Patients would either recover or (unfortunately) pass, but either way, any further infections would end. With these factors in mind, here are some considerations for our healthcare providers and for individuals.

  1. For the average American: Relax, this is a disease of healthcare providers. The chance of the average person coming into contact with an Ebola patient is vanishingly small. As noted by others, more Americans have been married to Kim Kardashian than have died from Ebola. Do you worry about being hit by lighting (twenty-three deaths last year)[1] , or dying from the flu (thousands die every year)? If not, you probably shouldn’t worry about Ebola. However, and this is generally true, if you are sick, you should probably limit your contact with others. And if you are sick with a high fever for several days in a row, contact a healthcare professional.
  2. For healthcare workers: Ebola is a disease that affects care-givers more than it does patients, and while healthcare providers have a responsibility to care for the sick, healthcare organizations also have an equal responsibility to care for their doctors, nurses and other workers. Considering that hospitals are small cities with people constantly coming and going, thus increasing the chances for transmission of disease, we should limit the number of people caring for the sick. In the case of the many nurses caring for the patient in Dallas, ideally there would have been just one person, supported by experts at a distance.
  3. Technology: I spend a lot of time thinking about telemedicine and care coordination. This is a perfect opportunity to put the technology to use. Traditionally, access to care is limited by distance. In this case, access should be limited by the risk to providers. Telemedicine has reached a point that it can offer more than simply video. It can be a tool for care coordination over cell phones and other available devices.
  4. Find a cure: This seems self-evident, and governments are working on vaccines and other drugs to limit the infection. I mention this now because there are still millions of people who refuse to get vaccinated for all sorts of diseases that are worse than Ebola.
  5. Get the right person to care for Ebola patients: The best person would be an individual immune to Ebola—an Ebola survivor. Ebola survivors, of whom there are thousands, could be quickly trained to be medical assistants, working with patients but assisted by remote specialists. This could help stem the tide in Africa, but there are still logistical issues for America.
  6. Monitor but don’t close the border: Closing the border will only lead to desperate measures. Imagine what you would do if you thought the US was the only place to save your loved one. We need people to disclose when they are worried, not hide their concerns.

Unfortunately, after thousands of deaths in West Africa, Ebola will almost certainly fade back into the shadows. This pandemic is an opportunity to think more broadly about how our healthcare system responds to infectious diseases. We can do a better job, but it will take original thinking about how we care for the sick . . . and more concern for the healthcare workers we put on the front lines.

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