At the beginning of 2014, an outbreak of the Ebola virus was occurring in West Africa. Although the continent of Africa had seen this disease in the past, this was the first time in the West African region. The organization, Doctors Without Borders, who have responded to previous outbreaks, immediately began containing the outbreak and mobilizing resources. However, as we know now, the outbreak has been a challenge to contain and is currently growing at alarming rates.
Even though the threat to the American public is minimal, the likelihood of an infected person coming to the United States is not out of the question, especially in the time of rapid air travel. As we live in a global community, transmission of disease is quick and as health care providers we need to be educated on its recognition and treatment. Not just for our patients but for ourselves and the public at large.
What is Ebola?
Ebola hemorrhagic fever is a virus first discovered in 1976 in Zaire. There have been a handful of outbreaks since then, all contained in Africa with affected patients numbering in the low hundreds. The virus has a mortality rate up to 90% but with treatment, mortality can be as low as 50%. As of August 11, 2014, the current numbers of reported cases are 1,975 infected, with 1,069 deaths (54% mortality rate). These are official reported numbers of the World Health Organization (WHO) and are suspected to grow much higher if people in remote villages do not seek medical attention.
How is it transmitted?
Ebola is transmitted through direct contact with blood or secretions from an infected person. Exposure to objects, such as needles that have been contaminated is another way one can obtain the Ebola disease. It can also be transmitted through environments such as; desks, pens, etc. that have been marked with infected fluids. The virus can survive on surfaces 1-2 days dependent on the temperature, humidity, pH, etc. As the patient’s condition continues to worsen they become more infectious due to increased viral loads. They remain infectious, even after death.
Signs and Symptoms
The most common signs and symptoms are; fever, headache, joint and muscle aches, diarrhea, vomiting and loss of appetite. Unfortunately, these are similar to a myriad of other diseases; however, discovering potential exposure will be the key to identifying potential cases. One common assessment question a nurse should ask is, “have you or anyone close to you traveled outside the country?” Blood tests are used to diagnose the disease; nonetheless, the patient should be isolated before results are back.
Is there a treatment?
There is no current approved treatment for Ebola, besides supportive care. Due to the excessive loss of fluids from diarrhea and vomiting, fluid and electrolyte imbalances are the key care issue to address. Recently, two infected American medical missionaries and a Spanish priest were administered an experimental medication called ZMapp. The medication is a monoclonal antibody produced by exposing mice to fragments of the Ebola virus. The antibodies produced by the mice were harvested to produce the medication. The medication had only been tested in a few animal trials and never on humans.
According to recent reports, the two Americans appear to be doing well; although, the elderly Spanish priest succumbed to the disease. Although it appears the medication has some promise, the ethics of administering such untested medications and who should get the limited supply are now being debated. On August 12, 2014, the WHO assembled an ethics panel and determined that considering the circumstances of the current outbreak, it would be ethical to offer unproven interventions. Despite this stance, the questions will continue on about who will receive the medications.
The effect on nurses
Prevention is the key to eradicating this disease and the transmission to others. As nurses, we are often in the forefront in identifying such patients. The Centers for Disease Control (CDC) has issued guidelines for health care workers for the care and treatment of suspected and known patients. They can be found at http://www.cdc.gov/vhf/ebola/hcp/index.html.
During this outbreak, health care workers, nurses, doctors and community leaders have been especially affected by the disease. Recently, a nurse died in Nigeria after caring for a Liberian-American who she treated shortly after arriving in Nigeria. In Liberia, of the 355 deaths, 32 have been health care workers caring for patients affected by the disease. Often, they are caring for patients prior to their diagnosis and therefore exposed without knowing it.
As the largest Ebola outbreak continues to evolve, it is our responsibility as nurses to be educated and knowledgeable about this new emerging disease. This knowledge not only helps us care for our patients and protect ourselves, but also helps quell the rumors and fears in our communities.
What else is there to know about the Ebola outbreak? Keep us informed and up to date in the comments below.