Ebola: A Role for Nurses in Sharing the Facts

By Shawn Kennedy, AJN editor-in-chief

The current Ebola crisis has everyone concerned over transmission, and rightly so. The public has been in a quandary as to who and what to believe. I can’t say I blame them. We should have been better prepared and anticipated that, given the situation in West Africa, we would eventually see a patient with Ebola present to a U.S. hospital ED (or clinic or urgent care center). What’s surprising is that it didn’t happen sooner.

I’d thought fears about widespread transmission of Ebola had abated after no more new cases arose from that of Thomas Eric Duncan in Dallas: his family, who were in the apartment with him during the time he was sick, did not contract Ebola and have since been released from quarantine; the two nurses who became ill treating Duncan have now been declared Ebola free and none of their contacts have become ill; no other nurses who provided care for him have fallen ill.

But with the onset of confirmed Ebola in a New York physician who had recently returned from caring for Ebola victims in West Africa, fears of widespread contagion resurfaced. Craig Spencer had been self-monitoring his symptoms while he went about his life; when he began to feel ill and developed a low-grade fever, he initiated a controlled transport in isolation to Bellevue Hospital.

And when nurse Kaci Hickox returned from volunteering in West Africa, she was caught in New Jersey’s new Ebola precautions and placed in mandatory quarantine in a tent outside a hospital in Newark. She protested, secured attorneys to advocate on her behalf (basing her protest on CDC recommendations that routine quarantine of nonsymptomatic health care workers is not justified), and was released to travel home to Maine, where she is now disputing Maine’s mandatory in-home quarantine and active monitoring requirement in favor of self-monitoring.

Having volunteer health workers self-monitor for symptoms is not new. Doctors without Borders, which has sent over 700 staff members to West Africa since the outbreak began in March, has a long history of treating Ebola in Africa and has long had protocols in place for returning health workers. And these protocols have worked. According to their Web site, “Their effectiveness was apparent last week in New York, when MSF aid worker Dr. Craig Spencer immediately reported the onset of fever symptoms, setting into motion his secure transfer to Bellevue Hospital in Manhattan . . . ”

The CDC has now issued updated guidelines for monitoring and movement of people with potential exposure in order to provide guidance for use with health care workers at various levels of risk. It does not support routine mandatory quarantine for health care workers traveling from Ebola-affected countries, and most health organizations, including the AMA, ANA, and AHA, agree. Aside from being unnecessary and creating an undue burden for the individual and the public health system, mandatory quarantine will discourage volunteers, and could lead indirectly to a worsening outbreak around the world.

It’s concerning that what should be a public health issue seems to be evolving into yet another means to fuel partisan political debate. Media coverage debating who’s right—the scientists or the politicians—has only created more confusion. (See this article in the Washington Post for a discussion of the issues.)

Nurses can help by learning the facts. Look to those organizations whose recommendations are based on science. Read them so you can explain them to family, friends, and neighbors and help people understand what the facts are. If there was ever a time to rely on evidence-based information, it’s now.