Ebola, One Year Later: What We Learned for the Next Big Epidemic

By Betsy Todd, MPH, RN, CIC, AJN clinical editor

Scanning electron micrograph of filamentous Ebola virus particles budding from an infected VERO E6 cell (35,000x magnification). Credit: NIAID

Scanning electron micrograph of filamentous Ebola virus particles budding from an infected VERO E6 cell (35,000x magnification). Credit: NIAID

U.S. hospitals have not seen a case of Ebola virus disease since November 11, 2014, when Dr. Craig Spencer was discharged from Bellevue Hospital Center in New York City. While the number of new infections has declined dramatically in the West African countries where the 2014–2015 epidemic began, it is virtually certain that the disease will continue to resurface.

This epidemic was by far the largest and most geographically widespread Ebola epidemic to date, with approximately 28,000 cases (suspected, probable, or confirmed) and more than 11,000 deaths in Liberia, Guinea, and Sierra Leone, the three hardest-hit countries. The seven other countries affected account for a combined total of 34 confirmed (and two probable) cases and 15 deaths.

According to a recent WHO report, these numbers include (through March of this year) 815 confirmed or probable cases among health care workers, more than half of whom were nurses or nurses’ aides. (Doctors and medical students made up about 12% of total health care worker cases.)

This epidemic has been, for some, a wake-up call about the ease of global disease transmission. The ever-increasing movement of humans and animals over and between continents has created what virologist Nathan Wolfe refers to as a “giant microbial mixing vessel.” Before U.S. health care collides with the next deadly virus, it might be helpful to review some of what we’ve learned from these events.

  • As Paul Farmer, a physician with decades of experience in outbreak control, emphasized late last year: “weak health systems, not unprecedented virulence or a previously unknown mode of transmission, are to blame for Ebola’s rapid spread.”
  • People with Ebola are more likely to survive when they have access to critical care services—care that is unavailable (or inaccessible) in many countries.
  • In monitoring the first large cohort of Ebola survivors, we are learning about possible residual effects of Ebola, including eye pain, blurred vision, hearing loss, swallowing difficulties, arthralgias, sleep problems, neurological changes, and memory loss and confusion. The virus can persist in semen for at least nine months. Pauline Cafferkey, a Scottish nurse who contracted Ebola while working in Sierra Leone, developed meningitis last month, 10 months after she was thought to have recovered from the infection. Ebola virus was detected in her cerebral spinal fluid.
  • More than 30 years ago, people with HIV and the nurses who cared for them were often shunned by family, friends, and coworkers. Neither Ebola nor HIV is spread by casual contact (here’s CDC information on what’s known about transmission risks), but experience during this Ebola epidemic has shown that people with “new” or “scary” infections continue to be stigmatized, even by health care workers.
  • Many nurses had not been using long-standing personal protective equipment (PPE) donning and doffing protocols in everyday practice—there was a scramble to reemphasize these protocols after the first case of Ebola arrived in the U.S.
  • Years of “bottom line” management in U.S. hospitals have left many facilities with inadequate staff, fewer education and training resources, and multiple systems issues that have impeded disaster preparedness and compromised the quality of protective gear and other supplies available to staff.
  • Content-hungry print and electronic media interfere with evidence-based responses to infectious disease threats when they pander to fear and hysteria. The damage during this epidemic ranged from unnecessary quarantine of asymptomatic individuals to willful denials of actual transmission risk in the U.S. to euthanizing the dog of a Spanish nurse after she contracted Ebola.

Nurses are inevitably on the front lines of any health care crisis. Will we learn from mistakes made during this epidemic to better prepare for the next one?

Clinical editor, American Journal of Nursing (AJN), and epidemiologist


  1. Jesus Varona April 18, 2017 at 6:53 pm

    Nurses are crucial in any healthcare team around the world. Every nurse should learn the safe healthcare practices that are required to protect themselves from deadly diseases like Ebola. By learning more about the spread of these deadly contagious diseases around the world, nurses along with their healthcare team can then prevent and contain the spread of diseases within the population. Sadly, Ebola is still infecting people in certain parts of the world, where there is poverty. It is ultimately our responsibility as healthcare providers to learn how to properly handle the situation while also educating all of our patients.

  2. Amanda April 18, 2017 at 2:27 pm

    Ebola was a scare in South Florida. I rememeber nurses havign to get fitted for suits, like hazmat suits. Nurses and employees in the healthcare system were frightened to take care of these patients because of being infected and not knowing enought information about the disease process. I do beliebe it was a “wake up call” for global disease transmission. The blog talks about Ebola patients surviving if critical care services are available. Just in south florida there is a handful of hospitals without critical care experiences. These patients are at risk for dying without proper training. Personal Protective equipment is very important to healthcare providers and education needs to be spread. We will just have to learn from mistakes to make healthcare systems more reliable, trustworthy and safe.

  3. Monica H. April 17, 2017 at 11:47 pm

    Mrs. Todd,

    I enjoyed reading your blog regarding the Ebola virus as it was very informative. This epidemic brought a scare to the United States when its outbreak could not be contained. Your blog mentions that the epidemic has been a “wake-up call” about global disease transmission. While preventive measures by the Centers for Disease Control and Prevention (CDC) have been implemented, it is important to continue research on the disease. The United States may have the resources and funding for this approach, however, other parts of the world must be educated as well. Areas such as West Africa continue to be affected, as people are continuing to receive treatment. Your blog points out that it is important to review the events that occurred, such as symptoms of the infected, the deaths that occurred and management of the epidemic. As other situations have occurred in the past, it is significant that we learn from our mistakes and continue to better contain global disease transmission.

  4. lazaro a gonzalez July 25, 2016 at 2:22 pm

    Nurses and health care providers are directly taking care of individuals with a variety of diseases and infections, Ebola, as stated in this blog, was one with unprecedented virulence in areas with weak health systems. The importance of fast acting and critical care is crucial in reducing the spread of any epidemic, and increasing the chances of survival of those infected. It is interesting to learn about the residual effects of Ebola, such as eye pain, blurred visions, hearing loss, swallowing difficulties, memory loss, confusion, and others. It appears special senses are involved. More interesting is the knowledge now learned about its survival and survival time in different bodily fluids.
    As stated, this Ebola epidemic again shows the stigmatization imposed by fear of new and life threatening diseases as a result of lack of knowledge and fear of these diseases. The point made regarding the importance of PPE for health care providers again brings about the importance of such practices in the treatment of infection control, as learned, this can prove to be deadly. I believe that understaffing in hospitals as discussed in this blog, as well as lack of education and retention of specialized nurses will not be beneficial in treating and preventing other outbreaks and associated complications. Proper staffing and proper training as well as evidence based practice is crucial in saving lives and staying healthy in all health care settings. It falls directly on nurses to engage in proper use of PPE to eliminate the chances of contamination as well as spreading of such diseases. Not only is this important when new diseases are identified and are directly affecting our country, but in general practice as well. Over all, training on communicable diseases should be enforced for all individuals involved in health care to better combat such epidemics, along proper staffing, and anticipation of possible outbreaks.

  5. Mervin Camare April 16, 2016 at 6:52 pm

    Nurses are at the forefront of healthcare. As such, education regarding proper PPE usage begins with us. It is necessary that safe healthcare practices are taught to other nurses and healthcare workers around the globe. It is also imperative that low income countries are properly supplied with PPE. Even though it requires a substantial amount of resources to accomplish such a task, and could even be viewed by many as excessive spending, it should be viewed more as an investment because millions of lives could be saved. Global communication would also greatly contribute to the success of initiatives like this. Healthcare professionals could exchange knowledge on effective ways that countries affected by outbreaks like Ebola have reduced the spread of disease, as well as how they and others attempt to prevent future outbreaks and human losses.

  6. Smarf November 23, 2015 at 9:44 pm

    This epidemic has exposed critical weaknesses in our ability to not only identify but also to prevent a deadly outbreak until they are already at our door steps, this time most countries got lucky however next time who knows what our apathy for outbreaks in other countries will lead to. People were dying in the streets literally in West Africa, the hospitals and treatment centers were filled to capacity because of the lack of preparation and shortage of healthcare professionals. Organizations early on in the outbreak begged for international help, and what happened, crickets, total apathy until it was being shown on the news because infected people were getting back into their own countries. The world health organization dismissed what these organizations and doctors said, and they admitted to reacting to slow, however I wonder how slow they would have reacted if this started in London or Rome. This response by the people that are specifically in place internationally is what lead to a large casualty rate. The community organizers and voluntaries in the affected cities stepped up when the rest of the world left the African countries to die. They educated families, disposed of the dead infected bodies, as well as getting sick patients out of their home and into an isolated area. Those people set up check points into communities were people going into new areas are quarantined until they do not show symptoms for three weeks. What’s worse is that the disease is still not over, people are still getting sick and the communities are dealing with it better than the world health organization that is kind of sad. Nurses are the expendable pawns on the front-lines, we at least need to advocate more in the future when we see a disaster on the horizon because it is the nurses that will be on the front lines no one else.

  7. Austin Reed Johnson November 23, 2015 at 1:06 pm

    The data presented here highlights several important take-aways that are vital to the spread of diseases such as Ebola. Many nurses and nurses aides, alongside doctors and medical students, were included in actual and potential infected individual counts. And as Paul Farmer noted, the weak health systems to blame could include the inadequate use of PPE in the health care setting and a lack of properly trained screening staff to investigate the travel of global citizens. As a nurse in a major country hospital, I was encouraged by my institution’s efforts to provide adequate staff, offering additional hours and wages for Ebola-prepared staff, and allocating needed resources in the form of additional PPE. This is a practice that should have been continued even after the media’s fear coverage died nation-wide. Health care professionals must embrace a professional responsibility to disseminate health information regarding diseases such as Ebola, the risks associated with it, and dispelling incorrect information. I believe we will learn from situations such as the Ebola epidemic and develop appropriate readiness strategies to prepare for the future of global health.

  8. Arlette November 22, 2015 at 1:50 pm

    The Ebola epidemic woke up the health care world on how poor our use of proper PPE really is and how much it cost us. As nurses we had the most to learn from the situation. When simple standards of practice like using hour PPE’s can mean saving our lives and the lives of people we love. As health care providers we come in contact everyday with contagious diseases and it is our jobs to know how to properly handle the situation and how to educate our patients. We must educate ourselves and start putting these standards of “everyday practice” into play.

  9. Arlette November 22, 2015 at 1:35 pm

    The Ebola epidemic woke up the health care world on how poor our use of proper PPE really is and how much it cost us. As nurses we had the most to learn from the situation. When simple standards of practice like using hour PPE’s can mean saving our lives and the lives of people we love. As health care providers we come in contact everyday with contagious diseases and it is our jobs to know how to properly handle the situation and how to educate our patients. We must educate ourselves and start putting these standers of “everyday practice” into play.

  10. Daylisis Palacios November 19, 2015 at 5:46 pm

    I’ve been a nurse for 3 years and have worked in different settings from hospitals to nursing homes. One thing I can say is that nurses need to be better educated on contagious diseased, transmission, and how to care for these patients. I don’t believe the nursing profession is properly educated or trained on the infection control, management, or how to properly respond to an epidemic. The Ebola outbreak was an eye opener because so many health care workers were infected. Nurses especially were the most commonly affected and infected by this disease, as the article states nurses are at the forefront of patient care. It is more likely for nurses to be infected in an outbreak because we spend the most time with the patients and in their environment. If the Ebola outbreak taught us anything is that as nurses it is up to us to keep our patients and ourselves safe.

  11. Waleuska Pallais November 12, 2015 at 3:29 pm

    When the Ebola epidemic broke out, I had only been a nurse for 18 months. This epidemic highlighted the fact that as nurses, we are at the forefront of handling any health crisis. Although continents away form the real crisis, I realized that if something like this happened where I lived, my hospital and coworkers would be grossly under prepared. Unfortunately, in my hospital, no real measures to re-educate staff on proper use of PPE was taken. Undoubtedly, as nurses we need to a more pro active role in ensuring the safety of ourselves and our coworkers. It is understandable that a country with such little resources, such as Sierra Leone would falter in many areas of medical care, but in the US, this is unacceptable. As the writer states, many corners are cut in supplies and staffing in order to affect the bottom line. I would have hoped that a health scare such as Ebola would have caused US health institutions to rethink these issues, but I fear that it hasn’t. It is human nature to not really see the importance of an issue until it truly hits home.

Comments are moderated before approval, but always welcome.

%d bloggers like this: