So a few months ago the country was enthralled with the idea of a few patients, infected with the Ebola virus, coming to the United States. Up until this point, we had been safe from Ebola due to the fact that bats can’t fly over the Atlantic. Some people were completely indifferent, while others had seen Outbreak one too many times. Most were a healthy mix, somewhere in between, but what bothered me the most was both the lack of education and the poor information that was spreading more virulently than the virus could ever hope to.
First, I want to stress that I am a nurse, not a virologist, and hopefully throughout my post you will see that I am not pretending to be one. I have a Bachelor’s in Nursing and am currently a graduate student. I have worked extensively with Infectious Disease Specialists. I have been exposed to almost every infectious disease known to the modern world. I have taken courses in Biology, Microbiology, Anatomy, Physiology, Pathophysiology, Advanced Pathophysiology, Pharmacology, and an assortment of others. However, I am not and will not pretend to be an expert, just an experienced professional. When it comes to an epidemic of any sort, my first focus is on the patient, protecting and healing them, my second focus is on protecting the community. I don’t care about which strain does what, or what we can do with in lab. As a nurse, I concern myself with the current patient and future possible patients. I feel the first thing we should examine is Ebola itself. It is foreign to the US, both literally and figuratively. What it does to people and how it harmonizes with nature are both things that most westerners have little concept of. It is a virus, not a bacteria. This means that it is not its own organism. It is actually much smaller and basic than you can imagine. It is nothing more than a few pieces of DNA/RNA and some proteins. No cell wall, no cytoplasm, no metabolic functions. This is both their advantage and their downfall. Viruses require a host. For this example I will use the HIV virus. HIV gets into the human body and invades the host’s white blood cells, T4 cells to be exact but I won’t get that involved. The proteins help get the virus into the cell and those few small sequences of DNA/RNA write themselves into the host DNA/RNA. Now instead of the white blood cell attacking invaders, it is nothing more than an HIV factory. All of its metabolic functions are redirected at producing more of the virus, which pours out of the white blood cell like a sieve until eventually the host cell dies. This is why HIV infected patients have poor immune systems. The virus re-writes the DNA of the host cells. This is not something we can stop. New viruses are pouring out of the white blood cells at a rate of millions a day. We cannot filter them out. We cannot “kill” a little chunk of DNA and we don’t know enough about the human genome to correct the DNA sequences. This is why a lot of viral infections like HIV, Herpes, and Hepatitis are life long infections. HIV invades the white blood cells, Herpes invade the nerve roots, and Hepatitis invades the liver.
Now that we have a better grasp of viruses, we will focus on Ebola a bit more. In tropical Africa, Ebola naturally lives in bats. It is nice to the bats and doesn’t cause them many issues. It is rumored that there are many viruses humans carry our entire lives and have no idea because they show zero symptoms. Therefore, they have never been studied. If this sounds crazy, just remember that it was in recent years the we discovered there was a virus behind cervical cancer. A virus that men can carry and spread without ever knowing they have it. Where the problem arises is that in tropical Africa, people like to eat bats. Sometimes they get infected with Ebola and it spreads. This process is called Zoonosis and can be true of bacteria or viruses. Racoons carry Rabies, Armadillos carry Leprosy, Birds carry the Flu, Bats carry Ebola.
When I said Westerners don’t really understand Ebola, the primary aspect that I am talking about is the patient. We don’t ever see what Ebola does. Our media is too censored, we hear how many died, and see people in haz-mat suits. Speaking of suits, we’ve all seen the pictures. Rubber gloves are adequate for AIDS and hepatitis, a simple mask (N95) stops Tuberculosis, but this requires space suits, just keep that in mind when you think its no big deal. So here is what happens when you catch Ebola, I figure you’re getting bored with reading right about now, so I’ll spice it up. First the virus gets into your system, I’ll elaborate on that later. Then, it hangs out for a few days, even up to 21, growing, multiplying at a rate of millions a day, and guess what, you’re infectious. Now at this point it would pretty much require a straight blood to blood interaction so the only real threat here is for IV drug users who share needles. Just like with the flu or hand foot and mouth disease, you can be spreading it to others before you show a symptom*(apparently not many see the *, so please read the elaboration at the bottom). Remember, nurse mind set, protect the community. At first it’s not bad, little nausea, some sweating, diarrhea, much like a stomach bug. But then the virus really starts to build up in your liver and adrenal glands, after it has saturated your blood cells, the lining of your vessel, your skin, and bones. Hepatocellular necrosis occurs, which is fancy term for your liver starts to decompose.Your liver is what regulates blood clotting. This causes your blood either clot up and turn to jelly in your veins, stay liquid and bleed profusely, or a combo of both. The adrenal glands then do the same, causing your blood pressure to drop. This requires lots of IV fluids to keep your circulating volume up. At the same time inflammatory cytokines are released which causes vascular leakage. Cells don’t do a good job of holding things together so it all becomes a bloody goop. Anywhere in your body that blood vessels are shallow, like your nose, ears, gums, throat, GI tract, urethra, vagina, rectum, all start oozing fluids and bleeding because the tissues that normally keep it contained are disintegrating. So now you bleed from every orifice, including your eyeballs. Every time someone or something touches you, your tissue gets damaged which further the cycle, so a shot in the arm can turn into a massive blood blister. Those who survive are left with massive scarring. Since the adrenals cannot keep your blood pressure up, and you are losing blood and fluids, we have to put IV fluids in to keep you out of hypovolemic shock. This in turn reduces your blood concentration, lowering your oxygen carrying capacity, which causes your heart to race. So you lay in bed, oozing fluids from everywhere, all while feeling like you just ran a marathon, with bloody diarrhea, oh and did I mention pain? Lots and lots of pain, but you can’t have any pain medicine because your liver and kidneys have failed. This why it pains me when I see this outbreak ONLY has a 50% death rate, when in Africa it is up to 90%…ONLY 50%. That is literally worse than cancer, and people are blowing it off. Imagine if cancer was infectious, and you lived in a country with zero cancer, and someone thought it would be a good idea to fly a few people in. I think there would be a different attitude.
The biggest part of the discussion is how Ebola is spread. I will say two things on the topic, no, it is not airborne, and yes, basic hygiene plays a HUGE factor. But while on the topic of whether it is or is not airborne, the definition of an airborne contagion is one that can freely float in the air, survive lengths of time, and infect someone else. VERY few things fit in this category, most have been eradicated, Small Pox, Tuberculosis, Measles. Things that are also NOT airborne, are the flu and the cold. For the flu, you have to come into direct contact with the patients body fluids. How then, do you explain why people catch it and have no idea how. Well for one, people can spread it before they show symptoms, just like Ebola, and one other HUGE factor…droplets….let that word really sink in. The virus may not be airborne, but the droplets are. I’m going to digress for a second and get back to HIV and Hepatitis, while I let droplets dwell in your mind. Everyone knows that HIV and Hepatitis are spread by blood contact, and sexual fluids, I don’t mean a drop of blood on the skin, or even a mucous membrane, it has to get INSIDE of you. This is why only gloves are required. HIV and Hepatitis are not found in urine, stool (Some forms of hepatitis are, but you have to eat the stool to get infected) saliva, sweat, tears, or mucous. This is where some viruses are different. The flu gets into your mucous and other secretions, Ebola tends to stay in the blood, but remember, every one of your bodily fluids are full of blood now. So a person with the flu sneezes, and now millions of little droplets (remember those guys?) shoot out of their nose at nearly mach 1, all across the room, same for a cough, all it takes is a little microscopic droplet to land in your eye, nose, mouth, or the unlikely scenario of an open wound, and you’ve now been infected, because you came in CONTACT with their bodily fluids. I see the word contact thrown around a lot, but most people think of mass amounts of contact with blood, but what they don’t realize is that contact also includes microscopic mucous and saliva droplets, each one chock full of Ebola. Bacteria can survive for long periods of time without a host because they are their own organism. They can feed on just about anything and be happy. Viruses lifespan without a host is much shorter. Their goal is to infect, replicate, and spread, if they cant replicate, they die. Measles only lives 2 hours. But Ebola, depending on what data you look at, can survive for several days.
So with all this information, lets have some role play, so that you can see exactly what this means, to a nurse, in the real world. Imagine it as a cheesy PSA or lifetime movie. You go to see your doctor because its that time of year, you need some blood drawn and refills of your blood pressure med. You sit patiently in the waiting room, thumbing a magazine while your 2-year-old plays with her toys. Like all two year olds, she touches everything, and everything goes in her mouth, toys, pens, her own fingers. She is a 22 lb drool factory and you love her to pieces. You see the doctor, get your goodies, and go home. A week later your angel starts vomiting blood and within 3 days she dies because her heart raced so fast it finally gave up while trying to maintain a blood pressure. Her eyes are blood red and demonic, her skin falls off in sheets. What you don’t know is that 3 days before your visit, someone thought they had the flu. It is October you see and they sneezed while thumbing through that very same magazine you thumbed through. The same thumb you grabbed her pacifier out of your purse with in the waiting room. The people caring for Ebola patients wear space suits, and burn the bodies, yet it still spreads. Here in America, we have much better protocols, and much better hygiene. So if it spreads, it will be contained much better. Still, it spreads prior to symptoms and survives will outside the body, just like the flu. Despite vaccines and good hand washing, thousands still get the flu every year. But while the flu kills 1-2% of its victims, Ebola kills 50% on a good day, and spreads the same way. So please, do not write it off as hype. It is a real thing and it is here.
The case in Dallas has been confirmed. The patient had contact with five children and adolescents prior to admission. Those five kids attend four of the largest schools in Dallas. One sneeze and we could already have thousands of people, who don’t know it yet, infected.
Thank you for reading. Please feel free to comment.
Symptoms* I have had a lot of comments in regards to this. I picked my words carefully, but I never imagined getting thousands of views an hour, or my article getting picked apart, but I will try to elaborate now. I said spread, the virus, I did not say you were contagious. What I meant by this, was the summation of two concepts. To fully explain everything I could write a book, but this is meant to be short and sweet. The first concept is that of a fomite. We have established that the virus can survive for an unspecified amount of time outside the host, and we have established that sneezing/coughing is a perfectly logical method of transmission. So if patient A is infectious/contagious, they sneeze on patient B, but then patient B goes home and picks up their sisters 1 6 month old, who rubs his face, and licks all over your shoulder, he could very well have just orally consumed large quantities of the virus, therefore become patient C. Patient B never got sick, the virus never entered their system, yet they are responsible for spreading the virus to someone else. This is why the 5 exposed kids are so important, there may only be a 2% chance or whatever that they’ll get sick, but if they went to school, and each rubbed up against 500 kids in the hallways, you now have 2500 exposed kids, 50 of which will statistically become infected, 25 of which will probably die. No I do not have a source for the 2%, that is just an EXAMPLE number used to represent the relatively low likelihood of contracting the virus if exposed, granted the R0 factor of R2 is correct. Remember, heal the patient, PROTECT the community. The second concept of this is defining “symptom”. Lets assume it means anything other than your baseline condition. That means the first signs of being contagious, are also the more mild symptoms, sneezy, achy, nausea, flu-like symptoms. So who is going to wake up, feel a little under the weather, and think, crap, I have Ebola, better get quarantined, no, THAT’S how you start fear mongering and mass panic. Again, flu season is upon us, the initial stages of Ebola are like the flu, and its human nature to be in denial, so many people, if infected, would hope its just the flu and wait it out, they are not showing symptoms indicative of Ebola, but they ARE symptomatic of something, and therefore, by the CDC definition, would be contagious. Its also normal procedure for people to be symptomatic BEFORE seeking medical care, so technically, everyone will be contagious, BEFORE knowing they have Ebola. But like I said before, I omitted this lengthy explanation because I didn’t feel it was necessary for the point of the article.
ADDENDUM: Sadly, I feel the need to point out that the title of this blog is “Ebola, A Nurse’s Perspective”, not “A Nurse’s Guide to Surviving the Apocalypse”, or “How to Become an Ebola Expert in 15 minutes”. It could just as well be “Hamburgers, A Chef’s Perspective” and no one would be hounding me over grammar, a misplaced comma, or wanting citations as to why I say it should be on the grill 5 minutes per side of 7 minutes per side. The point is those things are irrelevant to the goal of the article, this is MY perspective (a particular attitude toward or way of regarding something; a point of view.) I don’t have to prove anything, the point of my article is to take what the uneducated (in a medical sense) journalists say, what the talking heads on TV say, and then let you know what the people say who are on the front lines. That’s like discrediting your grandads account of what happened when he stormed Normandy beach, because its not what your history teacher told you. Have I experienced Ebola first hand? Nope, have I experienced a WHOLE lot of other things that the majority of the population has not? You bet your ass I have, and I felt the need to take the time to hopefully help other people out a little. So please keep that in mind, I’m not perfect, but my experiences are my experiences, and I wanted to share them with you, to let you inside the head of a nurse for a minute.
dtolar 
Why can’t the CDC stop saying this is not transmissible prior to symptoms?? I am so angry about that misinformation!!! Have you shared this with them? Do they care? I realize we don’t want mass panic but geez we want people to stay the hell home if they were in contact with infected people EVEN IF THE CONTACT WAS PRIOR TO SYMPTOMS!!!! I am also a nurse. It doesn’t seem like rocket science to me…..but then again if education worked….a lot of things would be eradicated.
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I can answer that question for you, the thing is that it might be transmissible prior to symptoms, but the likelihood of someone getting infected in that stage is low. The reason why is because viruses and bacteria are in the replication stage. They are replicating because they need a “quota” or a specific number of virions/bacterial cells in order to begin the attack to the body. For example Salmonella typhi needs about 15 cells to create an infection.Some pathogens are “rogue” which means they don’t need that many cells or copies to cause infection, others need more. Back to Ebola, the thing is that when an infected Ebola patient is not showing symptoms the amount of virions in the body fluids like saliva, sweat and or aerosol particles “solid particles suspended in air” is very low and the chance of the virus infecting a new host is very low. The transmission rate increases and the infection level increase as well. In other words if the infected patient is on day 1 or day 3 of infection, the likelihood of infecting other is probably less than 5%. Hope this is educational.
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I appreciate your article, I just want to mention 1 (major) error. Humans are NOT contagious until they show symptoms. http://www.who.int/mediacentre/factsheets/fs103/en/
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Yes they are, just not casually touching their body fluids. Read it again closely.
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No they aren’t, there isn’t enough virus in the body for a non symptomatic patient to be contagious. Fact
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You suck for this.
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To my fellow nurse. I have been trying to tell people since the media first posted the mere word EBOLA several months back that this was going to b here. It is coming fast. We are no where near prepared. Millions will become affected in these next few months. Trust me…. alot more are affected here in the US than the 3 that r now tested positive. These are only the beginning. It scares me to know that 2 of the 3 are NURSES! This is a tell tell sign of how UNPREPARED we really are. I thank you for this article. I pray for my 4 kids. I pray for our country. The bible says we will b destroyed from within. Im afraid this is the beginning of the worse epidemic since AIDS. I hope people treat this article with the respect it deserves.
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I have been a lab tech for 7 years. I just wanted to say I think you did a damn good job on this article. I am sorry so many people feel more compelled to dissect your article than to pay attention to the underlying message. There are a lot of ignorant people out there. I’m flab someone is trying to make the less educated individuals more aware of how spreading/contracting happens in the real world. Just wanted to leave you a word of encouragement, and thank you for taking the time to share your thoughts. Outstanding article!
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I thing you are correct
We are my prepared and this is the coming of the next plague
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Thank you for the info and your willingness to share. Much appreciated!! I most appreciate putting things in LAYMAN’S terms!!!!!! 🙂
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Thank you for sharing. As both a nurse and histology tech I have been having many MANY similar conversations of late re: Ebola. As a human nation we need to understand the mechanism of the disease and have compassion for the victim while protecting the community. Well stated and thought provoking article .
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Thank you for sharing your perspective – it actually helps my understanding of how this virus works.
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Thank you for posting this. I feel you have provided a much better education than anything I’ve heard in the news media. I am grateful to you because before I was minimizing what was going on. It seemed to be only a few people and a distance away, but now I am starting to understand the seriousness and the levity with which this situation needs to be regarded. Once again thank you.
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They should have never been brought to the us in the first place in the US knowing we were not prepared to deal with this now were all going to be sickened with this.and know cure they should have done a little more research on this before bringing them here
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Thank you.Very informative.
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I am a nurse as well and we are in fact contagious even BEFORE signs and symptoms, it’s called the incubation period. I fear that this is only the beginning to a major outbreak..
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Well written. Thanks for taking the time to explain things from your perspective. Don’t worry about the negative comments..there will always be a few who feel their job is to get out the red pen like your English teacher from middle school! I believe your perspective is “spot on”!
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Thank you
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From a nursing instructor’s perspective, that was an awesome article. I plan to have my students read this as an entry into medical asepsis and disease transmission. Ebola is on out minds daily because I can think of so many ways we are not prepared to care for the sick in an isolation that is 100% effective.
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Thank you. Having been a Veterinary Assistant and Manager I picture the symptoms of Parvo when thinking of what the infected go through. I have had this same conversation several times over the past few days. Hopefully, God and the universe will show mercy.
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Thank you for writing this! I was very eye opening and helped me better understand the virus and how it is spread. This is a very real thing and more people need to be educated so they can better protect themselves and their loved ones.
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Keep the info coming! Nurses are waking up to this deception.
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Well written for both the layperson & the healthcare professional. I am a nurse as well & absolutely loved your insightful, outstanding article! Kudos to you!!
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As a respiratory therapist for over 38 years…I listen…but draw my own conclusions….I too have seen and dealt with a lot….I would also heed the warning as us in healthcare know that everyone responds differently….to disease …treatment…etc
We as also know that people can harbor viruses and be hosts and never get sick…but pass on diseases….so…don’t be nieve….protect yourself…..ppe and good handwashing!!!!!
It’s working with nurses like you and seeing pts get better..the reason.why I’m still working!!!!! Love us girl
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is there anything like bleach and Clorox wipes that can help As a teacher I am wondering how to help with prevention in any way?
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Thank you ! You did amazing job!
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Very well written. Thank you for educating everyone. As an RN, I too am very, very concerned and scared of what this means.
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Wonderfully done. Thank you.
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Thank you Nurse! Screw the nasty comments from others. I enjoyed your article, especially the way you explain it in a non-medical way to those of us that are not nurses. Definitely a hot topic that won’t be going anywhere for a while, unfortunately!
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Nice job!! As a fellow nurse, watching the news about what happened in Texas frankly scares the hell out of me. Nurses being blamed for “breaches of protocol” infuriates me and just shows how ignorant people are about the seriousness of this outbreak. Instead of playing the blame game and lets focus on education, treatment and prevention!!! It’s gonna get worse before it gets better, I’m afraid
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Marry me!
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Thank you so much for your post
Ignore the ignorant
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Thank you for the article, so what what your saying is it does spread just like the common flu? Kind of makes it hard not to just run down the streets packing the basement and never leaving the house again…
It is helpful to have a nurses perspective to things … I personally feel nurses give it to you straight … they know what they’re talking about … sometimes i’d take a nurses advice over a doctor … Great Job! Thank you … scares the hell out of me though …
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No it doesn’t. Flu becomes airborne in cold dry air. Ebola is most easily spread through contact with infected blood. Completely different. Flu is highly contagious, not the same for ebola.
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Well Jason, why dont you trot on over to Liberia and give them a hand since you are such an authority?
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What an awesome article! This is well said and very informative.
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This was a very informative piece! Thanks for taking the time to write it! I live in Canada and I know and have known for a long time now that this disease will make it here as well. They still allow people from the countries that are infected to fly over to our cities. Maybe if they would stop that it wouldn’t come here, but the government is too stupid to do that!!!
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Thank you for this. It’s comforting that somebody has taken time out of their day to finally explain the ends and outs of this virus.
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thank you for the information it has really helped put things into perspective for a business professional like myself who is ignorant when it comes to the medical field. Great information that makes it easier to understand this virus and what it is/capable of. Again, thank you!
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Thank you… your comments where very educational. I have learned a lot and hope I can be somewhat prepared. Thoe never fully as people just won’t face facts…
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I am a nurse as well, and have tried explaining the same thing. Unfortunately, the media’s explanations are very misleading, especially with the technical use of the term “airborne”. Hopefully your article will educate people to realities of the situation.
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You did a wonderful job on this.Thank You.
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This mess is very scary and with a daughter as a hospitalist and a mommy of an 18 month daughter, I’m scared. Very scared. This article truly helped me understand this horror now released on the US and now those in the medical fields. God protect you and the community andyour loved ones. And thank you for caring enough to write this Blessings
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As a nurse in WV. I have been reading everythimg I can get my hands on. Your article was very well thought out and written so that the information was easily understood by anyone who reads it. I just hope Washington DC reads understands and comes up with a plan to try and contain it. So far it is like they are in denial and trivializing it. God have mercy on our great nation! I for one am worried about my family and my community.
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As a mom, thank you for sharing this! Its hard to find time to research EVERYTHING you hear about to protect your kids from, so thank you so so much for breaking it down and sharing! I really appreciate it!!
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It is an awakening that we, weather you are in medical or non-medical field, should take an extra care and precautions to protect ourselves and our family. I believe that we can stop it by stopping the spread of infection. And this article gave us a lot of information on how to do so.. To the author, thanks for this article. It scares me but then help me prepare.
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Excellent article. Thank you for writing. I will share.
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I too, am a nurse and I have been sitting on the sidelines watching, listening, wondering where this is all going. I would first like to mention, if you patiently read this article below, you will be better informed!!!! What I would like to express is that nurses are intelligently “quick” to catch a big message!!! Especially when involving the security of our safety as a whole. Such as “INADEQUATE INFORMATION GIVEN BY GOVERNMENT OFFICIALS AND THE CDC”, that raised everyone’s eyebrows!!! When nurses provide care to patients, they depend upon the facility to provide adequate protection (gloves, gowns, mask, hat, face shield) against diseases as well as up-to-date education.
Hospitals are for “public health” issues. As soon as the mention of “Ebola in America”, occurred, the United States should’ve been placed on high alert.
So, sit back and learn, from one of our own “A Nurse” who is for the people, to protect the people!!
Unlike our government officials.
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I’m a single parent with two kids and I’m very scare for them I don’t think I can protected them the way I really wanted to because they of to go to school all I can do is pray and do my best.thank u for ur eye opener article
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Thank you fellow nurse for taking the time to enlighten things for the masses! I too am a nurse and I absolutely share in your perspective!! We need to stay strong and voice our concerns loud and clear in our hospitals across the nation! Let the frontlines speak up now since the authorities do not seem to be grasping the magnitude of this problem.
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Last comment I copied after posting on my facebook page.
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Thank you for breaking it down where anyone can understand… myself i work with the public everyday and honestly im scared… then seeing on the news this morning that a second nurse is sick should really make people realize this has the potential to be really bad…
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Wonderful article. Thank you for getting this important information out there. Appreciate it so much. God be with all you health professionals fighting in the front lines. God bless American.
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Thank you for sharing your perspective and knowledge. I will share to help raise awarness. Forget the naysayers. You can’t fix stupid.
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