Ebola, A Nurse’s Perspective

Posted on by dtolar Posted in HealthTagged , ,

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.

2,089 thoughts on “Ebola, A Nurse’s Perspective”

  3. M Miller's avatar
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    M Miller says:

    Thanks so much for the information. I am a news junkie, but finally got a thorough explanation. I have written my Congressmen about shutting down these insane flights and get a canned answer. SO frustrating. Guess someone in Washington DC has to be infected before any action is taken allowing people from the infected areas come to our Country.

    Liked by 1 person

  5. Marcia Roberts Mikels's avatar
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    Marcia Roberts Mikels says:

    I have a sister who is a school nurse outside of Dallas and one who is a teacher outside of Dallas. I love them very much and worry and pray for them daily as well as their families. I pray that the government will come up with a good solution and protocol to keep people safe. In the meantime, it is important for everyone to take any illness seriously and to be smart about possible exposures. Thank you for your article although it definitely scares the crap out of me!

    Liked by 1 person

  9. Dorene Randall's avatar
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    Dorene Randall says:

    OMG I cannot believe what is this country thinking? Why aren’t these people being told that they must stay in quarantine in Africa in some isolation unit for 21 days to make sure they don’t have any symptoms? Why would you knowingly take the chance of spreading this when you KNOW how terrible it is!!!! My God, if I move to Hawaii, California, Florida or Arizona, I have to have my dogs in quarantine because it is an agricultural state. Why then would you allow humans to enter back into their country effecting everyone along the way? Why is this so difficult? It could have all been avoided and now this country is in chaos and every hospital is preparing for it! It should not even be here if the proper measures were taken in the first place! Keep anyone that travelled to Africa in that country in quarantine and isolation and watch for their symptoms. When and if they clear than they are allowed to travel. Simple. By the way, what are other countries doing? Are they allowing their people to return? Or are they too, coming here. This government just does not know how to think!

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  10. Pingback: 2nd nurse with Ebola flew to Cleveland Ohio!
  11. Melissa's avatar
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    Melissa says:

    You are absolutely correct. The public has NO idea what Ebola looks like, if they did they would want Washington to take stricter measures. Thanks so much for taking your time to inform us. And I am betting your ass and mine that there are many that feel the same way as I do GRATEFUL.

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  15. Jolene Rhodes's avatar
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    Jolene Rhodes says:

    I think your attempt to explain the concepts in simplistic terms was fantastic. I too am a nurse and am disappointed to say the least that the media and our government is acting as if this is not as big of a deal as it is. Seattle area has opened the doors to Ebola patients as well, not to be
    out done by other areas that are heroic in their efforts. It is interesting to me that the
    hospital that volunteered to potentially put another area
    at risk is a state run hospital.
    This is a chronically under
    staffed hospital that people
    who are low income are
    often routed to or high level
    trauma patients. Not a good mix. In addition our training has amounted to an email at the hospital I work at. If people really don’t think this is going to spread here in the United States , they are truly ignorant to the way things really work.

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  16. Jane's avatar
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    Jane says:

    I am constantly sharing your page, very informative and honest. Nice to hear the hard truth rather then the watered down version the CDC and our GOV is giving us thank you!

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  17. Bree's avatar
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    Bree says:

    Another thing to keep in mind is that many people in Africa do not trust their government and are not organized, so they do not trust the people showing up in hazmat suits claiming they are there to help. The people do not know if they are being poisoned or understand what is going on. This is causing them to not report a lot of the cases and they hide their dead so they are not quarantined. This is a major cause that this epidemic is taking so long to control.

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  22. April's avatar
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    April says:

    I am also an RN & teach infection control….I loved this blog. The non-medical and hell even some of the medical community could stand to take a little time and read this well written perspective on this NASTY virus. What concerns me most is the people that are NOT concerned. Great read !

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  24. lisbetta's avatar
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    lisbetta says:

    I am a medical worker. I completely understand that people don’t want to think about how horrible this is but putting our heads in the sand will not make it go away. I am way freaked out about the situation. I can’t believe they’re trying to blame the nurses for contracting this disease. I guarantee they washed their hands and sanitized a million times. I think you did a great job of giving people a reality check. 0.5 in 100,000 people who are infected with flu die of flu. They keep changing it but as of right now about 70,000 out of 100,000 people infected with Ebola die of Ebola. Anyone who doesn’t take that pretty damn seriously is either stupid or crazy.

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  25. Hallie's avatar
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    Hallie says:

    Thanks for writing this it was so informative I am so thankful. I was wondering if say my husband gets sneezed on at work would coming home and taking a hot shower and laundering his clothes disinfect him of passing any possible Ebola contagion on to our children?

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  26. B West's avatar
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    B West says:

    Good artical. Most of our gov. Can’t figre ouf how to speake the truth, what make anyond think they will think of the mm people. You have probably done more for this country, withthis artical than anyone. Thank you.

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  27. Harvey's avatar
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    Harvey says:

    This is so SAD I have 3 kids in school and a 3 year old at home. My 2 step sons are suppose to fly to Texas in December I don’t know this will be a good idea. Our government have lost their minds wait until someone in their families get it they shut it all down. We all need to pray to God because he is the only one at this point can stop it. We have to put it in his hands. God I pray you open our governments eyes.
    Thank you for this email

    Like

  28. Alan G's avatar
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    Alan G says:

    I am also a healthcare worker .. thank you for explaining to the outside public about ebola…Personally I think the 21 days ‘contagious’ period is a misconception…could be much sooner ??!! Also droplet infection (as explained) could be a factor, though it has not been proved in the 45 odd years that ebola has been around in W-Africa.
    Watch the movie ‘Outbreak’ , -1995- , about an ebola-like virus spreading in the USA, and how farcical the goverment try to stop it ….. Happy Halloween !

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  29. Angel's avatar
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    Angel says:

    Thank you for the info! I am a STNA since 2000 and I have been telling my family some of the info you have here and they are blowing it off ,saying there is nothing we can do so why worry ! This Ebola is some scary stuff 😦

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  30. Becky C's avatar
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    Becky C says:

    Thank you for the info. Helping keep the public aware of these things is always a good idea. Hope you get no more negative feedback.

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  31. k bosman's avatar
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    k bosman says:

    Thank you so much for describing symptoms and what actually happens when you contract the ebola virus…the news is bland and you made it simple enough for anyone to understand!

    Like

  32. Carolina's avatar
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    Carolina says:

    Well written. While my heart is with the health care workers that have the disease and my prayers go to all that are now helping. I do think this calls for action and action begins with our own behaviors. Stop the spread of infection and take a pledge to basic hyegene. http://Www.korazona.Com my blog is much shorter.. 😉 but take action

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  33. kelly's avatar
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    kelly says:

    Firstly, thank u for being a nurse and your article,
    Second, I agree w/what Doreen Randall commented, and
    Third, could this be transmitted by mosquitos in your opinion?

    Like

    1. dtolar's avatar
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      dtolar says:

      If a mosquito moved from person to person fast enough, it could, but they clean their “needle” between feedings, so a lot of things don’t survive. I havent seen thee studies myself, but I heard its been attempted but not successful.

      Like

  34. Stacey Crawford's avatar
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    Stacey Crawford says:

    This was very well written with a laugh or two…Thank You so much for breaking it down for the people who don’t understand how this spreads..This is a very scary situation and i honestly believe its far from over…its only the beginning of a horrible disaster…Did i leave out any comments or misspell any words ? 🙂

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  35. Debby's avatar
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    Debby says:

    Wonderfully written! I appreciate you telling the truth about this awful virus and most importantly, how it is spread. Will share on Facebook here in Cincinnati area. You did an awesome deed by writing about Ebola! Thanks for being concerned for others!! God bless you and stay healthy!!!

    Like

  38. beckey neal's avatar
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    beckey neal says:

    Thank you for a perfect explanation. I am a nurse, too, and I agree with everything you are saying. Those droplets are the culprit I fear in this entire scenario, not the touching of one tiny piece of skin.

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    1. Anita's avatar
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      Anita says:

      I think you should be concerned by touching the skin of an infected patient, especially if feces or other fluids had been smeared on the skin and improperly washed off.

      Like

  44. magarland's avatar
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    magarland says:

    I liked the comparison with the flu.1918 there was a flu epidemic that ran rampant through the US and Europe. It was not as worse as the Ebola but it quickly spread

    Like

  45. DLT's avatar
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    DLT says:

    Thank you for taking the time to share this information. I found it very educational. I’m currently in school to become a nurse and I really had a fear of the unknown (regarding Ebola) but this article definitely put some of the questions to rest for me. I appreciate your efforts of trying to share your experience and education with us.

    Like

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  48. Dawn Davis's avatar
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    Dawn Davis says:

    I am a Emergency Room Physician Assistant in NYC and I see patients who literally get off the plane and come straight to the ER and this article has definitely opened my eyes to be extra vigilant with who walks in our ER. I was already concerned about our unsuspecting exposure but my philosophy now is that every is a suspect until proven otherwise because I have two small kids at home that I would like to keep healthy. Thank you for this article.

    Like

  49. Reelmomof4's avatar
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    Reelmomof4 says:

    Great article, well thought out, easily understood, and who cares if there’s a misspelled word? Funny how they took the time to read the “silly” article… Thank you!

    Like

  50. Maria's avatar
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    Maria says:

    I pose my concerns here as I work at one of the 5 airports that will begin taking temperatures of arriving passengers. What can we employees do to protect us from Ebola? we are very concerned when meeting international flights? We feel this beinf taken very lightly by CDC and airlines. People put their passports and boarding passes in their mouths then hand it to us. Those are the thing we see but we are concerned of the things we don’t see. Thank you for your insight.

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