Ebola, A Nurse’s Perspective

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.

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2,088 thoughts on “Ebola, A Nurse’s Perspective

  1. Amy says:

    Hi, Julie! I’d be happy to provide info on toxic hep; however, this piece isn’t about hep. There is a general lack of understanding about that word and what it means in relation to the communicable A, B, C viruses, even within the medical community. My cognisence was borne from my diagnosis; fortunately my degree is in public health education, otherwise, I’d not have had the foundational knowledge of disease to sift through everything out there and determine which pieces were legit.
    Which speaks to your (bizarrely aggressive) post, Bill. I am NOT an ebola expert, so I can’t educate the masses, nor do I feel equipped to critique this piece. My point is, because I know the hep assertion is incorrect and presented as fact, I can’t accept the Ebola info as accurate. That’s not operating sans common sense; that’s display rational research skills. I don’t recall saying that I require officials to feed me information before I believe it. I don’t. I would encourage you; however, not to take every person’s blog as fact simply because s/he is NOT part of the government machine. If part of an educational piece is confirmed as incomplete or inaccurate, the whole should be questioned, regardless of authorship. THAT is common sense.

    Liked by 1 person

    1. yeti75 says:

      I think that if you read the first few sentences, you’ll say what you did in your whole comment. You’re just another person hung up on their perceived “knowledge,” as opposed to saying, “Yes. There is some good information here. Maybe I should do my due diligence here and study up on it.” Arrogance never got anybody anywhere.

      Liked by 1 person

      1. Amy says:

        I’m not sure I understand your comment, and I’m not sure how mine could be perceived as arrogant… I’m also not sure your comment was even directed at me, though, because you’re making the same point I am – no one should accept anything as fact or truth – from the media or this blog – without doing their own due diligence.

        Like

    2. Bill Wolf says:

      Fair enough…but then why waste your time commenting and picking apart a blog you admit you didn’t even finish reading? It isn’t gospel truth, nor was it presented in such a manner. I’m sure if we read everything you have written it, we could easily discredit on semantic errors as well…

      Liked by 1 person

  2. Charity says:

    (I want to remind people I am not trying to pick her apart..I just want answers to my questions. I have a family of my own and I am scared of this virus spreading…so here are some of my questions..) if it is as contagious as the article states its like a cold…why didn’t the 48 people Duncan was in contact with get it? Especially when he was set home with clear indications he had symptoms? Would he not have exposed these 48 people especially he fiance? Or are they lying and these people dud contract Ebola and they are just not telling us. Again I want answers not pointing fingers. I want my fear to be rational.

    Liked by 1 person

    1. yeti75 says:

      I think that if you read the first few sentences, you’ll say what you did in your whole comment. You’re just another person hung up on their perceived “knowledge,” as opposed to saying, “Yes. There is some good information here. Maybe I should do my due diligence here and study up on it.” Arrogance never got anybody anywhere. I accidentally liked your comment. I wish there was an ‘unlike’ button.

      Like

      1. Charity says:

        I wasn’t attacking her she had very good points and I have been reading up about it. I was just asking the question that is all…why did you have to get so defensive about it? Please, don’t bully or belittle someone wheney have an honest question.

        Like

  3. Amy says:

    And Bill, you’d do well to remember what DTOLAR just posted. This is an opinion/perspective piece. One opinion/perspective. It’s not fact, nor does it claim to be. You and others taking it as the substantiated, secret gospel truth suddenly breaking the surface despite the government’s attempts to stifle it!OMG! was not the author’s intention and is just as dangerous as accepting the media’s assertions at face value.

    Liked by 1 person

  4. Cindy says:

    EXCELLENT JOB!!! Thank you for saying what Obama and CDC won’t say!! Oh and I live in Texas just 3 hours from Dallas and fly out of that airport!! I also teach school and just had a discussion with high school students about sneezes and coughs that contain those droplets and how they land on surfaces etc (no I have not had any medical training…just common sense from a mother of 3) that was their “aw-ha” moment….Wake up America!!!

    Liked by 2 people

  5. Donna says:

    From another nurse’s point of view may I say, some of these possibilities don’t make allowances for personal hygiene. Using one of the senarios if you were wearing a jacket when the droplets hit you and before hugging your nephew you removed that jacket then you just decreased his chances of developing ebola. Hand washing and good hygiene are some of the most important weapons against viruses. Theoretically we should never touch our face without washing our hands first, that includes fingers in the mouth, rubbing eyes, wiping the nose, etc. and yet we do these very things without any thought, hence we spread cold, flu, ebola(?), and lots of other things.

    Liked by 1 person

  6. Doug says:

    Diane …
    back up your dogmatic “hype” proposal with some documented information or leave your hypocrisy inside your head.

    I’m thinking you need a lesson in reading comprehension.

    Thanks for the article and please ignore people like Diane.

    Liked by 1 person

  7. Dana Wilhite says:

    Thank you for your article, I’m having a hard time understanding why your article doesn’t seem like common sense for most of us in the health care field. I wonder why personal pertective equipment was/wasn’t used as though it should have been???

    Like

  8. Brent says:

    Thanks for writing this. A piece like this takes a lot of time and thought to put together. Whether it’s perfectly written or some slight errors here and there is not what we should be talking about. It’s sure helped me to understand a bit better. If you helped even a few people better understand… It’s way more than the aggressive fools who choose to pick apart your efforts have done.

    Like

  9. Chris says:

    Hi Dtolar, interesting article. I’m also a nurse and I had the same opinion of Ebola on Oct 1st, when you wrote this article, than I do now. I have a few theories. They say you’re contagious as soon as you show symptoms, and while this is probably true, I believe you’re still not able to spread it for at least 2 days more (unless you somehow come into direct contact with the pt’s blood at this point). Look at the fact that Thomas Duncan’s wife, child, and first healthcare workers, who had direct contact with him, never exhibited symptoms and now we’re pretty much past the 21 days threshold. To me that indicates that, even if you do have Ebola with initial symptoms (oh and sneezing hasn’t been one of those btw), the viral load in your body isn’t great enough to spread still yet for a few days. Also, Thomas Duncan came into contact with his landlord’s daughter in what sounds to be her last day to live. He showed symptoms 3 days later, I believe. Now look at both nurses, from Texas Health Resources, that contracted it days after HE died…. It appears to be the easiest time to catch it… as is probably the case of a full blown Aids patient on their death bed or of any patient about to die from a virus spread by similar methods (bodily fluids). The viral load is much greater and, with reference to Ebola now, I also believe this to be the time it’s spread through saliva, sweat and tears, not in the early stages. Is it coincidence or could Nina and Amy have contracted it in the first 2 days they weren’t required to wear PPE (when Thomas was finally admitted but still yet undiagnosed)? I think it was in those final days when they were wearing their millions of layers of PPE and unable to take it all off easily and safely. I don’t care how many layers you put on, the gowns we’re given are thin and in no way can they handle the fluids an Ebola pt can throw at it. I think full body suits would have been proper protection the last week or so.

    There’s still much to learn about Ebola but I don’t think it’s as easily spread in the beginning as we think. That could also explain its R0 of 2…

    Liked by 1 person

    1. gratefulgecko says:

      Good comment and I am thinking that is a reasonable speculation, that it’s in the latter stages in which it’s most easily communicable. In terms of symptoms, you did note that sneezing is not one of them, which means his girlfriend living with him wasn’t getting sneezed on, or even thrown up on at that point I don’t think. She’s healthy..and yet the healthcare workers are not. A puzzle, but like you said it may all point to that latter stage.

      Like

  10. TERESA RN says:

    Appreciate your perspective and the clarification of “droplet” vs “airborne”. Several of my nurse colleagues & I have had the same criticisms of the media misuse of the terminology. It’s critical that everyone understands that even though this is being characterized as not “airborne”, it can still be reasonably assumed to spread thru the air via moist droplets that translate to contact (see the clear explanation of “foamites”). The reason that it’s so important? – because it changes the response dramatically (as you described in the worst case scenario). Even before EBOLA I started carrying masks with me when I fly. I can’t count he number of times when someone adjacent to me – front, back, sides – started a wet sounding cough and I considered what organisms are now on the Skymall magazine and translating to the mini pretzels that are moving from my hand to my mouth. It is unconscionable to attempt to quell fear by deliberately misleading thru confusing conceptual words, Even though this particular bug doesn’t fit the strict definition of “airborne” (capable of remaining suspended in minute particles for a long time and moving over long distances), there is an absolute infection control science that says these type organisms can be transmitted in an air-borne-foamite-contact method.

    Liked by 1 person

    1. gratefulgecko says:

      Also, to clarify, the author stated the flu is not airborne, either. But yes, the flu is airborne. So there is a difference. When you read the article it almost makes it seem like there is no difference. Ebola is harder to get (for the general public), but perhaps not for healthcare workers. Still…the virus does scare me, and I have no doubt there will be more cases. There should be no traffic between W. Africa and the US, unless it’s essential. No one fitting Duncan’s description, for example (non-doctor or aid worker) should have been given a visa.

      Like

    2. TERESA RN says:

      Sorry – was not referring to the author when I wrote “It is unconscionable to attempt to quell fear by deliberately misleading thru confusing conceptual words” I really meant the media and the politicians

      Like

  11. gratefulgecko says:

    My first impression of this article is that it is excellent in terms of detail and scope. It gives us a perspective we didn’t have before, and it’s lacking in the media. So I say, good job on that and thank you for writing from a nurse’s view, and also explaining about how viruses function. However, the article slightly muddies the water for me in terms of transmission. It also flips back and forth from HIV, Flu, Ebola too much. Re-reading helped, but not fully. But let me also add that short of a chart, it’s difficult to provide total clarity. I wish someone WOULD do a chart on methods, percentages, viral load in comparable body fluids, etc, but the CDC is not on board with that and the media just wants to cherry pick the most sensational facts.

    My own take on this is that yes, Ebola is more difficult to contract than the flu, but over the years, since the familiar “Hot Zone” type books and movies, the virus has surprised me….it seems to have slightly evolved, and changed from a deadly bleeding-out virus that kills almost instantly and burns out in villages quickly, to something that hangs around, incubates without symptoms, and lasts long enough for a person to casually get on a plane and come across the ocean. That fact is frightening to me, and I’m not an alarmist. HIV used to be just a few cases, too, and it was described as something no straight person could catch, as long as there were no broken blood vessels (anal sex) and your partner wasn’t bisexual or a drug user. Then…everyone started getting the disease. I feel this is somewhat similar, the lack of education and information, lack of CDC involvement, lack of funding to kill it at it’s source, and describing it as something afflicting a small group and not a worry to the general public.

    Make no mistake….this virus is changing, growing, and moving. The math ALONE tells you. It’s an R02. If not stopped in Africa, not scaled back (which would require much more resources), in a year, or two years, it will be millions, not thousands, and it will exist in every nation and at the very least be meddlesome and we’ll have to inoculate against it, like we do with other diseases. They said by December there will be 5 thousand cases a week. That should give you an idea, if you can’t wrap your mind around 2016.

    Like

    1. Amy says:

      Apparently I can’t “like” comments without creating a WordPress account, but I can respond to them. So….”Like.” Superbly written and great questions/food for thought.

      Like

  12. Victoria Rumfield says:

    Thank you for writing this. I’m a pharmacy tech. I always thought it was this serious. And now you have put it into words and confirmed my beliefs. I have to say I am scared. But I’m am hopeful. Me and my family lives in Austin, TX. I really hope and pray it stays out of this area.

    Like

  13. Katie says:

    Thank you for the info. My take away from this was that Ebola spreads BEFORE SYMPTOMS ARE SHOWN which is huge, and scary!! Now the question is what are we going to do about it? Obviously cover cough/sneeze, wash hand, use hand sanitizer etc. Really I think we the people need to be hyperactive in protecting ourselves, washing clothes as soon as we take them off, wearing gloves, spraying lysol in the air and on surfaces when near someone who has coughed/sneezed. Ebola does not sound fun, and the fact that it can live for DAYS w/o a host is terrifying. Maybe I’m just paranoid? I know that I certainty DO NOT want to catch it nor do I want to pass it along. Again thank you, I look forward to reading more from you.

    Like

  14. Velma says:

    This is very sobering. I wonder if there will be anyone left standing a year from now –my question, too is this: Is there anything at all we can do? Feeling very helpless. Praying lots.

    Like

  15. I May says:

    Do you have any thoughts on this: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(00)02405-3/fulltext

    It is my understanding that there are many diseases that manifest symptoms in some but not in others. I wonder if these people could spread Ebola? I have a biology degree, went to vet school for a year and did work in vet medicine for about a decade and have some experience with quarantines/contagious diseases. Reading about contagious diseases, like HIV and polio, is kind of a hobby…I am a nerd.

    Like

  16. David Auts says:

    While this article is well written, we should keep in mind the author is hiding behind a nom de plume with no evidence of actually being a nurse. For all we know they are an English Major with a strong background in biology and is highly skilled at Google searches.

    Like

    1. TERESA says:

      Dear David –
      Whether the author is a nurse or not is irrelevant and does not change the information. Scroll thru the THOUSANDS of validating comments and discussion from members of the healthcare community.

      Like

      1. David Auts says:

        Ah, but it is one of the most important factors. An English Major can write a concise and thorough piece with seeming authority using Google searches. As to the other “authorities” here; the are as likely as not hiding behind a pseudonym as well.

        Like

    2. Amy says:

      Excellent point, but the author isn’t asserting any of this as fact either; some readers are simply choosing to take it as such. S/he even wrote an addendum to the blog to reiterate that it’s an opinion/perspective piece. Those are always valid, provided that people have the common sense to read them as such.

      Like

      1. David Auts says:

        That’s all well and good, except the author is using an appeal to authority by listing their alleged creds. The statement; “I feel the need to point out that the title of this blog is ‘Ebola, A Nurse’s Perspective’,” and is only their opinion does not negate the fact that the “perspective” expressed by this “experienced professional” has the potential to be taken as gospel by Jon and Joan Q. Public. After all “nurse” dtolar claims, “I have worked extensively with Infectious Disease Specialists. I have been exposed to almost every infectious disease known to the modern world.” Opinion or not, this persons “opinion” could well be taken seriously and the author knows it. While a good portion of this “opinion” piece is accurate, there are fundamental points that conflict directly with a good deal of information that has been published by well recognized and highly regarded health professionals.

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  17. kim sink says:

    Great article. Good things to think about. Thanks for trying to inform. You’ve made some people do what they normally would not do – research and try to become better informed.

    Liked by 1 person

  18. Vicky says:

    Oh they understand Granny! Believe me! They get it! They just don’t want the public to panic….which is why they are omitting so very much of the truth and telling outright lies “You can’t catch it like you can the flu” President Obama said….and that is an outright lie. THANK YOU for snatching back the blanket of denial and taking the sugar coating off of the truth!

    Liked by 1 person

  19. Judy Buck says:

    I am also a nurse, worked in infection control for years, RN, MPH. Questions I have: are the bloody, infected bodily fluids going into the sewer sytem (down toilets and hoppers) to treatment plants. Are workers there at risk? Also when I worked in isolation there were tons of paper garbage/ double bagged out (Gowns, gloves, dishes,linens,,etc). What is happening to that? Hospitals used to all have incinerators; now I’m sure it’s transported somewhere else in red bags. Burned? Bags which can be punctured? Is anyone re- looking at this process? Also the cleaning of the rooms after patient leaves. Pressure washing with bleach would be ideal but we know that doesn’t happen and cleaning staff are the lowest paid and often not well trained. Years ago in the 60’s (yes, I’m an OLD nurse) after a patient was in isolation and the room cleaned the room was aired out (with the door shut) for two days. Seems like a good idea now to resume this practice instead of filling a bed rapidly again that may not have been meticulously cleaned. Judy

    Like

  20. Nelsie Bryant says:

    Thank you for your article, it was very informative, shedding some light and knowledge on what have been hidden concerning the ebola virus and how it can be contacted, very informative.

    Like

  21. Just a man name Fred says:

    Population control. Very scary and only time will tell. Thank you for your insight on such a very serious topic. The damage is done. Now it’s time for us all to be more responsive and be more aware of the surroundings. God bless us all.

    Like

  22. jrh1939 says:

    Great piece of work! All things considered, it is interesting that third world countries like Ivory Coast and Belize have the good sense to restrict entry to their countries to those who have not been in Liberia. The U.S. refusal to do the same is an agenda driven political decision instead of one based on reality. For centuries, the answer to an epidemic has been to isolate it at its origin. When did this fail to become good advice?

    Like

    1. David Auts says:

      While what you and others are suggesting seems on its face to be pretty straight forward, it is actually quite complicate. There are no direct flights between the US and Liberia, Guinea, or Sierra Leone.

      Like

  23. saddened says:

    I reas with interest a nurses perspective. I hoped it actually came packed with experience but i am saddened again to see more of the same. I actually have cared for several hundred persons with ebola in west africa. I have no vested interest to promote the CDC agenda because when I was seeing pts their organization thought it was too dangerous to put their “expert responders” in treatment units. Their risk communication is too reassuring and not accurate but at the same time this persons information is far from what we can tell to be true.

    Ebola infectivity increases with symptoms. The sicker someone is the more infectious they are and the more likely someone is to get infected. When they are first symptomatic the major was its spread is through direct contact with blood, feces and urine. Most of us don’t contact such substances from strangers. In healthcare of course we do. So yes if I were a healthcare worker I would be concerned about exposure to someone early in disease but not if I owned a grocery store. All the Ed staff in Dallas who came in to contact with Mr Duncan were not protected before they shamelessly sent him home and none of them contracted the disease. Yes they were lucky and I am not saying put your guard down, but this persons claim of easy spread early in disease is just not the case. Many family members in Africa get infected when their loved one is very sick or due to certain burial traditions (washing body and then pouring water on other family members). Right after death, a dead body is incredibly infectious. That is why burial issues are so important in disease control.

    For healthcare workers family membs the major spreading time is when someone has terrible vomting and huge amounts of diarrhea. Its not like a little GI bug as the nurse stated. The vomiting is frequently projectile and the diarrhea can be similar in amounts to cholera. These people are not going to work, walking the streets, shopping…they are sick as stink. They are agitated and can’t get comfortable but they cannot even get up to drink to stay alive. I again have seen hundreds of patients. I have not read it in textbooks. I have not bought in to the CDC lack of patient experience for this outbreak. Amongst me and colleagues we have collectively seen approx 1000 pts ourselves. We have all seen the same thing.

    Ebola is very scary. Of course. Going in to the treatment units gives you pause. We had numerous very sick patients who could easily spread it to us had we followed the CDC guidance.

    The take home message is you can contract Ebola from someone who is symptomatic. Still this is only if you have direct exposure to highly contaminated body fluids (blood likely to worst followed by stool, urine). Nearly impossible when they have no symptoms…perhaps a blood transfusion which will set off another issue since Ebola test is frequently negative during asymptomatic phase so how do you protect blood supply. I think that’s a real issue, rather than what was laid out above. Ebola is very transmissible when someone is really sick but they are too sick to be hanging out in public. So casual contact with those folks can transmit disease but they are around close friends and family as caregivers or healthcare workers. Recently deceased persons who died from Ebola are also very infectious.

    Let’s keep the conversation steeped in fact and experience…and I am talking real experience.

    Like

    1. rn says:

      Very well stated. I am also a nurse, have had no first hand experience with ebola, but I value and respect the experience you’ve had first hand. You have further solidified my thoughts regarding transmission. It is certainly not as easily spread as the flu.

      Like

  24. Terance Healy says:

    Consider an Ebola Czar… An attorney required by Attorney-Client Privilege to maintain confidentiality for his clients. Now, why do you suppose they selected an attorney over a doctor for the position?

    As I indicated to the American Bar Association in August 2013.
    “I know what you have done. I am coming for my Constitutional Rights.” – Terance Healy

    The AMERICAN BAR ASSOCIATION has beheaded Liberty and shit down her throat for the last 30 years.

    http://work2bdone.com/live/2014/10/let-no-man-be-ashamed-to-speak-what-he-is-not-ashamed-to-think/

    Like

  25. eddie welsh says:

    I am also an RN, and wanted to thank you for your thoughts/experiences you shared here. Regardless, this is a deadly virus, and we should respect its power. ..

    Like

  26. Christina says:

    Hi I am a nurse of 20 years and specialize in ER, with a side interest in infectious and rare diseases, we used to play the game of find the most rare disease for a patients symptoms we called it looking for zebras. I have followed Ebola since1994 and it is a disease that has always given me a knot in my stomach thinking about what would happen when it spreads. Notice I don’t say If.
    I really enjoyed your writing and found it to be a good mix of knowledge and use of terms that a lay person could understand. I enjoyed how you used examples to explain how it can spread and the seriousness of it. I have been trying to educate friends and family about Ebola and I hope you don’t mind if I use some of your examples. Well done and thank you

    Liked by 1 person

  27. Sally Steadman says:

    Thank you for such an informative article. I am also a nurse and have concerns with the contagious issues in the hospital settings. I do not think that we are prepared at the community hospital levels for this type of disease process. Everything from the right isolation equipment to the actual air flow in the rooms of our patients. Do we need negative flow isolation? Do we need ante rooms for dressing in isolation garb? Most hospitals do not have those options and I for one am not anxious to be a nurse treating an Ebola patient in a room with a portable Hepa Filter machine. We in health care do seem to be at the top of the “food chain” to contract this virus. It is scary indeed.

    Like

  28. Cheryl says:

    I am not in the medical field, but many things you have written, I have thought myself. There are so many different hygiene habits within different cultures.

    I used to work at a company that employed a diverse international workforce. There was a particular group that would go into the restrooms and blow their nose into the sink, while holding alternate nostrils shut with the other hand. They never washed their hands or rinsed out the sinks.

    That is bodily fluids left on the surfaces other employees use. Even after the company nurse talked with them about hygiene, they continued to do it.

    Just that bad habit could become a nightmare if the virus lives that long. Never mind how many other different hygiene habits involving what ever body parts!

    Like

  29. Tina McDonald says:

    And as an added point, the virus can live on surfaces for up to six days. If people don’t understand what that means, they might want to take a “Blacklight” flashlight and look at toilet handles, door handles, etc. That lovely glow is from bodily fluids, folks. Now imagine trying to trace where every patient went to the bathroom or where they touched a doorknob. And from a patient who has a compromised immune system and keeps getting drug resistant superbugs from visits to the doc or the hospital, I’d like to plead with people in the medical field. Please, don’t touch that privacy curtain after you glove up and then try to touch me. 26% of them have MRSA on them, 44% have VRE. And if nothing else, hopefully this new (for the USA) will make medical workers (who I really DO appreciate) a bit more aware of when you are touching your face, or touching contaminated “things” and then touching a patient. Those hospital precautions, even the isolation precautions, are actually geared toward protecting you from pathogens, not protecting patients FROM pathogens that you carry.

    Like

  30. Joanne Dudley says:

    Thank you for the information. I have headed some of this in pieces at an informational meeting at the local hospital with a member of the CDC but it was watered down some. You know the Des wanted to say more but did not want to cause panic. This explained a lot. Thanks.

    Like

  31. Sue H says:

    Thank you so much for telling all of the truth and not just saying “Don’t worry”. I think that people need to know how to really protect themselves. This is what I have been trying to tell people, but you explain it much better than I could. (From a long time nurse)

    Like

  32. Dale says:

    With all due respect N U R S E, you self stated that you will not pretend that you are disease expert, but that is EXACTLY what you come across. The topic is Ebola, and yet you shifted your attention on everything else, including HIV far more than on the main topic!

    You did not focus on main interest of topic, which is: how does one transmit and what are indicatives to a person or NURSES that they should NOT board COMMERCIAL AIRLINERS or CRUISER SHIPS?!

    Your colleagues were directly involved in care of infected person. Protocols were according to CDC and hospital administration in place, and YET 3 nurses so far got infected as THERE WAS BREACH IN PROTOCOL!

    Nurses DID NOT adhere to 21 days of incubation period and yet placed countless people in jeopardy as they they boarded commercial airliner and cruise ship!

    If I need questions answered I will not be seeking your opinion, but solely one of the expert!

    What strikes me is the major contradiction with CDC, which is disease could be passed even when no symptoms are showing as it takes time for exposed or person that contracted it showing symptoms, which specified period is 2-21 days!

    Ebola is serious disease and it was poorly managed by US CDC authorities. EVERYONE should had been quarantined during incubation period for 21 days! Including nurses, patients, paramedics, CBP in contact, PEOPLE IN AIRPORT! Everybody, and HAVE MILITARY OVERSEE IMPLEMENTATION!

    What makes me angry is that nurses such as yourselves THINK that your experience of a REGISTERED NURSE makes you experienced enough in a critical outbreak and you have oudacity pretending to be an expert!

    Time is NOT for nurses to offer medical opinion as you are not REGISTERED MEDICAL DOCTOR or specializing UNDER CENTER FOR DISEASE CONTROL!

    That mindset that you have displayed and have arrogantly shown gives a slight perspective why those THREE NURSES from DALLAS hospital were confident that self monitoring is sufficient and that they should not be monitored during INCUBATION PERIOD!

    Incubation period means possible risk of developping symptoms is existent therefore ISOLATION in controlled medical suroundings is the only efficient method out there to minimize and try eliminate risk of transmission, NOT boarding commercial airliners and cruise ships, while SELF NONITORING!!!!!

    Time is NOT for nurses’ perspective, TIME IS FOR DOCTORS AND SPECIALISTS IN EBOLA, and SPECIALISTS IN CONTROLLING AND CONTAINING THE OUTBREAK!

    Enough of BS!

    Because of 1 idiot who lied on questionaire and that way placed in danger, as he knowingly was in close and immediate contact with pregnant woman who had Ebola, countless people were placed in risk, and Mr. Barack Housein Obama, feels that closing borders is not the good option, as people would be keen to lie about whereabouts and symptoms?!

    Duncan case clearly shows that regardless whether borders are open or closed risk of having people infected in source countries are high!

    By closing the borders from source countries by entire international communities we stand a chance of better controlling the outbreak!

    Congress needs to make a decision that is in favour of American people and international communuties, which have as of YET not been affected by the disease!

    Shut the border, locate possibly affected, bring them into isolation for a month, whilst monitoring and caring for them and STOP the spread!

    Like

    1. dtolar says:

      What you do no realise, is that I wrote this 18 days ago, before anyone else was sick, and as a nurse I literally could not imagine healthcare workers being so negligent with their actions.

      Like

    2. Bill Wolf says:

      In all fairness to those infected nurses, they were following protocol and advice sent forth presumably by experts on Ebola at the CDC. The problem is that these are administrators…the real experts in in west Africa where the outbreak is festering. And at least one is highly critical of the poor advice his bosses disseminated. These so-called experts are no more informative than common sense lay people.

      The CDC did not recommend full encapsulation like they follow, they didn’t quarantine or sequester the medical people, and they didn’t restrict allegedly low risk carriers from travelling. The “experts” at the CDC have admitted to these errors…so exactly which “experts” should we be listening to exactly?

      Like

  33. Dale says:

    One more thing, if we take approach by relying on honesty of people, we are in serious trouble! When people are infected, or exposed, very few would do the right thing, as the most people by nature ARE SELFISH!

    People realize that being in such poorly developped countries they don’t stand a chance for survival! Then, common sense would dictate that under such circumstances, THEY WOULD LIE, as THEY DON’T WANT TO DIE!

    That is exactly how Duncan felt! That is why he lied and completely disregarded well being of everybody else!

    Now, it would be much better closing borders by everyone from international conmunities, then nobody leaves source countries unless under strict and ABSOLUTELY CONTOLLED QUARANINE FORCat least 1 MONTH, provide financial and medical supplies to the source countries and volonteer doctors take care of those exposed and infected!

    SHUT THE BORDERS NOW and protect innocent civilians in North America and abroad by sealing borders shut and containing spread of Ebola!

    Like

    1. David Auts says:

      Banning passenger flights from source countries would be extremely complicated and expensive as there are no direct flights from the source countries. Who would pay for and manage the required infrastructure and complex multi-national bureaucracy?

      Like

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