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    Posted October 8, 2014 by
    Albany, New York
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    Ebola: An ER Nurse's Perspective


    10/17/2014 Update:


    As of today with 2 nurses in Texas now diagnosed with Ebola, I would like to add to my report.  First off, I am fuming mad at the CDC.  They had the audacity to initially place blame on the nurse for "breach of protocol".  What nurse in their right mind would not be hyper-vigilant about protecting themselves knowing full well they were caring for a patient with a very deadly virus?  And why are we still allowing people into the United States from the African nations infected with Ebola???  And if restricting outgoing flights is not possible then do us all a huge favor and quarantine anyone from those countries for the 21 days.  I would be more than happy to have my tax money utilized to provide food and housing for these people to keep the rest of us safe.  Anyone who then comes down with Ebola can be directly sent to the CDC, so the CDC officials and staff can care for these people directly. 


    Next I would start demanding the CDC and WHO begin immediately identifying how the virus is being spread to health care workers who are covered with personal protective equipment during the later stages of the disease?  What is the viral load in the patient's blood stream during the last days?  Has the virus mutated from the beginning when the patient is first tested to the end when the patient has died?  We need answers and we needed them yesterday, not tomorrow! 


    With the latest developments am I now frightened to go to work?  The answer is still no.  I have to work tomorrow and I will go in with more skepticism but not fear.  At this point I do not think those in the ER, while at the frontline of this potential catastrophe, are at high risk of "catching" Ebola.  It is those caring for the patients with Ebola at the end stages that are at the highest risk.  That would include the Intensive Care Unit staff of a hospital.  However if this virus keeps mutating at such a high rate and it becomes highly contagious at an earlier stage, then I would start looking for a job outside of healthcare. 


    Right now, the hospitals and the CDC can tell their ICU staff that they will protect them fully from now on from the virus, but who is going to believe them?  Who is going to go to work at a hospital knowing they have an Ebola patient in their unit and they may end up having to take care of that patient?  So far we only have 2 such patients who are at specialized units.  But what happens when we get 20 more people diagnosed and the specialized units run out of beds?  The human factor will start coming into play.  More and more nurses and staff will become "sick" for fear of having to deal with caring for an Ebola patient given what has now happened in Texas. 


    I now have serious doubts that we can contain the virus here in the United States.  I think the CDC has no clue how the virus is truly spreading.  And until they can figure it out, we all best be on guard.  I initially stated below that I felt it was nearly impossible for this to become an epidemic in the United States if the virus does not become airborne.  However I now feel quite differently.  Like many, I trusted the CDC to know what they were talking about regarding the spread of transmission of Ebola.  But since the CDC has failed us, I feel significantly less confident.  There is something about the spread of this virus in the later stages  that is perplexing and a mystery. 


    Below is the original iReport I wrote:


    I have been a Registered Nurse for over 17 years now, most of those years spent in the Emergency Room. I have spent the last 4 years as a traveling nurse, working in various hospitals across the country on short term assignments. I am here to give my perspective of the current Ebola epidemic.


    Currently the spread of Ebola is through direct contact with bodily fluids of an infected person (such as vomit, blood, saliva). This is fact per the CDC. So how are doctors and nurses who are trained to prevent the spread of disease coming down with Ebola? I asked myself that same question. There are rumors spreading that Ebola has mutated and is now spreading via the airborne route. But if that was the case there would be many more thousands of Ebola victims by now. So where did the few doctors and nurses go wrong? Well here are some facts that would explain transmission spreading as quickly as it has the last few months:


    1. The Ebola virus can live on nonliving matter such as doorknobs for many hours. If a person with Ebola vomits into a bag or toilet, and then wipes the back of their hand across their mouth, we are now looking at two highly likely sources of spreading: the toilet has fine particulates of vomit on it naked to the human eye. Another family member goes to the bathroom and sits on the same toilet seat - any small opening in the skin can cause transmission. The person infected doesn't wash their hands properly and transmits the virus from the back of their hand to any surface in their house. Any family member can then pick up the virus.


    2. The Ebola virus can live for DAYS on a surface if still in bodily fluids. A small amount of vomit not cleaned up can potentially infect anyone who touches it without gloves.


    So if one of those doctors or nurses took off their gloves, washed their hands, but then touched a wet spot on a surface where an Ebola patient coughed, sneezed, or vomited and they had a small break in their skin, then that could explain the transmission.


    What is the likelihood that Ebola becomes an epidemic in the United States? In my opinion, nearly impossible. We will probably see quite a few more cases in the the states, however with proper isolation of family members and proper screenings done across the board, we should not experience the threat of an epidemic. Doctors and nurses are already on high alert. The mistake in screening for the Ebola patient in Texas did not go unnoticed by the rest of the Emergency Rooms across the nation I can assure you.


    But (ah yes, the infamous BUT), if the Ebola virus decides to mutate and becomes "airborne" then all bets are off. The World Health Organization states: "Speculation that Ebola virus disease might mutate into a form that could easily spread among humans through the air is just that: speculation, unsubstantiated by any evidence," This sounds comforting to a point. It is known that the Ebola virus was transmitted through the ventilation system of a laboratory housing animals in a Canadian lab. The transmission occurred from monkeys to pigs. Given that one form of Ebola can be transmitted between mammals through the air does make me question the WHO's statement.


    I do not like to invoke panic nor go the route of conspiracy. However the airborne transmission of Ebola I believe needs to be studied further and sooner rather than later. In the very rare event the Ebola virus does mutate to the point of becoming transmitted through the air, the best healthcare system in the world will not be equipped to handle such an event. A person affected with an airborne disease like chicken pox needs to be placed in what is called a negative pressure room to prevent transmission within the hospital. A negative pressure room has its own special ventilation system designed to keep the bad germs in that room or outside via its own direct route. This prevents transmission of an airborne pathogen through the whole ventilation system. Unfortunately if 20-30 people in one area develop Ebola it will be near impossible to contain given there are a limited number of negative pressure rooms in any given hospital. Basically if the virus goes airborne, our healthcare system will not be able to contain the spread of the virus. Then one has to factor in the human aspect. Are nurses and doctors going to show up to work knowing there is a epidemic occurring in their city? Will they risk exposure not only to themselves but to the possibility of bringing the virus home to their loved ones?


    So while the CDC and WHO can try to quell our fears about the possibility of Ebola going airborne, I personally and professionally would like to know exactly what they are doing to monitor and study this highly unlikely, but not impossible event.


    I will go to work in a few days with little to no fear. I will protect myself like I always do with proper hand washing and the use of gloves. I will put on a gown and goggles for the typical isolation patient. I will not live my life in fear of any virus or germ. But I do want more answers from our government and governing healthcare officials on what they are doing to protect the citizens of the United States. Are they going to take the temperatures of more people at airports instead of the 5 airports announced today? Are they going to screen people coming in by car from the north and south borders? Are they going to eventually stop flights from coming in from the infected countries? At what number will they finally say we are getting too many people coming into this country infected? Again, at the current mode of transmission, Ebola is not a huge threat to our country at this point. However if the virus spreads further throughout Africa and even Europe, when will we say enough is enough and close our borders for a specific period of time? I am not saying that closing our borders is what we need to do this instant, but I would like to know what the disaster plan for Ebola is in the eyes of the CDC and our government.

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