In 2014, the Ebola virus decimated the health care workforce across Western Africa. In 2020, the Coronavirus threatens to do the same thing globally. With the emergence of COVID-19 disease, it is clear that the U.S. is not doing enough to keep our health workers safe.
Despite being the most critical human resource during a pandemic, frontline health workers are routinely underfunded, overworked, and often lack the protective equipment they need to provide care and treatment safely. The lack of preparation for a viral pandemic, which we have known for some time is not a matter of if but when, has come into sharp focus.
I worked in Sierra Leone during the 2014-15 Ebola outbreak, as a nurse and public health researcher studying ways to contain and mitigate an unprecedented epidemic, which claimed the lives of thousands of nurses, health workers and families — many of them friends and colleagues. I saw firsthand the chaos that ensues when an already week and unprepared health system attempts to cope with a major public health threat.
America’s health workers are pleading for adequate protective gear and protocols to protect themselves and their patients. As the public heads into isolation to slow the spread of disease, nurses remain exposed on the front lines of the epidemic response. They provide care for the most seriously ill at high risk to their own health and safety, and they are critical to slowing the spread of disease, from early detection to contact tracing.
An informal survey conducted by the National Nurses United union found that fewer than 30 percent of hospitals had a plan in place to isolate workers and patients potentially exposed to the virus. Fewer than half had received official guidance from their organizations on how to handle the virus. However, it is too little too late to be training and developing standards for a pandemic when the virus is already here.
Just as in Italy and China, we are now seeing escalating rates of infection among frontline health workers here in the U.S. too. As hospitals and clinics implement wartime triage conditions to treat surges of infected patients, they are finding test kits sorely lacking, and N95 masks and reusable respirators in short supply. The just-in-time inventory management systems - designed to cut costs by eliminating stocks of supplies on-site — that are in place at many hospitals now seem myopic.
Back in 2014-15, countries with the highest burden of Ebola infection lost huge swaths of their skilled health workforce, significantly weakening those nations’ abilities to protect the public from contagion.
Looking back, we now see how Ebola spread so quickly: governments were unprepared for the societal upheaval that rose in the virus’s wake and the rate at which the infection spread. New infections spread undetected as health systems scrambled to train and protect health workers, increase testing, and isolate the sick.
Health workers and caregivers were ill-equipped to protect themselves from the disease, lacking both critical infection prevention training and personal protective equipment. Five years on, they are still rebuilding a health workforce decimated by Ebola.
Despite many worrying reports, there are examples of the impact of a coordinated and rapid response to the current pandemic. Despite being its proximity to the epicenter of the coronavirus outbreak, Hong Kong swiftly ramped-up screening criteria and worked to quickly isolate infected patients in airborne infection isolation facilities. At the time of writing, no Hong Kong health workers have been reported infected.
To protect those at the frontlines in the short term, we urgently need to demand a surge in manufacturing for personal protective equipment and contingency plans for outdoor triage so that the health workers at facilities are not put at undue risk.
Health facilities and systems must define standard operating procedures, guidelines, and fail-safe systems when they are most needed. In the long term, we need to demand that our health infrastructures are able to enact coordinated and rapid response measures before the next novel virus hits our shores.
As deaths from Ebola mounted, heroic health workers developed and implemented workplace protections and protocols that successfully halted the spread of the virus a year after the epidemic started. Scores of nurses and health care workers died in the interim.
Our failure to prepare and implement the lessons learned from the Ebola outbreak could very well sentence our nurses to the same fate. Our health workers are critical to controlling this pandemic and we must do our utmost to keep them safe now — and when it happens again. It is not a matter of “if” but “when."
Susan Michaels-Strasser, Ph.D., MPH, is a public health professional with over 25 years of experience in nursing and public health, working on the frontlines of health emergencies such as the 2014 Ebola outbreak in Western Africa and the ongoing HIV epidemic across sub-Saharan Africa. She is the senior director for human resources for health at ICAP, a global health organization based at Columbia University Mailman School of Public Health. Dr. Michaels-Strasser is also an Assistant Professor in Epidemiology at the Mailman School of Public Health.