How might health care workers respond in the event of a disease pandemic?

Nurse, a key caregiver in health care emergencies

One of the tragedies of Hurricane Katrina had to do with the lack of responders in the emergency. This same sort of situation could well happen in the possibility of a pandemic of Ebola.  The same problem might occur in the event that Ebola becomes widespread in the United States, which most experts agree is at most a remote possibility.  What has research indicated might occur with health workers and what might be the overall response?

Approximately 1 in 6 public health workers completed a survey put out by the Centers for Disease Control in 2009, maintaining they would not report to work in the event of an emergency.  In that case the question was related to the potential of an H1N1 pandemic flu. Researchers at the time of the report declared that was a problem but also observed it was an improvement over a similar study made in 2005 where 40% of health care workers maintained they wouldn't respond to a pandemic emergency.

This is relevant as the world prepares for what the Centers for Disease Control and the World Health Organization maintain could be a major problem in adequately preparing health care workers and supporting them in responding to any disease emergency  For the individual hospital there may be a wait-and-see stance for some elements of preparation. The new study suggests ways of improving the response of the workforce in general that are essential in the preparation.of health care workers in the United States if there is a significant increase in the numbers identified with Ebola.

Daniel Barnett, MD, MPH, leading author of 2009 study, that took place under the aegis of the Department of Environmental Health Sciences at Bloomberg School of Public Health, underlined how important it is to understand the underlying factors involved in whether or not an employee will respond appropriately to an emergency." He goes on to say, "Overall, 16 percent of the workers surveyed said they would not report regardless of the severity of the outbreak."

1,835 public health workers participated in the online survey in Minnesota, Ohio and West Virginia during the period. What the survey found was those public health workers who were particularly concerned about what might happen in a pandemic threat and were confident they could fulfill their obligations were 31 times more likely to respond in an emergency then those
who perceived a threat was low or who didn't have confidence in their abilities to respond appropriately.

"We found belief in the importance of one's work was strongly associated with a willingness to report to work in an emergency. Our results could help preparedness planners to identify workforce needs and develop strategies for improving worker response," said Ran Balicer, MD, PhD, MPH, who is the senior lecturer in the Epidemiology Department at the Ben-Gurion University of the Negev in Israel, and Joint Editor of the Israeli Ministry of Health Pandemic Preparedness Plan.

According to OSHA the preparation of health care workers for a pandemic is especially difficult given travel restrictions and multiple emergency procedures that might need to be taken during a major catastrophe. It can increase the need for beds in hospitals, staffing, transportation and a host of other problems. The training across geographic locations, cultures, with communication issues makes the job of health care especially complex during emergencies. Add to this the pressures of time, the potential for health problems among those assigned to help others and personal needs, including families; and those who serve during emergencies will be under definite strain, according to experts.

On the other hand, many of the Ebola experts recommend regional centers for the treatment of Ebola patients as opposed to every individual hospital.  That being the case, the response could be different.  But again those involved in the study highlighted that attitude of health care workers is tied to how they perceive the disease, their training to deal with it and whether or not they believe they are well equipped to handle the emergencies that might occur.

The CDC has acknowledged it could have done better in its own initial responses to the Ebola health care personnel in Texas. The agency is underlining the importance of a more adequate and faster response in the future to any incident where a patient is identified with Ebola.  It is training that will help increase the potential for a good response from health care workers in the (remote) event of a major increase in Ebola cases in the United States.  Comprehensive training for those who care for others during a serious crisis can make a difference also in not just how health care workers respond but how the public responds in general, as avoiding a panic is also key to the management of the disease throughout any widespread geographic area.

Public refusal to take flu vaccinations worries health experts, fuels pandemic concerns

Carol Forsloff — According to January 10, 2012 reports, approximately 91 percent of the types of flu viruses are ones included in the currently available flu vaccine. The H1N1, or swine flu virus, that has been an ongoing concern since it was identified several years ago, is one of those types presently circulating. Yet, in spite of widespread publicity on television, newspapers, radio, and the Internet, many people refuse to accept the vaccine or the evidence of its protection, fueling pandemic concerns.

Around the country the flu outbreak is reported to be increasing and in some cases to be deadly. Boston, for example, refers to the flu season this year as a public emergency. But if it is an emergency, then why are there people who refuse the vaccine?

In 2009, a research survey found that 60% of Americans refuse to take the flu vaccination. This number reflects specifically the refusal to take the vaccine for the H1N1 flu virus. Reasons given include safety concerns, belief the vaccine won't work, or that there are side effects that can be troublesome. The percentage of those refusing the vaccine in the United States was reflected in the numbers found to refuse it in other parts of the world.

Ethel Hoover, a former nurse for IU Health Hospital Goshen, was recently terminated because of her refusal to take the vaccination, as she cited some of the reasons listed for that refusal. On the other hand, Elaine Cox, Director of Infection Prevention at Riley Hospital for Children, an IU Health Hospital, recommends the vaccine for health workers, saying, “If you go patient to patient, you can be the vector of which the flu is spread,” Cox said. “We get them the flu shot so they won’t unwillingly spread it to patients.” She also recommends college students get vaccinated since the flu symptoms are usually not noticed until three to five days of exposure.

Morbidity rates among young people were especially higher among young people during the outbreak of the swine flu virus in 2009.  By late 2009, 30,000 people had died worldwide.

But despite the entreaties from health care management, people continue to refuse vaccination for the flu. This is in spite of entreaties from national and international organizations and a history of influenza in the recent past that reveals the millions of people that died during epidemics, such as the one in 1918. More recent estimates by researchers indicate global mortality from the 1918-1919 pandemic at anywhere between 30 and 50 million. estimated 675,000 Americans were among that number. Life expectancy in the United States during those years was 20 - 25 years less than it is today, with part of the reason cited as the influenza virus and other diseases for which modern medicine has found prevention.

Some experts maintain vaccinations are being used to control the population, directed at infecting otherwise healthy individuals. An article on this publication presents an interview with one such "expert, "Dr. Rebecca Carley. " I say there is no such thing as a safe vaccine" and goes on the downplay the news information on vaccines such as those for polio viruses, although she has made a generalized statement about all vaccines and their risks. Dr. Carley, however, lost her license to practice, but is the kind of medical expert sometimes cited as an authority by those who retain fears of vaccine risks.

The Centers for Disease Control recommends vaccination, especially seniors and children, but also for for  the general population. The Agency maintains that some people can still get the flu even if vaccinated because of age and health factors related to given individuals,  because they were vaccinated after having been exposed to the flu virus, or because they have that small percentage of viruses not covered by the vaccine.

"It’s important that health care providers and the public remember that influenza antiviral medications are a second line of defense against influenza. CDC has recommendations on the use of these medications (sold commercially as “Tamiflu®” and “Relenza®”) to treat influenza illness." The CDC further states that " Influenza vaccination is not a perfect tool, but it is the best tool currently at our disposal to prevent influenza."