Throughout history there have been epidemics and pandemics, many causing high mortality (Woodrow, 2019). An epidemic is an outbreak of a disease that spreads quickly and affects many individuals at the same time and can occur in a community, geographical area or several countries. During an epidemic, the disease is actively spreading. A pandemic is a type of epidemic that relates to geographic spread and describes a disease that affects an entire country or the whole world. Declaring a pandemic allows national and global public health agencies to respond to the situation at a higher level. Declaring a pandemic raises awareness of the problem and increases measures to control it.
According to the World Health Organization (WHO) (2020a), the first influenza pandemic of the 21st century occurred in 2009–2010 and was caused by an influenza A (H1N1) virus. It was the first pandemic for which many WHO member states developed comprehensive pandemic plans, describing the public health measures to be taken, aimed at reducing illness and fatalities. For the first time, a pandemic vaccine was developed, produced and deployed in multiple countries. Although most cases of pandemic H1N1 were mild, globally it is estimated that the 2009 pandemic caused between 100 000 and 400 000 deaths in the first year alone.
Three influenza pandemics occurred during the 20th century, the most severe of which was the so-called ‘Spanish flu’ (caused by an A(H1N1) virus), estimated to have caused 20–50 million deaths in 1918–1919. Milder pandemics occurred subsequently in 1957–1958 (the ‘Asian flu’ caused by an A(H2N2) virus) and in 1968 the ‘Hong Kong flu’ caused by an A(H3N2) virus), which were estimated to have caused 1–4 million deaths each.
The latest pandemic was caused by a novel coronavirus that was first identified in Wuhan, China. Its full name is severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Royal College of Nursing (RCN), 2020). It causes the illness COVID-19, a respiratory illness that can spread from person to person (RCN, 2020). COVID-19 has been categorised as an airborne high consequence infectious disease (HCID). There is currently no vaccine to protect against COVID-19 and avoiding close contact with people who are sick and washing hands often are the only protections.
Since 26 February 2020, an increasing number of cases have been identified in Europe, with transmission occurring outside of travel to China.
Since then, new major epidemic foci of COVID-19, some without traceable origin, have been identified in Europe, North America, Asia, the Middle East, Africa and Latin America (Bedford, 2020). The Director-General of WHO characterised the COVID-19 situation as a pandemic on 11 March 2020. By 16 March 2020, the number of affected countries, states, or territories reporting infections to WHO was 143 (Bedford et al, 2020).
Some 81% of people with COVID-19 will have a mild illness, some will develop severe illness requiring oxygen therapy (14%) and approximately 5% will require intensive care unit treatment. Of the critically ill, most will require mechanical ventilation. The most common diagnosis in severe COVID-19 patients is severe pneumonia (WHO, 2020b).
Nurses and other allied health workers are on the frontline of the COVID-19 outbreak response and as such are exposed to several hazards, including pathogen exposure, long working hours, psychological distress, fatigue, occupational burnout, stigma, and physical and psychological violence (WHO, 2020c). The RCN (2020) state that staff may be anxious about what they read in the media and employers should ensure that all nursing staff are provided with factual information on COVID-19, the steps that their employer is taking to identify and manage suspected cases, and what nurses can do to protect themselves, including reinforcing hand hygiene. Staff required to deliver clinical care to affected patients should have the necessary skills and experience and be provided with training and information on any additional infection prevention and control measures needed to work in such environments, including the safe donning and removal of personal protective equipment.