On 13 March 2020 the pre-planned title of my lecture on the global health module aimed at student nurses was ‘What lessons can we learn from the West African Ebola outbreak?’ In the background, however, the rumblings of the growing storm, by then named COVID-19, could not simply be ignored. Although a very clear distinction needs to be made between the characteristics and contexts of these two viruses, I was struck by some remarkable similarities. At the time of the 2015 Ebola outbreak, with which I had some personal involvement (Boulton, 2015), the challenge of containment was strongly attributed to the poor healthcare system, lack of education and pervading culture in the countries affected (Chan, 2015). Surely, if the UK ever faced a sudden onslaught of a highly infective disease things would be very different? Or would they? The title of my lecture was hastily expanded to ‘What lessons can be learned from the West African Ebola epidemic … and what resonance can we see with COVID-19?’
In both cases, there was considerable lag time between the first infected case and its identification. For Ebola, this was almost 3 months (Petherick, 2015). The date of infection of the index case in Wuhan province is not known (Huang et al, 2020). The attention of the World Health Organization (WHO) was drawn to the risk on 31 December 2019 by the brave postings about a cluster of atypical pneumonia cases on social media by a group of doctors, one of whom later died (Hegarty, 2020).
Both viruses caused a climate of fear to quickly develop, further fuelled by various conspiracy theories (Alington and Evan, 2020). All seem to have their origins in contamination theory and blame culture—a common response when people want answers where there are seemingly none. In both outbreaks, further fuel was added to the fire as people were asked to trust ‘science-based’ messages about an unseen enemy, requiring treatment by people in ‘spacesuits’, the isolation of households, and the effects on almost every walk of life.
In the UK, the months leading up to the final announcement of lockdown on 23 March were particularly frustrating for nurses with experience in global health as reports from those ahead of us on the curve circulated. In the Ebola outbreak acceptance of the reality only began when people as highly regarded as doctors began to succumb. Contact tracing and intermittent periods of total lockdown were also enforced by the military. In the UK it eventually became apparent that general advice on social distancing was ineffective and messages were strengthened along with subtle linguistic changes—from advice to requirements enforceable by law.
Much attention was drawn to the pre-existing state of the healthcare systems in the countries in which Ebola was endemic (Chan, 2015). Johnson's reports from the field (2015) were chilling—there were not enough doctors, nurses, epidemiologists, logisticians, personal protective equipment (PPE) or body bags. Sadly, even here we find much resonance with the current situation in the UK. The Royal College of Nursing (RCN) has long warned of the shortage of nurses in the UK (RCN, 2017) and the shortage of PPE has become apparent (RCN, 2020).
I am hopeful that among the lessons learned will be a new appreciation of holistic care in its widest sense and the importance of public health within the nursing curriculum. Both Ebola and COVID-19, and the insight into behavioural science they afford, highlight the essential role of nursing care alongside the diversity of nurses' roles. Many colleagues continue to demonstrate resilience and fortitude at the acute end of nursing; others steadfastly continue their hospital or community work. This truly is the Year of the Nurse and Midwife (WHO, 2020) and the slogan ‘We're all in this together’ is truly apt.