Health-care workers in influenza pandemics
Authors: Robert Nash
Journal: The Lancet (2007)

With the possible threat of an avian influenza pandemic, the readiness of health services across the world is under the spotlight. Few doubt the critical need for preplanning, and thus agencies across the world are preparing frameworks for response. Drugs have been stockpiled, protocols prepared, and transport limitations outlined. All these plans, however, are contingent on staff. In a recent survey in Detroit by Charlene Irvin and colleagues,1Irvin C Cindrich L Patterson W Ledbetter A Southall A Hospital personnel response during a hypothetical influenza pandemic: will they come to work?.Acad Emerg Med. 2007; 14: 13Crossref Google Scholar only 50% of health-care workers replied "yes" when asked if they would report to work during an H5N1 avian influenza pandemic in human beings. This proportion is similar to those in a previous influenza survey in Germany2Ehrenstein BP Hanses F Salzberger B Influenza pandemic and professional duty: family or patients first? A survey of hospital employees.BMC Public Health. 2006; 6: 311Crossref PubMed Scopus (130) Google Scholar and a study on attendance during a hypothetical outbreak of severe acute respiratory syndrome (SARS) in New York City.3Qureshi K Gershon RR Sherman MF et al.Health care workers' ability and willingness to report to duty during catastrophic disasters.J Urban Health. 2005; 82: 378-388Crossref PubMed Scopus (357) Google Scholar Plans often account for workers' absence, be it due to illness, attending to relatives, or transport difficulties. However, such a high proportion of doubt in such a critical group seems worrying. The lead researcher Charlene Irvin speculates that lack of communication is the cause, with open dialogue and an appreciation of risks and protective measures being central to improving attendance. She told The Lancet: "This survey suggests that the US Government and the medical community may not be doing a very good job at educating our health-care workers about what measures would be in place to keep them safe." She also pointed out that "83% of the 'maybe' respondents noted that their decision would depend on 'How confident I am that the hospital can protect me'." But is education necessarily a solution? There is no doubt that doctors and nurses face real risks during infectious epidemics. Examples range from the 1918 influenza pandemic to SARS.4World Health OrganizationSummary of probable SARS cases with onset of illness from 1 November 2002 to 31 July 2003.http://www.who.int/csr/sars/country/table2004_04_21/en/index.htmlDate: Dec 30, 2003Google Scholar Some measures, such as hand-washing, barriers, and protective clothing, can reduce nosocomial infections in pandemic situations.5Yen MY Lin YE Su IJ et al.Using an integrated infection control strategy during outbreak control to minimize nosocomial infection of severe acute respiratory syndrome among healthcare workers.J Hosp Infect. 2006; 62: 195-199Summary Full Text Full Text PDF PubMed Scopus (43) Google Scholar However, the effectiveness of other protective measures has not been validated. Whether oseltamivir, the preferred antiviral, reliably inhibits H5N1 infection is not known,6Harrod ME Emery S Dwyer DE Antivirals in the management of an influenza pandemic.Med J Aust. 2006; 185: S58-S61PubMed Google Scholar and if it does, resistant strains will surely emerge.7ECDC Influenza TeamH5N1 virus resistant to oseltamivir isolated from Vietnamese patient.Euro Surveill. 2005; 10 (published online Oct 20.) (accessed May 31, 2007).http://www.eurosurveillance.org/ew/2005/051020.asp#2Google Scholar Vaccines, meanwhile, are still being developed. Perhaps the issue is not education, but rather the balance of the inescapable human desire for the preservation of self and family, and an indefinable feeling of duty, altruism, and heroism. We lack coherent ethical guidelines on behaviour in such situations.8Ruderman C Tracy CS Bensimon CM et al.On pandemics and the duty to care: whose duty? who cares?.BMC Medical Ethics. 2006; 7: E5Crossref PubMed Scopus (147) Google Scholar Human nature is unpredictable, especially under intense pressure. But one thing is certain: if a pandemic occurs, some staff will not attend. We need to educate our workforce, estimate the proportion that will attend, and make plans that use the available staff efficiently and effectively. I declare that I have no conflict of interest.