Healthcare Workers' Attitudes Toward Patients With Ebola Virus Disease in The United States

The public's reaction to the threat of Ebola virus mirrored that of the human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) epidemic when it first surfaced. Similar to Ebola virus, there were no effective management options when HIV first emerged, and both diseases had poor prognoses. Because healthcare facilities provide care to patients during any epidemic, healthcare workers (HCWs) are at increased risk of contracting infection, and not all HCWs have willingly accepted that obligation. In fact, during the 1980s, there were many publicized examples of providers distancing themselves from AIDS patients, leading the Surgeon General to publically assail those who were refusing to provide care and denouncing them as a “fearful and irrational minority” who were guilty of “unprofessional conduct.” It was during that period that the highly sensitive issues of law, ethics, morality, and social cohesion came to the forefront. In 1988, a seminal article was published reporting the degree to which physicians felt that it would be ethical to deny care to patients with AIDS [1]. Slightly more than one quarter of a century later, in the fall of 2014, the world's attention turned to Ebola, and a level of concern similar to that which had been seen in regard to AIDS in the pre-highly active antiretroviral therapy (HAART) era could again be seen in the lay press [2–4]. Not as much attention has been paid to whether physicians' attitudes towards Ebola mirror those of physicians in the 1980s in regard to AIDS. The biology and epidemiology of Ebola virus disease (EVD) have become increasingly well understood. Once infection is established in humans, Ebola virus can be transmitted person-to-person by direct contact of skin or mucous membranes with blood or body fluids of infected patients, contaminated objects (eg, needles), or the bodies of individuals who died with EVD. Of note, Ebola virus does not appear to spread by airborne route in the endemic setting, and infected individuals are only capable of disease transmission after the development of symptoms. Despite this enhanced understanding, there are still concerns about the health risks posed to contacts of patients infected with Ebola, including threats to HCWs. The infection of HCWs in Texas who provided care to the first Ebola patient in the United States fueled that concern [5, 6]. Of the four cases of Ebola diagnosed in the United States, only two were acquired by transmission within the United States. Both cases were nurses (diagnosed on October 10, 2014 and October 15, 2014, respectively) who cared for the first case of Ebola (diagnosed on 30 September 2014) in the United States, a man who had traveled to Dallas, Texas from Liberia. The fourth and last case in the United States (diagnosed October 23, 2014) was also a medical aid worker who had returned to New York City from Guinea, after serving with Doctors Without Borders. In the wake of those cases, a massive training program and the organization of a triage system among hospitals were undertaken in the United States. Despite (or perhaps, ironically, because of) those efforts, anxiety about the Ebola epidemic may be prevalent among HCW. However, despite a rich literature regarding physicians' concerns about HIV written during the 1980s, only limited assessments of HCWs' attitudes towards Ebola have been published. One recent study was written before any cases were reported in the United States, and it focused primarily on HCWs' knowledge and exclusively on pediatric providers [7]. Any hesitancy by HCWs in general to render care to patients with Ebola would have both ethical and public health consequences. Therefore, we assessed HCWs' attitudes toward the care of patients infected with the Ebola virus. To do so, we used an approach similar to one that had been used in one of the key studies from the 1980s that assessed attitudes of healthcare providers towards AIDS patients, and we conducted surveys using self-administered questionnaires at two hospitals; one that was a designated Ebola center and one that was not. The former hospital was also one of the sites of the earlier study by Link et al [1] on attitudes toward care of AIDS patients.