A day (nearly) like any other: health care work in a pandemic

SYDNEY LAW SCHOOL

A day (nearly) like any other:

health care work in a pandemic

PhD candidate [email protected]

Caroline Saint

In 1893

“[w]hen they take up nursing they know they must meet infectious diseases and are prepared to nurse them ...”.

Matron McMaster, The Coast Hospital Little Bay (NSW)

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PANDEMIC

“prevalent throughout an entire country or continent,

or the whole world”

The Macquarie Dictionary Online

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1918-1920

1918-1920 Influenza Pandemic

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A closely watched virus …

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But there are others …

Surveys – pre-2009 pandemic

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Authors Who? Findings

Damery et al (UK 2010)

Survey of professional and ancillary staff across 3 NHS trusts (1032 responses)

Most recognised a duty to work although nearly 30% nurses; 25% hospital medical staff and 18% GPs thought no duty to work if at risk

Stuart and Gillespsie(Australia 2008)

Cross sectional anon survey of professional and ancillary staff. Large Victorian metro health service (1440 responses)

10% HCW’s said they would refuse to work because of fear

Ehrenstein(Germany 2006)

Multi-choice survey medical (including 3rd yr m/s), nursing staff and administrators (664 responses)

28% believed it would be “professionally acceptable” for a HCW to refuse to work to protect themselves and family

SARS vs INFLUENZA

SARS INFLUENZA

Long incubation period 4-5 days Short incubation period 1-2 days

Infectious when symptomatic Infectious before symptoms

Contact tracing effective Contact tracing ineffective

No known asymptomatic carriers

Asymptomatic carriers

Containment possible Containment NOT possible

Mortality around 10% “worst known” mortality around 5%

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SARS vs INFLUENZA

SARS INFLUENZA

Long incubation period 4-5 days Short incubation period 1-2 days

Infectious when symptomatic Infectious before symptoms appear

Contact tracing effective Contact tracing ineffective

No known asymptomatic carriers

Asymptomatic carriers

Containment possible Containment NOT possible

Mortality around 10% “worst known” mortality around 5%Around 2-2.5% in Australia

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RISK

SARS low risk of getting the disease in the community (with a relatively high risk of dying

if you did)

As opposed to

INFLUENZA a high risk of getting the disease in

the community (with a relatively low risk of dying as a consequence)

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Work during a pandemic

An ‘express contractual’ obligation to work during

“a pandemic or other societal medical emergency”

be included in employment contracts

Malm, Heidi et al, 'Ethics, Pandemics, and the Duty to Treat' (2008) 8(8) American Journal of Bioethics 4

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Employment contract and pandemic influenza

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Fundamental basis of the employment contract is to work in return for money

Health care workers are employed to provide care to sick people

1918-1920 (the ‘worst ever’) Pandemic

“most nurses and physicians continued to work safely – without patient isolation equipment; personal protective equipment or measures; antiviral or antibacterial medications; or vaccines against influenza or respiratory bacteria”

Shanks, G. Dennis et al, 'Low but highly variable mortality among nurses and physicians

during the influenza pandemic of 1918–1919' (2011) Influenza and Other Respiratory Viruses , 213

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TORONTO 1918-1919

Occupational group/volunteers Numbers of deaths

Soldiers 131

Clerks 50

Students 30

Housewives 27

Retired persons 22

Nurses 18

Slonim, Karen, “Send only your serious cases." Delivering flu to Toronto: An anthropological analysis of the 1918-1919 Influenza Epidemic in Toronto,

Ontario, Canada. (Doctorate of Philosophy Thesis, University of Missouri-Columbia, 2010)

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Pandemic (H1N1) 2009 Risk for Frontline Health Care Workers

Clinical and non-clinical staff had similar levels of antibodies - small difference not significant

Found rates of antibodies in staff similar to that found in the community

- Risk at work didn’t seem any higher

- Staff at risk at work – not only from patients

- Workers with children at home had biggest risk

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Marshall, Caroline et al, 2011, Emerging Infectious Diseases, 17(6),

Life has risks …

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