sydney law school a day (nearly) like any other: health care work in a pandemic phd candidate...
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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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