The ethics of vital sign zero
Will increasing the evaluation of patients who may suffer from
infectious diseases during triage affect the timely treatment of these
patients? How can health care workers balance the benefits of providing
rapid treatment of patients, protecting the health of medical staff, and
preventing the spread of infectious diseases? These are all new
questions that must be addressed when caring for patients with COVID-19.
Medical workers around the world have increasing daily working hours and
workloads, and this has led to occupational health problems. These
include physical injuries, such as musculoskeletal disorders, and
infectious diseases such as Acquired Immune Deficiency Syndrome (AIDS)
and tuberculosis, and especially new infectious diseases, all of which
threaten the health of medical staff and increase occupational stress
(BeyMarrié, Engel, & Abdullahi, 2018)
Looking back on the SARS epidemic in
China during 2003, there was a lack of vigilance and failure to use
necessary personal protection measures by medical staff. Thus, about
1000 medical workers developed SARS, and these workers accounted for
about 1 of 5 cases and 1 of 3 of deaths. In February 2014, an outbreak
of Ebola occurred in Africa. As of August 2014, more than 240 medical
and nursing personnel were infected, and more than 120 people died (Le,
& Sorvillo, 2018)
Since late December 2019 when the first
SARS-Cov-2
infection was reported in China, this infection has spread many other
countries, and the epidemic has become a pandemic. As of February 11,
the China Health Commission reported that 1716 cases were confirmed
among medical workers, accounting for 3.8% of all confirmed cases. Six
of these individuals died, accounting for 0.4% of all deaths. Among the
1716 cases, 1502 were medical workers in Hubei and 1102 cases were in
Wuhan. Thus, it is very important to ensure the safety and health of
medical staff, and at the same time save lives and support patients.
The WHO examined the
issues
affecting medical staff, and pointed
out that the lack of personal protective measures, the irregular use of
medical equipment, insufficient staff size, and the long working hours
in isolated areas has led to the infection of a large number of medical
personnel (Hong-Xia et al., 2019). It is the mission of medical staff to
prevent suffering and to save the sick and wounded; however, while
actively treating patients, they must also balance the need for their
own safety. Medical staff cannot blindly treat patients and ignore their
own safety. It is a huge loss to patients and other medical workers when
medical staff become infected and can no longer treat patients.
Therefore, the concept of “vital sign zero” should be applied in the
treatment of COVID-19. Combining “vital sign zero” with relevant
policies, and establishment of early warning and timely notification
systems will greatly reduce the threat of
COVID-19 to public health.
Overview of the
Identify-Isolate-Inform system
It is also necessary to establish a rapid, simple, and effective system
for the identification and management of infectious diseases in the
emergency rooms and outpatient departments of hospitals and to monitor
individuals who may import or export the virus to different places.
Medical staff must identify patients during the early stages of disease,
and promptly implement prevention and control procedures to prevent
spread of the infection. The “3I system” is a set of early detection
and prevention methods that was designed to prevent and control the
Ebola outbreak. It was designed by Koening and approved by the Ebola
expert group of the American Association of Emergency Physicians
(Koenig, 2015). It was finally distributed to emergency rooms nationwide
by the U.S. Centers for Disease Control and Prevention on
Nov 5, 2014. The “3I system” was
subsequently modified and successfully used for the prevention and
control of MERS, measles, Zika, mumps, hepatitis A, and other infectious
diseases. The COVID-19 pandemic has been a public health disaster that
has affected people all over the world. It is very important to prevent
COVID-19 before an effective
treatment plan is developed. Based on the previous “3I system”, most
regions in China have formulated a “3I system”
for
COVID-19 prevention and control
(Table 1). The results indicated
this program was successful, but this system needs further development
and improvement.