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.