**2.5 Middle East Respiratory Syndrome Coronavirus**

This is a respiratory disease caused by a group of viruses known as coronaviruses discovered first in the Middle East region, specifically Saudi Arabia in 2012. These coronaviruses constitute a large family of viruses that can cause different kinds of diseases such as the common cold and Severe Acute Respiratory Syndrome (SARS). The clinical manifestations of Middle East Respiratory Syndrome Coronavirus (MERS-CoV) include cough, fever, and shortness of breath. Other symptoms include pneumonia, and some gastrointestinal complications such as diarrhea. There are cases when infected people go on asymptomatic, meaning that they do not present any clinical signs nor symptoms, but they test positive for MERS-CoV after a laboratory test is conducted. In order to track down these asymptomatic cases rigorous contact tracing of a laboratory-confirmed case should be done. It is reported that so far about 35% of confirmed MERS-CoV infected patients have died. Transmission is mainly through human-to-human infections especially in health care settings; when providing unprotected care to a patient. Health care associated outbreaks have debuted in several countries, with the largest outbreaks seen in Saudi Arabia, United Arab Emirates, and the Republic of Korea. Scientific evidence have suggested that dromedary camels are a major reservoir host for MERS-CoV and have transmitted MERS infection to humans [21].

#### **2.6 Marburg virus disease**

Marburg virus disease (MVD) was formerly known as Marburg hemorrhagic fever. This is a severe fatal illness in humans transmitted to humans by *Rousettus aegyptiacus*, a fruit bat of the Pteropodidae family. It spreads among humans through human-to-human transmission. The average MVD case fatality rate is recored at around 50%. Community engagement is critical to successfully controlling outbreaks. To achieve good outbreak control several sets of interventions should be considered which include case management, infection prevention and control practices, surveillance and contact tracing, a good laboratory service, safe burials, and social mobilization. Early supportive care with rehydration, symptomatic treatment improves survival. No treatment has yet been developed [22].

### **2.7 Zika virus infection**

Zika virus infectious disease is caused by a virus transmitted mainly by *Aedes* mosquitoes. Infected people present symptoms which include mild fever, skin rash, conjunctivitis, muscle and joint pain, malaise or headache. The symptoms usually last for 2–7 days. Zika can be transmitted from a pregnant woman to her fetus. Infection during pregnancy can cause certain birth defects such as microcephaly and Guillain-Barré syndrome. There is no vaccine or medicine for Zika virus infection [23, 24].

#### **2.8 COVID-19 Disease**

COVID-19 disease also known as Coronavirus disease is an infectious disease caused by a newly discovered virus called coronavirus. It is spread by droplet

transmission from one human to another who are in close physical interaction. The COVID-19 virus is spread primarily through droplets of saliva or discharge from the nose when an infected person coughs or sneezes. It's important that people practice respiratory etiquette (for example, by coughing into a flexed elbow). People who get infected with the COVID-19 virus experience mild to moderate respiratory illness and recover without requiring special treatment. Special populations of humans are affected differently; ie older people, and those with underlying medical problems like diabetes, chronic respiratory disease, cardiovascular disease, and cancer are more likely to develop serious physiological responses. Prevention of transmission is best achieved by slowing down transmission by ensuring that the population is informed about the COVID-19 virus, the disease it causes and how it spreads. Other protective measures include washing hands or using an alcohol based rub frequently using facial mask, and not touching the face. The most common symptoms include fever, dry cough, tiredness. There are less common symptoms such as aches and pains, sore throat, diarrhoea, conjunctivitis, headache, loss of taste or smell and a rash on skin, or discoloration of fingers or toes. More serious symptoms also showcase such; difficulty breathing or shortness of breath, chest pain or pressure, loss of speech or movement. It takes an average of 5–6 days from when an individual is infected with the virus for symptoms to show, however it can take up to 14 days. Treatment mostly is by symptoms An approved drug, remdesivir (Veklury) is used to treat COVID-19. Any treatments that are used for COVID-19 should be taken under the care of a healthcare provider [25].

### **3. The experiences of midwives during a disease outbreak**

Before elaborating on the principles that will guide midwifery care during virulent outbreaks. Let us appreciate the experiences of midwives during the 2-14-2015 Ebola virus disease outbreak in Liberia, West Africa. It is from this backdrop that the principles of midwifery care during virulent outbreaks are proposed. A study described the experiences of midwives during the EVD outbreak in Liberia; the midwives were living and working in fear and terror; their lives and those of their families were endangered [9]. The key concern of the midwives were concern for their family's safety, psychological, emotional, and social support. The midwives mostly felt obligated by virtue of their profession to continue caring for patients during the Ebola outbreak [9]. The midwives experienced stigmatization by the public during the outbreak due to fear of many that the midwives stood a greater risk to transmit the disease to their families and the public in general. However after engaging in the education of their families and patients, together with institutional influences, and government efforts eased the effect of stigmatization [9]. There is need for governments to improve their efforts to develop policies, provide safe working conditions, and fund training and educational programs in Ebola care [26].

Midwives experienced changes in the dynamics of the midwife-patient relationship and working in teams during the period of the outbreak. The training and education of the midwives, also the provision of protective equipment assisted the midwives to regain their confidence and self-efficacy. The midwives found ways to touch all patients despite the high risk involved, while using the personal protective equipment provided. They conducted midwifery procedures fully, improved the relationship between themselves and their patients. The spiritual dimension of health care was identified in a study as crucial to enhancing midwives' well-being [9]. Other authors have also reported that faith-based health care institutions and services are the vehicle used to drive spiritual health care [27]. The decision process involved in the midwives' choices either to render care or not to render

#### *Principles of Midwifery Care during Virulent Outbreaks DOI: http://dx.doi.org/10.5772/intechopen.95596*

care for patients were made on the basis of emotional connections between them and other midwives and nurses, their families, and society. The decision process also was based on their value system, including professionalism and spirituality. The findings of the Kollie, Winslow, Porthier, and Geade study indicated the spiritual resources of midwives had influence on their decision to work. The study identified a conceptual map which described the work decision process to include that the midwives were in a state of fear and terror. Their situation was associated with emotional and psychological dimensions of the fear and terror condition [9]. Several factors were shown to influence their decision to work; key among them the family. Midwives made decisions to either work or not during the Ebola outbreak based on family responsibilities and demands. The midwives decided to work as a result of their sense of professionalism and their realization that the needed to depend on God for safety. There were institutional influences and also government roles which was shown to have both positive and negative influences on whether the midwives decided to work or not. The midwives decision to work was influenced by stigmatization issues which caused sadness and frustration. Stigmatization however did not stand out as a reason for the midwives to decide to stop working during the Ebola outbreak. Those midwives who continued to work during the outbreak encountered changes in the relationship between the patients and themselves as well as, midwives. Further description of the factors that influenced the midwives to continue to render care to their patients during the fearsome and dreadful 2014–2015 Ebola virus disease outbreak [9] are as follows:
