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"We got hit pretty hard with the outbreak," said John Pape, epidemiologist with the Colorado Department of Public Health and Environment. "It was a busy summer."

Pape stressed that Colorado's relatively large population as well as a break in the region's recent drought and the prominence of a particular mosquito species adept at transmitting the virus all helped to give the state a thrashing.

Such an explanation offers cold comfort to Helen Lutz, RN, who spent the better part of the summer tending to West Nile patients on her floor at Longmont (Colo.) United Hospital. "It was crazy," she said. "There were a lot of sick people with horrible headaches, nausea and weakness. Summer is normally a bit of a slow time for us, but not this year."

Lutz said that one of the difficulties in dealing with West Nile patients is that many of them require extra time and attention from the nursing staff. "Their limbs and extremities are extremely weak, and so they need help walking and doing most other things. It was a labor-intensive couple of months for us."

Another challenging aspect of the disease, Lutz added, is the lack of a known cure-which leaves nurses with little else to do but try to make patients as comfortable as possible and wait for the virus to run its course. "It's definitely frustrating," Lutz said, "but you do the best you can to help the patients get through it. Pain management becomes the main focus."

Faber agreed. She said that much of her work with West Nile patients revolved around easing pain and suffering. She added that the closest thing she found to a wonder drug was Toradol (ketorolac tromethamine), a quick-acting anti-inflammatory medication. reduced the swelling in a lot of patients, which really helped their situation," Faber said. "You can't use it for too long because it can cause stomach problems, but it works quickly."

In addition to addressing the obvious physical suffering exhibited by West Nile patients, Faber said that nurses also should be prepared to address the emotional and psychological symptoms that accompany such a notorious and panic-inducing disease.

"There was a lot of fear," Faber said, referring to the patients she treated this past summer. "A lot of people, particularly our elderly patients, thought they were going to die." She added, "You have to keep them calm and reassure them that they're most likely going to be OK. This virus really requires you to treat the whole patient."

Westward, ho

Signs are cropping up that a possible cure may be on the way. Last year, scientists developed an experimental vaccine for the virus-made from the existing yellow fever vaccine with West Nile genes spliced in. Scientists say the vaccine has proved effective in protecting laboratory animals from the disease.

Officials with the National Institutes of Health recently reported to Congress that a biotechnology company, Acambis, plans to begin tests on the vaccine with a small group of people to determine whether it is safe and effective for humans. If all goes well, officials said, the vaccine could be available for public use in about three years.

That, of course, means that West Nile will enjoy at least a few more seasons of unabated activity. Perhaps nowhere is this more of a concern than in California, where officials fear the virus will strike hardest next year. West Nile, experts said, is expected to continue its westward migration-and that leaves the Golden State directly in its path.

The telltale signs of a looming invasion are already there. State investigators detected infected mosquitoes for the first time in August, and since then, more dead birds have begun turning up. Health officials believe that human cases erupt one season after the virus first appears in the environment. (California officials reported the state's first human case of West Nile several weeks ago, erasing any doubts that the virus might bypass the state.)

"We're definitely bracing for next spring," said Liz Jacobs, RN, spokeswoman for the California Nurses Association.

In light of California's well-known budget crisis, Jacobs said she doubts there will be much funding for any kind of well-organized statewide campaign against the virus. She sees more of a grass-roots effort, with nurses and other frontline health care providers working to get the word out early and often about what in the end is still the only way to combat the virus: prevention.

"It all comes down to preventive measures," Jacobs said, "wearing long clothing and strong repellent, and for some, such as the elderly and sick, avoiding outdoor activity in the evening." She added, "The key to battling this disease remains educating the public on the ways to avoid it."

Contact H. Cheever Griffin at cgcommunications@ameritech.net