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Disease is powerful.

It devastates communities and challenges modern health care. Florence Nightingale was the first nurse to link poor hygiene and sanitation to the spread of infectious disease. Cholera and typhoid were rife during the nineteenth century, when living conditions of the poor were overcrowded and squalid. When influenza struck in 1918, the impact on front line nurses and other clinicians was devastating.

Just over 100 years since the so called 鈥楽panish flu鈥�, every one of us living through 2020 has felt that impact for ourselves. The world we live in and the technology we use now looks very different. But throughout centuries of disease, it is the front line staff, who stand in the face of it.

With the help of vaccines many diseases are now rare. Smallpox for example, once rife, is now a fear of the past. Yet microbes that cause disease are adaptable, constantly modifying to be one step ahead of us. The more we fight them the stronger they become. Influenza has been visiting our homes for centuries, each time a different strain to the last. Nursing skills in this unpredictable environment become ever more vital, keeping infections at bay in our homes, clinics and hospitals.

In the late nineteenth and early twentieth centuries, infected patients, particularly those with tuberculosis, would be admitted to a sanatorium. Often these institutions had large open air balconies and porches, where patients could get plenty of fresh air.

Around this time nurses began taking an active role in caring for infectious patients. Fever nurses washed and fed the sick, applied poultices and lotions, and monitored the patient鈥檚 temperature and breathing.

Nurses with experience of TB nursing would have used similar skills when caring for patients with influenza. Maintaining well ventilated wards and high hygiene standards were key to the nursing role, as they are today.

One of the first wards to experience the effects of the so-called Spanish Flu was St Marylebone Infirmary, London, in October 1918. The Sisters tirelessly cared for the weakened North Kensington community, as well as for their own colleagues. The effect on nursing staff was devastating. Through history, when a new disease strikes, it is often the nursing staff who are hit by it first.

"Temporary wood partitions have been put up between each bed鈥�on each partition is hung a sheet wrung out in Lysol and kept wet鈥�Every nurse, doctor, ward-maid, char-woman who enters the epidemic block must wear the mask and overall.鈥�

Different viruses are spread in many different ways.

In the early 1980s, hundreds of men were becoming sick and dying from an unknown illness spreading through the gay communities. Misunderstandings about how the disease spread led to fear, stigma and public anxiety. In 1983, Human Immunodeficiency Virus (HIV) was discovered and recognised as the virus that causes Acquired Immune Deficiency Syndrome (AIDS).

The face of HIV changed overnight when Princess Diana visited the Middlesex Hospital, in 1987. She sat and held the hands of men dying from AIDS without wearing gloves. That same year, the world鈥檚 first government sponsored national AIDS Awareness campaign was launched: Don鈥檛 Die of Ignorance.

At the start of the epidemic nurses were at the forefront of breaking down myths about how HIV was transmitted and developing standards of care. Today we still have no cure for HIV. But a person living with HIV who is accessing care and treatment now has a normal life expectancy.