TB and malaria kill more people worldwide than any other disease- as a country, India could do without Ebola.
By Dr. Ramakanta Panda
India has isolated a man with Ebola infected Semen. But this is not our country’s biggest health problem right now.
CAN THE SPREAD OF EBOLA BE STOPPED?
Yes, by isolating anyone with symptoms while testing is done, taking precautions while providing them medical care and tracking down anyone they were in close contact with when they got sick. Those who have had direct contact with an Ebola patient are advised to take their temperature twice a day for three weeks, the incubation period for the disease. If they show symptoms, they should then be isolated and tested.
Ebola first appeared nearly 40 years ago. In past Ebola outbreaks, many cases have been linked to people burying their loved ones, involving ritual cleansing of the body and kissing the body. The World Health Organization recommends that only trained personnel handle the bodies of Ebola victims.
"We know how to stop Ebola," said Gregory Hartl, a WHO spokesman. "We have stopped all previous outbreaks in the past using old-fashioned methods."
"From what we've seen, there isn't any reason to think we can't stop the outbreak in West Africa using what we have done in the past."
Every three minutes, two people
die of tuberculosis in India, as per the Directorate General of Health
Services, Ministry of Health and Family Welfare. In 2013, India had 61
million cases of malaria and 116,000 deaths. Annually, TB and malaria
kill more people worldwide than any other disease- as a country, India
could do without ebola.
Can we avoid Ebola? Media reports paint an agonizing picture of Ebola in Sierra Leone, where there are no vehicles to collect dead bodies.
There
are homes where the parents are dead and the child is alive but
infected, with no one to take care of it. WHO estimates the Ebola death
toll to be 15,000 people ( miniscule as compared to India’s TB and
malaria numbers).
Where has Ebola come from?
Originating
from a remote village in Guinea in March 2014, Ebola spread to Nigeria,
Senegal and Mali, quickly. West Africa is struggling with the worst
Ebola outbreak until now. America and Europe have their own cases too.
Transmitted through blood, vomit, diarrhoea and other bodily fluids,
Ebola isn’t airborne, thankfully. The healthcare workers in West Africa
have been among the hardest hit by Ebola.
Though experts date
back Ebola to 1976, and say that this is not the first outbreak, it
could well be the worst, and will wax and wane with adequate preventive
measures or the lack of them.
So can Ebola reach India?
India
has quarantined a man who was cured of Ebola in Liberia but continued
to show traces of the virus in samples of his semen after arriving in
the country- this means that he is an Ebola-treated patient who is
negative in blood but whose body fluid is positive. He may have the
possibility of transmitting the disease through sexual route up to 90
days from time of clinical cure.
Flight patterns predict that
India has a low risk of importing a case of Ebola. Of course the virus
could land in the country, via a third country, and as this epidemic
continues, the risk of this progressively increases.
However, the countries affected show a pattern
1. All are low-income countries with weak health systems
2. They have very weak disease surveillance.
India has the same systemic problems. In fact, we have more of our own. TB, Malaria and Dengue.
There have been 14,413 reported cases of Ebola, with 5,177 reported deaths, up to November 14, 2014. (World Health Organization)
HOW IS EBOLA SPREAD?
By direct contact with an Ebola patient's blood or other bodily fluids like urine, saliva, and sweat. The highest concentration of virus is thought to be in blood, vomit and diarrhea.
The most vulnerable people are health care workers and family members or others who care for the sick. Because of the deadly nature of the disease, health workers should wear protective gear, especially when handling things like contaminated syringes. Such equipment is not commonly available in Africa, and the disease isn't always quickly recognized. Symptoms are similar to other diseases like malaria and cholera.
Someone can also get infected by handling soiled clothing or bed sheets without protection, and then touching their nose, mouth or eyes. People can also catch the disease by eating infected bushmeat, as Ebola can sicken animals including bats, chimpanzees and antelopes. Scientist think fruit bats might be the source of the virus, but aren't certain.
CAN EBOLA SPREAD IN THE AIR, LIKE FLU OR TUBERCULOSIS?
There is no evidence Ebola can be spread in the air by sneezing or coughing. "If there was a role for airborne transmission, we'd be seeing a lot more cases and deaths by now," said Ben Neuman, a virologist at Britain's University of Reading.
Ebola is in some ways similar to the AIDS virus because it is spread through bodily fluids, according to Stephen Morse, of Columbia University's Mailman School of Public Health. Unlike those infected with HIV, those with the Ebola virus are considered infectious only when they show symptoms, which include fever, vomiting and diarrhea.
(World Health Organization)
(World Health Organization)
(World Health Organization)
(World Health Organization)
(World Health Organization)
Travel to and from Ebola-affected countries is low risk. Here is what you need to know. (World Health Organization)
Ebola has killed 4,922 people, or about 50 percent of 10,141 confirmed, probable and suspected cases, mostly in Liberia, Sierra Leone and Guinea, according to the U.N.'s World Health Organization.
It says the true death toll may be three times as much or 15,000 people, while the death rate is thought to be about 70 percent of all cases.
Two nurses in the United States and one nurse in Spain have contracted Ebola outside of Africa. (Reuters)
Here are some facts about the deadly disease that you should know:
Some of the ultrastructural morphology displayed by an Ebola virus virion is revealed in this undated handout colorized transmission electron micrograph (TEM) obtained by Reuters August 1, 2014. U.S. health officials said September 30, 2014 the first patient infected with the deadly Ebola virus had been diagnosed in the country, in a new sign of how the outbreak ravaging West Africa can spread globally. REUTERS/Frederick Murphy/CDC/Handout via Reuters (UNITED STATES - Tags: HEALTH) THIS IMAGE HAS BEEN SUPPLIED BY A THIRD PARTY. IT IS DISTRIBUTED, EXACTLY AS RECEIVED BY REUTERS, AS A SERVICE TO CLIENTS. FOR EDITORIAL USE ONLY. NOT FOR SALE FOR MARKETING OR ADVERTISING CAMPAIGNS. MANDATORY CREDIT
There is no vaccine or cure for Ebola, a hemorrhagic fever. In past outbreaks, fatality rates have reached up to 90 percent. Ebola causes fever, flu-like pains, bleeding, vomiting and diarrhea.
Ebola emerged in a remote forest region of Guinea in March and has also turned up in Nigeria, Senegal and Mali. Health officials declared Nigeria and Senegal Ebola-free in October.
Pharmaceutical companies are working on experimental Ebola vaccines and antiviral drugs, but a significant number of doses will not be available until at least the first quarter of 2015.
Ebola is not airborne. It is transmitted through blood, vomit, diarrhea and other bodily fluids. Healthcare workers in West Africa have been among the hardest hit by the outbreak.
Recovery from Ebola depends on the patient’s immune response. People who recover from Ebola infection develop antibodies that last for at least 10 years.
Ebola symptoms generally appear between two and 21 days after infection, meaning there is a significant window during which an infected person can escape detection, allowing them to travel. However, they are not considered contagious until they start showing symptoms.
Ebola patients have been treated in the United States, Spain, Germany, France, Norway and the United Kingdom.
The U.S. Centers for Disease Control and Prevention (CDC) has estimated that the number of infections could rise to up to 1.4 million people by early next year without a massive global intervention to contain the virus.
The United States, Britain, France, China, Cuba and international organizations are pouring funds, supplies and personnel into the affected parts of West Africa.
Ebola's suspected origin is forest bats. The virus was first identified in 1976 in what is now known as Democratic Republic of the Congo.
SOURCE: World Health Organization and U.S. Centers for Disease Control and Prevention
Why India is uniquely susceptible to any epidemic
1.
We have one nurse for thousand people, monitoring the spread of this
killer virus is a herculean task. Only two laboratories are authorized
to test the virus – The National Institute for Communicable diseases,
Delhi, and National Institute of Virology, Pune.
2. 600 million people defecating in the open is enough impetus for any epidemic.
3.
The real issue is that though pharmaceutical companies are intensely
working on experimental vaccines and antiviral drugs, a substantial
number of doses won’t be ready until the first quarter of 2015.
4.
WHO predicted that diagnosing and segregating Ebola cases in India
could be more challenging as this virus’ early symptoms resemble those
of dengue and malaria, two diseases which are common across large parts
of the country.
5. Isolation of every patient who gets fever,
diahorrea or vomiting, or is suffering from non-specific viral symptoms
that could indicate any seasonal disease, is not a practical solution.
6.
In India’s poor households, like in West Africa, we often have many
people sleeping in one room. Ebola spreads in households. Because the
incubation period is up to 21 days, it often kills the family slowly,
one by one. But for each other family that keeps the virus from entering
its household, that can mean five or six fewer deaths. The death rate
is about 70% of all cases.
Lessons from Nigeria
More
pertinent for India’s situation, Nigeria appears to have successfully
eliminated Ebola. Its government took several critical steps.
1. Nigeria was prepared for the virus and trained healthcare workers on how to manage the disease.
2.
It widely disseminated information about the virus and preventive
measures; and, declared a health emergency when the first Ebola case was
identified. The Health Ministry organised the Ebola Emergency
Operations Center, a group of public health experts.
3. Reports
also say that thousands of home-care kits have been handed out. They
contain gloves, bleach, a bucket, plastic bags and a bleach sprayer.
Using them around the sick, and especially during burials, may have
helped.
These lessons are applicable for other healthcare epidemics as well, not just ebola.
Is India prepared?
Ashish
Jha, Professor of International Health at Harvard’s School of Public
Health and Director of Harvard Global Health Institute, said,
“Eradicating Ebola once cases emerge in a country will require
meticulous case management and public health skills, and India has way
too few of these kinds of people for a nation of its size and
complexity. Bottom line is – India is probably not as prepared as it
should be.”
So far, the Indian Government is doing the right things-
stepping up its efforts to prevent an outbreak of the deadly Ebola
virus, conducting mock drills at its airports and installing
surveillance systems.
The Centre has organized training programme son
how to handle Ebola, for doctors and auxiliary staff across various
states There was also talk of the Centre disbursing 50,000 kits across
various states.
But on a larger canvas, it is not about ebola.
India has many health concerns. A regular urbanite cannot even
comprehend the abject levels of poverty in some pockets of rural India,
and that a human being has to walk 5 kms to get to the nearest doctor.
There is no “health-seeking” behaviour in India.
The system
needs to offer basic services, and be ready to tackle a spectrum of
diseases that already exist in this country, as well as those that may
come up.
Dr. Ramakanta Panda is the Vice Chairman & Managing Director of the Asian Heart Institute, Mumbai.
