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Friday, August 22, 2014

Ebola—How Ready India Is to Manage Its Threat?

A disease with no  vaccine  and no  treatment  with a known 60% mortality rate is creating shock waves across the globe. As it has already killed more  than a 1000 in West Africa —Guinea, Liberia and Sierra Leone—the World Health Organization   has  declared its rise to an epidemic stage as a public-health emergency of international concern.

Though some American pharmaceutical companies claim to have experimental drugs in their kitty to kill the virus but no one is sure of it. For the being, all that the doctors are doing is to isolate the infected patients and provide them with supportive therapy—maintaining oxygen, maintaining blood pressure and importantly, keeping them well hydrated.  

One good thing with Ebola is: the virus, like the flu, does not spread through air. And the present level of research indicates that there is no sign of it mutating into something more dangerous. But contact with bodily fluids is found to be deadly. So all that the arrest of its spread calls for is: to ensure that no one comes in contact with the body-fluids of the infected persons, including hospital staff. According to the reports, the disease has already killed dozens of hospital staff who attended to the infected patients with inadequate protection.  

The developed west however believes that the disease cannot pose any threat to them for they are sure to diagnose the infected person and quickly isolate the infested from the rest and attend to the patient with highest-level care.  

But the reality is otherwise. Today’s world is more connected: airplanes can bring the disease from anywhere to anywhere in a single day.  And, scientists say, “Once the virus is in a city, it is difficult to ring it off and arrest its spread.” This is more so in the case of poorly equipped countries in terms of equipment, expertise, training to the nursing staff, and the awareness of people.   

In outbreaks of this nature, what matters most is: faster detection of the infection, immediately tracing the contacts of the infected, and isolating all such possible sources of the disease and of course, providing them with necessary medi-care, for that alone prevents the outbreak turning into an epidemic.

This simple logic poses us a daunting question: How alert our public-health system is? The answer to the question, to be honest, is anybody’s guess.  It is reported that as many as 50,000 to 60,000 Indians are residing in the Ebola-hit African countries. Obviously, many of them intend to return home, or are already on their way back. It means they, along with other travelers from these countries, constitute the likely carriers of the disease into India. Now, unless our screening at the airports and other places of entry of these people is that perfect, there is every danger of Ebola entering the country.  

The other most disturbing phenomena associated with the whole episode is: there is only one laboratory in India, virology lab at Poona, which alone is equipped to identify the virus. This poses another question: how equipped it is to cope up with such demand emanating from different centers and how soon?

Another disturbing feature is: the virus is said to have a long incubation period—the disease can manifest anywhere between 2-21 days. And the initial symptoms that resemble those of flu are said to be non-specific and misleading. So, there is a danger of travelers entering into country not knowing that they are the carriers of the disease. In this context, it becomes essential for the incoming people from the effected countries to declare about their health status and prior travel details and subject themselves willingly for quarantine. 

At the same time, public health system must also take it as its responsibility to monitor the health status of such people rather than leaving it to them to report any adversity whenever emerged. The infection, as it progresses, is said to result in:
·         shortness of breath,
·         agitation,
·         bleeding from nose and mouth besides from the injection-sites, and
eventually patient succumbs to multiple organ dysfunction, shock and coma. Unless all the interconnected agencies function in unison, the entry of this malice cannot be stopped.

Simultaneously, government should also restrict peoples’ travel to the effected countries. It should put in place immediately a robust system of screening for the possible carriers of the disease at the entry points and promptly isolate the suspected cases. The staff attending to such patients must also be provided with necessary protection gear and medical expertise.

Lastly, it is time for  the elite of  the society to  ponder  over the question: Are we not capable of establishing virus testing  laboratories and  necessary quarantine wards that could address threats  of this nature  which have become  very recurrent  in the recent  past, at least  in the cities of major international airports?


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