Ebola gives re­al­ity check

The rapid spread of Ebola to three con­ti­nents shows that the world needs ef­fec­tive surveil­lance and re­sponse sys­tem to check in­fec­tious dis­eases

Down to Earth - - CONTENTS - VIBHA VARSH­NEY| NEW DELHI

The rapid spread of Ebola shows that the world is not ready

to deal with deadly dis­eases

Tof the Ebola virus has HE SPREAD raised sev­eral ques­tions about the preparedness of the world to deal with emerg­ing in­fec­tious dis­eases. The dreaded virus, which was first re­ported in 1976, bleeds 50 per cent of its vic­tims to death.Yet clin­i­cal tri­als of po­ten­tial drugs have never been done be­cause the dis­ease re­mained re­stricted to Africa. Though the cur­rent out­break be­gan in De­cem­ber 2013, Ebola came in the lime­light only after it spread to de­vel­oped coun­tries like the US and Spain.

“This epi­demic is sur­pris­ing only in its scope. In many ways this is an ex­am­ple of the par­a­digm on emer­gence (the trans­fer of the dis­ease from an­i­mals to hu­mans and its rapid spread) that epi­demi­ol­o­gists have been talk­ing about for years,” says David Fis­man, pro­fes­sor at the Di­vi­sion of Epi­demi­ol­ogy, Univer­sity of Toronto, Canada. “De­spite all our tech­no­log­i­cal won­ders, in many ways in­fec­tious dis­ease epi­demics re­main a threat to lives, economies, and na­tions much as they were 150 years ago,”he says.

Ac­cord­ing to fig­ures re­leased by the World Health Or­ga­ni­za­tion (who) on Novem­ber 2, over 13,000 peo­ple have been in­fected and 4,818 killed in the “West Africa out­break ”that has spread to eight coun­tries— Guinea, Liberia, Sierra Leone, Nige­ria, Sene­gal, Mali, Spain and the US.An un­re­lated out­break of Ebola through a dif­fer­ent vi­ral strain in the Demo­cratic Repub­lic of Congo has in­fected 66 and killed 49.

A who study sug­gests that in Guinea, where the cur­rent out­break started, the

sit­u­a­tion is be­com­ing worse. To as­sess the im­pact of the dis­ease, who’s Ebola Re­sponse Team cal­cu­lated the ba­sic re­pro­duc­tive num­ber (de­noted by R0) of the virus for th­ese coun­tries. R0 of an in­fec­tion in­di­cates the num­ber of cases that one pa­tient can gen­er­ate. If R0 is more than 1, the in­fec­tion will spread.The study found that for Guinea the Ebola R0 has in­creased from 1.71 to 1.81 while it has fallen from 1.83 to 1.51 for Liberia and from 2.02 to 1.38 for Sierra Leone.The anal­y­sis was pub­lished in the New Eng­land Jour­nal of Medicine on Oc­to­ber 16.

But ef­fec­tive prepa­ra­tion can help check Ebola’s spread. “We may not be able to pre­vent the start of an out­break, but if we have an ad­e­quate surveil­lance and re­sponse sys­tem, we can quickly step in and quash it be­fore it ex­pands,” says Martin Meltzer, lead re­searcher at the Ebola Re­sponse and Mod­el­ling Task Force, Cen­ters for Dis­ease Con­trol and Preven­tion, US. Nige­ria and Sene­gal have man­aged to rid them­selves of Ebola by set­ting up ef­fec­tive surveil­lance and re­sponse sys­tem .“The cost of set­ting up such a sys­tem is re­mark­ably small, ”Meltzer says.

Prepa­ra­tions in In­dia

With a large num­ber of In­di­ans work­ing in Africa, there is a huge pos­si­bil­ity of the dis­ease en­ter­ing In­dia. The Union Min­istry of Health and Fam­ily Wel­fare says it has put in place the same surveil­lance and track­ing sys­tems to check Ebola that proved suc­cess­ful in Nige­ria. Ther­mal scan­ners have been set up in most of the 15 ma­jor air­ports and more are likely to be pur­chased and in­stalled.

Union health min­is­ter Harsh Vard­han claims that In­dia al­ready has an In­te­grated Dis­ease Surveil­lance Pro­gramme. He says the Na­tional In­sti­tute of Virol­ogy at Pune has been equipped to han­dle the test­ing work re­lat­ing to Ebola virus and Delhi-based Na­tional Cen­tre for Dis­eases Con­trol can con­duct molec­u­lar di­ag­no­sis. Vard­han says

"Coun­ter­ing threats such as Ebola re­quires a cer­tain depth in health ser­vices and th­ese are poor in In­dia"

over 22,100 pas­sen­gers have been screened till Oc­to­ber 15. Of th­ese, 56 were iden­ti­fied to be at a high risk of Ebola in­fec­tion and seven at medium risk .Th­ese sus­pected Ebola pa­tients are be­ing kept un­der ob­ser­va­tion for 30 days. But th­ese mea­sures may still not be enough be­cause the dis­ease has a long in­cu­ba­tion pe­riod and the pa­tients could travel away from the ci­ties where ar­range­ments for ob­serv­ing their health have been made.

“In­dia has a huge pop­u­la­tion, and ur­ban cen­tres are very densely packed. This could pose a chal­lenge be­cause it would be very dif­fi­cult to iso­late pa­tients and trace their con­tacts for ob­ser­va­tion. Th­ese el­e­ments could make con­tain­ing Ebola more chal­leng­ing in In­dia than in some other coun­tries,” says Peter Piot, co-dis­cov­erer of the Ebola virus and di­rec­tor of the London School of Hy­giene & Trop­i­cal Medicine. “This is an op­por­tu­nity for the In­dian health ser­vice to strengthen its in­fec­tion con­trol mea­sures,” he adds.

“Coun­ter­ing threats like Ebola re­quires a cer­tain depth in health ser­vices and this is poor in In­dia,” says Rajib Das­gupta, chair­per­son of the Cen­tre of So­cial Medicine and Com­mu­nity Health, Jawa­har­lal Nehru Univer­sity, New Delhi.

Most In­di­ans com­ing from Africa have ru­ral links, he says. But ar­range­ments to ob­serve sus­pected Ebola cases are vir­tu­ally ab­sent in ru­ral ar­eas.“You can­not quar­an­tine ev­ery­one on the ba­sis of sus­pi­cion and th­ese peo­ple will move to vil­lages,” he says. The Ebola surveil­lance sys­tem set up by the gov­ern­ment is sim­i­lar to the one es­tab­lished to con­trol sars. But in the case of sars, sus­pected cases came from Hong Kong and China and were mostly based in ur­ban ar­eas in In­dia where med­i­cal fa­cil­i­ties are avail­able.

Other threats

Ebola is not the only threat the world is fac­ing. who’s In­ter­na­tional Health Reg­u­la­tion Emer­gency Com­mit­tee is closely mon­i­tor­ing two other dis­eases: po­lio and Mid­dle East Res­pi­ra­tory Syn­drome Coronavirus. Just this year, who has re­ported out­breaks caused by 10 dif­fer­ent pathogens. Other than the ones men­tioned above, there have been cases of chikun­gunya, Mar­burg virus dis­ease, en­terovirus D68, avian in­fluenza viruses a(h7n9) and a(h5n1), cholera and yel­low fever.

Deal­ing with such dis­eases on a case-by-case ba­sis is not sus­tain­able. “A stronger pub­lic health sys­tem is an es­sen­tial com­po­nent of any ef­fec­tive surveil­lance sys­tem and rapid re­sponse. This re­quires go­ing into the com­mu­ni­ties to as­sess the spread and im­pact of a dis­ease and the ef­fec­tive­ness of any in­ter­ven­tion. Th­ese func­tions are not typ­i­cally car­ried out to any ma­jor de­gree by health­care sys­tems such as hos­pi­tals and clin­ics,” says Meltzer.

Fis­man says that it is time coun­tries start mak­ing big in­vest­ments in pub­lic health. “Free mar­kets do not support ‘pub­lic goods’, like in­fec­tious dis­ease con­trol, well. There is a role for gov­ern­ments and the UN in mak­ing the world safe from such threats.”

REUTERS

Over 13,000 peo­ple have been in­fected and 4,818 killed in the cur­rent Ebola out­break that has spread to eight coun­tries

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