An expert speaks: What India should do to best deal with the Ebola scare

The World Health Organisation has warned that the deadly Ebola epidemic is ‘vastly underestimated’ and that ‘extraordinary measures’ will be needed to contain it. The deadly outbreak that originated in the West African country of Guinea in February has already claimed over 1000 lives and spread to the neighbouring countries of Liberia, Nigeria and Sierra Leone.

Countries including India are bracing themselves to prevent the spread of the deadly virus by setting up screening procedures of passengers with a history of travel to Ebola-affected countries.

According to the Health Ministry, 9207 passengers have been screened for Ebola since 10 August by Airport Health Officers at Delhi, Mumbai, Bengaluru, Chennai, Trivandrum and Kochi.

So far there have been no confirmed cases of Ebola in India.

While the government insists that the situation is under control, there is a growing demand for more information on the little known virus and how best one can protect oneself from contracting the virus.

Firstpost spoke to Monika Puri, a specialist in community medicine and a Senior Resident at Lady Hardinge Medical College about how the spread of the Ebola virus can be checked and whether India is equipped to take on the challenge.

Excerpts from the interview:

How can we better prepare ourselves to deal with scare of an Ebola outbreak?

It is important to first understand a little bit about the epidemiology of this virus. Ebola is a viral disease like Dengue and Chikungunya. The preliminary symptoms are very much like the flu. For instance, you’ll have a high fever, headaches, body ache. And it can also lead to haemorrhaging tendencies, where you start to bleed from different parts of the body. It can further lead to a shock-like state and ultimately death.

The problem with this virus is that the case-fatality rate is very high. That is, if there are 100 people who are suffering from this viral disease, 90 out of them will eventually die.

An expert speaks: What India should do to best deal with the Ebola scare


There two reasons that.

First, the period of infection is very small. Within two to 14 days, anyone who is exposed to it will get it. And two, a country like India does not have any history of his virus and if this virus is imported in any form or there is an indigenous outbreak, people will not have immunity against it.

They have not been exposed to this virus earlier so their body does not have immunity against it. As I have said, because the case-fatality rate is very high, the morbidity and mortality rate will be very high.

Now, how is Ebola transmitted? It spreads via body fluids – saliva, sweat, semen, blood and physical contact. The risk of exposure to those who are handling Ebola cases, health care workers, for instance, is very high.

And when a patient dies and the body is being cremated or buried, at that stage too, the infection can be transmitted.

What we need to do is try and stop importation of the virus into India and if there is importation, we should be able to isolate and quarantine such a patient. The best way to do that is put check points at the entry points like airports and sea ports. For some time, people should avoid non-urgent travel to West African countries and to the Middle East. This will minimise risk of importation.

Eventually, the mortality and morbidity will wane off like in the case of Swine Flu because the population will start developing immunity.

Are there any symptoms that distinguish an Ebola flu from a normal flu?

It starts of like a normal flu. Headaches, fever, cough. In the case of Ebola, however, the symptoms won’t subside despite medication. Then within a period of two-three days, you’ll begin to have joint pains. Then you may develop rashes leading to bleeding from the nose or other sides of the body. It could eventually lead to a shock-like situation and organ-failure and ultimately death.

The best bet is to ensure prevention. If you can’t prevent, isolate and quarantine so that it does not spread to others, especially to health care professionals.

Does Ebola treatment require specialised care? Is India equipped to provide the necessary care?

The treatment stays the same. It is conservative treatment. Isolate the patient, maintain blood parameters, maintain blood pressure and so on. So Internal Medicine specialists will be equipped to provide care to the patient. The problems arise when complications set in. And for that, what is necessary is an ICU set-up.

The first and foremost requirement is to isolate the patient. And what is needed are designated wards. You can’t keep an Ebola patient in a normal ICU ward because the chance of spread of infection is so high.

So you need to have a designated nodal officer, a nodal ward, where every suspected case is tracked and tested. Till such time as test results come out, the patient has to be isolated and quarantined.

At present, the government has created a nodal centre at the RML Hospital, where any patient who has Ebola-like symptoms can be tested. The hospital has set up wards to quarantine such patients.

We also have the National Centre for Disease Control and National Institute of Virology. So we are equipped.

It is just that half-baked knowledge creates panic. If people are educated well and they are taught about preventive care, it can be contained.

Should India also make arrangements to procure the experimental drug that WHO has approved for use to combat the Ebola outbreak?

So far there has not been any confirmed case of Ebola in India. It is my personal view that if we put our maximum resources on the preventive aspect of disease we will be alright.

I think the resources and manpower should be more towards the preventive aspect. Let’s make sure that the infection does not come into India. I think that will be a better investment.

Given India’s size and the number of people travelling to and from Ebola-affected countries, what do you think will be the key challenge for the government and health professionals in keeping Ebola out?

I think the biggest challenge will be tracking the movement of people.

So far the virus has been seen in three Africa countries. We are also hearing of cases in the Middle East. I think it is important to educate travellers.

The biggest intervention is when you make people aware of their own health needs. In India, a lot of people don’t know what Ebola is. So we need to educate travellers and issue directives to avoid Ebola-affected countries. And if you have to travel, use personal protective measures like wearing gloves and masks.

Are public awareness programmes being conducted in Delhi to better equip the general public to deal with the Ebola scare?

At our health centres, we are trying to educate the masses by holding health talks and discussions about the Ebola virus and other flu-like symptoms so that people are aware how best to handle such situations.

We are also training our medical students and interns who come into contact with patients on how they should protect themselves from potential Ebola cases and to refer any patient with serious symptoms of flu to a bigger government facility.

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Updated Date: Aug 26, 2014 11:51:04 IST

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