It has already claimed more than 1,400 lives, yet the Ebola virus continues to spread across West Africa. On August 8, an emergency committee of the World Health Organization unanimously agreed to declare the virus a public health emergency of international concern, calling for a coordinated international response to stop the spread of the disease. Consequently, India’s health ministry has put in place several elaborate precautionary measures, including extensive screening of all airline passengers arriving from Ebola-hit regions of West Africa.
Despite these efforts, India’s somewhat panicked response to Ebola is indication of the power of media-led hysteria – and how it can set the priorities of an otherwise fragile system of public health. A number of public health experts have argued in the wake of this global spread of news about the disease that attempts to build a more proactive approach to disease control are actually hampered by these bouts of overwrought interest in one disease or the other.
Reality vs Hype
It is certainly a horrible way to go. Initial symptoms include fever, muscle pain, headaches and a sore throat. This is followed by intense vomiting, diarrhoea, rashes, impaired kidney and liver function, and in many cases severe internal and external bleeding. One reason Ebola generates such fear is the disease has no cure so outbreaks have a fatality rate of up to 90%. Some vaccines are currently being tested.
But despite Ebola’s horrific effects, the disease is not actually very contagious. Ebola can only be transmitted through direct contact with the bodily fluids of an infected person or animal. For this reason, Ebola is theoretically much easier to contain than other diseases: it requires early detection of infected persons, who are then isolated from the larger population to prevent spread. It is here that the West African governments have struggled. They simply lack the public health infrastructure to contain the disease. Additionally, after years of civil war in the worst affected countries, many civilians lack faith in governmental institutions, preferring not to take infected family members to hospital.
Robust public health system
In an August 18 statement to the press, Union health minister Harsh Vardhan expressed his satisfaction with the monitoring infrastructure in India.
“We have systems in place to track anybody with the remotest symptoms of EVD – Ebola Virus Disease – throughout the 21-day danger period,” said Vardhan. “Luckily the disease is not airborne and therefore the infrastructure of prevention will easily arrest its spread.”
Yet Vardhan’s mention of this 21-day danger period is what should cause worry. He was referring to Ebola’s incubation period – the time between initial infection and the first onset of symptoms. The WHO places Ebola’s incubation period between two and 21 days, meaning that an infected person could go as long as three weeks before showing symptoms – which would allow that individual to breeze through any airport screening. It is because of the limited efficacy of such airport screenings that public health experts advocate a more proactive approach towards Ebola and similar infectious diseases.
“You always have to strike a balance,” said Dr Manish Kakkar, senior public health specialist on communicable diseases with the Public Health Foundation of India. “While focusing on screening you should not miss out on the obvious possibility of whether the system is capable of handling potential cases.”
No cases yet
Despite several scares, there have been no documented cases of Ebola in India thus far. Yet containment of the disease – if it should appear on these shores – would depend more on the preparedness of India’s public health infrastructure than the ability to conduct simple airport screenings. As Doctor Kakkar pointed out, “Instead of heavily focusing on excessive screening of passengers, and then tracking them, we should be making sure hospitals are equipped, and that staff are trained and re-trained to deal with a potential outbreak. The health workforce should be educated about the proper procedures. Such incidents provide an opportunity to ramp up this sort of training.”
This failure of the public health system was exemplified during the 2009 swine flu pandemic, which claimed almost 2,000 lives in India. Health experts say the outbreak was exacerbated by the sudden public hysteria around the disease, as well as the failure of Health Ministry officials to provide basic education to health workers on the disease. The similarities in the situations are only too noticeable.
Dr T Jacob John, head of the department of Microbiology and Virology at Christian Medical College in Vellore, advocates a more sensible and scientific approach to infectious diseases like Ebola and swine flu. “The fear factor takes predominance over the transmission dynamics,” he says. “During the H1N1 [swine flu] outbreak, there was so much fear that hospitals stopped admitting patients, because we don’t have universal systems to protect health workers.” Dr John said that a student at his medical college died after being refused admission to several hospitals, all of which were afraid of the disease.
When India’s health systems can be crippled by fear, it is clear that large-scale screenings can ever only be a small part of the solution. Screenings need to be complemented by efforts to create a more robust system, one that is capable of treating people in the case of a widespread pandemic. As Dr Kakkar explained, “The size of the country is huge, and its vulnerabilities are huge. Things inevitably fall through the cracks. We need to be seen as more scientific and evidence-based in how we approach these issues.”
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Despite these efforts, India’s somewhat panicked response to Ebola is indication of the power of media-led hysteria – and how it can set the priorities of an otherwise fragile system of public health. A number of public health experts have argued in the wake of this global spread of news about the disease that attempts to build a more proactive approach to disease control are actually hampered by these bouts of overwrought interest in one disease or the other.
Reality vs Hype
It is certainly a horrible way to go. Initial symptoms include fever, muscle pain, headaches and a sore throat. This is followed by intense vomiting, diarrhoea, rashes, impaired kidney and liver function, and in many cases severe internal and external bleeding. One reason Ebola generates such fear is the disease has no cure so outbreaks have a fatality rate of up to 90%. Some vaccines are currently being tested.
But despite Ebola’s horrific effects, the disease is not actually very contagious. Ebola can only be transmitted through direct contact with the bodily fluids of an infected person or animal. For this reason, Ebola is theoretically much easier to contain than other diseases: it requires early detection of infected persons, who are then isolated from the larger population to prevent spread. It is here that the West African governments have struggled. They simply lack the public health infrastructure to contain the disease. Additionally, after years of civil war in the worst affected countries, many civilians lack faith in governmental institutions, preferring not to take infected family members to hospital.
Robust public health system
In an August 18 statement to the press, Union health minister Harsh Vardhan expressed his satisfaction with the monitoring infrastructure in India.
“We have systems in place to track anybody with the remotest symptoms of EVD – Ebola Virus Disease – throughout the 21-day danger period,” said Vardhan. “Luckily the disease is not airborne and therefore the infrastructure of prevention will easily arrest its spread.”
Yet Vardhan’s mention of this 21-day danger period is what should cause worry. He was referring to Ebola’s incubation period – the time between initial infection and the first onset of symptoms. The WHO places Ebola’s incubation period between two and 21 days, meaning that an infected person could go as long as three weeks before showing symptoms – which would allow that individual to breeze through any airport screening. It is because of the limited efficacy of such airport screenings that public health experts advocate a more proactive approach towards Ebola and similar infectious diseases.
“You always have to strike a balance,” said Dr Manish Kakkar, senior public health specialist on communicable diseases with the Public Health Foundation of India. “While focusing on screening you should not miss out on the obvious possibility of whether the system is capable of handling potential cases.”
No cases yet
Despite several scares, there have been no documented cases of Ebola in India thus far. Yet containment of the disease – if it should appear on these shores – would depend more on the preparedness of India’s public health infrastructure than the ability to conduct simple airport screenings. As Doctor Kakkar pointed out, “Instead of heavily focusing on excessive screening of passengers, and then tracking them, we should be making sure hospitals are equipped, and that staff are trained and re-trained to deal with a potential outbreak. The health workforce should be educated about the proper procedures. Such incidents provide an opportunity to ramp up this sort of training.”
This failure of the public health system was exemplified during the 2009 swine flu pandemic, which claimed almost 2,000 lives in India. Health experts say the outbreak was exacerbated by the sudden public hysteria around the disease, as well as the failure of Health Ministry officials to provide basic education to health workers on the disease. The similarities in the situations are only too noticeable.
Dr T Jacob John, head of the department of Microbiology and Virology at Christian Medical College in Vellore, advocates a more sensible and scientific approach to infectious diseases like Ebola and swine flu. “The fear factor takes predominance over the transmission dynamics,” he says. “During the H1N1 [swine flu] outbreak, there was so much fear that hospitals stopped admitting patients, because we don’t have universal systems to protect health workers.” Dr John said that a student at his medical college died after being refused admission to several hospitals, all of which were afraid of the disease.
When India’s health systems can be crippled by fear, it is clear that large-scale screenings can ever only be a small part of the solution. Screenings need to be complemented by efforts to create a more robust system, one that is capable of treating people in the case of a widespread pandemic. As Dr Kakkar explained, “The size of the country is huge, and its vulnerabilities are huge. Things inevitably fall through the cracks. We need to be seen as more scientific and evidence-based in how we approach these issues.”