BATTLING THE EBOLA VIRUS OUTBREAK

By Mohuya Chaudhuri*

The current outbreak of Ebola Virus Disease (EVD) in five countries in West Africa is one the worst ever in the history of West Africa and is rapidly getting out of control taking thousands of lives. Given the dreadful disease poses a massive threat, the World Health Organisation has declared a global emergency asking governments to take appropriate measures to tackle the crisis through better preparedness and preventive measures in order to control the outbreak.

The first nations that reported the deadly disease were Guinea, Sierra Leone, Nigeria, and Liberia and, on August 27 WHO reported that, the Ebola virus has spread to Democratic Republic of Congo, the fifth country to record fatalities, where as many as 13 people are believed to have died so far.

As of August 26, the figures for number of cases and number of deaths according to the WHO are 3069 and 1552 respectively. Liberia is the worst affected with 1378 cases and 694 deaths. In Guniea, 430 deaths have been reported, 422 in Sierra Leone while Nigeria has so far reported 6 deaths.

Ebola is one of the most dangerous viruses in the world that is life threatening and has no cure. The first outbreak of EVD first appeared in 1976 simultaneously in Sudan and Democratic Republic of Congo.

Before the current outbreak, till December 2013, 23 outbreaks were reported in which 2,388 people were affected and 1,590 died. The first case (the index case) in the current outbreak has been traced to December 6, 2013, in Guinea, when a two-year old child was diagnosed with the disease. It then spread to neighbouring countries, but the mode of transmission of infection across countries remains largely unknown.

Today five different species of the Ebola virus are known and three of them are endemic to Africa. These are Zaire ebolavirus, which caused the first outbreak in 1976, Bundibugyo ebolavirus and Sudan ebolavirus. The virus species implicated in the current outbreak too is the Zaire variety, which is known to be the deadliest species with a high fatality rate of up to 90%.

The symptoms of EVD include fever, headache, vomiting, fatigue and body ache and often also accompanied by internal and external bleeding or haemorrhage. If the disease is not quickly managed well, chances of survival are poor particularly if there is heavy internal bleeding which cannot be contained.

The virus is transmitted through close physical contact and spreads through body fluids like blood, secretions, organs during surgery or semen as well as contact with the blood and meat of fruit bats, which are known to be the natural hosts of the virus and which the Africans are known to consume, and that of other wild animals, which, though not natural hosts but can become carriers of the virus without contracting the disease.

At the hospitals, healthcare workers and doctors could contract the disease if precautions are not taken while attending affected patients. In many cases in Africa, during rituals like funerals, family members, relatives and friends often come in direct contact with the body fluids of the deceased and thus get infected. Since the current outbreak is of the Zaire strain, there is widespread panic across the world. Though the fatality rate in the current outbreak is about 60% there is fear that this could escalate.

So far, there has been no treatment for Ebola but there is a small ray of hope. Two American doctors who had been infected were treated with an experimental drug called ZMapp, which was successful in controlling the disease and saved their lives raising hopes of a medical breakthrough.

The drug will now be administered in other affected countries although so far there is no clear evidence that the drug will work on all patients. Also, the doses readily available are extremely limited.

Preventive measures are being taken across the world to tackle the outbreak. Across sub-Saharan Africa, authorities are taking major steps to protect their citizens.

Although WHO has made it clear that travel to the affected countries need not be stalled, countries like Kenya have stopped all travel from affected countries.

In India, while there is no presence of the Ebola virus, there are concerns that the virus can be imported through Indian nationals who live and work in these countries. For instance, at least 40,000 Indians live and work in Nigeria and 4,700 in Guinea, Liberia and Sierra Leone – along with 300 Central Reserve Police Force personnel; mostly women, who are working as UN peacekeepers in Liberia.

Since it is contagious, migrant populations face the greatest risk of contracting the disease and also transmitting the virus. Also, a significant number of people from India also travel for business to these countries and run the risk of infection if they come into contact with infected people.

The Union Ministry of Health and Family Welfare has initiated containment measures at the first point of entry into the country. All airports and other entry points where international passengers are arriving from affected countries, immigration officers have been sensitized about the disease and are screening each individual for Ebola. Travelers have to declare their history and medical conditions and in case any one displays symptoms linked to the disease, they are quarantined and tested and kept in isolation wards for 21 days.

So far, 15009 people have been screened, tested and then released since 10th of August. However, they have been advised that in case they notice any symptoms related to EVD, they should visit a doctor immediately. A helpline has been set up through which the health ministry’s control room can be accessed for any assistance.

As the number of deaths continues to rise, companies like Afcons Infrastructure in Liberia have flown 113 employees back to India. One was quarantined while the others were discharged. However, they will be tracked and monitored by state governments for 21 days, the time taken for Ebola virus to incubate and for the symptoms to show. They will be kept near local health facilities and monitored on a day-to-day basis. Meanwhile three passengers from Sierra Leone were admitted to the quarantine cum isolation facility at Delhi airport and tested but they too were found to be negative and released.

Apart from screening at airports, the Integrated Disease Surveillance Programme is tracking 887 passengers, who are from Tamil Nadu, Kerala and Maharashtra for Ebola even after their release.

Unfortunately, there are no vaccines to fight the virus or conclusive medications that can treat and cure it. The only way to combat EVD is to take precautionary measures such as ensuring basic general hygiene at home like drinking clean water, washing hands. Any food items, especially meat need to be cooked well in order to prevent the onset of the disease. In case of an outbreak, people need to pay special attention to their own activities and avoid going to places where they could come into contact with infected patients, especially in hospitals or where animal meat is being sold or even family members or relatives who have EVD.

Battling the Ebola Virus Outbreak

The current outbreak of Ebola Virus Disease (EVD) in five countries in West Africa is one the worst ever in the history of West Africa and is rapidly getting out of control taking thousands of lives. Given that the dreadful disease poses a massive threat, the World Health Organisation has declared a global emergency asking governments to take appropriate measures to tackle the crisis through better preparedness and preventive measures in order to control the outbreak.

The first nations that reported the deadly disease were Guinea, Sierra Leone, Nigeria, and Liberia and, on August 27 WHO reported that, the Ebola virus has spread to Democratic Republic of Congo, the fifth country to record fatalities, where as many as 13 people are believed to have died so far. As of August 26, the figures for number of cases and number of deaths according to the WHO are 3069 and 1552 respectively. Liberia is the worst affected with 1378 cases and 694 deaths. In Guniea, 430 deaths have been reported, 422 in Sierra Leone while Nigeria has so far reported 6 deaths.

Ebola is one of the most dangerous viruses in the world that is life threatening and has no cure. The first outbreak of EVD first appeared in 1976 simultaneously in Sudan and Democratic Republic of Congo.

Before the current outbreak, till December 2013, 23 outbreaks were reported in which 2,388 people were affected and 1,590 died. The first case (the index case) in the current outbreak has been traced to December 6, 2013, in Guinea, when a two-year old child was diagnosed with the disease. It then spread to neighbouring countries, but the mode of transmission of infection across countries remains largely unknown.

Today five different species of the Ebola virus are known and three of them are endemic to Africa. These are Zaire ebolavirus, which caused the first outbreak in 1976, Bundibugyo ebolavirus and Sudan ebolavirus. The virus species implicated in the current outbreak too is the Zaire variety, which is known to be the deadliest species with a high fatality rate of up to 90%.

The symptoms of EVD include fever, headache, vomiting, fatigue and body ache and often also accompanied by internal and external bleeding or haemorrhage. If the disease is not quickly managed well, chances of survival are poor particularly if there heavy internal bleeding which cannot be contained.

The virus is transmitted through close physical contact and spreads through body fluids like blood, secretions, organs during surgery or semen as well as contact with the blood and meat of fruit bats, which are known to be the natural hosts of the virus and which the Africans are known to consume, and that of other wild animals, which, though not natural hosts but can become carriers of the virus without contracting the disease.

At the hospitals, healthcare workers and doctors could contract the disease if precautions are not taken while attending affected patients. In many cases in Africa, during rituals like funerals, family members, relatives and friends often come in direct contact with the body fluids of the deceased and thus get infected. Since the current outbreak is of the Zaire strain, there is widespread panic across the world. Though the fatality rate in the current outbreak is about 60% there is fear that this could escalate.

So far, there has been no treatment for Ebola but there is a small ray of hope. Two American doctors who had been infected were treated with an experimental drug called ZMapp, which was successful in controlling the disease and saved their lives raising hopes of a medical breakthrough.
The drug will now be administered in other affected countries although so far there is no clear evidence that the drug will work on all patients and also the doses readily available are extremely limited.

Preventive measures are being taken across the world to tackle the outbreak.
Across sub-Saharan Africa, authorities are taking major steps to protect their citizens.
Although WHO has made it clear that travel to the affected countries need not be stalled but countries like Kenya has stopped all travel from affected countries.

In India, while there is no presence of the Ebola virus, there are concerns that the virus can be imported through Indian nationals who live and work in these countries. For instance, at least 40,000 Indians live and work in Nigeria and 4,700 in Guinea, Liberia and Sierra Leone along with 300 Central Reserve Police Force personnel; mostly women, are working as UN peacekeepers in Liberia. Since it is contagious, migrant populations face the greatest risk of contracting the disease and also transmitting the virus. Also, a significant number of people from India also travel for business to these countries may also get infected if they come into contact with infected people.

The Union Ministry of Health and Family Welfare has initiated containment measures at the first point of entry into the country. All airports and other entry points where international passengers are arriving from affected countries, immigration officers have been sensitized about the disease and are screening each individual for Ebola. Travelers have to declare their history and medical conditions and in case any one displays symptoms linked to the disease, they are quarantined and tested and kept in isolation wards for 21 days.

So far, 15009 people have been screened, tested and then released since 10th of August. However, they have been advised that in case they notice any symptoms related to EVD, they should visit a doctor immediately. A helpline has been set up through which the health ministry’s control room can be accessed for any assistance.

As the number of deaths continues to rise, companies like Afcons Infrastructure in Liberia have flown 113 employees back to India. One was quarantined while the others were discharged. However, they will be tracked and monitored by state governments for 21 days, the time taken for Ebola virus to incubate and for the symptoms to show. They will be kept near local health facilities and monitored on a day-to-day basis. Meanwhile three passengers from Sierra Leone were admitted to the quarantine cum isolation facility at Delhi airport and tested but they too were found to be negative and released.

Apart from screening at airports, the Integrated Disease Surveillance Programme is tracking 887 passengers, who are from Tamil Nadu, Kerala and Maharashtra for Ebola even after their release.

Unfortunately, there are no vaccines to fight the virus or conclusive medications that can treat and cure it. The only way to combat EVD is to take precautionary measures such as ensuring basic general hygiene at home like drinking clean water, washing hands. Any food items, especially meat need to be cooked well in order to prevent the onset of the disease. In case of an outbreak for visitors to affected countries, people need to pay special attention to their own activities and avoid going to places where they could come into contact with infected patients, especially in hospitals or where animal meat is being sold or even family members or relatives who have EVD.

Though the danger of an outbreak has been contained for the moment, the fear of the virus entering the country remains.

It is too early to breathe easy since we still need to identify gaps that exist, investigate with due diligence and make sure that each individual coming into the country is open about his/her health status. Many people are averse to being quarantined and therefore do not disclose their health status and since Ebola virus can take up to three weeks to incubate; it may not be caught during tests. However once it manifests itself, it may be too late for the patient.

It is critical that all containment measures are implemented so that the deadly virus does not embed itself in our midst. It’s a risk that India cannot afford as too many lives are at stake.
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* Mohuya Chaudhuri, former senior editor, NDTV, is a Delhi-based independent journalist, resarcher and film maker. She may be contacted at [email protected] – OST