Ebola and India

Ebola outbreaks are not new to our world. According to the World Health Organisation (WHO), Ebola outbreaks have been occurring since 1976 and exclusively in Africa. However, the current outbreak in West Africa is by far the largest since 1976; there have been more cases and deaths (the toll is 4,500 currently) in this outbreak than all others combined. The affected countries in Africa include Guinea, Sierra Leone, Liberia, Nigeria and Senegal — all low-income countries with weak health systems and disease surveillance.

The frightening things about this disease are its high case fatality (varies between 25 and 90 per cent, according to the WHO) and that there is no known cure for this virus. That Ebola arrived in the US, a wealthy country that had taken considerable precautions to prevent exactly such an incident from taking place, raises concerns about how countries like India, with weak health systems and disease control mechanisms, will deal with this deadly virus.

Can Ebola reach India? So far there has been no reported case of the disease here. Moreover, predictions based on flight patterns made by researchers at Northeastern University, US, indicate that India has a low risk of importing a case of Ebola. Of course the virus could land in the country, and as this epidemic continues, the risk of this progressively increases. Ebola cases that have spread outside Africa have made this journey through passengers taking flights from Ebola-affected countries in West Africa. While transport links between India and West Africa are limited, the virus can travel through a third country. Moreover, there are fairly large Indian communities living in these countries of West Africa, and if the situation there worsens considerably, one could expect them to return to India. So health authorities here need to be vigilant, and recognise that at some time, whether during this epidemic or the next ones, sporadic cases are likely to appear in India. The challenge, of course, will be to make sure that these sporadic cases are contained and do not spread in the general population.

Concerns over Ebola reaching Indian shores have motivated the government to take several steps to prevent it from spreading. Active screening of passengers at international airports is underway. Hospitals in major cities have been identified for referring suspected Ebola cases for investigation. Further, laboratories for testing the virus have also been designated. Health workers need to have a high index of suspicion for people with fever from Ebola-affected countries, as also the training and proper equipment, and follow precautions to safely screen and care for patients. If, however, the virus manages to evade these checks and reaches the general population, then health authorities in India could have a significant problem on their hands. The dense population of our cities, the poor sanitation, weak health infrastructure and surveillance systems provide the perfect recipe for a full-blown epidemic. It will be particularly problematic if the virus lands in urban slums. Further, given the fear that is now associated with Ebola, the willingness of health workers in India to care for Ebola patients will be tested. Indeed, there is an important need for sensitising health workers to this virus.

While the Ebola epidemic still rages, there have been some successes in the fight to contain the disease. For one, in the US it appears to have been contained, though fears over the disease led to the quarantine of a nurse who worked with Ebola patients in Sierra Leone, even though she tested negative for Ebola and was asymptomatic. This is especially counterproductive when the most important way to protect people around the world is to stop the epidemic in West Africa. More pertinent for India’s situation, Nigeria appears to have successfully eliminated Ebola. Its government took several critical steps — it was prepared for the virus and trained healthcare workers on how to manage the disease. It widely disseminated information about the virus and preventive measures; and, declared a health emergency when the first Ebola case was identified. This enabled the Health Ministry to organise the Ebola Emergency Operations Center, a group of public health experts. Such measures hold important lessons for India as it prepares to tackle this deadly virus.

( Krishna D Rao is an Assistant Professor (Health Systems Program) and Prof David H Peters is the Chairman of the Department of International Health, John Hopkins University, Maryland.)

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