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Sunday, 3 August 2014

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The Ebola outbreak

We hear of wars and conflicts that take a heavy toll on human lives around the world. Just recently the world commemorated the 100th anniversary of the start of WWI which killed millions of combatants and non-combatants. But all these wars pale into insignificance when we consider that micro-organisms have the power to wipe off human life on Earth. The world has seen such deadly plagues before, and right now we are seeing something that has the potential to do so.

It is called Ebola. It is a deadly viral disease that is often fatal for up to 90 percent of infected victims. Ebola’s symptoms include fever, headache, joint pain, lack of appetite, difficulty in breathing and sore throat, which somewhat unfortunately are also signs of many non-lethal diseases. In its advanced stages, Ebola leads to diarrhoea, impaired kidney and liver, vomiting and internal and external bleeding. The good news is that if treated early enough, most patients can fight the disease off and become totally normal again.

It is not a death sentence per se. Interestingly, our closest relatives Chimpanzees also get the disease.

The current Ebola outbreak began in Guinea in March. It has now killed more than 670 people across Guinea, Liberia and Sierra Leone, including one of the leading doctors in the field, from more than 1,200 cases. Several African countries have declared emergency situations due to the outbreak.

Doctors Without Borders (MSF) has declared that the disease is already “out of control”.

This is not the first time that Ebola has raised its ugly head. Previously, there were limited outbreaks in 1976, 1995 and most recently in 2007.

The biggest previous outbreak of the disease saw 224 deaths from 425 cases, and there have only been 2,300 deaths from all previous outbreaks of the virus. This outbreak, which has been growing since January, concerns the deadliest form of the Ebola virus, Zaire ebolavirus.

Dr Alexander van Tulleken, humanitarian medicine expert and senior fellow at Fordham University, has written an interesting editorial on the virus which he describes as “terrifying”. Here is an extract: Airlines Association, IATA, says the World Health Organization (WHO) is not recommending any travel restrictions or border closures due to Ebola outbreak.

In the Nigerian case, the infected victim entered on a passenger flight from Liberia. On its part, Liberia has closed all its borders except just three land crossings, where travellers can be screened and treatment services provided if needed.

Risks

The association added in the rare event of an Ebola sufferer travelling by air, risks to other passengers are low. But we cannot afford to relax because air travel within and outside borders is extremely common.

The biggest danger now is that viruses can travel round the world at 900 Km/hour. Air travel has made the world closer and at the same time, makes it easier for viruses to jump from one continent to another. Nevertheless, the Airlines Association, IATA, says the World Health Organization (WHO) is not recommending any travel restrictions or border closures due to Ebola outbreak.

In the Nigerian case, the infected victim entered on a passenger flight from Liberia. On its part, Liberia has closed all its borders except just three land crossings, where travellers can be screened and treatment services provided if needed.

The association added, in the rare event of an Ebola sufferer travelling by air, risks to other passengers are low. But we cannot afford to relax because air travel within and outside borders is extremely common and it is very hard to detect someone infected with the Ebola virus at the point of embarkation although airports are stepping up vigilance.

After all, the Ebola virus cannot be detected soon after infection - the first signs of the virus are red eyes and a rash, which could be caused by many different things. The virus takes anywhere from two to 21 days to incubate and start causing symptoms. The virus is transmitted through direct contact with fluids such as saliva or blood from infected patients.

Regions

At the moment only West Africa seems to be affected but there is a growing fear that it might travel to other regions. Infected individuals must be isolated in health centres to prevent the virus from spreading to others and to give them the care they need.

Bodies of victims must also be disposed of with care: The virus, present in bodily fluids, including sweat, is most infectious at the end-stage. In fact, experts have drawn up a list of 35 countries that are “only a flight away” from an Ebola outbreak.

In the meantime, ancient beliefs have got in the way of containing the disease.

Medical experts say that some of those in infected areas were not seeking medical treatment as they thought the disease was the work of sorcerers. Belief in witchcraft and traditional medicine is still prevalent in parts of West Africa, particularly the remote rural areas of Sierra Leone, Guinea and Liberia where the outbreak has been concentrated.

What is sorely lacking is proper awareness about the disease and how it is spread in the poorest parts of Africa and even in Asia, which also had its fair share of outbreaks such as SARS and bird flu. Indeed, the obstacles to bringing the virus under control are formidable, among them a shortage of medical resources and resistance from local communities terrified by a disease they do not understand. Many people are said to be hiding sick loved ones at home and transporting bodies for burial with no understanding of the precautions they must take.

Here in Sri Lanka, the health authorities have advised against non-essential travel to West Africa and have urged passengers coming from those areas to screen for Ebola. They must take additional precautions to ensure that Ebola does not enter Sri Lanka which previously successfully contained many infectious diseases and outbreaks. African officials are advising a 21-day fever watch to ensure that no active infection is occurring. Since we live in a connected world, it is better to be prepared for any eventuality.

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