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India has bigger worries than Ebola

TB and malaria kill more people worldwide than any other disease- as a country, India could do without Ebola.

By Dr. Ramakanta Panda

India has isolated a man with Ebola infected Semen. But this is not our country’s biggest health problem right now.

Every three minutes, two people die of tuberculosis in India, as per the Directorate General of Health Services, Ministry of Health and Family Welfare. In 2013, India had 61 million cases of malaria and 116,000 deaths. Annually, TB and malaria kill more people worldwide than any other disease- as a country, India could do without ebola.

Can we avoid Ebola? Media reports paint an agonizing picture of  Ebola in Sierra Leone, where there are no vehicles to collect dead bodies.

There are homes where the parents are dead and the child is alive but infected, with no one to take care of it. WHO estimates the Ebola death toll to be 15,000 people ( miniscule as compared to India’s TB and malaria numbers).

Where has Ebola come from?
Originating from a remote village in Guinea in March 2014, Ebola spread to Nigeria, Senegal and Mali, quickly. West Africa is struggling with the worst Ebola outbreak until now. America and Europe have their own cases too. Transmitted through blood, vomit, diarrhoea and other bodily fluids, Ebola isn’t airborne, thankfully. The healthcare workers in West Africa have been among the hardest hit by Ebola.

Though experts date back Ebola to 1976, and say that this is not the first outbreak, it could well be the worst, and will wax and wane with adequate preventive measures or the lack of them.

So can Ebola reach India?
India has quarantined a man who was cured of Ebola in Liberia but continued to show traces of the virus in samples of his semen after arriving in the country- this means that he is an Ebola-treated patient who is negative in blood but whose body fluid is positive. He may have the possibility of transmitting the disease through sexual route up to 90 days from time of clinical cure.

Flight patterns predict that India has a low risk of importing a case of Ebola. Of course the virus could land in the country, via a third country, and as this epidemic continues, the risk of this progressively increases.

However, the countries affected show a pattern
1.    All are low-income countries with weak health systems
2.    They have very weak disease surveillance.

India has the same systemic problems. In fact, we have more of our own. TB, Malaria and Dengue.

Why India is uniquely susceptible to any epidemic
1.    We have one nurse for thousand people, monitoring the spread of this killer virus is a herculean task. Only two laboratories are authorized to test the virus – The National Institute for Communicable diseases, Delhi, and National Institute of Virology, Pune.
2.    600 million people defecating in the open is enough impetus for any epidemic.
3.    The real issue is that though pharmaceutical companies are intensely working on experimental vaccines and antiviral drugs, a substantial number of doses won’t be ready until the first quarter of 2015.
4.    WHO predicted that diagnosing and segregating Ebola cases in India could be more challenging as this virus’ early symptoms resemble those of dengue and malaria, two diseases which are common across large parts of the country.
5.    Isolation of every patient who gets fever, diahorrea or vomiting, or is suffering from non-specific viral symptoms that could indicate any seasonal disease, is not a practical solution.
6.    In India’s poor households, like in West Africa, we often have many people sleeping in one room. Ebola spreads in households. Because the incubation period is up to 21 days, it often kills the family slowly, one by one. But for each other family that keeps the virus from entering its household, that can mean five or six fewer deaths. The death rate is about 70% of all cases.

Lessons from Nigeria
More pertinent for India’s situation, Nigeria appears to have successfully eliminated Ebola. Its government took several critical steps.
1.    Nigeria was prepared for the virus and trained healthcare workers on how to manage the disease.  
2.    It widely disseminated information about the virus and preventive measures; and, declared a health emergency when the first Ebola case was identified. The Health Ministry organised the Ebola Emergency Operations Center, a group of public health experts.
3.    Reports also say that thousands of home-care kits have been handed out. They contain gloves, bleach, a bucket, plastic bags and a bleach sprayer. Using them around the sick, and especially during burials, may have helped.
These lessons are applicable for other healthcare epidemics as well, not just ebola.

Is India prepared?
Ashish Jha, Professor of International Health at Harvard’s School of Public Health and Director of Harvard Global Health Institute, said, “Eradicating Ebola once cases emerge in a country will require meticulous case management and public health skills, and India has way too few of these kinds of people for a nation of its size and complexity. Bottom line is – India is probably not as prepared as it should be.”
So far, the Indian Government is doing the right things- stepping up its efforts to prevent an outbreak of the deadly Ebola virus, conducting mock drills at its airports and installing surveillance systems.
The Centre has organized training programme son how to handle Ebola, for doctors and auxiliary staff across various states There was also talk of the Centre disbursing 50,000 kits across various states.
 
But on a larger canvas, it is not about ebola. India has many health concerns. A regular urbanite cannot even comprehend the abject levels of poverty in some pockets of rural India, and that a human being has to walk 5 kms to get to the nearest doctor. There is no “health-seeking” behaviour in India.

The system needs to offer basic services, and  be ready to tackle a spectrum of diseases that already exist in this country, as well as those that may come up.

Dr. Ramakanta Panda is the Vice Chairman & Managing Director of the Asian Heart Institute, Mumbai.