The decision by the Indian Ministry of Health to keep under quarantine a 26-year-old Indian man, who travelled to Delhi from Liberia, was a valid precautionary measure, said David L. Heymann, Professor of Infectious Disease Epidemiology at the London School of Hygiene and Tropical Medicine.
The man had been hospitalized for febrile fever in September, and was certified by the Liberian government to be Ebola-free and accordingly cleared for travel. As a cautionary measure he was put in isolation at the Delhi Airport quarantine centre and put through further tests. The tests showed his blood to be Ebola virus-free, although his semen and urine contained traces of the virus. He has been kept under further quarantine until all traces of the virus disappear.
“It is up to the government to make decisions on how they want to quarantine. I think I cannot speak against or for that in any way, but there are alternative methods that could be used,” Dr. Heymann said.
Ebola patients have been known to carry the virus in their semen and other bodily fluids even after they have been declared infection-free, said Dr. Heymann, who had worked for 13 years as a medical epidemiologist in sub-Saharan Africa, on assignment from the U.S. Center for Disease Control and Prevention (CDC). He participated in control of the first, second and third outbreaks of Ebola hemorrhagic fever.
“There are many ways of quarantining — many patients are very willing and prepared to self-quarantine after understanding the problem. You can tell a person that if they have sexual relations, a condom should be used, so the person does not transmit the virus.”
“For emerging infections such as this, it not what is known that is important but what is not known. It is not known whether or not this could be a way of transmitting of the virus, but it is important to use any precautionary measures when you can,” he added.
Over 5000 people have died of Ebola in Liberia, Guinea and Sierra Leone. The mortality rate is around 60 per cent, said Dr. Heymann.
The chance to stop Ebola from becoming the “nightmare” it is today was lost in March, he said, when from being a rural phenomenon the disease spread to urban areas. “Many of these countries have just come out of civil war in the past two years. Their health infrastructure was not strengthened during the wartime period, and many health workers fled.
If three simple public strategies are enforced, the outbreak will die out, he argues. These are first, the “rapid identification and isolation of patients in facilities where health workers are protected”; and second, contact-tracing, i.e. to find all persons who have been in contact with the patient, making sure their fever is taken twice a day and if their isolation if they develop fever.
The third strategy concerns environmental safety and safe body disposal. “ We must provide services to the Red Cross and others for the safe and respectful burial or disposal of bodies, and to take environmental measures to decontaminate households where Ebola patients have died.”
“Once these things are accomplished the outbreak will stop,” he said.
Of the promising treatment tracks, Dr. Heynmann made special mention of the studies being conducted by Médecins Sans Frontières (MSF) in Guinea on whether blood from Ebola-survivors contains the anti-body that will help neutralise the virus in the patients. “If that is effective it would be a wonderful way of curing patients at least when they are early in the infection,” he said. It would bring down the “terribly high mortality”, he said. “Patients would want to come into facilities rather than avoid them,” he added.
