The risk of Ebola in India

With current flight schedules, scientists say there is a 75 per cent chance that Ebola could reach France and a 50 per cent chance that it could reach the U.K. by the end of the month. The three African nations at the epicentre of the Ebola earthquake are Guinea, Sierra Leone and Liberia. All the countries are French-speaking and have several flight connections to France — hence the high risk to France. Heathrow Airport is one the world’s main airline hubs, so the high risk to the U.K.

Preparing to deal with ebola

Ebola is a lethal virus with a long incubation period. More than half the people who are infected with Ebola die from it, but it takes between 8-21 days for the symptoms to show up once a person is infected. This now provides the making of a global epidemic — an Indian nurse working in Monrovia, Liberia, could come home infected with Ebola. She could pass through the airport thermal scanners and go home — completely asymptomatic. When she comes down with the disease, she will be initially treated with love and care by her family members; none of whom will wear gloves or masks. They will be infected. She may finally have to go in, very sick and contagious, to a local hospital. Fearful of quarantine and death, she may not reveal (or more likely not be asked) that she came from Liberia. The symptoms of an acute Ebola infection — high fever, headaches, nausea, diarrhoea — are the same as many of our home-grown but less fatal viruses. The hospital will not isolate her; nor will the nurses and doctors caring for her take any precautions. The epidemic will spread. Professor Peter Piot, the discoverer of Ebola, has said, “An outbreak in Europe or North America would quickly be brought under control. I am more worried about the many people from India who work in trade or industry in West Africa.”

Ebola would become a pandemic when it hits India. We are a poor country with health systems that are already stretched in the “season” of disease. We have one nurse per 1,000 people (according to 2010 World Bank data) compared to 1.6 nurses that Nigeria has or the 10 nurses that the U.S. has for 1,000 people. The U.S. has systems and adequate resources to effectively track and isolate victims of Ebola, and the people these victims could have infected, to stem the tide of the epidemic. Most importantly, they have a far lower population density. Imagine a tracking-and-quarantine operation in Dharavi in Mumbai or Egmore in Chennai.

We have two questions and one suggestion.

Prevention

Our best course of action is prevention. Prevent all persons originating from the three hardest-hit nations — Guinea, Sierra Leone and Liberia — from coming into India, no matter what their status (health or otherwise). Pre-boarding scrutiny of passports will accomplish this. If and when the epidemic intensifies, extend that ban to persons from Nigeria too.

Also, how many Indian healthcare workers are working in Nigeria, Sierra Leone, Guinea and Liberia?

Has due care (quarantine for instance) been exercised when they have returned to India?

How many passengers travel from the countries mentioned earlier to India every day? What are the main ports of embarkation? What are the preventive procedures in place today?

(Dr. Soumini Ramesh is chief medical director, Sri Krishna hospital, Madurai, and Mridula Ramesh is executive director, Sundaram Textiles Ltd.)