Ebola: Don’t panic but be ready
By Kumudini Hettiarachchi
Is Sri Lanka ready for the Ebola virus? This is what is on the minds of a large number of doctors, as public concern grows with this virus spreading in several continents.
In Sri Lanka, people do not know the gravity of Ebola and its deadly trail, pointed out many doctors while there were mixed reactions whether the virus (Ebola Virus Disease) would come to this country.
While some felt that it would only be a matter of time before Sri Lanka has to deal with this ‘disaster of a viral nature’, others said the chances were remote, quick to point out that this in itself was creating complacency.
“We say everything is in place and are complacent, but this is the very thing which will lead to our downfall,” one senior doctor stressed, calling for an emergency meeting so that all stakeholders could give their input and come up with a comprehensive plan to fight Ebola.
A veteran health administrator said that while preventing it from coming through to the country would be ideal, the plan to deal with it should it come here should be kept alive for any contingency even if the Ebola threat dies down.
While allaying fears that the risk for Sri Lanka is not at all high as there is not much travel between West Africa and Sri Lanka, well-known Sri Lankan SARS buster, Prof. Malik Peiris who is based in Hong Kong stressed that there is no reason to panic. “There is very little risk of Ebola spreading as an epidemic in Sri Lanka. However, it is wise to be prepared,” he said in an e-mail interview, adding that unnecessary travel to the three affected West African countries of Guinea, Sierra Leone and Liberia should be avoided.
The advice of Prof. Peiris — who is Chair of Virology and also Scientific Director of the HKU Pasteur Research Centre — with regard to possible patients who may present themselves in Sri Lanka are:
Maintain alertness of health care professionals to ask for travel history when dealing with severe infections. The travel history that is relevant is travel to the three affected West African countries of Guinea, Sierra Leone and Liberia during the past 21 days. (Nigeria and Senegal have not had evidence of recent ongoing transmission of Ebola for the past couple of weeks.)
Availability of rapid Ebola diagnostic tests (PCR tests) to test and confirm diagnosis of potential patients.
Good hospital infection control measures when dealing with suspected or confirmed Ebola cases. It is noteworthy that Medecins Sans Frontieres (MSF) is treating large numbers of Ebola cases in West Africa where facilities are very basic. It is using careful (not super-sophisticated) infection control procedures and with little risk to health care workers within their units where staff are well trained.
Essentially Ebola is transmitted only from patients once they are ill and only from patients body fluids, blood, vomitus and other secretions. MSF has shown that these infection control measures effectively protect health care workers.
Being prepared to undertake contact tracing of a confirmed Ebola patient (if such a case does occur in Sri Lanka) so that any close contacts are placed under isolation with monitoring for fever (and other symptoms). The incubation period is around 11 days but can extend up to 21 days. Again, note that such contacts are NOT infectious until they become symptomatic.
Meanwhile, with former UN Secretary General Kofi Annan severely critical of the response of wealthy countries to the Ebola epidemic, some doctors here too echoed his concerns.
While Mr. Annan stated that the international community “woke up” only after the crisis hit America and Europe but not when it started in Africa, a doctor said that the international community would ‘isolate’ Sri Lanka if the virus came here.
“Unlike Nigeria which has oil to offer the world, Sri Lanka would be isolated and blacklisted as a destination of travel, leading to a collapse of tourism and major effects on the economy,” this source said, adding that while prevention of the virus entering would be the best, a contingency plan is critical if it does come through.
Officials at the Department of Immigration and Emigration told the Sunday Times that there are no direct flights from the main Ebola-affected countries of Guinea, Liberia, Sierra Leone, Congo or Nigeria. No visas have been issued to anyone in those countries in the last two weeks.Pointing out that the issuance of on-line or on-arrival visas has been suspended, an official explained that nationals or foreigners who wish to travel to Sri Lanka from these countries should seek visas from the Sri Lankan embassies in those countries after submitting medical certificates. Those medical certificates would be forwarded to the Foreign Ministry which would then get their authenticity cleared by the Health Ministry, after which the Foreign Ministry would inform the embassy to go ahead and issue the visa.
Any Sri Lankan who may travel from these countries will be channelled to the Health Desk at the airport, the official said.
The Disaster Management Centre, meanwhile, is awaiting guidelines and directions from the health authorities to mobilise its personnel at the grassroots, the Sunday Times learns.
“We are not experts on health issues such as Ebola and are awaiting guidance from the health authorities,” said the centre’s Director-General, retired Major General Leonard Mark when contacted by the Sunday Times.
The centre has Assistant Directors in every district and they can be mobilised to coordinate preventive measures and disaster risk-reduction activities, he said. The centre is also awaiting an opportunity to hold discussions with international non-governmental organisations and UN agencies.
Since the current Ebola outbreak, the Sunday Times understands that there had been two suspected cases in Sri Lanka. When the blood specimens were checked at India’s Pune National Virus Institute they had turned out to be negative.
A woman who had gone to India and had fallen ill on her return in the second week of August had died at the Nuwara Eliya Hospital. Although she did not fit the typical Ebola case history, the Judicial Medical Officer had queried whether it could be and her blood had been sent for testing.
The other “real suspect” according to the Ebola case definition had been a Sri Lankan who returned to the country from Liberia in the third week of August and developed fever. He had been transferred from the National Hospital to the IDH and kept in isolation. His blood specimens also sent to Pune had been negative for Ebola. He had recovered from his illness and been discharged.
The WHO, the Sunday Times learns, has facilitated the training of 25 medical laboratory technicians, nurses and microbiologists mainly from the Medical Research Institute by bringing down an expert from India, on the collection of samples, packaging them and shipping them for testing.
It has also provided a list of 10 WHO Reference Laboratories, close to Sri Lanka where samples could be sent, it is understood, the results of which would be available in 24 hours.
Precautions to take against any viral disease
Many doctors reiterated the importance of making people aware of taking basic precautions with regard to any viral disease which may be doing the rounds.
“The emphasis should be on staying home if one is ill, be it a child or adult, refraining from sneezing or coughing into other people’s faces, spitting all over the place and making it a practice of washing hands, not just with water but with soap and water regularly,” said Consultant Physician Dr. Ananda Wijewickreme.
The public needs to be reminded over and over again about the coughing and sneezing etiquette, said Dr. Wijewickreme who is attached to the Infectious Diseases Hospital (IDH).
In case an Ebola emergency arises, he said it would be of importance to identify the patient early and isolate the person immediately, while also tracing all those who have come into contact with the patient.
He reassured that unlike H1N1, the Ebola virus’s infectivity is less. “The infectivity does not seem as high as H1N1 and so far there have been about 8,000 cases, mainly in West African countries which have poor-health settings. But Ebola has a higher death rate.”
Explaining the “drastic steps” taken by Nigeria to curb the spread of Ebola, he cited how a person who had come from Liberia collapsed at the airport. Nigeria confirmed it was Ebola and isolated all those who had come into contact with the person for some time, well past the likely incubation period. Nigeria also closed certain places of the city, under very effective ‘containment’ measures and this country is being cited as a good example to follow during such a contingency.
Referring to the ground situation in Sri Lanka, Dr. Wijewickreme said that airport staff and personnel of several hospitals have been trained in handling Ebola cases if such a need arises. Personal Protective Equipment (PPE) is being distributed to the IDH and to major hospitals by the Health Ministry. The IDH is also making its own kits.
Lamenting about the slow response to the Ebola situation from the global perspective, Nirmalan Dhas of the Foundation for Civilizational Transformation and Conscious Evolution said that there is a need for a strong global response. This would be applicable to Sri Lanka at a micro-level.
He strongly urges the establishment of a hotline, for anyone who fears or suspects that he/she or someone close to them has Ebola to inform the authorities immediately. An Ebola-hotline is a necessity. Then there should be a rapid response system.
A public awareness campaign to make people realise the danger of Ebola is needed, said Mr. Dhas whose interests are psychology, sustainable development and disaster management.
“People need to know that Ebola is a virus and not a bacterium and that the world’s knowledge of viruses is not complete. They are an ‘unknown quantity’. There is also not much knowledge on transmission patterns. Why is it that health care workers who handle patients are falling ill and dying but not those who bury the infected-dead?”
If news of a patient reaches the hotline, the solution is to advise that person to remain at home, as much as possible in isolation. People in the house should be advised to avoid contact with outsiders. There should then be a rapid response and the infected person and everyone else with whom he has had contact evacuated to be isolated in a health facility in separate quarantine units.
“Such evacuations need to be ‘humanitarian interventions’ carried out to the patient with respect,” he added.
