We are NOT authorized by Govt of India for Yellow Fever Vaccination

Wednesday, October 1, 2014

What happens when (not if) Ebola comes to India?

Ebola in India is not a matter of "IF" but "WHEN".
Given that USA has reported the first case of Ebola today ( Times of India - US confirms first case of Ebolaand the fact that there are more than 45000 Indians living in Nigeria which is now in the front lines for Ebola disease, we are going to get it sooner than later. 
According to CDC estimates it is likely that more than a million cases of Ebola are going to happen by 2015 (Fox news - Estimating Ebola cases in 2015). Given that US with all its rigorous standards and effective quarantine, and relatively smaller number of individuals in Africa has already reported a diagnosed case of Ebola, I believe that the first confirmed is not far off in India as well.
In fact, what worries me more is that there is possibly already someone infected with Ebola that has slipped through the airport and is infecting people in the community and getting mistreated!
Here is the reason why I think this scenario is scary but possible....

1. We have very poor quarantine & screening facilities. Here is a report from Maharashtra that a PIL had to be filed in the high court for screening facilities to be set up by the Government in Pune & Nagpur airports ! 
2. Our quarantine centers are dilapidated and understaffed and have poorly motivated and under trained people. While Delhi has created an updated Ebola screening facility , the practical experience of travelers is not very enthusiastic. The facility is crowded, since before the Ebola epidemic it used to cater to about 10-20 patients a month, while now it is required to cater for more than 30 people a day! Also people who are politically connected or serve in high posts in the government have got out of the quarantine without staying the required number of days (as per personal communication)
There are 3-4 beds in every room, and people who have absolutely no fever are also being quarantined in the same facility (for having non govt approved Yellow Fever certificate, or any other medical reason).
Given the close contact of these people, there is every chance that Ebola transmission may actually INCREASE in these quarantine centers if god forbid a case comes to these facilities.
And this is the situation in the 'best' quarantine center in the country! The other centers are likely to be even more poorly equipped and have less chances of containing the disease when it comes here.
3. The incubation period of Ebola is long ... up to 3 weeks. This means that a person coming from Africa may be completely without any symptoms when they are seen at the airport and may develop symptoms like fever, diarrhea vomiting etc even a couple of weeks after landing in India. This is exactly what happened in the case reported from USA
Now it is very likely that any person falling ill after 2 weeks after coming from Africa will not make a connection between the possibility of Ebola and is even more likely that they would not inform the doctors about the travel from Africa, who would in any case NOT suspect Ebola in this situation. The patient would be inappropriately treated for things like Typhoid and even suspected Dengue, but Ebola is unlikely to be diagnosed in most Indian settings.
By the time this is thought and tests done, others in the family or the hospital may be infected and this could lead to an epidemic of Ebola cases.
We can all imagine what would happen if the disease spreads in our overcrowded country with poor diagnostic facilities, and ramshackle health network. Given a complete absence of any vaccine or specific treatment for Ebola, I can foresee a huge tragedy that is likely to happen in the near future. 
Panic stricken people reporting in chaotic surroundings to overburdened government facilities, and overcrowding of our barely functional infectious disease hospitals may actually lead to such a serious problem that our economy may stall, and Modiji's laudable initiative to "Make in India" to improve our Indian economy may be affected as well.
I would recommend a strengthening of our detection infrastructure, separating people in quarantine - those with fever and those without fever are kept in different areas, and telling every one who is coming from Africa to make sure that they report back for any fever related symptom over the next 3 weeks, and following up each of these people diligently.
I believe that only a minor miracle can prevent Ebola from spreading in our country.

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