Ebola 101: Follow Nigeria, Pakistan

Detecting our first case of Ebola can potentially prevent an outbreak, but missing it can prove to be catastrophic.

As Pakistan battles numerous infectious diseases such as malaria, dengue, hepatitis A, typhoid, tuberculosis and polio, the western media is taken over by the Ebola scare. With the recent media frenzy surrounding three suspected Ebola patients in Pakistan, the hysteria is now equally palpable at home. The question being asked is: Will Ebola hit Pakistan?

Ebola is a severe viral infection with an average mortality rate of about 70%. The incubation period – the time between infection by the virus and onset of symptoms – is between two and 21 days. This means that it can take up to three weeks before the symptoms of the disease – fever, joint aches, nausea, vomiting and diarrhoea, and in some cases bleeding – appear. It spreads through contact with infected bodily fluids such as blood, vomitus, stool, semen or saliva (including droplets transmitted when coughing).

What makes Ebola scarier is the fact that there is neither an effective cure for it, nor an available vaccine (though one is currently being developed and tested). Treatment is largely supportive. Of the 16,899 people that have been infected worldwide in the current outbreak, 5,987 have died according to the World Health Organisation (WHO). Although the disease remains concentrated in West Africa, primarily in Liberia, Sierra Leone and Guinea, it has the potential to spread far in this age of international travel. In fact, out of 10 cases, eight cases have already been diagnosed in the United States. Our neighbour, India, has also reported its first tested case of Ebola.

While there have been a couple of suspected cases, there are, thankfully, no confirmed cases in Pakistan thus far.

Recently, a Pakistani travelling home from Liberia was hospitalised after suspected of having Ebola. The 47-year-old man had a fever of 103 degrees Fahrenheit. His blood samples have been sent to the WHO headquarters for Eastern Mediterranean Region (EMRO) in Cairo for confirmation. Till then, the gentleman has been quarantined at Jinnah Hospital in Karachi. Even though it is unlikely that he has Ebola, it is nevertheless reassuring to note that Pakistan has a surveillance system in place. This includes ‘Ebola counters’ at airports and ‘Ebola wards’ in some major hospitals. Medical personnel are also being specifically trained to this end.

Almost a week ago, another man with end-stage liver disease (from Hepatitis C) was admitted to Faisalabad’s Allied Hospital with suspicion of Ebola. He was actually found to have dengue, which proved fatal for the already frail gentleman.

It must be remembered that the symptoms of Ebola are shared by many other less serious health conditions. Unless you have a recent history of travel (within 21 days) to one of the high-risk countries, or have been in contact with someone who has, you can be certain you do not have Ebola. But, with such a travel or contact history, it is very important that you take these symptoms seriously, and report them immediately. The reason is simple. Even if there is a one per cent chance that you are infected with Ebola, the early diagnosis is crucial to your management, and to preventing any potential outbreak. The consequences of such an outbreak could be catastrophic for any city in the third world, let alone a densely populated one like Karachi, or Lahore.

Luckily, our government in collaboration with WHO, has prepared a plan to combat any such eventuality. Firstly, there are very few people, mostly our UN peace-keeping troops, who travel home from West Africa. Those that do are being screened at airports. Suspected cases, based on symptoms, are quarantined and tested for Ebola. Sadly, Pakistan lacks any such testing facility at the moment, and blood samples are being sent to Cairo for confirmation. Apart from this surveillance system, there exists a tracking system. Travellers from high-risk zones are followed for any concerning symptoms in the first 21 days of arrival.

In this regard, Pakistan should look up to Nigeria, which must be applauded for its impressive public health efforts to become Ebola-free. After the first case appeared in the country a few months ago, the government created and implemented a four-step plan that included declaring an emergency, training local doctors and managing public fear, while keeping borders open to high-risk nations. There is no reason we cannot replicate the same success at home.

Frankly speaking, what worries me more is not the possibility of detecting our first case of Ebola in the coming days, but of missing it. The former can potentially prevent an outbreak, but the latter can prove catastrophic. As long as the government-WHO plan in place is duly followed, I am confident that we will be able to prevent such a public health disaster at home.

So, back to the question: Will Ebola hit Pakistan? It probably will.

Will there be an outbreak? Likely not.

The most important factor will be the government ensuring that the surveillance-cum-tracking system in place is implemented seriously and effectively as was done in Nigeria. Meanwhile, make sure you do not contract malaria, dengue, hepatitis A or typhoid.