Health

Published: Sunday August 10, 2014 MYT 12:00:00 AM
Updated: Monday August 11, 2014 MYT 7:32:08 PM

Ebola alert: Epidemic precautions

A colourised transmission electron micrograph (TEM) of an Ebola virus virion. The culprit in the current Ebola epidemic is the Zaire species, which has the highest fatality rate of all five Ebola virus species – between 53% and 90%. – United States Centers for Disease Control and Prevention

A colourised transmission electron micrograph (TEM) of an Ebola virus virion. The culprit in the current Ebola epidemic is the Zaire species, which has the highest fatality rate of all five Ebola virus species – between 53% and 90%. – United States Centers for Disease Control and Prevention

In an outbreak that is rapidly claiming more lives, everyone needs to protect not just themselves, but also, the rest of the world.

If there is one thing we should have learned from movies like Rise of the Planet of the Apes (2011) and Contagion (2011), it is that it is entirely possible for highly-fatal viruses to spread like wildfire across the globe, decimating the human race.

Okay, perhaps that is a tad alarmist, and yes, it is Hollywood fiction.

But with the current Ebola virus outbreak in the West African nations of Sierra Leone, Guinea and Liberia, one cannot be blamed for wondering if the worse might actually happen.

Suspected cases have already popped up in Thailand, the Philippines, Hong Kong, the United Kingdom, the United States, Morocco, South Africa, Saudi Arabia and Nigeria, thanks to air travel between West Africa and those countries.

Fortunately, all these cases have tested negative for Ebola so far, with the exception of a Liberian national who died in Lagos, Nigeria, after travelling there from his home country.

The bad news however, according to International SOS Regional Medical Director for Corporate Solutions (Asia) Dr Greg Jakubowski, is that international travel is an unavoidable part of our globalised world.

“We now have so much international travel that it’s hard to not think that somehow, someone will get on a flight and transport the virus,” he says.

“This is the worst outbreak (to date), and the incubation period is anywhere from two to 21 days.

“So, conceivably, someone might get on a plane without symptoms, and be able to get through all the checkpoints and deliver the virus in a place like Singapore or Malaysia.”

However, the emergency medicine specialist by training notes that our connectivity with West Africa is not direct, with at least one or two transit points in between.

“It does take a bit of time. So, one would think that the symptoms would demonstrate themselves (during that time),” he says.

“The second thing is that when it comes to countries like Singapore, Malaysia, United States, (and) Canada, the mechanisms are highly developed and in place to very quickly identify someone with symptoms, isolate them, test them and do contact tracing.”

The Malaysian Government has already initiated screening and preventive measures at entry points to the country, like airports and ports.

And Health Minister Datuk Seri Dr S. Subramaniam has said that the Institute of Medical Research can test for the Ebola virus, while all government hospitals have the facilities to quarantine and treat potential Ebola patients.

Overall, Dr Jabukowski opines that “our risk in Malaysia and Singapore is low”.

International SOS Regional Medical Director, Corporate Solutions - Asia, Dr Greg Jakubowski (right) in discussion with a colleague at the company's Singapore office.
Dr Jabukowski (R) in discussion with a colleague. He believes that Malaysia and Singapore are at low risk of unknowingly letting in someone infected with Ebola due to the poor connectivity with West Africa and the mechanisms in place to detect such cases. – International SOS

Serious situation

But what about those who still need to travel to the affected countries, or are already working there?

So far, no country or organisation, including the World Health Organisation (WHO), has called for travel restrictions to Sierra Leone, Guinea or Liberia.

However, several countries and international organisations have advised their citizens and the public to defer non-essential travel to those three countries.

In fact, Dubai-based carrier Emirates has suspended flights to Conakry, Guinea, while British Airways has done the same for its flights to Monrovia, Liberia, via Freetown, Sierra Leone, due to safety concerns.

Emirates does not fly to Sierra Leone or Liberia, and British Airways does not serve Guinea.

Says Dr Jabukowski: “It is clear that the situation on the ground is quite volatile and rapidly expanding.”

He notes that WHO director-general Dr Margaret Chan had said on Aug 1 that the outbreak could have potentially catastrophic consequences.

Dr Chan had also observed that at that point in time, the disease was moving faster than the efforts to control it.

As of Aug 4, the outbreak has claimed 932 lives out of a total of 1,711 cases (laboratory-confirmed, probable and suspected) in Sierra Leone, Guinea, Liberia and Nigeria, according to the WHO.

And the end is not yet in sight.

In fact, the Government evacuated 24 Malaysians working at a Malaysian-owned plantation in Liberia over the past few days, due to concerns over their safety.

International SOS itself, an international company that provides medical assistance, security services and travel support to expatriates around the world, has seen a four-fold increase in calls for advice to its 24-hour assistance centres from May to June.

Nearly 90% of the calls originated from the three affected countries, where over 100 of the organisation’s multinational clients have employees.

Dr Jabukowski notes that the recommendation to defer non-essential travel to three West African nations is not only due to the risk of Ebola infection, but also because of the measures being taken to contain the outbreak.

“The risk of transmission is there, but also, our recommendation is based on the fact that because of the progressive actions (being taken by the affected governments), there is a very much higher probability of a staff member being really immobilised on the ground.

“There are delays caused by screening in airports, government institutions are being shut down and functioning at a minimum, and if you happen to develop a fever from a completely unrelated source, you will be quarantined, and you might even be sent to a hospital treating Ebola patients,” he says.

He adds that for travel to Nigeria, companies should conduct a risk-benefit analysis before making a final decision, as the country has also been hit by the virus, but not as severely as the other three nations to date.

Have to go

But for those who absolutely have to travel to Sierra Leone, Guinea, Liberia and Nigeria, Dr Jabukowski offers a few precautionary measures to take.

“The most important is to carry out hand-washing.

“Because what happens is, when you touch a surface that is contaminated with Ebola or a person who is sick and is vomiting or having diarrhoea, and then touch your eyes, nose or mouth, that means you are transferring the virus to the mucous membranes, which can absorb the virus.

“Also, if you have cuts on your hands, the virus can also be absorbed through those.

“So, the whole idea is to wash hands religiously, because Ebola is not actually a tough virus.

“You can get rid of it on your hands by washing with soap or water,” he says.

Another measure includes the common-sense step of avoiding anyone suspected of having Ebola and those who would have had close contact with them, for example, family members or housemates.

Dr Jabukowski also recommends avoiding funerals where traditional rites may include touching, hugging or kissing the body.

And lastly, “avoid eating bushmeat from chimpanzees, gorillas, and even some antelopes”.

In addition, those who are already on the ground should educate themselves on how to protect themselves, keep themselves updated on the latest situation, and avoid domestic travel as much as possible.

Note: Information is current as of Aug 8.

Tags / Keywords: Ebola, outbreak, West Africa, precautions

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