Keeping Ebola at a distance
It began as a handful of cases in Guinea in March, but quickly spread to neighbouring Sierra Leone, Liberia, Nigeria and Senegal. Ebola has gripped West Africa, claiming the lives of 2,630 people and infecting 5,367, according to the latest statistics published by the Centre For Disease Control (CDC).
The outbreak, which is the worst since the disease surfaced more than three decades ago, continues to outstrip relentless efforts to contain it. This week, United Nations officials declared Ebola a threat to peace and security as they launched a new offence to remedy the crisis. The World Health Organization and the Pan American Health Organization have advised all countries to be vigilant and prepare for a potential introduction of the virus.
Here at home, authorities have implemented a high-level response that entails the construction of an isolation unit at the Enmore Health Centre, the activation of quarantine units at the Grantley Adams International Airport and the Barbados Port Authority, training across sectors on how to respond, real-time simulation exercises and a public education campaign.
Dr Corey Forde, a consultant for internal medicine and infectious diseases at the Queen Elizabeth Hospital, is concerned about the number of infectious diseases like Ebola that have been on the rise in recent years.
“Fourteen point nine million people died of infectious disease. Outbreaks remain a major threat to patients and public safety,” he said as he pointed to the H1N1, SARS and Bird Flu epidemics in recent years.
Speaking at a public lecture on Ebola Virus Disease And Other Emerging Infectious Diseases, Dr Forde stressed that the risk of Ebola reaching Barbados remained low, but he suggested that a country’s best defence was arming its citizens with accurate information about the disease while implementing appropriate measures to respond.
Ebola is a viral illness that affects multiple organ systems in the body. It is named after the Ebola River in the Democratic Republic of Congo (formerly Zaire), where one of the first outbreaks occurred in 1976.
“There are five types of the Ebola virus and, interestingly, they are named after where they emerge in the world. In 1976, the Sudan virus and the Zaire virus first started; the current outbreak really highlights the fact that the Zaire virus, the most virulent form of the virus, is the one which is causing the problem.”
According to Dr Forde, between 1976 and 2012, there have been 20 outbreaks of Ebola concentrated in Africa. Experts believe the fruit bat may be the natural host of the Ebola virus in Africa.
“The reservoir is the fruit bat. They’ve never been able to culture the organism within the bats per se, but they have been able to do other techniques . . . to identify it as the reservoir. It is also a reservoir for some other haemorrhagic-type viruses. So bats can affect chimpanzees and gorillas and forest antelopes and porcupines.”
He pointed out that humans contract the infectious disease through contact with infected animals or the bodily fluids of infected humans.
“Humans often handle and eat bush meat, including bats, chimpanzees and gorillas,” he said, adding that common cultural practices were also contributing to the spread of infection.
“In some of these regions in Africa, when a person dies, someone bathes the body down; so that is another way in which the virus is spreading. The other way in which the virus is spreading is among health care workers.”
Early symptoms include sudden onset of fever, weakness, muscle pain, headaches and a sore throat. These symptoms, which can appear two to 21 days after infection are very similar to other viral infections. These later worsen to vomiting, diarrhea, impaired kidney and liver function, and sometimes internal and external bleeding.
But according to Dr Forde, an infected person can only spread the virus when they are sick.
“Anywhere between two to 21 days you can have the virus on board. You cannot spread it until you get symptoms; so if I am asymptomatic I cannot spread the illness.”
He stressed there was no specific medicine or vaccine that had been proven effective against Ebola, despite the recent use of the experimental drug Z-MAPP, which was administered to two infected American missionaries who have fully recovered.
“Our methods of managing the disease at this point is through providing fluids and electrolytes to the patient, providing them with oxygen if required, maintaining their blood pressure and treating infections when they come up.”
Once a person recovers and survives Ebola, Dr Forde notes, it is unlikely that they can spread the disease, though he explained that some precautions were recommended.
“We don’t think at this point they can spread the disease. They often ask the males to abstain from sexual intercourse or use condoms for about three months because the virus can persist for up to seven weeks.”
The doctor is concerned that early projections show the disease spreading even more, citing some mathematical models which estimate that by year-end that Ebola infections could exceed 277,000 cases.
“We hope and pray that none of those cases reach Barbados.”
Dr Forde underscored that controlling the virus did not require any drastic action such as washing your hands in gloves, carrying your own toilet seat, or stopping shaking hands. Rather, he insisted that infection control meant breaking the chain of the virus.
“So you have an infectious agent, you identify the susceptible host, you look at the port of entry and then you define the transmission.”
The best defence he says is good hand hygiene, and he called for public facilities to have appropriate handwashing and sanitizing facilities.
“How can you protect yourself? Wash your hands frequently; you should not handle items that have come into contact with infected people; tell your doctor about your travel history; seek medical attention if you develop fever or any of the other symptoms . . . .”
Dr Forde stressed that an outbreak required action from everybody and a change in bad habits.
“A lot of these diseases, whether emerging or re-emerging diseases, are often the result of things that we do as humans . . . and it is not until we correct our bad practices that we will be better off.
“So safety and responsibility in your home, in your workplace, at church, on the bus, when you go to the hospital. Every single Barbadian must take responsibility.”