How India is keeping Ebola out

India has so far succeeded in staving off the deadly virus that has claimed over 4,500 lives abroad. Dhruv Munjal and Veenu Sandhu look at how the country is protecting itself



On the first floor of the old building at Dr Ram Manohar Lohia (RML) Hospital in New Delhi, removed from the main hospital complex that is chock-a-block with patients, a board reads: Ebola ICU.

Isolated and almost deserted but for a security guard, some doctors and a few nurses, this six-bed intensive care unit is where any person suspected of Ebola infection is brought and treated.

This is Delhi's nodal centre, and the only one in the capital, for monitoring and treating Ebola patients. Between August and September, it received over two dozen suspected cases.

All of them tested negative. "Doctors and nurses have been provided with basic training and full-body protective gear to deal with Ebola cases," says H K Kar, medical superintendent at RML Hospital.

So far, India has not reported a single case of Ebola, which has assumed epidemic proportions and claimed 4,500 lives across seven West African countries -- and that's how the government hopes to keep it.

Terming the ongoing Ebola outbreak "unprecedented", the World Health Organisation's (WHO) India office says it is holding regular meetings with the technical staff at the Union health ministry for developing "appropriate response measures".

It is also guiding the ministry on how to prevent and control the infection "at health facilities, train rapid response teams for laboratory testing, surveillance and emergency contingency planning".

Screening for the virus at the country's 18 international airports has been stepped up.

Scanners that can detect high body temperatures have been placed at the immigration counters. A mandatory health card is distributed to all passengers who have either travelled to the four Ebola-affected countries, Liberia, Guinea, Sierra Leone and Nigeria (now declared Ebola-free), or have transited through these countries during the past 21 days.

Travellers are questioned about their contact, if any, in the last 21 days -- the incubation period for the virus - with any Ebola patient and whether they worked or visited high-risk areas like hospitals. All flights carrying suspected cases are disinfected before the next batch of passengers is allowed to board.

To date, around 22,000 passengers have been screened at airports across India.

Of these, 55 were found to be high-risk (those with fever), seven were medium-risk (those with contact history) and 21,737 were low-risk (those who did not have symptoms or history of contact) passengers. The health ministry says the suspected and high-risk cases have all tested negative. Over 1,000 passengers, mostly from Maharashtra, Kerala, Tamil Nadu, Gujarat, West Bengal and Delhi, have also been tracked by the Integrated Disease Surveillance Programme (IDSP).

High-risk passengers are taken in an ambulance to the designated quarantine facility through a dedicated route without entering the immigration area or mixing with other passengers. Medium-risk passengers have to share their contact details and are tracked actively for at least 21 days by IDSP.

Low-risk passengers are provided another health card and advised to contact a helpline if any symptom appears. The immigration staff deputed for Ebola detection has been provided with protective gear.

Like at IGI, at the Chhatrapati Shivaji International Airport in Mumbai, a team of trained doctors appointed by the Airport Health Organisation is screening passengers at counters in the pre-immigration arrival area.

"Doctors have been instructed to keep a look out for passengers suffering from flu," says an airport health official. The airport does not have a laboratory, so blood samples of any suspected Ebola case are sent to the National Institute of Virology in Pune for testing.

"The test result is ready in 24, at most 48, hours," says a scientist at the Pune institute. "The virus shows in the blood once the symptoms appear," he adds.

The only other designated laboratory equipped to test for Ebola is the National Centre for Disease Control in Delhi. Now the Indian Council for Medical Research has shortlisted another 10 laboratories to test the virus.

At the government's 24-hour Ebola emergency helplines (011-23061469, 23063205 and 23061302), set up at the health ministry in Delhi, doctors from central government hospitals are on duty round the clock.

"We have been getting calls from people wanting to discuss their travel history and risks attached," says a doctor on duty.
Private hospitals too have been calling for details about Ebola symptoms and precautions to be taken. The control room has received about 800 calls since its inception on August 9. The standing instruction is to immediately direct suspected cases to RML Hospital.

But what happens if a suspected Ebola case first reaches a private hospital? "Each private hospital is preparing its own guidelines," says Supriya Bali, senior consultant at Max Super Specialty Hospital in Delhi.

"At the slightest suspicion we will refer the case to RML Hospital. There is no question of us conducting even a blood test on the person. That will be immensely risky," she says.

The health ministry has issued no advisory on Ebola to any private hospital, says Suchita Katoch, the medical superintendent at Delhi's Sir Ganga Ram Hospital.

Only an advertisement was issued in the newspaper informing that RML Hospital was the nodal centre for Ebola and that all suspected cases were to be sent to it, she adds.

"But there is no reason to panic," says Virander S Chauhan, former head of the International Centre for Genetic Engineering and Technology. Not much travel to India happens from countries that are Ebola-affected, he says. "India," he adds, "is as prepared as any other country to combat Ebola."

Stuff YOU should know about Ebola:

What is Ebola Virus Disease?

The Ebola disease, previously known as Ebola hemorrhagic fever, is a rare and lethal disease (fatality rate is 50 per cent). The Ebola virus can affect humans as well as nonhuman primates (monkeys, gorillas, and chimpanzees).

How is Ebola transmitted?

Through direct contact with the blood or bodily fluids (saliva, tears, semen, and even breast milk), of an infected, symptomatic person or though exposure to contaminated objects such as needles. The virus can permeate the skin. It is, however, not transmitted through air, water or food.

Incubation period

May range from two to 21 days.

Symptoms

Usually begins with a sudden influenza-like stage characterised by tiredness, fever, pain in the muscles and joints, headache, and a sore throat. The fever is usually greater than 100.9° F. This is often followed by vomiting, diarrhoea and abdominal pain. Shortness of breath and chest pain may occur next along with swelling, headaches and confusion.

When should you seek medical help?

A person who has been to any country hit by Ebola or has come in contact with a person suffering the infection must seek medical advice.

Who is most at risk?

Health care workers (if they handle the patients without protective gear, which is the full-body personal protective equipment suit). And, contacts and family members of the patients.

Treatment, vaccine or drugs to cure Ebola

There is no Ebola-specific treatment. And there is no vaccine. The patient needs to be immediately isolated and treated symptomatically. "Like dengue, Ebola causes hemorrhagic fever, so hydrate the patient and monitor his platelet count," says Virander S Chauhan, former head of the International Centre for Genetic Engineering and Technology.

There are no drugs designed specifically to treat Ebola. Several pharmaceutical companies have come out with experimental drugs, but they have been largely ineffective.

How can Ebola be prevented?

Those in close contact with the patient must follow standard infection-control practices. Any person who has come from Ebola-affected areas or has been in contact with a suspected patient must immediately report to the nearest hospital if he develops symptoms within 21 days. And he should continue to follow infection-control practices for about two months even after getting cured.

Guard against rumours

No case of Ebola has been reported in India so far. However, rumours have been circulating on social media and WhatsApp of an Ebola death in Maharashtra. Such rumours are not true.

Lessons from Senegal and Nigeria

To win the battle against Ebola, India has only two options: to ensure that the virus doesn't enter the country, and in the event that it does, to immediately contain it - the way Senegal did. That's the model India is following.

On August 29, Senegal confirmed its first Ebola case. The patient had brought the virus with him from Guinea. An Ebola alert was issued and he was immediately put in isolation. The health authorities then tracked 74 people who had come in contact with him, quarantined them and closely monitored their health. None of them got infected.

By September 18, the patient too recovered. And on October 17, WHO officially declared Senegal Ebola-free. With the virus in its neighbourhood, Senegal also briefly closed its borders. For India, checking illegal crossings from its porous borders in case of an Ebola outbreak in its neighbouring countries would be a huge challenge.

Another country that has successfully defeated Ebola is Nigeria - through rapid, coordinated response; immediate isolation of the suspected patient; a relentless system of tracking and monitoring contacts; and door-to-door and social media campaigns to educate people.

Ranjita Ganesan contributed to this report

Image: A member of a burial team prepares to spray a colleague with chlorine disinfectant in Monrovia October 20. Photo: Reuters