Preparing for prevention without panicking

To prevent Ebola cases in unaffected countries, strong and comprehensive national preparedness is a prerequisite

October 28, 2014 01:21 am | Updated May 23, 2016 07:10 pm IST

BUSTING MYTHS: In unaffected countries, national public health authorities have initiated screening of passengers coming from Ebola-affected countries. Picture shows a poster on the disease at Suvarnabhumi airport in Bangkok, Thailand.

BUSTING MYTHS: In unaffected countries, national public health authorities have initiated screening of passengers coming from Ebola-affected countries. Picture shows a poster on the disease at Suvarnabhumi airport in Bangkok, Thailand.

As Ebola continues unabated in three West African countries and the number of cases and deaths increase exponentially, alarm bells are ringing across the world. The actions of the national governments of Guinea, Liberia and Sierra Leone, supported by the international community, are yet to yield the desired results. Greater efforts and resources are being mobilised to reverse the escalating epidemic of this dreadful disease in the next few weeks. So far there is no case of Ebola in the World Health Organization’s Southeast Asia region. Now is the time to step up our preparedness, to test our response plans and ensure effective implementation on the ground.

To prevent Ebola cases in unaffected countries, strong and comprehensive national preparedness is a prerequisite. The preparedness plans should be developed and implemented under the guidance of national, multi-sectoral, high-level and empowered coordination committees. WHO has provided a comprehensive checklist of core principles, standards, capacities and practices, which all countries can use to assess their level of preparedness, guide efforts to strengthen capacities and request for assistance. Items on the checklist include infection prevention control, contact tracing, case management, surveillance, laboratory capacity, safe burial, public awareness, community engagement, and national legislation and regulation to support country readiness.

Monitoring of passengers To prevent the spread of infection, WHO recommends exit screening, which is being implemented in countries that are currently affected. In unaffected countries, national public health authorities have already initiated screening of passengers coming from Ebola-affected countries. Apart from public health officials, the airlines staff and immigration officials have been oriented to spot potentially infected persons at the ports-of-entry. All-encompassing simple mechanisms for efficient monitoring of incoming passengers have been shared by WHO with all countries.

Only informed and empowered communities can complement public health efforts to fight Ebola

However, given the nature of the virus and the disease, the likelihood of missing a few infected patients during point-of-care screenings must be considered and planned for. Detection of such cases and their quick isolation warrants intensive and sustained surveillance which can be undertaken by rapid response teams. Many countries have these teams in place to investigate and manage outbreaks. For countering Ebola, these response teams should be provided appropriate training to update their skills.

Depending on the population density and geographical characteristics of a country, a sufficient number of well-equipped health care facilities are required to isolate and manage suspected Ebola patients. These facilities must be managed by staff who have been provided rigorous training in the proper use of Personal Protective Equipment (PPE). Health care workers must be trained to apply recommended infection control practices. We must recognise that health care staff — our frontline workers — are vulnerable to this infection and require greater support in enhancing their skills to efficiently look after the patients, contain the disease, and at the same time protect themselves, their families and communities. Guidelines for appropriate infection control practices in different settings have also been developed by WHO, and need to be used vigorously and scrupulously.

Role of communities Communities have to play a critical role in this public health emergency. Many outbreaks of infectious diseases in the past have led to panic among people. This invariably creates obstacles in surmounting the challenge of outbreaks. Fear is our greatest enemy. We need to empower communities with information about modes of transmission of the disease and actions they can take to protect themselves. Only informed and empowered communities can complement public health efforts to fight this disease.

Knowledge of two aspects of Ebola must be shared with the public. It is extremely dangerous to take care of an Ebola patient at home. It not only spreads infection to family members and those who visit these homes but is also detrimental to the recovery of the patient. Ebola patients require intensive treatment by skilled and trained health professionals in health facilities. Data clearly indicates greater mortality in West Africa among patients who were provided domiciliary care as compared to those who were immediately rushed to health care institutions.

Secondly, avoiding contact with body fluids of a patient who is suspected to have Ebola and applying simple infection-control practices at homes are advocated. In day-to-day routine, hand washing is the most basic and extremely useful infection-control practice that everybody should practice. It protects against a large number of infections.

The global community has been working overtime to develop effective vaccines and medicines against Ebola. Recently, Canada has developed one such vaccine and shared 800 vials with WHO for using it in the high-risk populations of Ebola-affected countries. Nevertheless, widespread availability of these pharmaceutical interventions may take more time. Till then, awareness and preparedness for early detection, rapid isolation, proper management, meticulous application of infection-control practices and enabling cooperation from communities are crucial in combating the disease. WHO stands ready to assist national governments.

One of the most important development since the SARS outbreak has been the implementation of International Health Regulations (2005). Augmenting IHR (2005) core capacities that especially pertain to preparedness, human resource, laboratories, risk communication, response, and surveillance are now benefitting countries in their fight against Ebola. WHO continues to work closely with all countries in augmenting their IHR (2005) core capacities.

A global response to Ebola is possible through sustained and strong leadership, national commitment and comprehensive preparedness. Recent success in Senegal and Nigeria in rapidly containing the spread of the disease not only raises optimism but also demonstrates the need and impact of effective preparedness and efficient health systems in combating Ebola.

(Poonam Khetrapal Singh is WHO Regional Director for Southeast Asia.)

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