Ebola virus – flight bans will not compensate for public health shortfalls

Friday August 29 2014

By BETTY WAITHERERO
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 One of the adverse outcomes of the recent Ebola virus outbreaks in Liberia, Sierra Leone and Guinea seems to be the manner in which the media and the governments have responded to the crisis.

Slow, barely-visible responses by the governments of affected countries meant that the virus spread consistently and unaddressed over eight months, despite several warnings that these governments received on the seriousness of the situation.

It is the first time that Ebola virus has appeared in West Africa, and perhaps that is the reason why the first infections went unchecked. However, months later, reports of the kind of healthcare patients are receiving make it doubtful that the affected countries have adequately responded to the situation.

Ebola is defined by the World Health Organization (WHO) as “a severe, often fatal illness, with a death rate of up to 90 per cent. The illness affects humans and nonhuman primates (monkeys, gorillas, and chimpanzees).”

Despite the death rate from the disease being so high, transmission of the virus is actually only through direct contact with an infected person. Transmission occurs through broken skin, mucous membranes or blood and saliva.

An estimated 2000 people have been infected thus far and with a death toll of 1,145 people and rising.  The outbreak has now spread to urban areas in all three countries, causing several nations to ban flights to these nations and issue travel advisories to their citizens.

Considering that the main reasons that the virus is spreading and killing appears to be a lack of adequate health care resources, the decision by governments to ban flights to affected states seems reasonable on the surface.

A LARGER SCALE

Yet a flight ban that is not coupled with adequate information, resource preparedness and training of healthcare workers on the disease and treatment means that should an infected person makes it across our border; we are likely to have an outbreak here as well.

More importantly, an international quarantine on three countries certainly does not take into consideration the foreign healthcare workers and relief organizations currently trying their best to support the poor healthcare services in these West African states.

So far, three Americans have been infected by the disease, one of whom collapsed and died upon arrival in Nigeria. These cases show that it is quite possible that citizens from outside those three countries can travel to Kenya and cause infections here as well.

Having said that, WHO asserts that the risk of infections via air travel is low.

"The scale of the outbreak is much larger than anything ever seen before," said Gregory Hartl, a WHO spokesman. "It is an obvious source of concern and it is not to be underestimated, but we must take measures commensurate with the risk. What you don't want to do is to take blanket measures to cut off travel and trade."

MEDIEVAL TACTICS

Fear caused by inaccurate media reports is quite alarming, and is likely driven by a general ignorance of how the disease spreads and what protective measures should be taken by healthcare professionals and facilities.

Already, there are measures being taken to curb the risk of infections through air travel; the screening of passengers in the three affected states.

“We know it's happening. It makes sense at the departure end and there is nothing to stop screening at the incoming end. These are much better measures. You do not need a sledgehammer to crack a nut," says Hartl.

In Liberia and Sierra Leone, governments have deployed troops to quarantine and cordon off affected communities, using disease control tactics not seen in nearly a century – the cordon sanitaire where a line is drawn around the affected region and no one is allowed out.

The results of such medieval tactics are that the entire region is stigmatized, and people isolated upon suspicion, while sick patients are unable to receive adequate care from caregivers because of the fear of being infected.

Many of the deaths from the Ebola virus in these regions result from such patients being literally left to die; they are denied food and no one wishes to touch or treat them.

While the Health Ministry sees fit to reassure the Kenyan public that they are ready to deal with any potential infections, the reality on the ground is very different.

DEPLOY SUFFICIENT RESOURCES

Indeed, ever since the devolution of health services to the county governments, several counties have struggled to manage basic health services adequately, with a number of public hospital staff going on strike while decrying abysmal working conditions, lack of pay and understaffing.

In addition, the manner in which the Kenyan media chooses to address the Ebola outbreak underlines the stigmatization of citizens from the three West African states, while failing to point out that our own healthcare sector continues to be in a dire state.

What is necessary at this juncture is for the Kenyan government to deploy sufficient resources as per their national obligations, train staff and continue to provide education to the general public on the symptoms of the disease.

Emphasis should be made on ensuring that families whose loved ones are unwell should not choose to care for the sick at home, rather to take them to a heath facility as quickly as possible, so as to prevent deaths or further infections as per WHO guidelines.