While nations with sophisticated health networks debate the merits of mandatory quarantine and whether to place a temporary ban on passengers flying in from West Africa, Asian nations are bracing for the worst, with some experts saying an outbreak of Ebola in the region is almost inevitable.
With at least 13,000 cases of the acute illness and 4900 deaths so far, Ebola has exploded through Sierra Leone, Liberia and Guinea in West Africa.
The prospect of Ebola striking Asia’s least-developed cities has galvanised medical specialists, many of who remember how quickly the respiratory virus SARS rocketed through Asia 11 years ago, leaving an eventual worldwide death toll of 744.
Epidemiologist and infectious diseases expert Professor Mike Toole, deputy director of Australia’s Burnet Institute, says poorer nations near Australia — including East Timor and Papua New Guinea — would find dealing with an Ebola outbreak extremely challenging.
“How would PNG cope? It’s the same as asking how Sierra Leone would cope,” he tells Inquirer.
PNG, he points out, has six doctors for every 100,000 people; roughly 400 doctors in total, only slightly better than the patient-doctor ratio in Liberia and Sierra Leone. All bar 50 of the doctors are in the capital, Port Moresby. An Ebola outbreak there could easily evolve into a health disaster of enormous proportions.
The similarity of Ebola symptoms to the symptoms of malaria and typhoid fever makes the epidemic response in Asia even more difficult. A group of health academics writing in The Lancet medical journal recently concluded that an average of nearly three people infected with the lethal virus would fly out of the three worst-hit African nations every month on commercial flights, and the number would increase as the epidemic spread.
Crunching the numbers of disease transmissions and historic flight data, and taking into account flight restrictions, the authors recommended screening passengers departing from Liberia, Guinea and Sierra Leone for fever and Ebola contact. Led by Toronto University infectious diseases expert Dr Kamran Khan, the authors warned that effective departure screening was essential and urgent. Some departure screening has been in place for months in West Africa, yet it can’t be completely effective. Ebola-carriers can be fever-free for days while the virus incubates in their bodies. Infected passengers have already slipped through the net and arrived in the US.
Government and health authorities across Asia have ratcheted up their screening systems and reporting regulations. China has implemented strict arrival controls and temperature screening for arrivals from Africa, and local health authorities have been warned to prepare for a potential outbreak.
More than 8500 people from Ebola-ravaged areas of West Africa have arrived in the nation’s southern Guangdong province since late August, according to health authorities. Tabs have been kept on more than 5,000 of these arrivals, but no cases of Ebola have been reported in China to date.
China has strong social and economic links with Africa. By some estimates, hundreds of thousands of Africans live in Guangdong province, in clusters in and around the province’s capital of Guangzhou, many in a district known locally as “chocolate city”. Meanwhile, Chinese media estimate that as many as 20,000 Chinese citizens live in the worst Ebola-struck African nations of Liberia, Sierra Leone and Guinea.
Dr Ben Cowling, head of Hong Kong University’s school of public health, tells Inquirer that experience with past epidemics is assisting Asian nations to deal with the Ebola threat.
“Control of Ebola outbreaks requires rapid detection of cases, effective isolation, and careful contact tracing to break chains of transmission,” he says, explaining that over the past decade, Asian nations had coped with viral outbreaks of the respiratory virus SARS and bird flu, and knew the importance of a rapid response to emerging infectious diseases. “Many countries have now built up very good capacity for surveillance, diagnosis and reporting of infections, and control of outbreaks.”
Cowling lives in Hong Kong, where 11 years ago SARS left 299 dead and an economy in tatters. Originating in China, SARS rocketed around the world, but was heaviest in crowded Hong Kong.
Border and health authorities in the city are on high alert for Ebola. As well as monitoring suspect individuals, Hong Kong health authorities are targeting specific population groups, including the region’s African community, providing health advice, pamphlets and briefings for local representatives.
Thailand, too, has a sizeable African community, with a “Little Africa” in Bangkok. The nation’s health authorities are confident that long experience of dealing with infectious diseases such as bird flu, swine flu, and SARS has prepared the nation. Anyone arriving from Ebola-affected nations must report to the health authorities immediately, their details are then noted, and they are contacted daily for 21 days to check on their health. About 2000 Thai nationals have returned from the Ebola region since mid-year and none of them has exhibited any Ebola symptoms, the authorities say.
In the Philippines, the Aquino administration has reassured the people that it is taking “protective measures” to deal with a possible outbreak of the deadly virus, noting that it had dealt with SARS and bird flu in the past. About 3500 Filipinos work in Guinea, Sierra Leone and Liberia, according to government statistics.
Foreign experts have been recruited to help train the local health authorities on the proper use of protective clothing and how to best implement patient handling, contact-tracing and infection control. Twenty hospitals, the Philippines government says, will be retrofitted to cope with Ebola patients, and three set up as specific treatment centres.
Malaysia, too, is stepping up its preparations to quash any Ebola emergence. Foreign students, haj pilgrims and all arrivals from Ebola-affected nations are screened for potential infection. Nine patients with suspected Ebola have been monitored and tested negative.
Echoing humanitarian agencies and epidemiologists around the world, Australian experts say the need for more assistance in West Africa is urgent. Delay could easily mean the virus spreading through other regions and continents. While the spread of the disease appears to be slowing in Liberia, at least according to the latest reports, officials have warned against hasty and counter-productive optimism that could slow efforts to control the epidemic.
The Burnet Institute’s Dr Tony Stewart is in Geneva as chair of the World Health Organisation’s “Global Outbreak and Alert and Response Network” working on the response to Ebola.
“The real worry is the countries with weaker health systems and poorly served sections of their populations like PNG, Timor Leste, the Philippines, and large cities in South America and South Asia,” the medical epidemiologist explains.
As far as the experts know, Ebola — like cholera, polio and hepatitis — can only be transmitted via bodily fluids, such as blood, spit, sweat, urine and vomit, whereas SARS germs could travel through the air on a cough.
Besides the death toll and the horrendous anguish and suffering in West Africa, Ebola is already wreaking economic damage with delays and cancellations of trade and travel.