Dr Hemant Thacker

Deriving its name from a river in Congo, Ebola today has become the leading medical terrorist. As African as it can get, though Ebola is endemic to Guinea, Liberia, etc in western Africa, its tentacles have spread into Spain and USA as it threatens to invade the world, which is a global basket with quick connections.

Essentially a virus infection with the highest fatality rate, its natural reservoir is believed to be bats and spreads from them to humans through body fluids. Likewise the virus is then transmitted from one patient to another only by contact. The patient's secretions like sputum, urine, stool, semen, breast milk, etc, and formites (any articles that the patient may touch) like handkerchiefs, utensils, etc, are infectious. So sensitive is this mode of spread that even door handles that patients may have used remain potentially infective.

The incubation period varies from two to 21 days and initially, the classic flu-like symptoms of fever, fatigue, sore throat, muscle and bodyache appear. It is the later-onset appearing vomiting, diarrhea (often with blood), rash, external bleeding (oozing from gums) and symptoms of impaired liver and kidney function that cause fatality according to severity.

While it can be confused with malaria, typhoid or other viral infections including dengue, the apparent bleeding gives the game away. Confirmatory diagnosis is easy but problematic since blood samples from the patient are an extreme biohazard risk, which makes testing and disposal of paramount importance.

Like the dengue epidemic which we just faced, there is no specific treatment. The only aim is to support the patient with hydration and nutrition whilst waiting for the viremia to abate. Despite a lot of experimental therapy, mortality remains more than 90%. In certain African countries, entire towns and districts have been wiped out.

After the shocks in Spain, Texas and New York, measures have been undertaken to prevent spread of the virus from people returning from stricken countries. Whilst Indian airports are on an alert for such traffic, one reason for comfort is that there are no direct flights to India from any of these African countries—so that even if a sick patient mistakenly boards a flight, he would be filtered out at the transit airport. Nevertheless, we have to be prepared since Ebola in any one of our crowded metros would be catastrophic. The alarm is for real and our health authorities cannot be complacent.

Prevention? In the era of paltry lab facilities and only basic science, people like Jenner and Pasteur could devise vaccines against smallpox and rabies. But scientists of today, with all the advances and rocket science are still struggling against viruses like HIV, Hepatitis C, Ebola, etc. Until then, the red cross flag of preparedness, alert and control should be the motto to prevent the community from being "Ebolized". The "zid" of these viruses is not worth doing "Ungli" with—so fingers crossed!

(Dr Hemant Thacker is a consultant physician & cardiometabolic specialist attached to south Mumbai hospitals.Email:dochpt@gmail.com)

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