Can Pakistan protect its citizens against Ebola?

What's needed is an integrated system that links, sustains elements of screening, detection, management of Ebola cases

The world is facing the biggest and most complex Ebola outbreak in history. While global efforts are being made to end the current outbreak in Africa, it is essential that Pakistan takes all possible measures to protect its citizens from this deadly infectious disease. Pakistan needs to address two major concerns on an urgent basis: developing the capacity to screen, detect and control real or suspected cases of Ebola at all entry points, as well as developing the preparedness and response capacity of healthcare organisations to deal with such cases.

Life and well-being of citizens is not always a high national priority. It may, therefore, not come as an earth-shattering revelation that almost no controls exist in Pakistan to screen and detect passengers with Ebola symptoms. Incoming international flights do not give any health card or health questionnaire to passengers arriving at Pakistani airports. Even if a passenger was to fill a health card, there is no arrangement for collecting or scrutinising this information.

In a recent study carried out at the Karachi airport, it was found that the health card system has been effectively discontinued. Passengers are not even verbally questioned about the countries visited or contact made with an Ebola patient in the last 21 days. It is interesting that a large purposeless desk, with the word ‘Ebola’ written on it, is prominently placed along the route of the arriving passengers. An impressive and costly thermal scanner has been installed to give an impression that it is there for temperature monitoring. This, too, is, however, ineffective in trying to detect a particular high temperature person amongst the hordes of people walking past in groups.

The health officials who stand around the ‘Ebola’ desk appear to have no particular mandate. They ask no questions, collect no forms, examine no suspect cases and wear no protective equipment. Pakistan may, therefore, be the only country that is waiting to welcome Ebola with open arms.

It is critical that Pakistan urgently institutes a number of integrated mechanisms to screen, detect, control and manage real and potential cases of Ebola. As a first step, all airlines arriving at any Pakistani airport must be asked to give health cards to all disembarking passengers before landing. It must be mandatory for every arriving person to fill and submit this card to health officials at the airport of landing. Secondly, health counters must be established at all entry points, making it mandatory for all incoming passengers to pass through them. These counters need to be manned by trained staff wearing protective equipment, i.e., gloves, goggles, caps and face masks. All health cards must be collected and examined at these points. Passengers, who have visited Liberia, Sierra Leone or Guinea or had any contact with an individual suffering from Ebola in the last 21 days, should be separated, questioned and examined in a segregated examination room. Such examination rooms must be established at each airport for detailed questioning and examination of those who visited any of the three Ebola-stricken countries or had any contact with an Ebola patient in the last 21 days.

Depending upon the level of exposure, passengers should be categorised into one of the four risk levels — high risk, some risk, low risk and no risk. People showing any Ebola symptom and categorised in any of high, some, or low risk categories, must be shifted to isolation wards of designated hospitals. Such individuals must be kept in isolation until doctors are certain that Ebola is not a concern.

Those who show no Ebola symptoms, but have been exposed to high, some or low risk levels could be allowed to go home under controlled conditions. Depending upon their risk level, such people are monitored (by physical examination or telephonic feedback) till they safely complete 21 days of their last Ebola-related contact.

One needs to appreciate that the official announcements such as ‘Ebola counters should be set up at airports, doctors must be trained, hospitals must develop isolation wards and provinces have been told to report cases’, while pleasing to the ear, are hardly of any consequence. What is needed is an integrated system that can link and sustain all elements of screening, detection and management of Ebola cases. It is quite possible that no Ebola-infected case ever arrives in Pakistan. But it is just as possible that one such case does slip in undetected. Such an event will cause an outbreak of unimaginable proportions and needs to be prevented at all costs.

Published in The Express Tribune, November 7^th, 2014.

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