Vulnerability grips Asia as Ebola spreads

Senior officials in China and India have been scrambling to prepare their medical systems to cope with possible cases.

 
With hundreds of advanced infection-control hospital rooms left over from the fight against SARS, and with some medical professionals suggesting that the Ebola virus was inherently fragile and unlikely to spread in places with modern medical facilities, many doctors in Asia paid little attention to the disease until very recently.

But that confidence, some say complacency, was punctured two weeks ago when two nurses in Dallas and another in Madrid fell ill while treating patients who had contracted the Ebola virus in West Africa. Governments and doctors around Asia are now much more worried that the region’s densely populated cities and towns could be vulnerable if infected people start flying here from Africa.

An analysis published online last week by The Lancet, a medical journal, reviewed International Air Transport Association data for flights from September 1 to December 31 this year, as well as data from 2013, out of the three countries in West Africa with the biggest outbreaks of Ebola virus: Guinea, Liberia and Sierra Leone.

It found that six of the top nine estimated destinations for travelers from these countries were elsewhere in Africa. But the 10th-largest destination was China. India was 13th. No other Asian countries appeared in the top 20, and there have been no publicly confirmed cases of Ebola yet in Asia.

Senior officials in China and India have been scrambling to prepare their countries’ medical systems to cope with possible cases. In India, top officials overseeing policy on health, civil aviation, shipping and other related issues met on October 16 to coordinate plans. In China, the National Health and Family Planning Commission has called for medical institutions across the country to upgrade infection-control precautions by the end of this month.

Cities at the frontline

Malik Peiris, director of the School of Public Health at the University of Hong Kong, who is best known as a leader in the fight against severe acute respiratory syndrome (SARS), in 2003, said that flight and trade patterns between Asia and West Africa meant that five cities in the region would be at the front line in preventing Ebola from spreading: Beijing, Shanghai and Guangzhou in mainland China; Hong Kong, a semiautonomous Chinese territory; and Mumbai in India.

Mainland China and Hong Kong have one unusual advantage in dealing with Ebola: their experience with the 2003 outbreak of SARS and their subsequent experience in coping with a series of outbreaks of rare strains of human and avian influenza viruses. Hong Kong, Guangzhou, Shanghai and Beijing have all responded with lavish investments in hospitals equipped with the latest infection control equipment, much of which is made in China.

Hong Kong, for example, only had several dozen hospital beds at the start of SARS, that were designed for patients with highly infectious diseases. That total has expanded to 1,400 beds in a construction frenzy over the past decade.

The special biocontainment hospital rooms in Hong Kong, with one or two beds apiece, were built with features like negative air pressure and outdoor venting in case of another severe outbreak of a highly infectious respiratory ailment – features of little value in dealing with a disease like Ebola that is spread by contact with bodily fluids. But each special room also has an anteroom that is designed for the safe donning and removal of personal protection equipment, making them well-suited for coping with Ebola.

Guangzhou, the commercial hub of southeastern China, has been a particular concern for an Ebola virus outbreak because it is the host of the Canton Fair, which is held twice a year and is the world’s largest trade exposition.

It attracts 200,000 foreign buyers to each session, with up to a 10th of them from Africa. At the current session of the Canton Fair, which began on October 15, officials have been screening everyone arriving at the site for fevers.

The Lunar New Year, which falls in the middle of February next year is the main season when tens of thousands of Chinese workers in Africa will come home for annual vacations. And, while the biggest mainland Chinese cities have advanced hospitals, health facilities are far less sophisticated elsewhere in China.

The SARS and influenza outbreaks that prompted China’s heavy investment in infection-control facilities largely bypassed India. But if the Ebola virus reaches India, it could pose an even greater challenge to manage there than it would in China, Peiris said.

India is already struggling to manage an outbreak of dengue fever that is reaching epidemic proportions. The analysis of flight information showed that India has less than one-fifth of China’s health care spending per person. India also has less than a fifth as many hospital beds per 1,000 people as China.

Any widespread transmission of Ebola in Asia would be a humanitarian disaster. But even a handful of cases could also bring economic disruption to a region that is heavily dependent on trade. Ben Simpfendorfer, an economist who has specialised in China’s trade ties with the Middle East and Africa, warned that Asia was vulnerable to outbreaks of disease. “This region is particularly vulnerable to pandemics,” he said, “because of the number of people flying to here and from here.”

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