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The African fruit bat is considered to be the natural host for the Ebola viruses as well as the major source of human infection. The chimpanzee and the gorilla can also carry the virus and infect humans but they are merely accidental hosts and not natural reservoirs. How the human first gets infected in an outbreak is not clear but close contact with bats is considered to be the major reason.
Ebola then spreads through direct contact with body fluids of an infected person which includes blood, urine, saliva, semen and indirect contact with environments contaminated with such fluids.
Close contact with infected dead persons can also cause the infection. However, unlike flu viruses, Ebola does not spread through air.
Although the very thought of Ebola raises and creates fear and panic, the risk of infection from a visit to an Ebola affected area is extremely low. The risk even for health-care providers who directly deal with Ebola patients also remains low if all basic precautions are taken. In this context, media reports about some doctors making a bid to leave hospital locations in Ebola-affected countries not only comes as a surprise but also raises medical, ethical issues.
While Ebola virus infections can be easily diagnosed with certainty in laboratories through standard tests like ELISA and RT-PCR assay, obtaining samples from patients is extremely risky and can only be conducted under highly sophisticated containment facilities. Unfortunately, Ebola infections have occurred in places where these facilities are not readily available. Another difficulty experienced in its detection is that initial symptoms are similar to those of many other fever-causing diseases like influenza, malaria, typhoid, cholera and other viral haemorrhagic fevers.
Currently, there is no vaccine or drug that can prevent or cure the disease. Experimental vaccines are being developed but they are in early stages of development. Since working with a virus as lethal as Ebola is extremely hazardous, research and developmental activities can only be undertaken in highlevel bio-safety laboratories. Therefore, it is very difficult to carry out these activities in countries with poor scientific infrastructure. Developing countries like India, China and Brazil, which have a highly developed scientific and pharmaceutical industrial base, and skilled manpower, should take the initiative in working towards solutions to diseases like Ebola. However, even when drugs and/or vaccines are developed, testing for their efficacy will pose serious scientific and ethical challenges.
These are still early days of research and a highly coordinated approach and leadership will be required to find cures.
Two American aid workers who contracted the disease in West Africa and their treatment in Atlanta, U.S., are being closely watched by world health agencies. This represents the first example in modern medicine of the treatment of patients with therapeutic agents yet to be tested in humans; unusual situations leading to unusual methods! Such unprecedented measures, recently also endorsed by WHO, raise ethical issues and simultaneously capture both the hopelessness as well as the helplessness of the current situation.
How and why did the present outbreak spin out of control? Why did the world neglect what was happening in West Africa? Perhaps lessons learnt from previous Ebola outbreaks, particularly in Uganda in 2000 and in Gabon and Congo in 2001-3, about the disease being greatly reduced through education and increased awareness led to some complacency. There are no simple explanations about why the epidemic was allowed to spread as far as it has, except for the fact that this time, the epidemic occurred in extremely poor countries with very fragile health care and poor infrastructure.
Contrast this with the SARS outbreak in 2003 in China and Hong Kong which threatened to spread to the western world, when highly coordinated control and prevention efforts were put in place in record time. The present negligence around the containment of the Ebola outbreak becomes even more intriguing when one finds that the horrors of Ebola infections are well-known enough to become themes of Hollywood films like “Outbreak.”
The current outbreak has shown no signs of abatement. The immediate need is to reach out to the communities living through its horrors. Given that there is no effective treatment or vaccine, raising awareness through educative messages and providing much needed health care has to be the top priority. Public health messages should focus on reducing the risk of animal-to-human, as well as human-to-human transmission, particularly through body fluids. Containment measures, including burial of the dead, should be strictly enforced. Given that this outbreak is happening in very poor settings, the provision of basic supplies including gloves, masks, disinfectants and basic drugs must be immediately ensured. Equally, or perhaps even more important, is the setting up of active surveillance systems to detect the early onset of the disease in susceptible animals and humans.
Travel to and from locations where the Ebola epidemic continues to rage should be done with care, and anyone developing fever on account of such travel should immediately be reported to the health authorities for observation and treatment, if necessary.
The current outbreak is sure to subside, though unfortunately only after consuming many lives. At the same time, it is bound to reappear somewhere, sometime, and mostly for man-made reasons.
Unfortunately, it might happen before long. Would the world have learnt from the present deadly outbreak? If and when Ebola strikes again, would it be able deal with it better? Hopefully during the lull, scientists, researchers and the industry would treat Ebola as a common enemy that must be defeated with modern medicine and better health-care infrastructure. Modernisation and development should not become the key reasons for viruses to take centre stage.
(Prof. Virander S. Chauhan, former director of the International Centre for Genetic Engineering and Biotechnology, New Delhi, is an active researcher in infectious diseases and vaccinology.) India, China and Brazil, which have a highly developed scientific and pharmaceutical industrial base, should work towards solutions to such diseases.
Scientists, researchers and the pharmaceutical industry should treat Ebola as a common enemy that must be defeated with modern medicine and better health-care infrastructure. Modernisation and development should not become the reasons for such viral outbreaks to take centre stage An admission that does too little, too late
NARAYAN LAKSHMANThe pressures of November’s mid-term elections may have been weighing onPresident Obama’s mind as he made the torture statement harsh treatment:Tensions at Gitmo have spiked dramatically since 2013 when approximately 106 inmates went on a hunger strike and many were subsequently subjected to force-feeding. Picture shows U.S. Military Police escorting a detainee to his cell at the offshore prison in 2002.— Photo: Reuters When U.S. President Barack Obama said earlier this month, “We tortured some folks,” he may have thought he was simply stating, under the cloak of faux hominess, what was obvious to everyone for the best part of a decade.
Yet, in openly admitting that the Central Intelligence Agency (CIA) had used “enhanced interrogation techniques,” the Commander-in-Chief has left his administration open to lawsuits calling for the prosecution of the responsible entities and persons under the United Nations Convention Against Torture (UNCAT).
Article 4 of the convention, to which the U.S. is party, requires state parties to “ensure that all acts of torture are offences under its criminal law... [and] Each State Party shall make these offences punishable by appropriate penalties which take into account their grave nature.” It is worth taking a step back to understand the broader context of the President’s confession.
The broader context First, it came days ahead of the planned release of a 6,000-plus word Senate report that is expected to issue unprecedented criticism of the CIA for brutalising terrorism suspects through its covert rendition and detention programme, especially as the use of torture techniques such as waterboarding “did not yield any life-saving intelligence.” Second, the pressures of November’s mid-term elections may have been weighing on Mr. Obama’s mind as he made the torture admission, perhaps even with the hope that the expression of this antitorture sentiment would burnish his legacy of walking back some of the more egregious acts of the George W. Bush administration as it trampled on a broad array of civil liberties at home and abroad.
It is true that in 2007, then-Senator Obama said, “The secret authorisation of brutal interrogations is an outrageous betrayal of our core values, and a grave danger to our security. We must do whatever it takes to track down and capture or kill terrorists, but torture is not a part of the answer.” Yet, despite the fact that ostensible penitence expressed by the President the U.S. continues to inflict “cruel, inhuman or degrading treatment or punishment,” to use the language of the UNCAT, on different groups of people at home and abroad, some of these practices undermine Mr. Obama’s campaign promises.
The most obvious among these is the continued detention of nearly 150 “illegal combatants” from the Bush-era occupation of Afghanistan in the U.S. prison at Guantánamo Bay, Cuba, despite at least 86 inmates at one point being cleared for release.
Even though he campaigned in 2008 on the promise to close the prison, Mr. Obama has blamed the U.S. Congress for stymieing his efforts to either move the detainees to the U.S. mainland and face trial in a civilian court or transfer them back to their home nations, such as Afghanistan and Yemen.
But for the man who saw a bitterly divided Congress pass an even more controversial healthcare reform bill in 2010, for the decisive commander who risked it all to assassinate Osama bin Laden in 2011, does this sound like a convincing excuse?
It cannot be that he is unaware of the consequences of continuing the detainee programme there, especially after tensions at Gitmo have spiked dramatically since last year when approximately 106 inmates went on hunger strike and many were subsequently subjected to a harsh regimen of forcefeeding via nasal tubes.
A year ago, Mr. Obama himself admitted that Gitmo was “expensive,” “inefficient,” “hurts us in terms of our international standing,” and was a “recruitment tool for extremists,” even though such words came scarcely three months after the State Department quietly closed down the office responsible for the inmates’ resettlement, and two years after he issued an executive order allowing indefinite detention without trial of inmates being held at the U.S. military installation.
A second striking example of state-supported cruelty inflicted upon its citizens is the American death row system, where inmates often languish for decades awaiting an appointment with the lethal injection and then, as at least three cases in 2014 prove, go on to endure agonising deaths linked to the use of untested lethal drugs and botched procedures — all firmly within the definition of “cruel and unusual punishment.” In this case, however, it is a small mercy that some U.S. states have proved to be beacons of enlightened thought on the subject, including California, where last month a federal judge ruled that the state’s application of capital punishment was so “dysfunctional” that it was unconstitutional.
Role of the media
Finally, as The Hindu pointed out a few years ago, U.S. law enforcement seeking to obfuscate its way out of serious blunders committed and human rights violated would not be able to do so with such success without the help of a pliant media that happily amplifies propagandistic messages.
A 2010 Harvard study titled ‘Torture at Times: A Study of Waterboarding in the Media,’ examined TheNew York Times, the Los Angeles Times and others and found that from the early 1930s until 2004, these newspapers almost uniformly described waterboarding as torture or implied it was torture, but almost never did so between 2002 and 2008.