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 urgent basis. Those needed to screen, detect and control real or suspected cases of Ebola at all entry points and those needed to develop 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 or those who may be at risk to themselves and others. The incoming PIA flights (and many international flights) do not give any Health Card or health questionnaire to passengers arriving at Pakistani airports from other countries. Even if a passenger was to fill a Health Card, there is no arrangement for collecting or scrutinizing 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 of temperature monitoring. This too is however ineffective in trying to detect a particular high temperature person among the hordes of people walking past in groups.
The Health officials who stand around the high-profile ‘Ebola’ desk appear to have no particular mandate. They ask no questions, collect no forms, examine no suspect cases and wear no personal protective equipment. Pakistan may therefore be the only country awaiting 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 virus disease. As a first step, PIA and all other airlines arriving at any airport of Pakistan be asked to give Health Cards to all disembarking passengers before landing at any Pakistani airport. 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 (similar to immigration counters) be organized 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 personal protective equipment i.e. gloves, goggles, caps and face masks. All Health Cards be collected and examined at these points. Passengers who 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 completely segregated examination room. There is a need to establish such examination rooms 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.
Symptoms of Ebola are evidenced by fever, severe headache, fatigue, muscle pain, vomiting, diarrhea, stomach pain, unexplained bruising or bleeding. Depending upon the level of exposure, passengers should be categorized into one of the four Risk Levels – High Risk, Some Risk, Low Risk and No Risk. People showing any of Ebola symptoms and categorized as either High, Some, or Low Risk categories, MUST be shifted to the isolation wards of the 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 proportion and needs to be prevented at all costs.