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Ebola, beyond Africa

With virus travelling to US and Europe, threat of an outbreak looks much more real to Asia than ever before.

By: New York Times | Hong Kong | Published: October 28, 2014 1:30:38 am

By: Keith Bradsher

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 recently.

But that confidence was punctured two weeks ago when two nurses in Dallas and another in Madrid fell ill while treating patients who had contracted Ebola in west Africa. Governments and doctors around Asia are now much more worried that the continent’s densely populated cities and towns could be vulnerable if infected people start flying in from Africa. “What happened in the States took us by surprise,” said Louis Shih, president of the Hong Kong Medical Association.

An analysis published online last week by The Lancet 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 travellers from these countries were elsewhere in Africa. The others were in Europe: Britain, France and Belgium. But the 10th largest destination was China. India was 13th. (Mali, a west African country, was 11th, and the US was 12th.) 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 rushing 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 this month to coordinate plans. In China, the National Health and Family Planning Commission has called for medical institutions to upgrade infection-control precautions by October 31.

“The first thing at the top of their minds now is Ebola,” said Malik Peiris, director of the School of Public Health at the University of Hong Kong. Peiris, who is best known as a leader in the fight against SARS, or Severe Acute Respiratory Syndrome, in 2003, said 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, Guangzhou, Hong Kong, and Mumbai.

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. 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 in Hong Kong also has an anteroom designed for the safe donning and removal of personal protection equipment, making them well-suited for coping with Ebola, Peiris said.

While the biggest mainland Chinese cities have advanced hospitals — Shanghai’s are particularly elaborate — health facilities are far less sophisticated elsewhere in China, and often rudimentary in villages. Buyers and other businessmen from Africa tend to stay in major cities when they travel to China, but there are also tens of thousands of Chinese workers in Africa who come home for annual vacations.

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, a mosquito-borne disease, that is reaching epidemic proportions. The analysis of flight information in The Lancet 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 small number of cases could also bring economic disruption to a region that is heavily dependent on trade.

“This region is particularly vulnerable to pandemics,” he said, “because of the number of people flying to here and from here,” said Ben Simpfendorfer, an economist who has long specialised in China’s trade ties with the Middle East and Africa.

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