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Monday, October 20, 2014

Ebola and India

The biggest-ever Ebola epidemic is taking place is West Africa. Through travellers, this could spread elsewhere. Carriers are asymptomatic for 2-21 days, and hence border screening does not block transmission.

Ebola is very virulent. That is, the Pr(death|infection) is high. However, it is not a complicated pathogen for a public health system to deal with. It has no method of jumping to new victims other than direct contact with body fluids. This is unlike (say) a virulent airborne influenza where there is no easy strategy for blocking transmission. The simple strategy of tracing, diagnosing and isolating cases suffices to block Ebola in its tracks.

Ebola is easy if and only if there is a capable public health system through which tracing, diagnosing and isolating cases is easy. It's a disaster for the countries that don't have such a capability.

Do the public health authorities in India have this organisational capability? We in India will be sorely tested, for we do not have a focus on public goods in our health system.

Our health system is a socialist mish-mash of a government that produces and gifts out private goods. We try to run primary health centres, we try to run hospitals, and such like. We don't do the things that a public health system does -- such as the analysis and control of epidemics. We lack the intellectual clarity that the public health system is not about the health of the public; it is about public goods in the problem of health. This could prove to be a costly mistake in coming weeks and months, if Ebola spreads well beyond West Africa.

The fact that most people in India cremate the dead, and that we don't have rituals which involve touching the victim, will help. Cremation procedures will need to be modified to address the biohazard.

1 comment:

  1. All faiths involve touching the corpse - be it cremation, burial, or even consignment to the vultures. Tricky one for a nation of diversity like ours.

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