Plague

“Tis the times’ plague, when madmen lead the blind.” So wrote Shakespeare. And, looking at the state of the world today, there certainly appear to be plenty of madmen leading the blind, if not blind men leading the mad. Be that as it may, we are faced with a more literal plague in the form of the potentially deadly Ebola. Is Poland ready?

Yes, according Poland’s deputy health minister, Igor Radziewicz-Winnicki. He told Polish Radio that were a patient with Ebola to reach Poland, the response procedures would guarantee safety. The health ministry has been in discussion with the ten hospitals in Poland which are being prepared to receive Ebola patients. The hospitals have been chosen on the basis of their being both the best equipped and having the appropriate staff.

The Polish health system will, Radziewicz-Winnicki added, follow internationally accepted procedures and standards to guarantee the safe treatment of any hypothetical Ebola patients. But, of course, as events in Dallas and Madrid have shown, it’s the actual not the hypothetical that is the problem and any procedure is only as good as the fallible humans who follow it.

Meanwhile, the EU grapples for an appropriate common response. Poland’s prime minister called for European unity in response to the outbreak during her meeting with President Hollande in Paris last week. A united response will be planned at the EU summit in Brussels on 23 October which will seek to harmonize procedures, determine standards of treatment for the management of patients and the behaviour of medical staff. In the UK, screening of passengers from affected countries has begun today at Terminal and will be extended to Heathrow’s other terminals by the end of the week, and Gatwick airport and Eurostar next week. But with incubation periods of between 2 and 21 days any such screening is of limited value.

So far the outbreak has killed 4,000 in West Africa where it began in March. This exceeds the number of dead in recent outbreaks in Central Africa since 1976 which typically see fewer than 500 deaths (there were no reported deaths from Ebola between 1979 and 1994). To put this in context, each week there are some 12,000 deaths from Malaria a disease for which, unlike Ebola, there is a proven cure.

Why experts seem so concerned about this outbreak is that the numbers of cases and deaths appear to be growing exponentially as medical staff, particularly in Guinea, Liberia and Sierra Leone struggle to cope. With queues growing for the inadequate number of beds available at treatment centres, the conditions are created not for containing an epidemic but for creating one. Added to this is the fact that the majority of new cases are outside the original epicenter of disease which increases the risk of the spread of Ebola internationally. The only saving grace is that richer countries are better able to prevent an isolated case becoming an uncontrolled outbreak, something which many African countries with poor resources cannot do. And, as if this wasn’t enough, the malaria season in West Africa is beginning. How will already struggling hospitals cope both with the increased numbers seeking help and when the symptoms of Ebola and malaria are similar?

Indeed, Ebola may never be contained. Prof Jonathan Ball, a virologist at the University of Nottingham fears the virus is being given its first major opportunity to adapt to thrive in people, due to the large number of human-to-human transmissions of the virus during this outbreak. The Ebola virus has a high rate of mutation and with mutation comes the possibility of adapting. He thinks that this is happening. And there is a relationship between how deadly a virus is and how easily it spreads: if a virus is less likely to kill you, then you are more likely to spread it.

And while Poland, thankfully, thus far remains free from Ebola, it is not wholly untouched by viruses originating in Africa. A group of sixteen wild boar have been found dead in the north-eastern Podlasie region, the eighteenth case of African Swine Fever in Poland. This incident is the first case of a whole group of wild boar being affected together. The animals were found in a corn field, some 15 kilometres from the country’s border with Belarus and eight were found to have the ASF virus. All the cases of ASF in Poland so far have been located in the Podlasie region in the vicinity of the border with Belarus.

Returning to Ebola, we do need take all necessary measures, and soon, to contain the Ebola outbreak while we still have the chance. After all, as Shakespeare reminds us: “Diseases desperate grown,
By desperate appliance are relieved, Or not at all.”

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