VIEWS POINT. TB in the time of Ebola

The Ebola virus has globally infected over 10,000 people and over 4,900 have died, the World Health Organisation said last week. That very week, another WHO report cautioned that around three million people with tuberculosis were being ‘missed’ by health systems each year, because they are not diagnosed, or because they are diagnosed but not reported.

This information got limited visibility as Ebola-deaths continued to top global headlines, sending Governments across the world scrambling to treat and contain the Ebola virus if it came to their shores from the present “ground zero” in West Africa. Trials commenced on vaccine candidates in multiple countries, and in India too, the Government started screening at airports, as it took note of the disease now surfacing in the US and Spain.

And soon enough, the “what if” question came up at discussions in India, as people wondered, what if Ebola was detected in India, how safe are we?

The memory of air-borne viruses like SARS and H1N1 (swine flu), and the hysteria being drubbed up by Western media, seemed to fan the fear over Ebola.

But consider this. TB is a leading cause of mortality in India – killing two people every three minutes, and nearly 1,000 every day. And you could be susceptible to the spread of TB while travelling in a bus, train or just taking the lift with a bunch of people!

In fact, unlike air-borne viruses like SARS and HINI – where every aircraft coming in from a country reporting infection brought in the scare of infection – Ebola does not spread through air. It spreads through close contact with body fluids of a person infected by the virus.

Public health experts caution that India, home to several infectious diseases, should not divert attention from infections like TB – that are not just air-borne, but worrisome because of those showing resistance to medication.

But that does not mean Ebola is not a concern in India. It becomes extremely worrisome, given the high population density and the fact that healthcare professionals need to be better trained and alert to pick up symptoms and refer people to the right hospitals.

Ebola has brought into focus the desperate need for the Government to inject a huge doze of dynamism into the public health infrastructure to be able to handle emergencies. It needs to designate and train key health institutions across the country to be able to quarantine and contain the Ebola virus, in case people with the illness arrive on Indian shores.

In fact, healthworkers are at a high risk, as they come into direct contact with body fluids like urine or vomit of an Ebola virus-infected person. The US even considered putting its healthcare workers returning from helping in Ebola-hit regions under mandatory quarantine. But the move attracted much criticism as it discourages aid workers from going to the disease-hit region at a time when more outside help is needed.

In the case of TB, about 9 million people developed TB in 2013, and 1.5 million died of it, says WHO. And though timely diagnosis and interventions have helped curb the disease, there is the disconcerting reality of those who have slipped through the cracks of surveillance.

Compounding this critical situation is the “insufficient funding” that is hampering efforts to tackle the global epidemic, says WHO. The multidrug-resistant TB crisis continues, with an estimated 4,80,000 new cases in 2013. And treating resistant cases is not just harder and more expensive but also has poorer cure rates, the WHO explains.

With this being just a part of on-the-ground reality in India, its approach needs to be tempered. India needs a nimble-footed public health system that is able to morph quickly to tackle existing challenges like TB and new ones like Ebola.

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