Bangladesh is at low risk of being hit by the deadly Ebola outbreak, but if any infected traveller enters the country undetected, the consequences might be devastating because of the highly dense population and poorly equipped hospitals, say medical experts.
Officials of the Directorate General of Health Services (DGHS) said there is no need to panic, as there is no direct flight between Bangladesh and the affected West African nations. Some people, mainly from Nigeria, visit Bangladesh for business or sports purposes, they added.
No case of Ebola infection has been reported so far in any part of Asia, yet the authorities concerned should exercise extreme caution, said Dr Saif Ullah Munshi, associate professor of virology at the Bangabandhu Sheikh Mujib Medical University.
A weak infection control system and lack of critical care facilities will pose a major challenge for public hospitals if they are to deal with Ebola patients, he added.
The Ebola virus disease has killed 1,552 people in 3,069 cases in West African countries -- Guinea, Liberia, Nigeria and Sierra Leone -- as of August 28. According to New England Journal of Medicine, the outbreak might have started in the Guéckédou district of Guinea in December 2013.
Alarmed by the fatality rate and the spread of the disease, the World Health Organisation (WHO) has declared an international public health emergency.
The infection is transmitted by direct contact with the blood, body fluids and tissues of infected animals or people, says WHO, adding that Ebola's fatality rate is up to 90 percent and no licensed treatment or vaccine for the disease is available yet.
A total of 61 people have arrived in Bangladesh since August 11 from Guinea, Nigeria, Liberia and Sierra Leone, four of the badly affected countries, mostly through Hazrat Shahjalal International Airport, according to the Institute of Epidemiology, Disease Control and Research (IEDCR).
Five to six people travel from Africa every day on an average, said an immigration police official at Hazrat Shahjalal International Airport.
Meanwhile, the Bangladesh health ministry has declared a 90-day surveillance starting from August 11 and medical teams have been deployed at 25 entry points, including international airports, seaports and land ports. As of August 27, no case of any Ebola-infected traveller entering the country has been found.
IEDCR Director Professor Mahmudur Rahman said Bangladesh has experience of tackling the Nipah virus and Avian influenza. He noted that out-bound travellers from the five affected countries are screened beforehand and anyone with symptoms of the disease is not allowed overseas trips.
Dr Munshi, however, said symptoms of Ebola can be detected in two to 21 days, depending on the number of viruses.
“One having the virus may come out of the entry point without being detected, but the symptoms may show up later. It is therefore important to follow up on the travellers for up to 21 days,” he said.
Medical personnel deployed at entry points check travellers' temperature, tongues and eyelids and record their names and contacts to follow them up for 21 days.
Referring to the deaths of many health workers in Africa, Dr Munshi said the doctors and nurses need to be fully protected but our hospitals are not well equipped to follow these practices.
IEDCR Director Professor Mahmudur Rahman said doctors and nurses are receiving training on the matter.
“We are now training physicians, nurses and other health workers in Dhaka and also at district and upazila levels,” he said.
Apart from a 20-bed isolation ward at Kurmitola General Hospital in Dhaka, there are isolated wards at the district hospitals, he added.
Ebola patients need intensive care under “barrier nursing” arrangement, which means the nurses should be equipped with gloves, masks, gowns, shoes and other instruments in a way that they come to no direct physical contact with patients.
“It is a very sophisticated way of handling a patient. Though we trained health workers, there is certainly scope to equip them better,” Prof Rahman said.
Also, Ebola patients need Intensive Care Units (ICUs) with ventilator facilities, but such facilities are limited and are mostly occupied at the hospitals.
However, Professor Be-Nazir Ahmed, director (communicable diseases control) at the DGHS, said, “If need be, we will use all ICU facilities for the purpose. It will not be a problem.”
About the medical team members deployed at the entry points, he said they don't need to wear masks and gowns all the time.
Dr Saif Ullah Munshi raised concerns about Bangladeshi peacekeepers in Liberia and some Bangladeshi migrant workers in the five African countries.
Prof Mahmudur Rahman said peacekeepers' movement has already been restricted, and that 200 personal protection equipment have already been sent for them.
“The Bangladesh migrant workers in those countries must have known about the emergency situation. And their relatives here can and should contact and ask them to take protective measures,” said IEDCR Principal Scientific Officer Dr Mushtuq Hosain.
The health desk set up at Hazrat Shahjalal International Airport has so far screened 57 travellers who arrived from African countries.
“We've not yet taken anyone for test since no one was found with any symptom,” said a health department staff member at the airport.
The people screened are mainly from Nigeria, Rwanda, Ghana, Kenya, Liberia, South Africa. A few Bangladeshi citizens coming from those countries have also been screened, he added.
“The chance of Ebola patients entering the country is slim as we get prior information, including their nationality and boarding place, from the airlines,” said an immigration police official, wishing anonymity.
Medical teams have also been deployed at different land ports and airports in Sylhet, Chittagong, Dinajpur and Jessore. No case of any Ebola infected traveller has yet been reported from these entry points.