Gorakhpur – VIJAY SHAH via PRABHASH DUTTA and India Today
The latest stage in a series of infant encephalitis outbreaks has claimed the lives of around sixty children in the Indian city of Gorakhpur, in Uttar Pradesh state, India Today news magazine reported this Saturday. The city, which lies 200 kilometres north-west of India’s capital New Delhi has been the scene of yearly outbreaks of both Japanese encephalitis and acute encephalitis syndrome since 1978, a period of nearly forty years.
Official figures claim that so far, around 25,000 children have succumbed to both conditions, which is spread by mosquitoes and causes inflammation of the brain and can leave survivors mentally and physically disabled, since the first outbreak in 1978. Unofficially the death toll since then has been claimed to be double that, at 50,000. The unofficial tally includes those children who never made it to hospital and were not officially recorded by doctors. Lack of medical facilities, poor nutrition and hygiene and close contact in crowded family environments in Gorakhpur and other parts of Uttar Pradesh has seen regular encephalitis outbreaks impossible to control.
Government records suggest that since September 2016, 224 children had died of encephalitis at just one hospital, BRD Medical College hospital, where already sixty children died just this year. This is the only hospital within a 300-kilometre radius that has the facilities to treat encephalitis victims, some of which come to the hospital from as far away as Nepal. Most of the victims were below the ages of eight and ten. Including all age ranges, Gorakhpur has lost 114 residents to the lethal diseases this year alone..
Government support of medical facilities and initiatives to combat the outbreak, of which Gorakhpur is the epicentre, have been minimal most of the time. In 2007, a government initiative was launched to save people live’s using drugs imported from China. While successful in many other parts of India, it failed to halt the march of encephalitis in the struggling eastern regions of Uttar Pradesh.
Recently, the Yoga Adityanath administration that governs the northern state launched a massive anti-encephalitis drive, vaccinating babies against catching the illness, but it will be years before results become conclusive, and the yearly sceptre of death is lifted from Gorakhpur’s innocent children.
The outbreak occurred in the town of Gaya in Bihar state, which lies around 100 kilometres from the state capital Patna.
Acute encephalitis syndrome (AES) is a severe inflammation of the brain caused by a variety of pathogens including viruses, bacteria, fungi and brain-dwelling parasites. In adults, AES can cause fever, headaches, confusion, and occassionally, seizures. In children, the most reported symptoms are irritability, poor appetite and drowsiness.
It is not yet known which pathogen is responsible for today’s outbreak.
In June 2014, a similar AES incident in the city of Muzaffarpur, also in Bihar, claimed the lives of 30 people, including several children, which was blamed on poor environmental hygiene and lack of ‘proper food’, according to the Times of India.
The World Health Organisation (WHO) has warned that the Ebola virus crisis in West Africa could be dangerously underestimated as families hide members afflicted by the highly fatal contagion for fear of quarantine and persecution, according to a report by America‘s Fox News. The warning also claims the existence of ‘shadow zones’ where medics have no presence, means that many people are carrying or perishing from the virus without medical agencies realising, making an effective response to the outbreak more challenging.
Since the middle of this year, more than a thousand people have died in the West African states of Sierra Leone, Liberia and Guinea, with possibly several thousand more infected or likely to be exposed to Ebola. The virus, first discovered in the 1970s, causes excessive sweating, fever and internal bleeding and kills between fifty and seventy per cent of the infected. It was believed to have originally spread to humans via the consumption of ‘bushmeat’ from apes which had themselves carried a different version of the virus. Ebola can easily be spread by coming into contact with an infected person’s body fluids, including sweat and blood and is extremely contagious. There is no known definite cure, although an experimental drug, ZMapp, which has not yet passed official human trials, has proved promising when it was used to treat infected Western medical staff in Sierra Leone. A state of emergency has already been declared in Liberia, with crematoriums struggling to cope with the influx of victims and relatives of Ebola carriers being forcibly quarantined in their homes. A curfew has recently been put in place in two lesser-economically developed areas of the Liberian capital, Monrovia.
The agency, a part of the United Nations, reports that many families, distressed by the likelihood of quarantine and the stigma the disease carries, are hiding infected loved ones from the attention of local medics and hospitals. The WHO also is concerned over the presence of ‘shadow zones’, in remote areas, which medics are unable to enter to treat patients and to report infection rates, the agency reported yesterday (Friday 22 November). The report also gave reasons why the Ebola outbreak has been underestimated, after the WHO was criticised recently for reportedly failing to respond quickly enough to contain the killer virus, which is increasingly spiralling out of control as poorly-funded and equipped hospitals in the region struggle to treat rising numbers of victims.
Experts operating separately from the WHO have also claimed that the outbreak figures are underestimated as suspicious locals in West Africa have reportedly chased away medics who attempted to treat their infected relatives and where also many Ebola sufferers are refusing treatment altogether. It is believed that more than 1,300 people have already died in the epidemic and experts have stated that there is very little chance the rampage of Ebola will be brought to a standstill by the end of this year.
The underreporting of infections is reported to be especially acute in the countries of Liberia and neighbouring Sierra Leone. The WHO has said it will tackle this issue by working closely with the medical charity Medecins Sans Frontières (MSF) and the United States governmental agency, the U.S. Centers for Disease Control and Prevention, to produce what they hoped would be ”more realistic estimates”.
MSF’s head has implored the WHO to do more to help victims and communities harmed by the lethal virus. In an interview with the Reuters news agency, the MSF’s head said that the fight against Ebola was being hampered by a lack of co-ordinated international leadership and the provision of emergency management skills abroad and on the ground in West Africa.
The stigma surrounding Ebola and other dangerous diseases such as HIV/AIDS, in traditional West African communities also poses a challenge to fighting the epidemic and calibrating the figures for patient numbers that the WHO needs to formulate an action plan. The outbreak, which has also being reported further afield in Nigeria, is said to be the worst in terms of fatalities since the virus’ discovery in central Africa four decades ago.
“As Ebola has no cure, some believe infected loved ones will be more comfortable dying at home,” the WHO statement said.
“Others deny that a patient has Ebola and believe that care in an isolation ward – viewed as an incubator of the disease – will lead to infection and certain death. Most fear the stigma and social rejection that come to patients and families when a diagnosis of Ebola is confirmed.“
Fearful of the widespread stigma surrounding infectious diseases like Ebola, and distrusting of local medical facilities, put off by rumours of hospitals euthanising Ebola patients, many families have taken to burying corpses of loved ones secretly without the official authorities finding out. In addition, there exists an uncalculated number of ‘shadow zones’ with little penetration by international health NGOs or local medical workers. Most of these shadow zones exist around rural villages and remote settlements where medical care locally may be non-existent, and a visit to the nearest general hospital or Ebola treatment unit may take hours or even days. There have been rumours that many people in such villages have been infected and killed by Ebola, but their cases cannot be investigated due to community opposition or a lack of available transport services.
In other cases, where treatment has been made available, clinics are struggling to cope with the numbers of infected and possible carriers of the disease coming through their doors. This suggests there is an invisible caseload of patients that is not on the radar of the official surveillance systems, as they cannot get access to a doctor for proper infection diagnosis.
The WHO has announced that it will draw up a ‘strategy plan’ to tackle West African Ebola in the coming months as it collects more data on infection rates in the three countries that have borne the brunt of the epidemic. The drafting and realisation of the plan is expected to take between six and nine months which means that it will still be several months before there is a cohesive mission to fight back against Ebola and stop its onslaught. The disease is still relatively poorly understood and should the virus appear outside of Africa, may mean it could spread rapidly as doctors with no experience of treating Ebola victims are poorly placed to recognise symptoms and access suitable quarantine centres and drugs.
A map outlining previous Ebola viral outbreaks in the African continent.
“WHO is working on an Ebola road map document; it’s really an operational document [on] how to fight Ebola,” WHO spokeswoman Fadela Chaib said at a news briefing. “It details the strategy for WHO and health partners for six to nine months to come.“
When asked whether the timeline of the strategy plan will mean Ebola in West Africa being curtailed before the beginning of 2015, Chaib responded: “Frankly, no one knows when this outbreak of Ebola will end.“
The virus will only be considered truly confined if no new cases are reported within the time frame of two ‘incubation periods’ which works out as forty-two consecutive days. However, as the virus seems to be picking up new cases with every passing week, this seems a long way off under current conditions.
“So with the evolving situation, with more cases reported, including in the three hot places – Guinea, Sierra Leone, and Liberia – the situation is not yet over,” Chaib added.
“So this is a planning document for six to nine months that we will certainly revisit when we have new developments.“
Further preliminary details of the WHO action plan are expected to be announced by the beginning of next week, Chaib told the news briefing.
The panic of Ebola has already spread out far beyond the disease itself. Border officials in the United Kingdom have been warned to be alert to signs of infection in people arriving into the country from affected nations. A Nigerian man in Spain was placed under quarantine at a local hospital in the Costa del Sol after allegedly reporting a feverish high temperature but was later given the all-clear. South Africa has been stated in international media that it has banned anyone from the three states originally affected by the outbreak from entering its territory. One worrying recent development occurred in Senegal, regarded as West Africa’s ‘humanitarian hub’. Government officials there blocked a United Nations plane carrying aid from landing in the country to offload goods intended for Ebola sufferers, while the country’s airports agency has terminated all flights originating in or destined for Sierra Leone, Guinea and Liberia. The blockade has been put in place as Senegal seeks to prevent Ebola from reaching its people. Aid agencies have cautioned against the Senegalese embargo, saying that it could harm aid efforts and the emergency response against Ebola.