Health Secretary Enrique Ona cited the following procedures that the Department of Health, with the newly created Inter-Agency Coordination on Prevention or Minimization of Entry/Spread of Ebola, has put in place.
1. The National Summit on Ebola Virus Disease was held on October 10, where the national plan of action was presented, and pledges of action from government agencies, the medical community, and the private sector were made.
2. All arriving passengers at major airports in the country undergo thermal scanning to measure their temperature. Fever is one of the symptoms of the Ebola Virus Disease (EVD).
3. As soon as they go through Immigration, arriving passengers fill up a health form which checks whether they have been in any of the countries with an Ebola case for the last 21 days. The EVD has an incubation period of two to 21 days.
4. Arriving passengers who have been exposed to EVD patients are quarantined at the airport and will be properly cared for. If they are found infected, they will be brought to the hospital for treatment, with authorities seeing their case through even up to possible death, as well as the handling of the body.
5. Guidelines have been developed to address the repatriation of Overseas Filipino Workers and Filipino United Nations Peacekeepers. The latter will undergo a 21-day quarantine period in a facility monitored by United Nations Mission for Emergency Ebola Response, while 126 OFWs repatriated from Sierra Leone in mid-October are being monitored by the DOH.
6. The hospitals willing to take in EVD patients have been identified. In Metro Manila, the main hospital is the 50-bed Research Institute for Tropical Medicine (RITM). The Lung Center of the Philippines and San Lazaro Hospital will also be accepting patients. At least 18 other major DOH hospitals in Luzon, Visayas, and Mindanao are also on the list. While RITM has the highest capacity to handle patients, it will still be upgraded to enable early diagnosis procedures. Each hospital will have a team trained according to DOH guidelines based on WHO recommendations. All will have an isolation area for the patients, as well.
7. “Several thousands” of personal protective equipment (PPE) are already in place, but more are being ordered from a Singaporean manufacturer.
8. The disposal of waste from an EVD patient will be monitored. These will have to be burned or incinerated, according to Ona. Even embalmers will have to be trained, he added.
9. In a meeting with the DOH, Metro Pacific Investments Corporation (MPIC) committed to assist in a public information campaign for the prevention and control of EVD, the purchase of additional PPEs, and possible participation of its hospital group in the treatment of EVD cases.
10. The Japan International Cooperation Agency has also committed to co-fund the enhancement of RITM’s laboratory capabilities.
11. Advertisements to create awareness about EVD will be released soon.
12. RITM, St. Luke’s Medical Center, Lung Center of the Philippines, and National Kidney and Transplant Institute might also collaborate on research into an antibody for EVD.
A scientist isolates blood cells from plasma cells to isolate Ebola in Reuters file photo.
Ona said that the funds for Ebola response will come from the P500-million departmental disaster quick response fund of the DOH.
POEA Administrator Hans Cacdac said the Philippine Overseas Employment Administration has mapped out where OFWs are located in the three West African countries most affected by the outbreak –Guinea, Liberia, and Sierra Leone – although the addresses still need to be verified on the ground. The information has been given to the DOH.
Cacdac said an advisory issued last Oct. 17, where the deployment of OFWs to these countries has been put on hold.
Bureau of Quarantine director Emmanuel Labella, for his part, said they know how to track travelers who had been exposed to EVD patients. They are also launching an information campaign in major airports, as well as seminars for airport employees.
Lorenzo Jungco from the DFA Office of the Undersecretary for Migrant Workers said they are in constant communication with foreign service posts, gathering information and disseminating them to Filipino communities in West Africa, as well as to the DOH. They are also partnering with the Department of Tourism so that tourists who showed symptoms of the disease could immediately be referred to authorities.
Philippine College of Physicians president Tony Leachon also stressed the importance of exit screening (as opposed to screening upon arrival) to prevent the spread of the disease.
Read more at HOW TO FIGHT EBOLA SPREAD IN PH? Doctors' group pushes for 3 actions.
Ona stressed, however, that if the Philippines were to have a case of EVD, it would probably be only one or two in number.
Fear travels faster than virus
He did say that Ebola was a global concern, and that if the disease was not contained, it could very easily be spread.
Control of the disease was not just the government’s responsibility, he said, but that of the public, as well. Filipinos have a duty to understand the nature of the disease, he stressed.
“The fear is stopping people from moving,” said WHO country representative Julie Hall. “It is the fear that travels much faster than the virus. Control the fear so that we can deal with the realities of the disease.”
She explained that small Ebola outbreaks had actually been occurring for the past 38 years. The first two outbreaks happened in Congo and Sudan in 1976, and 23 outbreaks in seven countries in Africa have occurred since then. Previously, the biggest outbreak involved 425 cases and 224 deaths. It took five months to control.
The latest Ebola outbreak, with over 9,000 cases and over 4,500 deaths, is the worst the world has seen.
5 different strains
There are five different Ebola strains, all “related cousins” which are “a little different genetically.” One of these, Reston ebolavirus, can be found in the Philippines, but it has never caused human disease. It is the “distant cousin” of four other Ebola strains in Africa. The Zaire ebolavirus strain is responsible for the outbreak today.
The virus was transmitted from the fruit bats in African jungles to the animals in their surroundings, such as monkeys and other primates. The bats do not get sick from the virus, but they excrete it and infect other animals.
Humans who live close to these animals often hunt, butcher, and eat the meat of these animals. Unfortunately, said Hall, this butchering process can spread the virus.
This was what medical experts think happened in December last year in Guinea. Villagers could have butchered and eaten these infected animals, and from there, the mode of transmission became human to human.
“Heat does destroy the virus,” said Hall, so it was probably the butchering and handling of the raw meat that infected the people.
However, EVD is “not very infectious” as compared to, for example, measles and influenza. One needs to have direct contact with infected bodily fluids, and these must enter the body.
Merely sitting next to an EVD patient cannot infect another. But if the patient’s bodily fluids splash into the other’s eyes, mouth, or nose, or through small cuts in the skin, one can get infected. One can also get infected through handling the patient’s blood, vomit, urine, and feces.
“Contamination of surfaces is an issue,” Hall said. Cleaning it with normal disinfectants is enough, but if untreated, the virus can potentially live for one to two days on surfaces under the right circumstances.
Human incubators, sans EVD symptoms, not infectious
People incubating the virus but don’t have symptoms of EVD are not infectious to others.
Nevertheless, said Hall, precautions must be in place, given that 50 to 70 percent of cases are dying of Ebola. The one in three, or one in two who survive must have as much “supportive care” as they can get.
“There is no specific treatment and no specific vaccine for Ebola,” said Hall. Because the patient vomits and gets diarrhea, he or she must continually replace the fluids he or she is losing.
Symptoms include fever, headache, muscle ache, sore throat, vomiting, diarrhea, bleeding, and organ failure. As patients progress with the illness, they become more infectious.
WHO has declared the highest level of emergency grading, Level 3. However, it has no recommendations to restrict travel or trade with the affected areas.
On Wednesday night, the third meeting of the International Health Regulations Emergency Committee concerning EVD will be held. Hall advised the public to wait and see if their recommendation changes.
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