Disease Without Borders: How China is Prepared for Ebola

Airport passenger temperature screening in China’s airports introduced a decade ago after SARS.

By Dr Bernhard Schwartländer, World Health Organization Representative in China

As world leaders gather in Beijing this week for the Asia-Pacific Economic Cooperation forum (APEC), one issue that has already featured in the discussions is the Ebola epidemic in West Africa – and this region’s preparedness to deal with an outbreak. In managing the threat of Ebola, there are many lessons to be learned from China.

This is the worst Ebola outbreak the world has ever seen. It is more than just a health crisis. This outbreak has become a complex emergency with significant social, economic, humanitarian, political, and security dimensions.

As of 12 November there have been a total of 14,098 cases of Ebola reported since the outbreak began, with 5,160 reported deaths. However, clinical follow-up of Ebola patients shows that as many as 7 in 10 patients who become infected with Ebola die. Modelling work published in October showed that cases may reach as many as 10,000 a week by year-end.

The threat from Ebola has been recognised at the highest levels. In September, the United Nations Security Council passed a resolution declaring Ebola a threat to international peace and security. The UN established the United Nations Mission for Ebola Emergency Response (UNMEER) – the first time in history that the UN has created a special mission for a public health emergency.

The worst hit countries are in West Africa. The vast majority of cases occurred in Liberia, Sierra Leone and Guinea. Senegal and Nigeria have been able to contain small outbreaks. Both countries were declared Ebola-free in October. A small number of cases have now been reported in Mali. And, showing that no country is immune from this disease, isolated cases have occurred in the United States and Spain. No country has been immune from concern.

With numerous economic, trade, political and cultural links between China and West Africa, there is significant interest in China’s preparedness to respond to a potential Ebola case. There are two key points to make.

First, the best way to stop an Ebola case from arriving in China is to fight the outbreak at its source. In the worst-affected countries of Liberia, Sierra Leone and Guinea, China has made a significant contribution to the global response effort. China has provided around US$120 million worth of support to the response to date, both direct financial assistance as well as deploying medical teams and humanitarian aid. These include 252 health and medical personnel deployed from China now working in West Africa, along with essential supplies and equipment, such as mobile testing laboratories. Speed is essential to managing Ebola, and quick diagnosis close to the case is critical for good management of Ebola-infected patients.

China is to be commended for both the speed and substance with which it has responded to WHO’s call for countries to support the international response to the outbreak in West Africa. This is making a real difference on the ground.

Second, and closer to home, is that China has been working to ensure its own systems are well-prepared to respond quickly and effectively should a case arrive. China has learned a lot since the outbreak of SARS in 2003.

In the last decade, China has invested significant resources to upgrade general screening and detection capacity at 259 points of entry, such as airports.  This long-term capacity building stands China in good stead now. In August, China strengthened these systems in line with WHO’s declaration of the Ebola outbreak as an international public health emergency.

For example, there are in place today clear and tested protocols to identify and manage incoming passengers who may have Ebola-like symptoms such as fever, as well as passengers who have been in Ebola-affected countries and had possible exposure to the disease. In Guangzhou, visitors from Ebola-stricken countries to the Canton Fair were given pre-paid mobile phones with phone numbers of health facilities saved for use if necessary.

Border screening alone will not prevent an Ebola case from arriving. The disease has an incubation period of 21 days. It is possible that, even with the most sophisticated entry screening systems available, a case could come into the country without detection at the airport. That’s where a well-prepared health network and good information to the public is crucial.

Overall, China has a strong public health system. And the country has been working hard to ensure it is well prepared should an Ebola case arrive. For instance, special infection control guidelines have been developed and communicated, with specialist staff training.

A series of hospitals have been designated to treat Ebola cases or suspected cases. These have specially designed, state-of-the-art infection control systems in place. Medical and general staff have been given special training, including in the correct use of Personal Protective Equipment. Specially equipped ambulances are on standby to transfer any suspected or actual cases to the designated hospitals. I personally inspected the systems in place at Ditan Hospital in Beijing, one of the designated Ebola hospitals, and was impressed with what I saw.

The possibility of an Ebola case arriving in China cannot be excluded. While there is an outbreak in West Africa, there is a chance of Ebola arriving in China. However, given the systems in place in China to detect early, and respond quickly, should a case appear here the risk of an isolated case progressing to widespread outbreak is currently low.

Of course China, and every other country, must remain vigilant. Further learning from global experience will ensure all countries continuously improve, identify possible gaps in the response, and respond quickly with timely solutions.

Diseases like Ebola do not respect international borders. So China is helping at the source of today’s outbreak in West Africa, ensuring its borders are well-protected and preparing its health system to manage any possible cases.

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