10/29/14, 1:25 PM Learning From Past Viral Epidemics, Asia Readies for Possible Ebola Outbreak | TIME

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WORLD ASI A
Learning From Past Viral Epidemics,
Asia Readies for Possible Ebola
Outbreak
Elizabeth Barber / Hong Kong

2:39 AM ET
Recent experiences with SARS and bird
flu make Asian nations especially skittish
when faced with the possibility of an
Ebola outbreak
As Ebola continues to play global
hopscotch, Asian countries are seeking to
make good on the advanced notice that
the deadly virus could turn up anywhere,
anytime.
At issue in Asia and everywhere is
not just that medical scaffolding varies
across and within nations, with some
lacking robust medical facilities, but that
even sophisticated cities boasting top-
notch hospitals are foundering. The
infections of two health care workers in
Dallas, as well as a nurse in Madrid, have
illustrated that even highly developed
nations are not immune.
Perceived preparedness and actual
preparedness are not the same thing, says Stephen Morse, professor of epidemiology at
the Columbia University Medical Center.
We thought the U.S. would be well prepared, but certainly our first case [in Dallas] was
not a good model for replication, and I dont think Spain did too well either, explains
Morse. But thats what happens when you havent seen this before. You dont know what
to do.
Still, Asia has some advantages as it readies itself for Ebola. Flight patterns suggest that
the influx of travelers from Ebola-stricken West African countries to the Asian continent
is far less than it is to Africa, Europe or North America.
Asian nations also have an edge in that they have been through epidemics before: SARS
tore through the West Pacific in 2003, killing almost 800 people worldwide, mostly in
Hong Kong and mainland China. Avian flu also pummeled this area around the same
time, and outbreaks of virulent influenza strains perennially menace the region.
Government health workers practice
wearing Ebola protective suits on the first
day of training on hospital management for
Ebola virus at the Research Institute for
Tropical Medicine in the Philippine city of
Muntinlupa on Oct. 28, 2014
Bullit MarquezAP
10/29/14, 1:25 PM Learning From Past Viral Epidemics, Asia Readies for Possible Ebola Outbreak | TIME
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The most likely scenario, if we have an imported case of Ebola, is that there will be some
risk of having secondary cases, but I dont think we will have a big outbreak at this point
in time, says Hitoshi Oshitani, professor of virology at Tohoku University Graduate
School of Medicine in Sendai, Japan.
In part, thats because Ebola is much more straightforward to contain than the airborne
SARS spread through coughing and sneezing if procedures are followed rigorously,
says Oshitani, who from 1999 to 2005 was the regional adviser for communicable-
disease surveillance and response at the WHOs Western Pacific Regional Office during
the SARS and avian-flu outbreaks. When SARS first appeared we didnt know what to
do at first, he says.
But having weathered these outbreaks now makes Asian nations stronger. After SARS
and Avian flu, Asian countries have invested quite a lot in infectious disease control,
says Oshitani. Before 2003, many countries in Asia had very limited capacity, and today
they have much more capacity.
That said, much depends on where across Asias socioeconomic smorgasbord a
hypothetical Ebola case makes landfall.
For example, Hong Kong, blistered by the memory of SARS, has made significant
preparations, says Malik Peiris, director of the School of Public Health at the University
of Hong Kong. Infectious diseases, especially diseases coming from the outside, have
been a constant threat to Hong Kong and have kept people on their toes, he says.
Hong Kong, which had just a handful of isolation beds in 2003, now has about 1,400,
plus a designated infectious disease hospital, says Peiris. At that hospital, he adds, the
facilities are more than adequate to deal with SARS and certainly more than adequate to
deal with Ebola.
Preparing for Ebola is also foremost on health officials agendas in mainland China,
Peiris says, while noting that health care is uneven across the worlds most populous
nation, with world-class hospitals in major cities but spotty health care in rural areas.
Dense populations and an incubation period of up to 21 days make Ebola potentially
extremely problematic.
Chinese officials told state media in August that security at the airport in Chinas
southern Guangdong province, which does roaring business with African traders, had
been bolstered.
India also presents a problem. Peter Piot, director of the London School of Hygiene and
Tropical Medicine who co-discovered Ebola, told the Guardian earlier this month that
Ebola outbreaks in Europe or North America could quickly be brought under control.
However, I am more worried about the many people from India who work in trade or
industry in West Africa, he said.
Indian Health Minister Harsh Vardhan told Parliament in August that some 4,700
Indians are working in Guinea, Liberia and Sierra Leone. India is using thermal scanners
at its airports similar to those used at Nigeria, which was declared Ebola-free earlier this
month. The country has also designated hospitals for handling the virus, and has also
held preparedness drills, though a paltry ratio of 0.07 hospital beds per person does not
bode well for any significant outbreak.
The big problem is in high-density populations with low health coverage, says Peiris.
In Mumbai, you have areas of quite significant poverty, and if Ebola enters such a
situation, you could have a problem on your hands. Major cities really need to be
prepared.
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The Philippines, boasting an estimated 1,700 nationals working in West Africa, is also
bolstering readiness. Lyndon Lee Suy, spokesman at the Philippines Department of
Health, says that three hospitals are designated to handle any Ebola cases, plus a
training workshop is being run at 19 government hospitals, about 50 private hospitals
and numerous local government clinics. All hospitals in the Philippines, which battled
SARS in 2003 and H1N1 in 2009, have isolation rooms, he says.
No country can ever rate how prepared it is for something like this, says Lee Suy. But
the health system here is not the same as the one in West Africa. We are in a better
position.
Even Asian countries that have no direct flights to West Africa, and have limited ties to
the region, are wary of being caught off guard.
Krishna Kumar, president of the Malaysian Medical Association, says his country was
jolted by the Nipah virus in 1999, which killed more than 100 people nationwide, and has
learned hard but important lessons.
We werent expecting it, he says. It woke us up.
Krishna says public alarm is low in Malaysia, but health officials are yet mindful
anything could happen. All airports have thermal checks, and 28 government hospitals
have isolation rooms and are fully equipped with protective gear.
We have the systems in place, he says, but to know how ready you are well, its only
when something happens, then you know if you were ready.