KARACHI: Pakistan is on a high risk of having Ebola virus disease as most international airlines operating in its airspace are not complying with the requirement (under national and international regulations) of collecting information on passenger health status while the airport health department is severely incapable of facing the challenge, it emerged on Thursday.

These airlines, according to sources, include the Emirates, Saudi Airlines and Pakistan International Airlines, which are bringing a huge number of Haj pilgrims back to Pakistan these days.

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Saudi Arabia, where more than 250 people have died this year of Middle East respiratory syndrome coronavirus (Mers-CoV), the sources said, was on high alert these days to tackle the threat of both Mers-CoV and Ebola virus.

Information on health status of international passengers was the first tool at an airport to prevent spread of infectious disease in another country, they said. This information, they added, was provided by passengers by filling forms provided by the airline and, then, by the pilot-in-command/authorised agent, who was required to fill a general declaration form, seeking details about any sick passenger on board. No such procedures, however, was being followed in Pakistan, they added.

“If there is a health emergency as in this case, a third form is needed to be filled under the International Health Regulations 2005,” an airport official told Dawn, adding that provision of information on international passenger health status was mandatory under national and international laws.

(The World Health Organisation declared the Ebola outbreak a public health emergency of international concern on Aug 8.)

It is noteworthy that Ebola virus disease, a highly dangerous infection, has so far claimed lives of nearly 4,500 people, most of them in West Africa, since its outbreak a few months ago. The worst affected countries are Liberia, Guinea and Sierra Leone, though a few cases were reported in Nigeria, eight in Europe, one in Senegal and two in the US.

According to the sources, Pakistani officials have denied entry to at least one confirmed case of Ebola infection some weeks ago. The patient of Pakistani origin working in Nigeria wanted to travel to his home country.

The sources said that the health department at Karachi airport operating under the ministry of national health services, regulation and coordination had been failing to perform mainly because of lack of cooperation from the Civil Aviation Authority (CAA) and a paucity of funds.

“We are being constantly denied a room at the international arrival section, where we could interview and examine patients in privacy. The staff lacks specialised training while the federal government is not providing funds to modernise the infrastructure,” said a senior airport health official on condition of anonymity.

No agency operating at the airport, including the airlines, was taking the Ebola threat seriously, he claimed.

A visit to the Isolation Hospital, the quarantine facility for suspected patients, located in Bhitaiabad showed that the authorities were yet to build a short secure route to access the health facility. The building guarded by a chowkidar, the only person present at the facility during a recent visit, had literally nothing that could show that it was meant for patients suffering from a serious infectious disease.

Interviews with some people who have recently returned to Karachi from abroad also showed that there was no system in place to ensure that all incoming passengers duly filled in and submitted the health declaration form — a tool to identify suspected case of any infectious disease.

“We received no literature on Ebola, though airlines abroad are distributing pamphlets on the disease to educate passengers. I did receive the health declaration form but forgot to submit it at the airport,” said a doctor who travelled to Bangladesh and returned to Karachi via Dubai a week ago.

Upon contact, airport manager Ali June Agha conceded serious lapses in the system and confirmed that most airlines were not complying with national (Personal Declaration of Health and Origin rule), International Health Regulations 2005 and International Civil Aviation Organisation rules.

On the question relating to the PIA, Emirates and Saudi Airlines, he said: “We are holding meetings with relevant staff to sort out this issue. Efforts are being made to make the passage to the Isolation Hospital secure.”

Dr Anwarul Haque heading the airport health department said that the department lacked the required support from the government and the CAA needed to face the challenges posed by infectious diseases.

“I have been writing to all international airlines (around 18 in number) for one year to distribute health status forms among passengers and ensure that the airline staff also gives their feedback on passenger health status, but haven’t received a reply from anyone so far,” he said.

“If this indifference continues, there shouldn’t be any doubt that the Ebola virus is bound to come here,” he warned.

According to Mr Haque, the CAA is yet to move on the department’s repeated requests for a passenger examination room at the international arrival section and an office at the Cargo Complex to inspect goods.

The PIA and the Shaheen Air International, he complained, had been constantly refusing to have medical examination of their food handlers.

Replying to another question, he said that thermal scanners were installed at the Jinnah International Airport and, under a federal health ministry advisory, a suspected patient of Ebola would be quarantined while a confirmed case would be sent to the Jinnah Postgraduate Medical Centre.

Giving some facts about Ebola virus, Dr Altaf Ahmed, senior expert on infectious disease, said that it was dangerous because of high mortality rate.

“It causes high grade fever with severe bleeding and there is no specific treatment available. It is highly infectious and has the potential to spread between humans by direct contact with infected blood, bodily fluids or organs, or indirectly through contact with contaminated environments,” he said.

On precautionary measures, he pointed out that there should be strict passenger checking and collection of declaration forms mentioning travel history to Africa, from all passengers particularly from VIPs as well as crew members.

“Any person having history of travelling to Africa during a month must be checked for rise in temperature and any other symptoms. They should be questioned in a separate room within the terminal away from passengers.

“If there is any suspicion, the relevant person should be quarantined immediately in security in a dedicated ambulance. Airport staff and ambulance drivers must be trained properly. Airport should have proper disinfectant and hand sanitizers all over passenger areas and within the aircraft.

“If there is no sign and symptoms but a person has a history of travelling to an infected area, then contact addresses and telephone numbers of individuals must be recorded. Such passengers should be given written instructions and a hotline number in case they develop any symptom,” he said.

Published in Dawn, October 17th, 2014