In 2 years time the Ebola virus will celebrate the 40th year of its discovery. It really is a twin birthday because it was 1st reported in 1976 in humans in both Zaire (now the Democratic Republic of the Congo) and Sudan writes Dr. Charlie Easmon, Medical Director at ALC Health and Your Excellent Health

I am privileged to know two of the original investigators/discovers of the virus who both work at the London School of Hygiene and Tropical Medicine, Professor Peter Piot and Dr David Heymann.

We know now that this virus has 5 subtypes, 4 of which can cause severe illness in man. The 5th affects monkeys and can infect man but does not cause any significant illness.

How long this virus has been on the earth is unknown but we do know that it has animal reservoirs such as bats. How it first gets into a human is not definitely known but it probably starts with eating infected animals (so called ‘bushmeat’)

Interestingly the virus is known to survive several weeks in semen but we do not know if that is a definite mode of transmission.

We know that once a human is infected the mortality without treatment will be between 50-90% depending on the strain. We know that it spreads by contact with infected blood or mucus. To date we do not know if the virus can be air-borne but fortunately we think it is not.

The symptoms start as sudden but non-specific with headache, muscle pains malaise, diarrhoea and fever. These are quickly followed by a bleeding tendency which is often fatal. Bleeding occurs from every orifice or any inflicted wound or medical access point. The incubation period is 2-21 days, which means that if you are exposed and not ill after 21 days you are safe.

Health care workers are infected by contact with blood or mucus and hence the need for basic precautions such as gloves, masks, goggles and where available bio-suits.

Relatives get infected by caring for the living and direct exposure to blood or mucus or as in many traditional African practices washing and cleaning the dead body. In the 1st outbreak it is now clear that non-medically trained nuns spread the infection by using unsterilised needles on a few hundred patients.  Controlling this virus in a country with good public health, trust in medical services, non-traditional practices and rule of law is relatively straightforward.

The spread within Africa is an indictment of lack of early political will, public health and lack of trust (understandably) in poorly functioning health systems.

With WHO and the African Development Bank offering millions to help control this infection let us hope that the money is used wisely.

What can you and your staff do to reduce the risk?

One option is not to go until the whole thing is declared over and recently borders have closed and airlines have stopped flying to affected countries.

However, business still needs to go on and you may have existing staff there.

Your staff should know the symptoms of Ebola, they should know who to send home when ill. They should know where to seek appropriate medical help.

A suspected contact case should be monitored for 21 days with daily temperatures.

If a local clinic does not have the basics such as gloves, masks, goggles and is suspected of reusing unsterilised medical equipment such as needles do not go there. You may need to supply your staff with their own kits including thermometers..

Local staff need to be educated about the disease and the public health measures required to control it. Traditional burial practices that involve washing or handling dead bodies need to cease.

Is there treatment for Ebola?

There is currently no vaccine and given the huge cost of vaccine development this may never happen. There are experimental drugs which use serum antibodies such as that used on the doctor flown to the USA.

The bleeding tendency and fluid loss need well-managed fluid regulation which is difficult and increase the risk to medical staff.

Conclusion

The spread of Ebola could have been stopped in the earlier stages for a few thousand of pounds but is now going to cost the UN agencies and African governments million in lost revenues and costs of control.  As long as the virus does not become airborne with the correct draconian public health measures it will be controlled within the next few months and business will return to normal.

This infection reminds every company to review its disaster recovery/business continuity plans since Ebola is just one bio-threat. There are things out there that we do not yet know about. We still have the possibility of another pandemic flu, extremely drug-resistant Tuberculosis and Middle East Respiratory Virus to contend with. So all companies should be bio-vigilant!

Dr Charlie Easmon
MBBS MRCP MSC Public Health DTM&H

Medical Director, ALC Health
Medical Director, Your Excellent Health

Health Alert Update / Ebola outbreak

The Ebola outbreak in West Africa continues to evolve.  Case counts and deaths in Guinea, Sierra Leone and Liberia have continued to rise .

While still generally confined to specific groups in high risk situations (ex. those participating in traditional burial practices; eating bush meat), and of little risk to travellers who maintain previously outlined prudent hygiene practices,  the regional response to the outbreak threatens to pose significant impediments to foreigners’ movements, especially if they are seeking treatment or evacuation for illness.

 Confirmed, probable, and suspect cases and deaths from Ebola virus disease in Guinea, Liberia, and Sierra Leone, as of 27 July 2014

Several key developments have occurred in recent days that should be noted:

1)     Today, the United States Center for Disease Control issued a travel warning that any non-essential travel to Guinea, Sierra Leone or Liberia be deferred

2)     An air ambulance from a major assistance company attempting to evacuate a prominent physician from Sierra Leone who was infected with Ebola was prevented from doing so by the local authorities. He expired while awaiting evacuation and unconfirmed reports indicate the aircraft was grounded until it can be secured as “clean.”

3)     A Liberian national flew by commercial airline to Lagos, Nigeria.  After arrival in Nigeria he was admitted to hospital where he died of Ebola.  He was reportedly symptomatic during his travels. Health authorities are tracing his contacts during travel.  He passed through Ghana and Togo to transfer planes. No new Ebola cases are reported in these countries so far.

4)     Two African airlines (ASKY and Arik) have suspended flights and from the Ebola –affected countries and Nigeria.

5)     Liberia has closed its ground borders entirely, though the airport in Monrovia remains open.

6)     Sierra Leone has declared a state of emergency and will take more proactive measures perform contact tracing and enforce home isolation for suspected contacts.

7)     Airport screening of travelers is not yet common, even in the affected nations.  Monrovia airport is screening passengers who intend to travel. Ethiopia and Nigeria announced they will conduct airport screening of all passengers arriving from the affected countries.

8)     Monrovia:   Unconfirmed reports are that JFK Medical Center, the top level hospital facility in Monrovia is closed to new patients and under quarantine because of Ebola cases within the hospital. ELWA medical center in Monrovia is the regional treatment center for Ebola.  We advise travelers to avoid these two facilities when seeking medical care.

As the outbreak evolves, it is anticipated that affected and surrounding nations will impose increasing restrictions on crossing borders and at airports.  International health and immigration authorities will likely place tighter restrictions on travelers attempting to enter other countries from the affected countries.   For this reason, the general advise is that all non-essential travel or stays in these 3 countries be curtailed.   Please be prepared for the following realities in case of urgent travel requirements or illness:

1)     Travelers with any form of febrile illness are likely to be subject to close screening and evaluation for the possibility of Ebola and may even be quarantined in their locality until authorities are satisfied they are not infected with Ebola virus.  Since the early symptoms of many other infectious illnesses (such as flu, malaria/paludisme, gastroenteritis, a common cold) may be indistinguishable from early Ebola, patients who turn out to have these maladies may find themselves subject to such handling.

2)     Airports and airlines at both departure and reception points will likely screen for symptoms or exposure history for possible Ebola and deny passage, boarding or entry into the destination country.

3)     Similar restrictions may be set up at land border crossings with neighboring countries.

4)     If hospitalized with an illness of any sort, especially of a febrile or infectious nature, authorities may restrict evacuation from these countries and regular transportation providers may be reluctant to transport the patient until  Ebola has been definitively ruled out. We expect there will be an increasingly limited supply of air ambulance providers willing to service requests in the affected countries.

5)     If suspected of or diagnosed with Ebola, please anticipate the patient will not be allowed to exit the country.  Rather, they will likely be obliged to be admitted to a local Ebola treatment center.

For obvious reasons, request to evacuate travelers or expatriates with suspected/confirmed Ebola will receive even greater scrutiny with uncertainty as to whether they will be allowed to leave the affected country or enter another. This will be case-by-case dependent. No privately organized evacuation of an Ebola patient has yet taken place.

Policies help more than 4,300 people a week who need medical treatment while abroad

Travel insurance helps over 4,300 people a week who need medical treatment while they are abroad, but a fifth (19%) of all Brits risk travelling abroad uninsured, data shows.

The figures from the Association of British Insurers (ABI) show that in 2013 the average claim for emergency medical treatment was £930.

Travel insurers pay out an average of £4m every week to cover medical costs.

Aidan Kerr, head of travel insurance at the ABI, said: “No one expects to go holiday and have to make a claim on their travel insurance. However, unfortunately for many travellers, having something go wrong can be a very real experience. It can be especially traumatic when you or someone you are travelling with is taken ill or injured.” reports the Health Insurance Daily

The ABI said people travelling in Europe must have a valid European Health Insurance Card (EHIC), which allows them to receive emergency treatment from public hospitals across Europe.

It also said consumers should shop around for the best deal but should not buy a policy based on price alone as it might not cover all of their needs.

There is a wide belief that expats are career-driven youngsters, passionate adventure seekers and important business leaders. However, a significant chunk of the expatriate community is also made up of retirees. Those who have worked hard and are now looking to move to sunnier and peaceful locations abroad, to enjoy the rest of their lives.

A number of factors need to be considered when seeking out which country is best for retirement. Climate and the cost and quality of living is what is most instantly thought about, but looking at the healthcare system is equally as important. Here are the top countries with the best healthcare systems according to IL’s Annual Global Retirement Index 2014, all ranking with 90 points and above.

• France – 97 points – The country is renowned for the quality of its healthcare. It is always at the forefront of pioneering research, with fantastic hospitals and a high life expectancy rate. Even international medical insurance companies advice that expats choosing to live in France permanently, should join the national state health insurance. The CMU scheme is a popular option with any pre-existing conditions being disregarded. Expat retirees who have the E121/S1 are eligible from the start.

• Uruguay – 96 points – Quality healthcare is available to all in Uruguay. There is a free public system that all residents are eligible for. The free clinics can be crowded but also ensures that those who do not have health insurance still have the basic cover. Every town is privy to this and assures that no one is left without quality cover. The private health system is well-equipped and inexpensive, of which an estimated 50% of the population enjoy. Each private healthcare organisation has its own standards for accepting new members, including age.

• Malaysia – 95 points – The country is famed for its quality healthcare and the cheap cost. The staff are well trained and facilities are modern. There is a comprehensive range of healthcare services but foreigners cannot access the free public healthcare system. This shouldn’t be a problem however, as health insurance is extremely low in cost and can actually be paid out of pocket. However, age is a factor when considering annual premiums.

• Costa Rica – 94 points – Costa Rica is known for its constant advancement in the public and private sector healthcare systems. Private healthcare is affordable and of high quality. Free medical services can sometimes be quite long and overcrowded but still works well for the residents. Expats becoming legal residents can join the CCSS and get free treatment for virtually everything, all at a small monthly fee.

• Mexico and Portugal – 93 points – The countries’ healthcare systems includes a big universal health insurance programme as well as small private ones. There are an abundance of high quality hospitals and health insurance in both countries is relatively cheap. The cost of medical care will depend on the condition and the hospital.  Portuguese healthcare is available to legal residents of the country with their local healthcare. Basic cover is provided but additional insurance may be a good idea to cover any additional needs.

• Spain and Panama – 91 points – The standard of hospitals and clinics in the Spain have been compared to the NHS. Private medical cover is advised and is usually set up in advance but registering with the local authority when you arrive is also crucial as it gives you the same healthcare rights as Spanish residents. In Panama, the quality of healthcare is high in the cities but not so much in rural areas. Private health insurance is very cheap as are prescription drugs.

• Colombia, Thailand and Brazil – Hospitals in Colombia are of good quality and the staff are well trained and often English-speaking. Private medical insurance is advised on top of the national healthcare plan. The health system in Thailand consists of the private medical sector and the non-profit sector which was introduced in 2001. There are many English-speaking GPs. Medical care is available to anyone who is a legal resident in Brazil, including foreign residents

As the spiritual home of healing, Asia is an ideal choice for a detox holiday to cleanse your body, clear your mind and improve your overall well-being. To help you along the way and ensure you get the very best out of your healing escape, Health and Fitness Travel, the UK’s leading specialist in healthy holidays worldwide, handpicked some of the best detox holidays to be found across the exotic continent we know and love as, Asia. Whether you take detox holidays on a regular basis or are looking to try out your first, Health and Fitness Travel’s tailor-made holidays combine a variety of holistic spa treatments, fitness activities and healthy detox diets, for a personalized life-changing experience that will have you ‘spring-cleansing’ year after year writes the healthytravelblog.com

Thailand: Absolute Sanctuary Detox With lush rainforests, beautiful beaches and crystal clear waters, Thailand is the perfect place to detox, de-stress and relax away from the worries of modern life. Using a combination of detoxing drinks and natural spa therapies, the tropical oasis of Absolute Sanctuary offers guests a range of holistic wellness programs to boost your well-being revival. Heal your body with up to 4 detox drinks a day, together with coconut juice and unlimited broth soups; all designed to improve your digestion and leave you feeling re-enerzised. Also renowned for its comprehensive yoga holidays, Absolute Sanctuary provides a selection of disciplines across multiple classes every day, to complement your detox.

Bali: Como Shambhala Detox Holiday Renowned for its idyllic landscapes and rich cultural heritage, heavily influenced by the Hindu- Buddhist ideals of spiritual well-being, Bali is an ideal choice for a destination detox holiday. Cleanse your body of toxins with a choice of healing therapies and a diverse menu of fresh and nutritional detox cuisine at Como Shambhala. Take advantage of the multi-award winning spa and indulge in luxury treatments, designed to help remove an accumulation of harmful toxins from your body. Meals at the resort’s restaurants can be personalized to your specific detoxing goals and tastes, so you can improve your body’s natural defense system while enjoying mouth-watering and healthy Asian-inspired cuisine.

India: Ananda Detox As the birthplace of yoga and holistic Ayurvedic spa treatments, it should come as no surprise that some of the best detox holidays in the world can be found in inspirational India. Set in the foothills of the Himalayas, Ananda’s beautiful scenery adds to the healing power of the resort’s detox program. Structuring their programs to address all areas of holistic healing, Ananda provides the key to an effective detox with treatments to improve blood circulation and the efficiency of the lymphatic system. Rejuvenate with healing treatments including mountain dew skin facials and detoxifying salt scrubs, alongside daily wellness classes performed with stunning views of the scenic backdrop.

Philippines: The Farm Detox Formed of over 7,000 islands, boasting lush rainforest and secluded beaches, many of the Philippines sparsely inhabited islands provide the ideal retreat for a detox escape. Cleanse your body and restore balance to your life with a detox holiday at The Farm. Tailor your escape with a range of cleansing treatments combined with award-winning raw vegan cuisine to leave you feeling renewed and revitalized. Consultations with a medical doctor and personal trainer will not only help you achieve your goals, but also set you up to improve your lifestyle and nutritional choices after you return home.  

Guest Author: Health and Fitness Travel Health and Fitness Travel is a global luxury wellness travel company that originated in the UK in 2010 and is committed to providing healthy holidays that enhance and change lives. Created by Paul Joseph and Adam Heathcote as a result of their passion for health and fitness travel and offering bespoke holidays to improve people’s well-being to lead happier and healthier lives.    

Health and Fitness Travel offers clients a tailor-made seamless service with the very best health and fitness holidays, handpicked by its expert team, together with exclusive and added value packages with the best deals. As leading specialists, Health and Fitness Travel has also created their own collection of trademark healthy holidays in various destinations which include Fusion Fitness™ BodyBreaks™ and Discover Recover™, offering clients the best value and holiday experience. For more information visit: www.healthandfitnesstravel.com

According to research 47% of companies believe health insurance cover is an essential part of the benefits package for expat employees. The Anatomy of an international business research, which surveyed 1,000 employers, also found that 43% believe that share options are an essential part of the package writes expathealth.org

More than a quarter (27%) of those polled said their staff had used a 24-hour medical helpline abroad, and 26% have had to make use of medical evacuation where facilities were not available locally. Nearly half (45%) think medical evacuation should be included as part of an international insurance package, with the same percentage calling for a 24-hour medical helpline

A survey by a leading international private medical insurance broker amongst expatriates has discovered that most expatriates were positive about their lifestyle with 80% of the sample saying they either ‘really enjoyed’ or ‘enjoyed’ their lives abroad writes iPMI magazine.
By contrast, less than 2% said they were not enjoying their time overseas. Nearly 60% of the sample cited a better climate as the main reason for their positive outlook, closely followed by an improved standard of living. Being away from their home country was also an influencing factor. A better social life, additional income, experiencing different cultures and their job did not add significantly to the overall happiness of respondents