Mitali Saran: Ebola - think global, act local

It stands to reason that Hollywood has, from its sanitised, vaccinated, over-medicated seat in America, relegated horrifying illness to the realm of (typically B-grade) fiction. Its wily, culturally colonising ways have infected the rest of the relatively healthy world with the same illusion. You might say it's gone viral. Movies such as Outbreak, Contagion, Quarantine, 12 Monkeys and others are so much their own genre that it sometimes takes an effort of perspective to shift to acknowledge that they borrow from life, not the other way around. If you haven't lived or worked in the middle of an epidemic, as many Hollywood aficionados haven't, that can be hard to remember.
 

It's not that Ebola is straight out of Contagion so much as that Contagion is straight out of Ebola. There's more than a little of the horror movie in what is unfolding in West Africa. The photographs of health workers wrapped in biohazard suits and of the dead lying in the streets covered in blue plastic being sprayed with disinfectant are enough to make one's blood run cold. The fact that affected countries, such as Sierra Leone, Guinea, Liberia and Nigeria, have declared a national emergency should make the world sit up. The virus jumps from fruit bats to chimps and people, and spreads among people via bodily fluids. The fact that Lagos, where some patients are, is not the typically remote forest hamlet, but Nigeria's most populous city is terrifying.

But the scariest report is that these countries are resurrecting an outbreak-fighting tactic called the cordon sanitaire, which simply seals entry or exit to affected areas, so that the outbreak of an infection is contained by simple virtue of killing all the limited number of hosts it can kill. If you're in there and survive, bully for you; but nobody is going to help you do it. The cordon sanitaire is the acknowledgement of our total helplessness in the face of this virus.

African countries, intimately acquainted with the savagery of Ebola, have leapt to contain the present outbreak by whatever means possible. But containment in the age of airplane travel is a whole different ball game. The infected American health workers who were flown back to Atlanta to take their chances with an experimental drug travelled with all the precautions you can possibly take. The man who has been placed in an isolation ward in Saudi Arabia, however, was a regular passenger. There's no way to tell whom he did or didn't infect along the way. This outbreak has so far killed twice as many people as were even infected in the largest previous one.

Outbreaks of infection are a natural part of the biosphere, and it is only the firm belief that humans shouldn't die that keeps us fighting natural culls with medical and administrative research and innovation. Epidemics are as fascinating as they are horrifying - the Black Death (suspected to be the Bubonic plague) killed 25 million medieval Europeans; the smallpox killed an estimated 500 million people over the course of the 20th century; the Spanish flu killed somewhere between 50 million and 100 million people at the start of the First World War. More recently we have seen small outbreaks of the severe acute respiratory syndrome (SARS), the avian flu, the swine flu and other zoonotic (species-jumping) diseases, but none of them are as dangerous as the Ebola virus, which has a fatality rate of between 60 and 90 per cent.

If Ebola (poetically named after the Ebola River in the area of the first outbreak in the Congo in 1976) were to go global, the effects would look more like the smallpox than the SARS. This is not a disease to be messed about with. There is no cure for Ebola, only supportive treatment - though there is some hope that a set of experimental drugs may help, but they have not yet been tested on humans, so that remains to be seen. The fact that the United States Food and Drug Administration and the World Health Organization have sanctioned their use in this outbreak should tell you how terrified the organisation is.

As in all cases of dangerous infectious disease outbreaks, the world is struggling to find a balance between red alert and pointless panic. If this outbreak in West Africa is contained, the world will have bought itself some time to accelerate pharmaceutical research and development. If not, it will be interesting to see how India, with its large diaspora on the African continent and in the Gulf, will act to address the threat and protect itself from a potentially hideous public-health situation.

The prime minister made an appeal to the nation, in his Independence Day address, to build and use toilets. By that indicator for our health and sanitation conditions, Hollywood could well set its next medical horror movie in India.