In the last few days, cholera cases have been reported from across the city, and there are fears about a large-scale outbreak. Let us quickly understand certain basics of the disease, how it affects us, what we can do to safeguard our health and life, and be an agent of change to control the spread of the disease.
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Let us look at the facts first. Every year, cholera infects 1.3 to 4 million people globally, and claims the lives of 21,000 to 1.43 lakh people, according to the World Health Organisation (WHO). What makes it so virulent as to turn into an epidemic is that a single episode of diarrhoea can cause a million-fold increase of bacterial numbers in the environment.
Cholera, as an epidemic, was responsible for deaths on a mass scale in the past. Concerted community and health efforts resulted in decimation of the disease, and it was effectively archived in the books. But the recent cholera cases in Bengaluru highlights the necessity of always being alert as regards communicable diseases.
The good news – about 75% of people infected with cholera may not have any symptoms. But the bad news is that they can excrete the bacteria in their stools for 7-14 days. These are shed back into the environment, possibly infecting other individuals.
What causes cholera?
Cholera is a disease caused by a comma-shaped bacteria named Vibrio Cholera. This is good news because this bacteria is susceptible to antibiotics. But the risk for the community is that this disease spreads through water contaminated by faeces, as well as through contaminated food.
The disease is manifested by sudden, severe diarrhoea, which is typically described as rice-water stools. This leads to severe dehydration and electrolyte loss, and it is this which causes death in vulnerable people.
Cholera has been around for more than 2000 years!
Sushruta Samhita mentions isolated instances of cholera in 5th century BC. Hippocrates, in 4th BC, mentions a similar medical condition. Aretaeus of Cappadocia mentions such cases in 1st century AD.
The most lethal epidemic of cholera was reported from India in the 19th century. The first cholera pandemic started from Jessore, India, in 1817, after the consumption of contaminated rice. The disease quickly spread pan-India, to Myanmar and Sri Lanka. By 1820, it spread to Thailand, Indonesia (killing one lakh people on the island of Java alone) and the Philippines. From Thailand and Indonesia, the disease made its way to China in 1820, and to Japan in 1822, by way of infected people on ships.
Somalia and Yemen saw an outbreak in 2017. By August 2017, the Yemen outbreak affected 500,000 people and killed 2,000 people. (Does it ring a bell, when we consider the march of coronavirus through countries and continents?)
There have been numerous outbreaks and seven global pandemics of cholera so far.
Treatment and prevention
The most important step in treatment would be to replace the lost electrolytes and water. This can be done with ORS (Oral Rehydration Solution) – mix ORS powder with water and keep drinking regularly. If ORS is not available, lemon juice should be used until arrangements are made to get ORS. In case a patient cannot drink or has vomiting, then water and electrolytes should be given through intravenous route.
More importantly, how can we avoid contracting cholera? This is relatively easy if we follow a few simple steps:
- Drink and use safe water – water that is boiled, treated with chlorine or radiation.
- Also, the water you use for brushing, washing your utensils and making ice, should be safe.
- Wash your hands frequently, and that too with safe water every time. If soap is not available, ash or sand can be used.
- Avoid eating uncooked food, fruits and salads if you’re not sure of the quality of water used to wash these. Cook food well, and eat it while it is hot.
- Avoid eating street food.
Public Health authorities need to up the ante with respect to preventive measures. As a citizen, you can help prevent the spread of cholera by ensuring that people defecate in latrines and not in the open. You should also inform authorities if you suspect an outbreak, so that they can carry out their investigations.