One of South Africa’s top infectious disease experts has warned that it’s simply “a matter of time” before an Ebola case is imported to South Africa if the outbreak in the Democratic Republic of Congo (DRC) is not contained, reports Business Day.
“We have daily flights to the DRC. The fact that there haven’t yet been cases in South Africa is a reflection of the work being done to keep it contained, but it is spreading,” said Professor Salim Abdool Karim, director of the Centre for the Aids programme of Research in South Africa (Caprisa) and chair of a panel that advises the Africa Centres for Disease Control and Prevention (CDC) on infectious diseases.
“We are one continent. What impacts the DRC impacts all of us,” he added.
The outbreak is one of the biggest recorded to date, with more than 1 000 confirmed cases and at least 200 deaths in the DRC, with Uganda now also reporting cases, according to the Africa CDC. Yesterday, France reported its first case with a doctor who recently returned to the country from a humanitarian mission in the DRC tested positive for Ebola, the Health Ministry said. Reuters reports that the patient has been placed in isolation and health authorities are tracing contacts. A US citizen treated for Ebola in Germany was discharged earlier this month after no virus had been detected in the patient since May 30.
Abdool Karim, who recently travelled to Bunia, the epicentre of the outbreak, said the void left after the dismantling of the US Agency for International Development (USAID) was vividly apparent.
“Normally in these kinds of responses, USAID would play a huge role in logistics,” he said.
Not only did USAID have the ability to quickly procure supplies, but it also had the expertise and systems in place to import, warehouse, and transport the goods to where they were most needed, he pointed out, urging other countries to do more to assist the DRC.
Healthcare facilities urgently need more isolation facilities and are desperately short of construction materials that have to be shipped in, including even basic items, like gravel, he said.
Abdool Karim suggested China, which rapidly built emergency hospitals during the Covid-19 pandemic, could provide its expertise to help construct isolation wards in the DRC. Chinese authorities built a 1 000-bed hospital in Wuhan in just 10 days, using pre-fabricated sections that were assembled on site by crews working around the clock.
He said although staff kept meticulous hand-written records at the two hospitals he visited, the DRC’s efforts to contain the outbreak are being hampered by the lack of an electronic information system.
“In every battle – military or epidemic – intelligence is key to effective action. To control Ebola, every case needs to be identified timeously for isolation and contact tracing. Electronic information is essential for this to be effective.”
Meanwhile, doctors treating Ebola patients in the DRC say the symptoms may be milder than in previous outbreaks of the disease, but while this might be good news for patients, they fear it will make controlling the spread of infections more difficult, reports The New York Times.
While there are not enough data yet to be certain, an assessment by the Congo Health Ministry suggests that about 90% of patients do not seem to develop the extensive internal and external bleeding that usually accompanies the disease’s horrific end stages, according to Dr Marie-Roseline Belizaire, who leads the WHO’s response to the outbreak.
Some early data also suggest that fewer people may be dying this time than in previous outbreaks, and experts say that despite what may be a lower chance of death, this could paradoxically make it harder to control spread and end the outbreak.
“That’s really what I’m a bit anxious about, that this might be an indicator for an outbreak that lasts a lot longer,” said Dr Chikwe Ihekweazu, executive director of the WHO Health Emergencies Programme.
Public health experts think the number of infections are likely to be much higher than official statistics and that the outbreak may have simmered undetected for months: the milder symptoms may partly explain why.
The virus causing the outbreak, Bundibugyo, is distinct from the virus, often known as Zaire, that caused most previous epidemics of the disease. But all Ebola patients generally progress from what doctors call “dry” symptoms – fever, body ache, fatigue – to “wet” symptoms of diarrhoea and vomiting.
Both of those stages can mimic myriad other illnesses affecting people in the DRC, including malaria, typhoid and dysentery. With Ebola, however, eventually people’s blood vessels and organs start to break down, and the failure of multiple organs may precipitate gruesome deaths.
In the case of Zaire Ebola, which killed more than 11 000 people in the 2014 outbreak in West Africa, about half of the victims developed the dramatic bleeding symptoms. If only about 10% of patients with Bundibugyo reach that stage, many who become ill might continue to interact with others and spread the virus without seeking care.
“It makes total sense to me now how this was missed for months,” said Dr Nahid Bhadelia, Director of Boston University’s Centre on Emerging Infectious Diseases.
Bhadelia and her colleagues have found four unresolved clusters – including one in Burundi and one in South Sudan – of viral haemorrhagic fever that they suggest may be part of the outbreak. If they are, the virus may have spread far more widely and for longer than previously thought.
So far, patients have named five to eight contacts on average, compared with the expected range of 15 to 40 contacts per case, said Dr Craig Spencer, a public health expert at Brown University who has treated Ebola patients. And only about half of those named contacts have been found.
Those unfollowed contacts “are out there continuing to spread smaller fires, each one of which can blow up into something much bigger”, he said.
The mortality rate of the Zaire virus can top 80% when no vaccines or treatments are available. The rate in this Bundibugyo outbreak has varied widely, depending on the resources available in a community, but overall it seems to be less than 30%, according to the WHO.
As in previous outbreaks, health workers have been most at risk of exposure, and at least 18 have died so far. Some who became sick earlier in the outbreak may have gone undiagnosed.
Many patients are arriving at hospitals only when they are close to death. Some refrain from seeking care because they mistakenly attribute the symptoms to malaria, witchcraft or poisons. Others fear their organs will be harvested when they are isolated.
“It’s quite severe and difficult to control once they reach that stage,” said Dr Abdou Sebushishe, who is helping to lead the outbreak response for the International Medical Corps.
Kenyan resistance
Meanwhile, reports The Guardian, in Kenya, the Health Minister has told a court he had ordered preparations for a US-run Ebola quarantine facility to stop, after being held in contempt for ignoring a previous order to end work.
Many Kenyans strongly oppose the facility, with deadly protests erupting since the complex was announced in May for US citizens evacuated from the DRC, which is grappling with its outbreak.
The US facility was being constructed at Laikipia air base, about 200km from the capital, Nairobi, with about 50 isolation beds. It was expected to be managed by US medical staff.
However, rights groups had petitioned the court, saying the facility was being developed secretly and without consultation. Last month, the High Court ordered a stop to the centre’s construction until the groups’ case was heard.
After the government continued to press ahead, the court said on Monday it was holding Health Minister Aden Duale in contempt of the order, and that he would appear for sentencing.
On Tuesday, Duale apologised to the court, saying he had ordered “the immediate and complete cessation of any intended construction, site preparation, or related activities concerning the Laikipia air base facility pending the hearing and determination of the substantive petition or until further orders of this court”.
The judge, discharged Duale with a warning against further disobeying the court’s orders.
Specialist staff and medical equipment had continued to be flown into the airbase after last month’s order, US officials and diplomats told Reuters. There was also a build-up of structures, including tents and paved areas, according to satellite imagery from 22 June viewed by Reuters.
Three people have been killed in protests against the quarantine centre. Two died on 1 June and another was shot dead by police on 9 June.
Kenya has never recorded a case of Ebola and many Kenyans oppose bringing potential carriers of the highly contagious disease into the country.
“If it is too dangerous for America, it is too dangerous for Kenya,” Dr Davji Atellah from the Kenya Medical Practitioners, Pharmacists and Dentists Union, said last month.
In court on Tuesday, Duale defended the US quarantine facility, saying that fears Ebola would spread beyond it were “scientifically unfounded”. The country’s President, William Ruto, said earlier this month that Kenya was doing “the right thing” by allowing the facility to go ahead.
The US has promised $13.5m to support Kenya’s Ebola preparedness efforts, but critics also oppose what they see as the arrangement’s colonial overtones.
Reuters – France reports Ebola case in doctor returning from Congo
The New York Times article – Ebola Symptoms in Current Outbreak May Be Milder Than in Previous Ones
Business Day – ‘Only a matter of time’ for Ebola in SA if DRC outbreak not contained: Abdool Karim
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