Democratic Republic of Congo faces a “very high” public health risk from Ebola after the disease was confirmed in one patient in a major city, the World Health Organisation (WHO) said on Friday of last week, raising its assessment from “high” previously. The risk to countries in the region was now “high”, raised from “moderate”, but the global risk remained “low”.
Polity reports that the reassessment came after the first confirmed case in Mbandaka, a city of around 1.5m. Previous reports of the disease had all been in remote areas where Ebola might spread more slowly. “The confirmed case in Mbandaka, a large urban centre located on major national and international river, road and domestic air routes increases the risk of spread within the Democratic Republic of the Congo and to neighbouring countries,” the WHO said.
WHO deputy director-general for emergency preparedness and response Peter Salama is quoted in the report as saying that the risk assessment was being reviewed. “We’re certainly not trying to cause any panic in the national or international community,” he said.
“What we’re saying though is that urban Ebola is very different phenomenon to rural Ebola because we know that people in urban areas can have far more contacts so that means that urban Ebola can result in an exponential increase in cases in a way that rural Ebola struggles to do.”
The WHO has convened an Emergency Committee of experts to advise on the international response to the outbreak and decide whether it constitutes a “public health emergency of international concern”.
The report says the nightmare scenario is an outbreak in Kinshasa, a crowded city where millions live in unsanitary slums not connected to a sewer system.
The WHO is sending 7,540 doses of an experimental vaccine to try to stop the outbreak in its tracks, and 4,300 doses have already arrived in Kinshasa. It will be used to protect health-workers and “rings” of contacts around each case.
The vaccine supplies will be enough to vaccinate 50 rings of 150 people, the WHO said. As of 15 May, 527 contacts had been identified and were being followed up and monitored, it said.
The spread of Ebola to a major city in the DRC is worrying but the outlook is much more optimistic than when a major outbreak was reported in West Africa in 2014, the head of the WHO director general Tedros Adhanom told health ministers at the start of the WHO’s Annual Assembly. “It’s concerning that we now have cases of Ebola in an urban centre, but we are much better placed to deal with this outbreak than we were in 2014.”
Polity reports that the WHO’s previous leadership was heavily criticised for its slow response to the outbreak that was declared in March 2014 and continued until January 2016, killing over 11,300 people. It was later found to have begun in late 2013, but WHO did not call an emergency meeting until August 2014.
This time the WHO has moved rapidly to mobilise the response, convening an Emergency Committee and sending a vaccine to ring-fence the outbreak and stop it spreading further. “I’m pleased to say that vaccination is starting as we speak today,” Tedros said.
The report says the latest outbreak is Congo’s ninth since the disease made its first known appearance near the vast central African country’s northern Ebola river in the 1970s.
Tedros said WHO staff and health workers were working around the clock to stop the outbreak, and said he had been impressed by seeing health workers “risking their own lives” in the remote town of Bikoro a week ago, just after the outbreak was declared.
“The outbreak in Bikoro illustrates again that health security and universal health coverage are two sides of the same coin. The best thing we can do to prevent future outbreaks is to strengthen health systems everywhere,” Tedros said.
The DRC’s health minister says a nurse has died from Ebola in Bikoro, the rural northwestern town where the outbreak began, as the country begins a vaccination campaign.
News24 quotes Health Minister Oly Ilunga as saying that the nurse’s death brings the death toll to 27. There are now 49 haemorrhagic fever cases: 22 confirmed as Ebola, 21 probable and 6 suspected.
Ilunga said two patients have recovered from Ebola, returning home.
The Africa Centres for Disease Control and Prevention (Africa CDC) is deploying 25 epidemiologists, laboratory experts, and anthropologists to support the government of the DRC’s efforts to control the Ebola outbreak in Mbandaka and Bikoro. The Africa CDC deployed an assessment mission within 48 hours of the DRC’s announcement of the outbreak on 8 May and activated its Emergency Operational Centre to link, scan and monitor the situation.
“The global community needs to respond to this outbreak as a crisis and not as an emergency, by quickly deploying public health assets to the affected areas expeditiously”. I want to applaud the Minister of Health of the DRC for his exemplary leadership in managing this current outbreak so far. “All our efforts should be geared towards supporting his leadership” said Dr John Nkengasong, the director of the Africa CDC, upon his return, with a high-level delegation, from the affected areas in Mbandaka and Bikoro.
The DRC government is working with partners to improve coordination mechanisms, enhance surveillance, laboratory confirmation, contact identification and follow-up, case management, infection prevention and control, safe and dignified burials, social mobilisation and community engagement, logistics, risk communication, vaccination, partner engagement, research and resource mobilisation.
During the Africa CDC team’s visit they assisted the Ministry of Health, together with other partners, to develop three strategies: a) surveillance and contact tracing, b) defining the various health areas affected, and c) laboratory testing and network. The Africa CDC will provide up to $2m to support Africa CDC interventions. Due to the remote nature of the Equateur Province, it is expected that more efforts will need to be put in supply chain issues to ensure that essential items needed are delivered swiftly.
The African Union Peace and Security Council has been briefed on the situation and will continue to receive reports. Under Article 6(f) relating to its mandate with regard to humanitarian action and disaster management the Council can authorise deployment of military and civilian missions and assets to tackle emergency situations as it did in August 2014 in the Ebola outbreak in the West Africa sub-region. This outbreak is the 9th outbreak of the Ebola virus disease over the last 4 decades in the country. The affected health area of Bikoro covers 1,075 km and has a population of 163,065 inhabitants. This huge population is supported by only 3 hospitals and 19 health centres, most of which have limited functionality.
Two new deaths from Ebola and seven new confirmed cases have been recorded in the DRC, Polity reports the Health Ministry said. One of the deaths occurred in the provincial capital of Mbandaka, according to a daily bulletin. A nurse also died in the village of Bikoro, where the outbreak was first detected, ministry spokesperson Jessica Ilunga is quoted in the report as saying.
The seven new confirmed cases were registered in Bikoro, the ministry said.
Health officials administered an experimental vaccine on Monday to 33 medical workers and Mbandaka residents, WHO spokesperson Tarik Jasarevic said. The vaccine manufacturer Merck has provided WHO with 8,640 doses of the vaccine and an additional 8 000 doses are expected to be available in the coming days, WHO said.
Meanwhile, health workers fighting the Ebola epidemic have run into an invisible but powerful hurdle – a belief system that deems the disease to be a curse or the result of evil spirits. Some people are refusing medical care and turn instead to preachers and prayers to chase away the threat, they are quoted in a report in The Times as saying.
The pastor of an evangelical church last Wednesday died several days after he “prayed” for an Ebola victim who went to him for help, a doctor said. “Some sick people believe that the Ebola epidemic comes from sorcery – they refuse to be treated and prefer to pray,” said Julie Lobali, a nurse on the front line against the DRC’s ninth Ebola outbreak.
She is working in a hospital in Mbandaka, a port city on the Congo River in northwest DRC where the first urban case was reported last Thursday. One superstition that has become prevalent in the city, she says, is believing that Ebola began in Bikoro as “a curse on those who ate stolen meat” – a wild animal hunted in the countryside.
Blandine Mboyo, who lives in Mbandaka’s district of Bongondjo is quoted as saying that “a hunter put a curse on the village because his big game was stolen.” “This curse is so powerful because it hits those who ate this meat, having heard about the theft or having seen the stolen animal,” added Nicole Batoa, a local vendor.
Another resident, Guy Ingila, observed that officials have said on the radio “this disease is incurable… It’s because it’s about witchcraft.”.
The report says for doctors and health officials these beliefs raise serious concerns, complicating efforts to contain and roll back the deadly Ebola virus.
IHR Emergency Committee meeting statement
WHO Ebola news
The Times report