As the number of Ebola deaths rises to more than 130 in the Eastern Congo, and despite the WHO having declared a global emergency due to the outbreak in east Africa, South African officials have said there is a low risk of local transmission but emphasise the need for vigilance, reports Daily Maverick.
Global health authorities, however, have warned that the number of people infected by the virus could be much higher than reported and that the outbreak could last for months.
South Africa’s National Institute for Communicable Diseases (NICD) said that based on current assessments, there is minimal chance of the outbreak spreading to this country.
The WHO has declared the latest outbreak in Uganda and Democratic Republic of the Congo (DRC) as “a public health emergency of international concern”.
Identified as the Bundibugyo strain, it was detected when a hospital in the Ituri province in DRC reported an unusual cluster of severe illnesses and deaths among healthcare workers, who showed symptoms consistent with this strain.
Unlike other strains, it has no approved vaccines or treatments, with a death rate ranging from 25%-40%.
On Tuesday, health authorities said 26 more suspected Ebola deaths had been recorded in 24 hours, with the head of the WHO expressing deep concern about the outbreak’s spread.
The new deaths brought to at least 135 the fatalities associated with the region, reports Reuters. There have been 543 suspected cases and 33 confirmed cases in DRC, and two confirmed cases in neighbouring Uganda.
The NICD said that the WHO and Africa Centres for Disease Control and Prevention (Africa CDC) had declared the outbreak a public health emergency of international concern because of cross-border spread between DRC and Congo, the absence of approved vaccines and treatments for the Bundibugyo virus, and the risk of spread within the region.
“The global risk is currently considered low to moderate but concerning enough to warrant urgent international action. The concern at this stage is particularly for continued spread to other parts of the DRC, continued spread to and in Uganda, and to South Sudan,” said Dr Jacqueline Weyer, principal medical scientist at the NICD’s Centre for Emerging and Zoonotic Diseases.
“Based on the current risk assessment, we consider a low risk for the virus disease outbreak to spread to South Africa, but continued monitoring is required.”
On Sunday, President Cyril Ramaphosa highlighted the need to strengthen surveillance systems, laboratories and contact tracing to contain the outbreak.
“Ebola does not respect borders. In a region marked by high population mobility, insecurity and humanitarian movement, the risk of regional spread is significant and demands urgent, co-ordinated action,” he said.
Only two cases of Ebola have ever been reported in South Africa – both in 1996 after a medical professional who was exposed to patients with the Ebola-Zaire strain travelled from Gabon to South Africa and subsequently infected a nurse.
High positivity rate
Because Ebola requires direct contact with infected fluids, the risk of transmission is significantly lower than with airborne diseases like Covid-19, and those most at risk are caregivers for infected patients, including medical professionals.
However, the WHO says it is concerned by the high positivity rate in the latest outbreak. It has issued an advisory against travelling to the region. At this stage, the true number of infected people and the geographic spread of the disease are uncertain, although cases have been reported in Kinshasa and Kampala.
Meanwhile, Médecins Sans Frontières (MSF) said it is responding to the outbreak by mobilising medical teams to assist the DRC health authorities in affected areas in Ituri.
“The number of cases and deaths we are seeing in such a short timeframe, combined with the spread across several health zones and now across the border, is extremely concerning,” said Trish Newport, MSF emergency programme manager.
WHO’s representative in DRC, Anne Ancia, told Reuters that identifying cases was slowed by limited diagnostic capacity for the Bundibugyo strain, with just six tests possible per hour.
Experts say the delays in detecting the outbreak show gaps in preparedness after cutbacks by the US and other major donors to global health funding.
One American has tested positive for Ebola, the US CDC said on Monday.
The man, identified as Dr Peter Stafford by his Christian mission organisation, and six other Americans who were exposed to the virus, were being moved to Germany for care and monitoring, the CDC said.
The US has suspended entry of travellers who had been in the DRC, Uganda or South Sudan during the past 21 days, with certain exceptions, for 30 days and urged Americans not to travel to those countries for any reason.
At the same time, the WHO urged countries not to close their borders or restrict travel and trade out of fear, as this could lead to people and goods making informal border crossings that are not monitored.
The Africa CDC has criticised the “use of broad travel restrictions as a primary public health tool”.
“Global health security cannot succeed if countries are penalised for transparency during outbreaks,” said Dr Jean Kaseya, the head of the organisation.
Antibody
The US, which said it had mobilised an initial $13m to respond to the outbreak, is working to develop a monoclonal antibody therapy as a potential treatment, the CDC said. Secretary of State Marco Rubio said that he was worried about the outbreak and that American funds would help open 50 clinics to treat Ebola cases.
“It’s a little tough to get to it because it’s in a rural area … But we’ll have more to announce on that,” he said, without providing details.
A panel of experts led by the WHO met on Tuesday in Geneva to discuss vaccine options that could help tackle the outbreak. The WHO’s Ancia said Merck & Co’s Ervebo was one candidate but that it would take two months to be available.
But experts say that relying on a potential vaccine will not be enough and that containment measures are key.
“At this point, it’s really a race against time,” said Alessandro Vespignani of the Centre for Advanced Epidemic Analytics and Predictive Modelling Technology in the United States, known as EPISTORM. “Every day is important.”
Conflict
The outbreak is currently centred in the east of the DRC, where people, including migrant labourers working in gold mines, move across borders. The area is also in the grip of a conflict that has displaced more than 1m people, gutted health clinics and slowed the public health response, officials said.
“The last outbreak in this area took two years to contain,” Ancia told The New York Times.
Congo’s Health Minister, Dr Samuel-Roger Kamba said awareness of the virus had been delayed by a misunderstanding. Some people, he said, initially did not take protective precautions when burying the dead, allowing the virus to spread. The initial hesitation over reporting cases has abated since this weekend’s official declaration of a virus outbreak, he added.
He argued that the country had been able to contain 15 previous outbreaks of Ebola without vaccines or treatments, suggesting that public health measures could suffice to contain this latest one.
At the same time, he said, the outbreak is a matter of international concern. “The virus knows no border and knows no race and knows no tribe,” he said.
A model of the outbreak published this week by the MRC Centre for Global Infectious Disease Analysis at Imperial College London, found that the current number of cases could be well more than 1 000.
“Our analyses suggest that the true number of cases may be substantially higher than those confirmed to date,” said Dr Anne Cori, an associate Professor in Infectious Disease Modelling.
Ancia said that WHO officials had been in Bunia since Sunday and that while medical equipment, disinfectant and protective gear had arrived, it was not enough.
“We need more people, more hands on the ground,” she said. Moving equipment to the region became more difficult after rebels took over the city of Goma, home to the region’s main airport, she pointed out.
The WHO said the deaths of healthcare workers and the absence of vaccines or therapeutics to treat the Bundibugyo species raised fears that the outbreak would spread further. Cases have already been reported in urban areas, including in Kampala, the capital of Uganda, and in Goma.
Reuters article – Ebola deaths in eastern Congo rise to 131, WHO voices deep concern (Open access)
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