Crowds of fearful residents flock to their local pharmacies before dawn, desperate to buy masks and antibiotics to stave off a plague outbreak sweeping Madagascar. News24 reports that in just the past few days, the highly infectious disease has wreaked havoc in the poor Indian Ocean island nation, claiming six lives in the capital city Antananarivo and causing widespread panic.
Like many of his neighbours, 50-year-old Johannes Herinjatovo quickly became overwhelmed by fear as news of the outbreak spread. The report says he too joined the long lines forming outside the capital's chemists. "I'd already visited six this morning and at each one they told me that they didn't have any more masks," he said as he left a pharmacy empty-handed. His wife Miora Herinjatovo, 55, had better luck, successfully locating a mask in a hospital. "Everyone is looking for one," she said. "Some pharmacies are saying that there won't be any more in the city. Others are telling us to wait. We just don't know." Having failed to get hold of a mask, her husband instead collected a handful of generic antibiotics.
The report says the health ministry has advised against using the treatment preventively against the plague, but that has done little to deter worried members of the public. "We are scared – all of these deaths show that the situation is serious," said Herinjatovo.
Prime Minister Olivier Mahafaly Solonandrasana dropped a bombshell on national TV on Saturday when he announced that 24 people have so far died from the plague since the end of August.
The report says Madagascar is in the grips of a double plague: both bubonic plague, which is spread by infected rats via flea bites, and pneumonic plague, spread person to person. Pneumonic plague can kill quickly, within 18-24 hours of infection if left untreated, but common antibiotics can cure it if they are given early on.
Madagascar has suffered plague almost every year since 1980, often sparked by rats fleeing forest fires. But, the report says, the current outbreak has affected large urban areas, increasing the risk of transmission according to the World Health Organisation.
The government has been forced to take drastic action, banning all public gatherings in the capital in a bid to slow the disease's spread.
Many residents of Antananarivo suspect that authorities have been caught off-guard and have sought to lay their hands on whatever preventative measures they can – regardless of their efficacy. "We do what we can and what we think could help protect us," said Rondro Razafindrainy, 37, as she queued outside another pharmacy. "Pneumonic plague is spread by airborne transmission, I read that online, so I think a mask is essential," she said. "I don't know if this mask will actually protect us, but everyone has one and I want one too," said Maurice Rakotomanana interrupting her.
The report says as the concern has grown, so too has the price of a standard mask: doubling from 300 ariary ($0.10) to 600 ariary in a matter of hours. It has become a common sight on the streets to see people wearing masks.
Authorities are attempting to keep the public calm, laying traps to catch the rats whose fleas have spread the disease while also spraying insecticide. "We have focused our efforts on Facebook because there is too much misinformation going around social media and causing panic," said Manitra Rakotoarivony, a government doctor, during a recent press conference. "We can treat the plague, we have the means."
But, the report says, despite a campaign of radio adverts and free helplines for concerned citizens, Madagascar's people do not appear to have be reassured by the efforts of their leaders. Henri Rakotoarilalaninaivo, a married father of four, was one of those caught up in the anxious attempts to avoid infection. When he returned home, his doctor wife insisted that he strip naked, take a bath before eating and sleep on his own for fear that he might be infectious. "I accept the situation for the good of my family. But I feel like I'm being punished," he said.
The World Health Organisation (WHO) is rapidly scaling up its response to the plague that has spread to the capital and port towns, infecting more than 100 people in just a few weeks.
The government of Madagascar has confirmed that the death of a Seychellois national was due to pneumonic plague. The basketball coach died in hospital in Antananarivo on Wednesday (September 27) while visiting the island nation for a sports event. Health authorities are tracing people with whom he came into contact in recent days and who may have become exposed to the illness. Once identified, they will be given antibiotics to prevent infection as a precautionary measure.
The incident brings the death count to 21 since the outbreak was identified in late August; at least 114 people have been infected.
“WHO is concerned that plague could spread further because it is already present in several cities and this is the start of the epidemic season, which usually runs from September to April,” said Dr Charlotte Ndiaye, WHO representative in Madagascar. “Our teams are on the ground in Madagascar providing technical guidance, conducting assessments, supporting disease surveillance, and engaging with communities,” she added. “We are doing everything we can to support the Government’s efforts, including by coordinating health actors.” Further deployments of WHO staff and response partners in the Global Outbreak Alert and Response Network (GOARN) are underway, as well as increased supplies of antibiotics, personal protective equipment and other supplies.
WHO has released $300,000 in emergency funds, as well as critical medical supplies, to quickly scale up operational efforts, and is appealing for $1.5m to support the response.
Plague is endemic to Madagascar, where around 400 cases of – mostly bubonic – plague are reported annually. Contrary to past outbreaks, this one is affecting large urban areas, which increases the risk of transmission. The number of cases identified thus far is higher than expected for this time of year.
Bubonic plague is spread by infected rats via flea bite, pneumonic by person-to-person transmission. The current outbreak includes both forms of plague. Nearly half of the cases identified so far are of pneumonic plague.
Plague is a disease of poverty. It thrives in places with poor sanitary conditions and inadequate health services. It can kill quickly if left untreated, but can also be cured by common antibiotics if delivered early.
The last reported outbreak in December 2016 was mainly bubonic plague occurring in remote area.News24 report World Health Organisation material