24 May 2018

Congo-Kinshasa: Lessons From Last Ebola Outbreak Guide Approach

Photo: Le Pays
Des malades atteints d'ebola

When Ebola broke out in West Africa in 2014, no one was prepared. A potential vaccine had been in limbo since a previous outbreak a decade earlier. Governments dragged their feet while failing to recognize the risks the outbreak carried. Local health workers were quickly overwhelmed. And aid agencies were scrambling to catch up.

By the time the epidemic was brought under control in 2016, more than 11,300 people had died in Guinea, Liberia and Sierra Leone and the costs had risen to $4.3 billion.

Flash forward to May 8, when word emerged about a possible Ebola outbreak in a remote village in the Democratic Republic of the Congo. Within two days, the DRC had dispatched experts to the scene. International agencies shipped in personnel, mobile medical labs and a batch of vaccine that had been tested during the West African outbreak.

Painful lessons from the last Ebola outbreak are being applied in the current one, in hopes of limiting its scope.

'Quick and robust response'

"The coordinated action is essential," said Tarik Jasarevic, spokesman for the World Health Organization (WHO), which so far is reporting 27 deaths among 51 cases of hemorrhagic fever. "We know how damaging Ebola can be in the communities. And we have to mount a quick and robust response not to get to the point where a transmission chain would get out of control."

But concerns remain that the virus could elude containment efforts.

The aid group Medecins Sans Frontieres (MSF), or Doctors Without Borders, reported that three patients left an isolation ward at a treatment center in the Congolese city of Mbandaka sometime between Sunday and Tuesday. Two of the patients died; a third had been scheduled for discharge.

"You can imagine having the Ebola virus in a community is a cause of concern for the local population," Jasarevic said. The city has roughly a million residents.

The Associated Press quoted MSF emergency coordinator Henry Gray as saying in a statement Wednesday, "One of the men died at home and his body was brought back to the hospital for safe burial with the help of the MSF teams; the other was brought back to the hospital yesterday morning and he died during the night."

Every epidemic has its unique challenges. In this case, the villages initially affected were in remote locations. Land had to be cleared, first for helicopters and then planes.

With quick action came the need for funding. Last Friday, the WHO requested $26 million. More than half of that had been pledged as of Tuesday, with the United States committing $8 million of the amount.

"It's better to spend more today than to be forced to spend much, much more afterward, because we know what damage, economic damage, was done to the countries in West Africa in 2014," Jasarevic said.

Jasarevic said the requested amount was small, given the costs of the last outbreak.

One upside

The repeated outbreaks have had the positive side effect of developing a core of health workers whose experience is proving priceless, including those in the DRC, now dealing with its ninth outbreak.

"Obviously, they are leading the response," Jasarevic said of the Congolese.

He added that WHO also had created an international emergency medical team roster, which includes experts who've participated in previous outbreaks.

The experts include anthropologists and others, who can help explain how individuals can safeguard themselves and others. The experts can instruct that anyone showing symptoms consistent with the virus, such as flu-like symptoms, "should be brought to the treatment center so they don't affect other people," Jasarevic said.

The experts also want to increase awareness of safe burial practices, limiting exposure to the body of someone who has died of the infectious disease. It can spread through direct contact with bodily fluids.

The bottom line now is to keep the outbreak from spreading.

The vaccine is being used first on health workers and the friends and relatives of those who already have been infected. If it all works, the aid agencies and various governments soon will be looking for new lessons.

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