Congo Ebola
Outbreak Declared An International Emergency
Unparalleled
Situation Is Impeding Control Measures
Epidemiologists
Banned From Participating In Hot Zone
An outbreak of Ebola
in the Congo has persisted for a year with 2,512 probable or confirmed
cases and killed at least 1,650 persons as of mid-July without showing
signs of abating. An estimated 12 new cases are being reported each
day or about 80 per week, and this number is believed to be an
underestimate. The case fatality rate for
confirmed cases is 67% and
there is
special concern that approximately 30% of the cases are
children under 18 years. Health workers are accounting for 5% of the
cases.
Expanded Risk
Now, the report of a
new case in the highly populated region of Goma, a large population
center in the Democratic Republic of the Congo on the border with
Rwanda, has sounded alarm bells even more loudly. The World Health
Organization, triggered by the case in Goma, has declared a public
health emergency. The declaration means the outbreak is “an
extraordinary event that poses a public health risk to other countries
through international spread and that potentially requires a
coordinated international response.” WHO’s assessment is that risk
remains very high at national and regional levels but still low at
global level. There is cause for special concern linked to the recent
case in Goma because the city is a provincial capital with an airport
which has international flights
Complex Environment
Because of the lessons
learned from the last outbreak in West Africa five years ago and the
development of an effective vaccine since then, it is puzzling to
understand why the current year-old outbreak has not yet been halted.
Official reports, eyewitness observations, and multiple media articles
all point to a complex and uniquely challenging situation in which
lessons learned from West Africa may not really apply. The major
factors which have proven to be serious impediments to the control of
this outbreak include the following:
Fear of unintended
consequences
Three previous meetings by the WHO Advisory Committee have not
recommended declaring an emergency out of fear of doing more harm than
good because of
unintended consequences. A similar declaration five years ago in West
Africa caused travel bans, visa cancellations, trade freezes,
cancelled flights and other hardships which amplified the negative
social and economic effects of the outbreak and actually backfired to
impede control measures.
Lack of Resources
The resources needed to properly combat the outbreak have not been
provided. “Unless we get substantially more financial resources
immediately, it will not be possible to end the outbreak,” according
to Mark Lowcock, a United Nations Emergency Relief Coordinator.
Previous decisions not to declare an emergency have meant less
leverage for those arguing for more resources, which hopefully will
now be forthcoming.
Tenuous Security
Insecurity is the greatest concern, especially after two more
community health workers were killed recently. Media Express reports
“as many as 134 separate armed rebel groups have sparred for control
of the mineral-rich region in recent years, and an explosion of
ethnically motivated kidnappings, maimings, and sexual violence
displaced at least 300,000 people in June alone. There is a
humanitarian crisis underway with millions of people displaced from
their homes and on the move.
Political
considerations
Epidemiologists and Ebola experts from CDC have been banned from full
participation. “High income countries fear a Benghazi moment: If they
let trained experts into the hot zone and they got killed—or
worse—kidnapped—it would be a political crisis,” reported Medical
Express in speaking with Georgetown University’s Larry Gostin
who directs an institute on national and global health law.
Lack of trust
Contact tracing has not been possible in a place where there is
distrust of the government and other authorities and the population is
mobile. If they can be found, families which are identified for
preventive measures hide loved ones behind closed doors for fear they
will be hauled away. Contacts who need the proven effective vaccine do
not get it.
Lack
of Information & Misinformation
Conspiracy theories and misinformation circulates on social media.
Lancet reported that a quarter of residents of North Kivu do not
believe the virus is real. Other claims are that it is a biological
attack by white Westerners or deliberate spread by the Congolese
government.
According to the
latest situation report from WHO, “The continuous transmission in
major hotspots and the involvement of new health areas remain a grave
concern, and thus necessitates both the continuation of proven and the
introduction of novel outbreak control interventions in all affected
areas.”
World Health
Organization Issues New Recommendations To Intensify Ebola Control
Measures
Triggered by its
Declaration of a Public Health Emergency of International Concern and
citing the International Health Regulations, the WHO has issued new
recommendations for officials in the Democratic Republic of the Congo
and for neighboring countries. The spread of the infection to a large
population of 2 million persons in Goma on the border with Rwanda has
heightened regional and international risk. The recommendations
include:
Temporary
Recommendations
In its emergency
declaration, WHO makes the following temporary recommendations under
international health regulations to improve control of the outbreak.
Recommendations for
the Congo
• Communication:
Continue to strengthen
community awareness, engagement, and participation, including at
points of entry, with at-risk populations, in particular to identify
and address cultural norms and beliefs that serve as barriers to their
full participation in the response.
• Screening
Continue cross-border screening and screening at main internal roads
to ensure that no contacts are missed and enhance the quality of
screening through improved sharing of information with surveillance
teams.
• Security
Continue to work and enhance coordination with the UN and partners to
reduce security threats, mitigate security risks, and create an
enabling
environment for public health
operations as an essential platform for accelerating disease-control
efforts.
•Surveillance
Strengthen surveillance with a view towards reducing the proportion
of community deaths and the time between detection and isolation, and
implementing real-time genetic sequencing to better understand the
dynamics of disease transmission.
• Vaccination
Optimal vaccine strategies that have maximum impact on curtailing the
outbreak, as recommended by WHO’s Strategic Advisory Group of Experts
(SAGE), should be implemented rapidly.
• Nosocomial
infections
Strengthen measures to prevent nosocomial infections, including
systematic mapping of health facilities, targeting of IPC
interventions and sustain support to those facilities through
monitoring and sustained supervision.
Recommendations for
neighboring countries:
• Preparedness
At-risk countries should work urgently
with partners to
improve their preparedness for detecting and managing imported cases,
including the mapping of health facilities and active surveillance
with zero reporting. At-risk countries should put in place approvals
for investigational medicines and vaccines as an immediate priority
for preparedness.
• Mapping
Countries should continue to map population movements and sociological
patterns that can predict risk of disease spread.
•Communication and
Engagement
Risk communications and community engagement, especially at points of
entry, should be increased.
Recommendations for all States:
• No country should
close its borders or place any restrictions on travel and trade.
• National authorities
should work with airlines and other transport and tourism industries
to ensure that they do not exceed WHO’s advice on international
traffic.
• The Committee does not consider entry
screening at airports or other ports of entry outside the region to be
necessary.
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