Thursday, August 16, 2018

New Ebola Outbreak: This One In Cities



Ebola outbreak is most dangerous test of world's ability to respond since global crisis



The latest Ebola epidemic in the Democratic Republic of the Congo is shaping up to be the most dangerous and difficult test of the world’s ability to contain the disease since the catastrophic West African outbreak in 2014 and 2015.
Like an outbreak earlier this year, in the western part of the country, cases have been reported across multiple locations, disease transmission is taking place in cities where hundreds of thousands of people live, and there’s the potential for the virus to spread across several international borders.
But this outbreak is occurring in a part of the Congo that has long been a conflict zone, with over 1 million displaced people, scores of armed combatant groups, and “red zones” where outsiders hoping to contain a deadly disease may not be able to travel.
The possibility that the virus could spread unchecked in one of these areas raises prospects of an outbreak that could make this year’s earlier brush with Ebola seem like a training exercise.

“That’s really the worst-case scenario: That we can’t get in quickly enough to an alert [of possible cases] or we just have a blind spot because of security. And then an outbreak really begins to take hold in those blind spots and becomes a multicountry regional outbreak,’’ Dr. Peter Salama, the World Health Organization’s deputy director-general of emergency preparedness and response, told STAT.
“That’s what keeps me up at night.”

The outbreak was declared in North Kivu on Aug. 1, a week after the previous epidemic was deemed contained. Genetic analysis of viruses from the two show that while they are caused by the same species of ebolaviruses, Ebola Zaire, they are not linked.
Two weeks into this outbreak, the toll has already surpassed that of the earlier epidemic, which was centered around Bikoro, near DRC’s western border. There were 54 cases and 33 deaths over roughly four months in the Bikoro outbreak. As of Tuesday, there were 73 confirmed and probable cases and 43 deaths in North Kivu, and the case count is rising steadily.
North Kivu is in northeastern Congo, near the border with Uganda and Rwanda. It’s the country’s most populous province, with 8 million people. It is also its most dangerous.
Under a scoring system used by the U.N. to determine the level of risk for its personnel in conflict zones, North Kivu is at level 4. Level 5 means the U.N. must evacuate; it is simply too perilous to be present.
The security concerns mean that the WHO insists responders have armed escorts as they move about — a requirement the medical aid group Doctors Without Borders always refuses on the ground that it undermines the group’s ability to claim neutrality.
The operational strictures they face mean Ebola responders will need to be “very flexible” and “pragmatic,” WHO Director-General Tedros Adhanom Ghebreyesus said this week in Geneva.

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