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A Congolese health worker is administering the Ebola vaccine to a boy who has been in contact with an Ebola patient in the village of Mangina, North Kivu province, on 18 August. (Olivia Acland / Reuters)
Robert Redfield, director of the Centers for Disease Control and Prevention, said Monday that the outbreak of conflict-ridden Ebola in Congo had become so severe that international public health experts needed to consider the possibility of to not be able to be restrained and rooted.
If this occurred, it would be the first time since the deadly viral disease was first identified in 1976 that an Ebola outbreak was causing the persistent presence of the disease. In all previous epidemics, most of which had occurred in remote areas, the disease had been controlled before it spread widely. The current outbreak is entering its fourth month, with nearly 300 cases, including 186 deaths.
If Ebola becomes endemic in important areas of North Kivu province, in northeastern Congo, "this will mean that we will no longer have the ability to spot contacts, stop transmission chains and contain the epidemic," said Tom Inglesby, Director of the Johns Hopkins Health Security Center, who organized the information meeting at Capitol Hill. featured the Ebola discussion with Redfield.
In this scenario, the deadly virus would spread in a sustainable and unpredictable way, with major implications for travel and trade, he said, noting that there are 6 million people in North Kivu . In comparison, the total population of Liberia, one of the countries hardest hit by the Ebola outbreak in West Africa 2014-2016, is rising in about 4.8 million.
The epidemic occurs in part of Congo which is an active war zone. Dozens of armed militias operate in the region, attacking government outposts and civilians, complicating the work of the Ebola teams and jeopardizing their safety. The violence has intensified in recent weeks, severely hampering the intervention. The daily rate of new Ebola cases more than doubled in early October. In addition, there is resistance from the community and a deep distrust of the government.
Some sick people have refused to go to treatment centers, health workers are still infected, and some people are dying of Ebola or spreading the virus to new areas. It is estimated that about 60 to 80% of new confirmed cases have no known epidemiological link with previous cases, which makes it very difficult for respondents to follow up on cases and discontinue the case. transmission. In late August, the United States withdrew some of Ebola's most experienced Ebola CDC experts who were stationed in Beni, the provincial epicenter of the province, because of security risks.
"I think this is one of the challenges we will have to face, whether we are able to contain, control, and end the current epidemic with the current security situation, or are we moving to idea that this is becoming more of a problem. Endemic Ebola outbreak in this region, which we have never really faced, "said Redfield.
If this happens, health care providers may need to consider vaccinating larger populations instead of the current strategy of vaccinating people who have been in contact with infected people.
When the search for contacts begins to crumble, "you are entering another phase and lose hope of being able to stop the epidemic with standard interventions," said J. Stephen Morrison, Executive Vice President of Center for Strategic and International Studies, in a statement. interview. In a new report, Morrison wrote that it was urgent "to attract high-level political attention on generating an updated game plan" to improve security, train and maintain deploy community health workers and gain the trust of the community.
"The situation will be complicated and deeply problematic, and we must prepare to face this long term," Morrison said.
Redfield, officials from the World Health Organization and other experts say that one of the biggest concerns is the spread in Congo of places such as Butembo, an important port and an urban area trade, where the risk of widespread transmission increases considerably.
In mid-October, the World Health Organization had declared that she was "deeply concerned" by the epidemic but that the situation did not warrant yet to be declared a global emergency. The US health agency has called for "intensification of intervention activities". WHO Director-General Tedros Adhanom Ghebreyesus and a senior UN peacekeeping officer are in Congo this week to take stock of the response.
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