Ebola outbreak in the Democratic Republic of Congo (update)
It’s been 4 weeks since the World Health Organisation (WHO) officially declared an outbreak of Ebola Virus Disease in the Democratic Republic of Congo (DRC). In a previous post I outlined some of the possible control strategies that the response effort may put into place to prevent the spread of infection. Seeing as the media reporting around the outbreak has died down, I thought that now would be good time to check back in with the situation, see how the outbreak has progressed and see what parts of the response plan has been implemented so far.
Cases and the case fatality rate
Since publishing my previous post on the 18th of May the virus has continued to spread and a few of the cases and deaths originally suspected as Ebola have been dis-confirmed (i.e. after laboratory testing they were found to be due to other diseases with similar symptoms, such as malaria). As of today the WHO report a total of 51 cases and 25 deaths across the whole outbreak 1.
This is what good news looks like during an ebola outbreak.
Currently there are only one or two new cases being confirmed per day. This is markedly different from the 2014/15 which saw the cases grow at a near exponential rate 2. Sadly the case fatality rate is still around the 50% mark, but at least the virus has been kept largely under control so far with most of the cases remaining the regions of Bikoro and Iboko and the city of Mbandaka. As of yet it has not as, many feared, spread south west, through the river transportation system, to Kinshasa (my guess is that if you are to ever hear about this outbreak on the new again, it will be because of the virus has spread to Kinshasa).
What has changed over the last two weeks?
Ring vaccination
So far 400 individuals have been vaccinated with this new Ebola vaccine. Among the vaccinated are a primary ring of those that have been in contact with infected individuals (as identified through contact tracing), and a secondary ring of possible contacts of those within the primary ring. From this effort it has been suggested that 90% of those deemed as at risk from Ebola are protected 3. This of course is only based on those that are known to be at risk. Due to the lack of perfect data collection it is highly likely that many more at risk have not yet been identified, but this is an excellent start.
In reference to the current situation Peter Salama, WHO Deputy Director-General for Emergency Preparedness and Response says:
“We can’t conclude that we’ve safeguarded the city of Mbandaka but we can say that so far there has not been an explosive increase in cases. So that’s a positive sign and a positive development,”
Additional treatment developments
Yesterday Reuters reported 3 that the WHO may also be trialing five experimental drugs to treat those that develop Ebola. With such a high case fatality rate this falls under the same criteria for “compassionate use” as the vaccine (see my previous post for more on this topic).
This however may be problematic as…
some drugs require 6-12 hours of daily intravenous infusions and daily assessment of liver and kidney function.
Again, don’t forget all this treatment will have to be delivered by healthcare workers in sweat drenched scuba suits.
Behavioural change in response to Ebola
As a country well versed in the ways of Ebola it appears that communities have adapted quickly to the situation. Bars and restaurants have started providing water and soap for hand washing and word has spread about not shaking hands 4
When in doubt a elbow bump. Which, to be honest, I’d personally much rather have as general form of greeting anyway!
Open access
Lastly, The Lancet and Nature journals (and likely other I have not seen notification from) have made all of their research on Ebola open access. This is incredibly helpful to people in the field but also in preparation for the next outbreak.
This may therefore be an excellent time for the #steemstem community here to write more about Ebola. All the science you could possible want is just a few clicks away!
The situation continues
For now the outbreak continues. For it to be declared as over the WHO requires 42 days (two incubation periods) of no new cases. Currently, those that have anything to say one the subject are optimistic, which is great!
Here's hoping my next post on the topic will be the officially end of the outbreak!
About me
My name is Richard, I blog under the name of @nonzerosum. I’m a PhD student at the London School of Hygiene and Tropical Medicine. I write mostly on Global Health, Effective Altruism and The Psychology of Vaccine Hesitancy. If you’d like to read more on these topics in the future follow me here on steemit or on twitter @RichClarkePsy.
References
[1] The World Health Organisation: Ebola situation reports: Democratic Republic of the Congo
[2] Nishiura H, Chowell G. Early transmission dynamics of Ebola virus disease (EVD), West Africa, March to August 2014. Euro Surveill.2014;19(36):pii=20894.
[3] Reuters: Almost all in Congo city at immediate risk of Ebola now vaccinated -WHO. By the way, this is shitty headline writing in my opinion. I had to read it a good few times to get that this was actually good news!
[4] The BBC: Ebola outbreak: Experimental vaccinations begin in DR Congo
Thanks for the update. I'm glad to see that journals are making research on Ebola open access, but we really need to move to open access for all scientific publications and away from the old journal model.
Yeah, hopefully this is a sign of pressure for journals to move more in this direction. It'll get there but for now journals are providing a service that sadly still needs funding some how (preferably not from the public). If you're on twitter I highly recommend following Richard Horton who is the editor-in-chief of The Lancet. From listening to him talk over the last few years it’s really put in to perspective the role that a good journal can play in the public discourse around science.
Good post once again. Resteemed to help with your visibility.
I thought I read that there was a development of asymptomatic Ebola (at least for the first week or so) but I think it was just someone postulating that this might be a theoretical possibility.
It would be a bad day for us all if that ever happened.
Hey, thanks man! That’s a really big help.
Yes, it’s rare but apparently so. This is news to me, but it makes a lot of sense. This paper has asymptomatic Ebola at 2-6% of individuals that have had contact with Ebola patients.
The important question is whether it is contagious when asymptomatic (or even before symptoms are shown). The WHO are still saying it is not, that said it is thought to be present in semen for around three months after recovery although I don’t think there have been any cases of transmission through such means (i.e. sexually transmitted after recovery)
Good to see that people have learnt to deal with the disease more effectively this time round. Do you expect to see less of this disease in the future?
The trouble with Ebola is that it also lives in animals so it can jump back into the human population at any time, as such outbreaks are likely to continue happening. However, a lot was learnt from the 2014/15 outbreak, so I would be surprised if it gets that bad again. The only way to be certain that it won’t be an issue again to move towards strengthening health systems rather than relying on emergency response
I see. From your post sounds like the health system is getting a bit better, more emphasis on washing hands etc
Possibly. It’s more likely the community has a good understanding of Ebola now, realise it as the threat that it is and are more likley to take protective precautions. To be honest though I’m not entirely sure, although you’ve sparked my interest with this. I’ll look into it for a post sometime.
very good post, I still remember your post a few days ago, and this is good news for many people, I think it would be great for people to check immediately to avoid Ebola virus, and I personally am very grateful with the posting you, and very helpful to many parties, my best regards @ fauzan93
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