Why the Ebola crisis in the DRC is different from anything before | Congo News

It is the worst outbreak of Ebola to have struck Democratic Republic of Congo (DRC) – and the most complex.

Since August, the country's authorities, along with a number of partners, have been trying to contain a new outbreak of the disease in the eastern provinces of North Kivu and Ituri.

As of November 21, there were 373 suspected Ebola cases, including 347 confirmed cases. At least 217 people have died.

There have been 10 outbreaks of Ebola since 1976 in the Democratic Republic of Congo, which is considered one of the most experienced in dealing with the virus.

The situation this time, however, is different.

The provinces of North Kivu and Ituri are among the most unstable and densely populated in the country, and subject to some of the highest levels of human mobility.

At the same time, there are warnings that a "perfect storm" of insecurity, community resistance to vaccines and political manipulation threaten efforts to stem the spread of the virus.

These factors collectively make the latest outbreak unlike anything the DRC, which is scheduled to hold a crucial presidential election on Dec. 23, has experienced before.

What is Ebola and how does it spread?

Ebola Virus Disease (EVA) is introduced into the human population through close contact with blood or other body fluids from infected animals. These include, but are not limited to, frugivorous monkeys or bats.

The virus is known to cause high fever, vomiting and diarrhea, in addition to internal and external bleeding; puts the body in a state of shock and results in a decrease in blood perfusion to vital organs, ultimately inducing multiple organ failure.

Once infected, patients have a very low chance of surviving.

When did the last outbreak in the DRC start?

At the end of July 2018, the North Kivu provincial government reported 26 cases of acute haemorrhagic fever resulting in 20 deaths.

Six specimens of blood were sent to the National Institute for Biomedical Research (INRB) in the capital, Kinshasa, where four samples tested positive for the Ebola virus.

"The result of the genetic analysis by the INRB confirmed the strain of Ebola Zaire, but not linked to the Equateur outbreak strain, which means that we are dealing with a new outbreak," said Lianne Gutcher, a communications officer at the World Health Organization WHO). Al Jazeera.

The country's Ministry of Health has officially declared an outbreak on August 1, 2018.

The center of the outbreak is now Beni, in North Kivu, although the medical charity Médecins Sans Frontières, also known by its French initials MSF, has warned that there is a possibility of moving to Butembo, a city near Uganda.

How does this outbreak compare with previous outbreaks in the DRC?

Ebola is considered endemic in the DRC, with the first cases in 1976 appearing simultaneously in Yambuku – in the north of the country, near the river Ebola, from which the disease bears the name – and Nzara, in what is now South Sudan.

Although there is still no cure, the introduction of a vaccination program earlier this year has been singled out as the next step towards more effective management of future outbreaks.

The DRC has been hit by two outbreaks this year.

The first was declared in May after the death of 29 people in the town of Mbandaka, in the province of Equateur. Although there were concerns about the city's proximity to the Congo River, the virus would go to Kinshasa, the timely implementation of a vaccination campaign saw the virus quickly contained.

This outbreak was announced on July 24.

Both Uganda and the DRC were able to prevent the mammoth epidemic from spreading, as it did in West Africa between 2014 and 2016, which infected 28,000 people and caused 11,300 deaths. But since the current outbreak in North Kivu may be the first time the virus has spread in an area that is already housing a large-scale humanitarian crisis, halting the spread of Ebola this time is proving much more difficult.

It is already the largest outbreak in the DRC and is on track to become the second largest ever Ebola outbreak.

"The difference is that we are now operating in a war zone," Axelle Ronsse, emergency coordinator for MSF's response to the Ebola, referring to the violence of the militia that has long haunted parts of the eastern part of the country, told Al Jazeera.

How has the security crisis impacted efforts to contain the virus?

North Kivu is home to several armed groups, including the Allied Defense Forces (ADF), a Ugandan rebel group that has operated with impunity since 1995.

The endless revolts in the region meant regular expropriation and the relentless movement of refugees to neighboring countries or within the province itself. As it stands, there are more than one million IDPs in North Kivu.

"Violence affects our daily work," says Ronsse. "We're not targets, but it's a matter of being in the wrong place at the wrong time."

Similarly, WHO's Gutcher says some attacks have resulted in medical activities being severely hampered or temporarily disrupted.

"Community violence has also sometimes prevented the work of safe teams from burying the ability to make safe and dignified burials."

In October, rebels killed 13 civilians and kidnapped 12 children in an attack on Beni.

In November, seven Malawian soldiers and a peacemaker from Tanzania were killed in another attack on the city.

Instability has also made it difficult for health care professionals to locate other people who might have been in contact with suspected victims in what is known as "contact tracking," considered a basic pillar of any effort to contain Ebola.

Last month, the New England Journal of Medicine (NEJM) wrote that "conducting effective contact tracking and community involvement can enable the rapid identification of sick people and facilitate early clinical care, which has shown to improve the likelihood of survival. "

Jessica Ilunga, a communications officer at the DRC's Ministry of Public Health, told Al Jazeera that all safety-related incidents affected field activities. She added that the underlying security context also created a climate in which health professionals face an unprecedented level of community resistance.

"The prevalence of traditional healers, who are more reliable by the population than modern medicine, has also led to a significant number of nosocomial transmissions of the virus," said Ilunga.

Citing instability in eastern DRC, the WHO raised the national crisis to "very high" by the end of September. The crisis is not yet considered a public health emergency of international concern and the World Health Organization does not recommend imposing trade or travel restrictions on the DRC.

How did the DRC and the international community respond to this crisis?

Since the introduction of the vaccination program by the DRC government and the WHO, a key intervention involved the vaccination of suspected patients and the administration of a second "ring" to those who might have come into contact with these suspected cases.

The vaccine is developed in Canada, but licensed and produced by American Pharmaceutical Company Merck.

According to WHO, about 300 medical specialists were deployed to the country to support the response plan. Approximately 32,500 people at risk were vaccinated, including 10,600 health workers and 8,600 children.

On Nov. 24, the government and WHO said they would conduct clinical trials to assess the safety and efficacy of drugs used in patients with ebola to find the most effective treatment for the virus.

Authorities have begun using the drugs on a case-by-case basis at about 151 people. Those who used the drugs had a 63% chance of survival, while those who did not receive medication had a mortality rate close to 80%.

"Now that trial protocols are in place, patients will receive treatments under this scheme at the facility where the test was started," WHO said.

In addition to vaccines and medicines, efforts were made to disseminate information through door-to-door advocacy, with more than 2,500 residences visited, including almost 1,400 homes in Beni alone.

"In the face of rumors and misinformation, some families have chosen to care for sick relatives at home, some patients leave health centers to find alternatives or actively avoid follow-up," says Gutcher.

Authorities also trained about 1,700 volunteers to assist community efforts. Across the border in Uganda, 758 health workers at 19 health centers were vaccinated.

In mid-November, WHO said the outbreak would end in mid-2019.

But Ilunga, of the DRC's Ministry of Public Health, says his government is hopeful that efforts to stem the outbreak would succeed sooner than the WHO goal, but admits that "the success of this response also depends on several factors that We do". does not control, as security. "

Why do the outbreaks continue to occur in the DRC?

Microbiologists argue that viruses such as Ebola usually occur in populations of animals that face restricted movements.

However, health professionals are concerned that if Ebola becomes endemic to the problem areas in the northeast of the DRC, this would mean "a sustained and unpredictable spread of the deadly virus, with major implications for travel and commerce."

"This will mean we have lost the ability to track contacts, disrupt transmission chains and contain the outbreak," said Tom Inglesby, director of the Johns Hopkins Sanitary Safety Center, in a statement earlier this month.

For his part, Ilunga says that the country must accept the fact that the disease "will resurface regularly "and"make preventive and curative treatments more available and improve people's knowledge about the virus. "