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Concerns as Ebola resurfaces in time of COVID-19

With the number of confirmed COVID-19 cases on the African continent reaching 3,819,576 on Saturday, a fresh outbreak of Ebola in Guinea and Congo is becoming a source of concern to the World Health Organisation (WHO), the Africa Centre for Disease Control and Prevention (Africa CDC), International Federation of Red Cross and Red Crescent Societies (IFRC) and the European Union, Bola Olajuwon, ASSISTANT EDITOR writes

COVID-19 and health care facilities

The death toll related to COVID-19 pandemic stood at 100,993 as of Saturday with a total of 3,372,490 people infected recovering across the continent so far, according to the continental disease control and prevention agency’s Africa COVID-19 dashboard.

The deaths of several African ministers and eminent personalities due to COVID-19 have sparked a conversation about the need to strengthen local health care facilities that were largely neglected before the pandemic.

So far this year alone, South Africa, Eswatini, Zimbabwe, and Malawi have lost cabinet ministers to the pandemic. These high-profile deaths have led to concerns that health care systems may be overwhelmed due to a second wave of the coronavirus and the possible spread of a new, more transmissible COVID-19 variant that was first detected in South Africa and has now been found in other African countries: Nigeria, Botswana, Comoros, Ghana, Kenya, Mozambique and Zambia.

Most politicians in African countries often bypass local health systems and seek care elsewhere. President Muhammadu Buhari had on several occasions gone to United Kingdom (UK) to receive medical treatment for undisclosed ailment.

In 2019, former Zimbabwe President Robert Mugabe died in Singapore after receiving treatment in the city-state for several months. In the same year, current Zimbabwe Vice President Constantino Chiwenga spent four months in China receiving medical treatment for an unknown illness.

But COVID-19 has closed borders and made travel impossible, meaning even those in positions of relative privilege have had to rely on the dilapidated health systems in their own countries.

With healthcare systems in Africa suffering from neglect and underfunding, the idea of the continent facing a fresh pandemic is a serious concern to health professionals and regulators.

The WHO said Guinean health authorities have declared an outbreak of Ebola in a rural community in the south of the country with no fewer than seven people infected.

Similarly, on Feb. 7, the Democratic Republic of Congo (DRC) recorded fresh case of Ebola in the North Kivu province of the country. WHO stated that DRC announced that a new case of Ebola had been detected in Butembo, a city in North Kivu Province, where a previous outbreak was declared in June 2020.

According to the statement, this is the first time the disease has been reported in the country since the deadly 2014-2016 outbreak in West Africa, which claimed over 11,000 lives.

The sad Ebola experience of 2013–2016

Ebola virus disease (EBOV) was first described in 1976 in two simultaneous outbreaks in the Democratic Republic of the Congo. The outbreak was the first anywhere in the world to reach epidemic proportions. Previous outbreaks had been brought under control in a much shorter period of time. Extreme poverty, dysfunctional healthcare systems, distrust of government after years of armed conflict, and the delay in responding for several months, all contributed to the failure to control the epidemic in Congo. Other factors included local burial customs of washing the body and the unprecedented spread of Ebola to densely populated cities.

According to media reports, the Western African Ebola virus epidemic (2013–2016) was the most widespread outbreak of Ebola virus disease (EVD) in history, causing major loss of life and socioeconomic disruption in the region, mainly in Guinea, Liberia and Sierra Leone.

The first cases were recorded in Guinea in December 2013 and later the disease spread to neighbouring Liberia and Sierra Leone. It caused significant mortality, with the case fatality rate reported which was initially considerable, while the rate among hospitalised patients was 57–59%, the final numbers 28,616 people, including 11,310 deaths, for a case-fatality rate of 40%. Small outbreaks occurred in Nigeria and Mali, and secondary infections of medical workers occurred in the United States and Spain with isolated cases recorded in Senegal, the United Kingdom and Italy. The number of cases peaked in October 2014 and then began to decline gradually, following the commitment of substantial international resources. As of 8 May 2016, the WHO and respective governments reported a total of 28,646 suspected cases and 11,323 deaths (39.5%), though the WHO believes that this substantially understates the magnitude of the outbreak.

The outbreak left about 17,000 survivors of the disease, many of whom report post-recovery symptoms termed post-Ebola syndrome, often severe enough to require medical care for months or even years. In December 2016, the WHO announced that a two-year trial of the rVSV-ZEBOV vaccine appeared to offer protection from the variant of EBOV responsible for the Western Africa outbreak and is considered to be effective and is the only prophylactic which offers protection. About 300,000 doses of rVSV-ZEBOV, which received regulatory approval in 2019, have been stockpiled.

Nigeria’s Index Case

The index case in Nigeria was a Liberian-American, Patrick Sawyer, who flew from Liberia to Lagos on July 20, 2014. Sawyer became ill upon arriving at the airport and died five days later. In response, the Nigerian government observed all of Sawyer’s contacts for signs of infection and increased surveillance at all entry points to the country.

The Liberian-American was believed to have suspected he was infected with Ebola because he cared for his sister, who died of the disease on July 8, he was hospitalised in Monrovia for fever and Ebola symptoms on July 17 before discharging himself against professional medical advice to fly to Lagos. On getting to Lagos, he lied to the staff of First Consultants Medical Centre that he had not had any exposure to anyone that had contracted Ebola. Key medical professionals who treated him lost their lives, including Dr. Ameyo Adadevoh (October 27, 1956 – August 19,  2014).

Dr. Adadevoh was credited with having curbed a wider spread of the Ebola virus in Nigeria by placing Sawyer in quarantine despite pressure from the Liberian government. When threatened by Liberian officials who wanted the patient to be discharged to attend a conference, she resisted the pressure and said, “for the greater public good” she would not release him.

DRC and Guinea bracing to contain outbreak in Congo

The Democratic Republic of Congo, WHO, and Humanitarian agencies are rushing to stop the spread of the deadly disease after three cases were confirmed in one week. These cases are reported in Butembo, an epicentre of a previous outbreak (the 10th in the country) that was declared over in June, last year.

Anne-Marie Connor, the National Director for World Vision in DRC said: “Thankfully, World Vision had trained and equipped faith leaders and motorcycle riders on how to help their communities contain such outbreaks. This provides a ready and available force for effective community engagement to safeguard families, especially children.”

“Since March 2020, we adapted our programmes to augment the COVID-19 standard operating procedures, and thankfully most of the measures like frequent handwashing, and physical distancing work for Ebola prevention as well,” World Vision East Zone Director, David Munkley added.

WHO begins shipment of vaccine doses

WHO and the government have commenced shipment of vaccine doses to Butembo and ensuring shipment of cold chain equipment to the affected zone, as well as working to strengthen laboratory capacity.

Dr. Matshidiso Moeti, WHO Regional Director for Africa, said: “It’s a huge concern to see the resurgence of Ebola in Guinea, a country which has already suffered so much from the disease.

“However, banking on the expertise and experience built during the previous outbreak, health teams in Guinea are on the move to quickly trace the path of the virus and curb further infections.”

According to the UN health agency, the cases, which were confirmed by the national laboratory, occurred in Gouéké in N’Zerekore prefecture, in southern Guinea.  Initial investigations found that a nurse from a local health facility died on January 28.

Following her burial, six people who attended the funeral reported Ebola-like symptoms and two of them later died. The other four are in hospital.

AU to send an emergency team of experts to Guinea

The African Union (AU) was due to send an emergency team of experts to Guinea as part of efforts to tackle an Ebola outbreak, recently detected by the government of the West African country.

The health authorities in Guinea declared an outbreak of Ebola over the last weekend, reporting at least three fatalities caused by the disease. The resurgence was detected in the Goueke sub-prefecture, located not far from the country’s second-largest city of Nzerekore.

“The Africa Centre for Disease Control and Prevention (Africa CDC) is preparing to deploy an advance emergency response support team of experts in the next 48 hours. It will continue to mobilise its expertise and resources to support the response,” the bloc’s statement said.

EU ready to assist affected countries

The EU is ready to assist countries affected by the Ebola disease, European Commission spokesman, Balazs Ujvari said yesterday.

This assurance is coming a day after the Guinean government declared an outbreak of the infection.

“When necessary, we are available to help, and on any request coming from these countries, we would answer,’’ Ujvari said at a briefing.

The spokesman noted that the disease was also detected in Congo, making it one of the nations, eligible for the EU aid initiatives.

He noted that the EU has allocated 200 million euros ($242.5 million) to the development and production of vaccines against Ebola since 2014.

Red Cross: outbreak requires immediate response

The resurgence of the Ebola disease in Guinea requires a fast response that will allow the country to mitigate its negative impact, an official of the International Federation of Red Cross and Red Crescent Societies’ (IFRC) Regional Director for Africa, Mohammed Mukhier, said in Conakry.

The resurgence of the Ebola is happening against the backdrop of the global COVID-19 health crisis, the organisation said. A network of more than 700 trained Red Cross volunteers has been mobilised to provide an emergency response.

“We need a response that is faster than the virus itself.

“Unless the response is swift, the health, economic and social impacts are likely to be immense for millions of people in a country with a relatively weak health system, and where more than half of the population lives below the poverty line,’’ Mukhier said.

The IFRC’s official added that though the resurgence of the disease occurred during the COVID-19 pandemic, the recent medical discoveries would help to contain the new outbreak.

“The resurgence of the virus in Guinea comes at the worst possible time when the country is already facing the COVID-19 pandemic. There are reasons for fear, but there are also reasons for hope.

“While we are extremely concerned, we are also reassured by the lessons we learned from previous outbreaks, and by recent medical advances,’’ Mukhier said.

A public health advisory will be issued soon, says NCDC

The Nigeria Centre for Disease Control (NCDC) said it is aware of confirmed Ebola cases in Guinea and is assessing the risk to Nigeria. In a social media statement, it said it would soon issue a public health advisory over the rising in Guinea.

“NCDC is aware of confirmed Ebola cases in Guinea and is assessing the risk to Nigeria,” it said.

It added that talks have started with WHO and the Africa CDC in coordinating efforts in the region.

Ebola virus and how it spreads

Ebola virus disease, a highly infectious and acutely lethal viral disease that has afflicted humans and animals primarily in equatorial Africa. The pathogens responsible for the disease are the five ebolaviruses recognised by the International Committee on Taxonomy of Viruses: Ebola virus (EBOV), Sudan virus (SUDV), Reston virus (RESTV), Taï Forest virus (TAFV), and Bundibugyo virus (BDBV). Four of the five variants have caused the disease in humans as well as other animals; RESTV has caused clinical symptoms only in non-human primates. RESTV has caused subclinical infections in humans, producing an antibody response but no visual symptoms or disease state manifestations.

Transmission of the ebolaviruses between natural reservoirs and humans is rare, and outbreaks of Ebola virus disease are often traceable to a single case where an individual has handled the carcass of a gorilla, chimpanzee, bats, or duiker. The virus then spreads person-to-person, especially within families, hospitals and during some mortuary rituals where contact among individuals becomes more likely.

The WHO, while learning from failed responses, such as during the 2000 outbreak in Uganda, established its Global Outbreak Alert and Response Network, and other public health measures were instituted in areas at high risk. Field laboratories were established to confirm cases, instead of shipping samples to South Africa. Outbreaks are also closely monitored by the United States Centres for Disease Control and Prevention (CDC) Special Pathogens Branch.

Nigeria is the first country in West Africa to successfully curtail the virus, and its procedures have served as a model for other countries to follow.

The Ebola virus spreads through contact with the body fluids – such as vomit, faeces or blood – of an infected person, or through surfaces and materials (such as bedding, clothing) contaminated with these fluids.

The incubation period – the time interval from infection with the virus to onset of symptoms – is from two to 21 days. The symptoms of EVD can be sudden and include fever, fatigue, muscle, pain, headache, and sore throat. This is followed by vomiting, diarrhoea, rash, symptoms of impaired kidney and liver function, and in some cases internal and external bleeding.

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