Chapter 1: What is the current state of the Ebola outbreak in the DRC?
The Ebola outbreak, which has killed hundreds of people in the Democratic Republic of the Congo and Uganda, now risks becoming the deadliest on record, according to Human Rights Group, the International Rescue Committee. Shortly, I'll speak with Armand Sprecher, emergency physician and epidemiologist for Médecins Sans Frontières.
But first, David Jones is Concern Worldwide's country director in the DRC. David, good morning. Good morning. Can you tell us what it's like on the ground there, David?
Absolutely. It's tense, to be quite honest with you. This is a disease that is well known amongst the population. There have been outbreaks in that area as recently as 2019.
Chapter 2: How far is the affected area from Kinshasa and what challenges does that pose?
And the community definitely remember the kind of impact it can have on both individuals, but their families and the community, and with a huge impact longer term as well.
And you're in Kinshasa, which is the capital. How far away is the affected area from there?
Well, DLC is an enormous country, so it's about 1,800 kilometres away from the epicentre of the issue. However, this is a disease that's spread very far and wide, very, very quickly.
Yeah, I mean, that's one of the concerning points about it. Can you describe the epicentre to us, the area, what it's like, what communications with it are like, how easy it is to get equipment and personnel into it?
Absolutely. So the epicenter of the outbreak is in a province called Ituri in the northeast of the country. It's home to about five million people and it's right on the border with South Sudan and Uganda.
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Chapter 3: What are the characteristics of the epicenter of the outbreak?
And it's really at the center of a very busy commercial corridor, which is one of the elements that really makes this particularly challenging. And that's a very dynamic, busy social culture already. But it's also on this major commercial corridor, which is part of the reason it's spread across to Uganda so quickly and also spread as far south as places 700 kilometers away.
away from the actual epicentre. But it's a very busy place. There's lots of interconnectivity between the different towns and locations, lots of busyness, lots of movement, and that's what makes this even more concerning.
And all it takes is one infected person to spread it to a new area.
Absolutely. And that's exactly what we've seen with these cases popping up at very large distances from the epicentre.
And it seems to be a particularly transmissible variant of the virus.
I think it's been very far and wide, most likely because of where it's actually situated and the business of it. Some of the symptoms can take a while to come through and then actually having the right testing equipment to be able to identify this properly is a major issue.
A lot of the initial symptoms are very, very similar to a lot of other very familiar diseases from malaria to dengue fever to even the flu. Some of these can be mistaken for other diseases unless there's a high alert. And that's probably one of the reasons it's led to a slight delay in the announcement.
Yeah, and because it's a different variant than the one authorities are more familiar with, that led to some delay as well?
I think that's led to some elements. The issue is we've only seen this variant twice before in 2007 and 2012. The last one actually led to a mortality rate of 50%. So one in two people who actually contracted the disease died from it.
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Chapter 4: What treatment options are available for the current Ebola strain?
But as a result, there's no drugs, there's no vaccine for this particular strain, whereas there is for the one that was more widely known for the impact on West Africa, for example.
Okay. That must be really terrifying for people who realise that it is just so dangerous.
Absolutely. Absolutely. It's absolutely clear that the population, both in Ituri and in neighbouring North Kivu, where we've got a number of our bases, the majority of our bases and our work is done, there's a huge amount of concern amongst the population currently. Absolutely. Absolutely. The concern is very real. It's very much based on memory. People have been through this before.
And as I say, they've been through the experience. They've seen the impact it can have. And they're very concerned about where this could lead.
Talk to me about treatment. What are the treatment options?
The treatment options so far are relatively straightforward. A lot of it is symptom management, pain management. And that does definitely help the process.
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Chapter 5: How are healthcare workers being protected during this outbreak?
It does provide some hope for people. But again, we're seeing quite significant rates already. And as you know, this is a strain that does not have any approved drugs or vaccines at the moment. So there's a huge risk associated still.
OK. And there is a risk for health care workers as well, obviously. So how are your own staff, how are other health care workers being protected from contracting the virus?
There is a risk to health workers, and we've seen the impact already. A few health workers have been some of the confirmed cases that we've seen so far.
One of the main elements that we've put in place for our own team is we've acted very quickly and very decisively to make sure we've got the proper protection measures in place, whether that's enforcing hand-washing protocol on entry, temperature checks for staff, even mask wearing, even though it is not an airborne disease.
Anything that can help reduce the potential spread of this needs to be inputted. And that's exactly what we've done.
We've seen in previous outbreaks the use of personal protective equipment that people would be familiar with from COVID and so on. I mean, are there supplies of that available? Is that needed?
There are supplies of that currently available. Whether they will continue to be available is one of the main preoccupations that we have here. With this kind of outbreak in general, obviously, the faster we can respond, the more we can limit the spread and limit the ongoing impact of this disease.
So it's really something we need to act very decisively, very quickly to maintain or to contain the disease and to make sure that we can do that. The longer this goes on, the harder it will be to respond.
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Chapter 6: What strategies are being used to inform the community about the virus?
And so we're acutely aware of the urgency of the situation.
What sort of message are you giving to the general population about how this virus might be kept away from their homes?
Well, as concerned, we've responded to a number of different outbreaks in the DRC. This has been from cholera outbreaks, COVID-19, as you mentioned, and previous Ebola outbreaks. So we've got quite a lot of experience in making sure that people are very well informed. And we're taking a three-pronged approach, one of which is information, exactly as you say.
So how can we make sure that the community is incredibly well informed in how this disease is transmitted, how they can protect themselves and their families, and also just make sure they have information on who to contact and how to contact them if they do suspect a case in the family. But it's not just information that's got to do the work. We need to do significant work on preparation.
So we're already mobilizing our emergency response teams to make sure that Access to water, which is a huge issue in the area, is deeply improved. Hygiene practices are reinforced. And there's proper sanitation available. So this is something that is transmitted through bodily fluids.
So anything that can rehabilitate water points, construct latrines and showers, and also providing hygiene kits for households. And that can be as simple as providing buckets, plastic basins, soap, clothes detergent, menstrual hygiene products. Anything around that really helps limit the spread of it.
And I mean, I imagine that this is an area, this is a country which is facing immense challenges already. So trying to distribute items like that, trying to get that message across, it must be incredibly challenging.
It is incredibly challenging.
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Chapter 7: What are the challenges faced in delivering aid in conflict-affected areas?
And as much as that's part of the work, it's also part of our concerns. So conflict is a massive issue in the region. There's been waves of conflict over decades that have deeply affected the population. There's about 7 million people currently internally displaced, and that effectively means they're forced from their homes, the majority due to conflict.
About 5 million of those are in the east of the country where the outbreak is. So this is something that we're seeing. People have been forced to stay with host families in displacement camps. And we're having to find ways to protect them in such constrained situations as well. And it's having a deep impact already. So we need to respond, as I say, incredibly sharply.
And this is why Concerns launched our emergency appeal to try and bring as much support as we possibly can. And so I would ask that anyone that people give what they can, they share the information, they make sure people in Ireland are very well informed on this as well, because we need all the help we can get, but we are absolutely ready, ready to respond and mobilising our teams as we speak.
And that was David Jones, Concern Worldwide's country director in the Democratic Republic of the Congo. I want to bring in Armand Sprecher, emergency physician and epidemiologist with Médecins Sans Frontières. Armand, good morning. Good morning. From a medical point of view, how worried are you about this outbreak? How bad could it get?
It's a good question.
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Chapter 8: What lessons have been learned from previous Ebola outbreaks?
We are in a rather difficult situation for two important reasons. One, as has already been mentioned, we got to this one a little bit later than usual. And the number of cases that are out there already at the get-go are such that we are stretched thin from day one. And they are spreading out over the region. The other is, as has been mentioned, this is the Bundibugyo virus, not Ebola virus.
And although this means that we don't have treatments and vaccines, it also means that we do not have the diagnostics we need. The tests that we have that we've used so well before are geared up for Ebola virus, not Bundibugyo. And so right now we're in a situation where we cannot determine who has the disease or not, because Ebola doesn't look... like people have a scarlet E on their forehead.
It's just a febrile illness that used to look very sick. And these people in this region can be sick for a number of reasons, you know, malaria, typhoid, any one of a number of diseases. So sorting out the people who have Bundibugyo virus and who have other pathogens is going to have to wait until the tests show up.
So once you build a treatment unit where you can care for people safely, how do you know who to put in? How do you know who to keep out? So that puts us in a very difficult situation for managing the outbreak. So we're behind, we're getting set up, but we're already in a management difficulty because it's hard to know who has the disease that we have to manage.
Okay, so as you mentioned, you're getting geared up to try and deal with this. What is MSF doing? What sort of extra supplies, extra personnel are you bringing in?
We're mobilizing again like it was the West Africa outbreak. Already we're trying to get as many people brought online as we can, but we also have to learn how to pace ourselves because this looks like it could go for a while. And if we throw everybody into the fight right now, they're going to have to rotate out and then we're going to be stuck.
So we're trying to figure out how we can scale up our human resources to respond appropriately, but then make use of our experienced resources in a way that will allow us to continue this fight. for the duration of the outbreak. We're getting everybody into the epidemic zone. MSF Geneva has been running five projects in Eturi for many years.
So we already have a significant presence there and know the region and how difficult it is. But we're bringing in additional people with the skills and equipment to deal with
uh ebola outbreaks the trick is of course that we have to figure out where to set up where the chains of transmission where are we most able to bring our medical impact to bear but also how to scale back the regular projects there the people who are taking care of problems that didn't have anything to do with ebola have to figure out how to do this safely and keep their patients safe from the
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