Good news: the Ebola outbreak in DRC is contained

We know how to stop Ebola outbreaks — and we just proved it again.

Just seven weeks after an Ebola outbreak was discovered in the Democratic Republic of Congo, it’s already looking like the end is in sight.

According to the DRC’s health ministry, as of June 28, all people who were potentially exposed to the Ebola virus have finished a 21-day incubation period. It can take that long for a person exposed to Ebola to show symptoms of the disease. All those people remaining healthy means the epidemic is under control.

Oly Ilunga Kalenga, the DRC’s health minister, said in a statement, “This is an important milestone in the Ebola response, as it marks the start of the countdown towards the end of the ninth Ebola outbreak in the Democratic Republic of Congo.”

It’s also a testament to what can happen when national and international health officials work together to swiftly stop the virus from harming and killing people. We know how to stop outbreaks of Ebola, and we just proved it again in the DRC.

What this means is that with some effort and coordination, the world can rapidly stamp out an Ebola outbreak. What this doesn’t mean is that the world is ready for the next pandemic.

The impressive response to the DRC outbreak

On May 8, DRC health officials notified the World Health Organization: They had just confirmed two Ebola cases in Bikoro, a remote region in the country’s northwest Équateur province.

A few days later, WHO Director-General Tedros Adhanom Ghebreyesus was on the ground visiting the areas affected by Ebola — and signaling to the global community that his organization was going to take the outbreak seriously.

The response then kicked into high gear. Days after Tedros’s visit, Doctors Without Borders, the WHO, Gavi, the Vaccine Alliance, and the DRC’s health ministry announced their plan to roll out an Ebola vaccine, in the first field test for the shot early on in an Ebola outbreak. That impressive effort vaccinated more than 3,200 people.

It’s worth noting that humanity’s latest brush with Ebola could have played out very differently. The Ebola virus is a hemorrhagic fever that kills many of its victims — especially in low-resource countries like the DRC. The DRC’s Ilunga Kalenga also called it “the most challenging and complex outbreak the country has ever had to face.” That’s because the outbreak spread to Mbandaka, an urban area with a population of 1.2 million people 100 miles from Bikoro.

To date, there have been 55 cases (38 of them confirmed) and 28 deaths. The risk of new cases is not zero. The end of the outbreak will only be officially declared when 42 days — or two incubation periods — have passed without any new cases.

But even WHO critics are optimistic.

“It was an incredible response,” said Seth Berkley, the CEO of Gavi, the vaccine public-private partnership. And the response was also a dramatic contrast to the WHO’s sluggishness during the 2014-2016 West African Ebola outbreak, which killed more than 11,000 people before it was over.

“This outbreak was handled quickly and effectively and we should all breathe a sigh of relief that it didn’t spread further,” said Ashish Jha, senior associate dean for research translation and global strategy at Harvard T.H. Chan School of Public Health.

This doesn’t mean we’re ready for the next one

Still, it’s too early to declare total victory over Ebola or any other pandemic threat for several reasons.

• Health professionals in the DRC had several advantages over the West African countries affected in 2014. This is the DRC’s ninth Ebola outbreak; whereas health officials in Guinea, Sierra Leone, and Liberia had never dealt with the disease.
• While the virus spread to urban Mbandaka, the outbreak was mainly concentrated in rural areas. “These more typical settings in Central Africa are very remote pose challenges — but they also pose some degree of insulation of transmission because they are relatively remote,” said Daniel Bausch, the director of the UK Public Health Rapid Support Team, who has been advising on the outbreak response.
• Medical professionals also know what’s needed to contain Ebola outbreaks: They mount vigorous public health awareness campaigns — to remind people to wash their hands, that touching and kissing friends and neighbors is a potential health risk. They employ a tried and true public health strategy called “contact tracing”: isolating those related to the sick before they have had a chance to infect anyone else and thus interrupting the human chain of transmission. These strategies seemed to work, as they have in dozens of Ebola outbreaks before.
• This time, we had a vaccine — and despite early fears, acceptance of the vaccine among locals in the DRC was very high. “[The vaccine] had been previously tested and found to be quite effective,” Jha said.
• We’re still not too far out from the last Ebola outbreak. “The world was paying very close attention,” Jha added, and the WHO had much to lose if they didn’t mount a rapid response.

This combination of experience with a known virus, a vaccine, and a relatively convenient geography won’t be there in every outbreak. That’s why it’s too early to say the success in stamping out this outbreak means the WHO and its partners are going to be better prepared the next time.

“The next big disease outbreak may very well come be an unknown pathogen — or a known pathogen in a place where we haven’t seen it before,” Jha said, “and is the world better prepared for that? I don’t think this tells us.”

Ron Klain, the Ebola czar under President Obama, called the response a success — but also noted that the US feels less prepared now than it did in 2014.

Just one day after the Ebola outbreak was declared, the head of global health security on the White House’s National Security Council, Rear Adm. Tim Ziemer, left the Trump administration. The administration has been looking to claw back public health funding that would help pay for a pandemic response.

“The fact that this outbreak was beaten without significant US involvement and leadership does not mean that others will be similarly vanquished,” Klain said. “We need to fully fund a public health emergency fund, reverse the proposed cuts in CDC’s global health security efforts, and restore global health leadership in the White House.”

from Vox - All https://www.vox.com/2018/6/29/17518144/ebola-outbreak-drc-contained
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