TWO new outbreaks of Ebola in two weeks – first in the Democratic Republic of Congo and now in Guinea – have sent health teams scrambling to try to contain the spread of the deadly disease, ramping up contact tracing and medical support to local authorities.
Guinea declared an Ebola epidemic on 14 February after three people died and four others became ill in the rural southeast of the country – the first reported outbreak in West Africa since a region-wide pandemic ended five years ago after claiming more than 11,000 lives.
The initial case in Guinea’s new outbreak involved a nurse in rural Gouéké who died on 28 January, and the six other reported cases were people who had attended her 1 February funeral – with unsafe burials a known danger in Ebola transmission.
“The re-emergence of Ebola in Guinea is hugely disappointing since the country and region is already dealing with the ongoing COVID-19 pandemic,” Krutika Kuppalli, an infectious disease expert at the Medical University of South Carolina, told The New Humanitarian.
The town of Gouéké is close to the borders of Liberia, Sierra Leone, and Côte d’Ivoire, raising concerns of a potential regional spread.
Liberian President George Weah has called on his country’s health authorities to “immediately engage communities in towns and villages bordering Guinea and increase anti-Ebola measures”, his office said in a statement on 14 February. Sierra Leone’s President Julius Maada Bio has reportedly flown to Guinea to consult with Guinean President Alpha Condé.
Guinea, Sierra Leone, and Liberia bore the brunt of the 2014-2016 West African Ebola outbreak – which began in Guinea – and killed 11,300 people.
Aid agencies are warning that speed is key to containing the spread of the virus, and the International Federation of Red Cross and Red Crescent Societies (IFRC) and the Guinean Red Cross say teams that include more than 2,500 volunteers have been activated in Guinea to provide contact tracing, psychosocial support, water, and sanitation.
“Time is of the essence,” Mohammed Mukhier, IFRC’s director for Africa, said in a written statement. “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.”
Guinea’s new outbreak follows a resurgence in eastern Congo, where four cases have been reported – the latest on 14 February. Since August 2018, the region has been grappling with the world’s first Ebola outbreak in an active conflict zone. The new cluster emerged three months after the country’s last outbreak – in the west of the country – was declared over. In total, there have been 12 outbreaks in Congo since Ebola was first identified in 1976.
The virus is spread by infected bodily fluids, and is believed to jump from an animal host, most likely bats. Survivors can still harbour the virus – especially in semen and breast milk – long after they are “cured”.
Lessons have been learnt from past Ebola outbreaks, and “community engagement” is now seen as vital to the response, the medical charity Médecins Sans Frontières said in a press release. “So, we will be trying to get the right balance between responding quickly and taking steps to make sure the community is a willing and active participant in both prevention and response,” MSF said.
In eastern Congo, where the new cases were discovered near the city of Butembo, that was not always the case. The humanitarian response was all too often an alienating “top down” approach that failed to appreciate the importance of listening to affected communities.
The lack of trust fed community resistance, while the medical language used by aid workers – in what was an already scary experience – further intimidated those supposed to be receiving help. The experience cemented the need for anthropologists and social scientists to be part of the health response.
Insecurity in eastern Congo – where over 10 armed groups operate – made it a particularly difficult area for health teams to work in. But exclusive reports by TNH also outlined how corruption and cases of sexual abuse undermined the relationship between aid workers and the local community.
The availability of Ebola vaccines – long in development – has been a game-changer. Inoculations began in Butembo today, and the World Health Organization said it would also help procure vaccines for Guinea if its outbreak is confirmed to be the Zaire strain of the virus covered by the current vaccines.
“So, it is great that we have [these vaccines] now, but the other part of the response is going to be working with the community to educate and engage so they will take up the vaccine,” Kuppalli, who led an Ebola Treatment Unit during Sierra Leone’s outbreak, told TNH.
But prevention and surveillance is also key. “We need to continue to invest in building up healthcare systems and surveillance,” she added.