Ebola is one of those whips where the fear of the name itself: a virus that kills about half of those infected by body fluids is difficult to control. Due to the long incubation period, healthy-looking people can spread the deadly disease for many weeks before symptoms appear.
This means that the best, perhaps the only way to control an epidemic, such as that currently ravaging Democratic Republic of the Congo, is obsessive tracking of infected people – monitoring their social environments and their movements and limiting their contact with other people for many weeks. time. In the Democratic Republic of the Congo, he manages to stop, but Robert Redfield, director of the Center for Disease Control and Prevention, offered an alarming opportunity. The current Ebola outbreak may be out of control, he said, and may – for the first time since the lethal virus was first identified in 1976 – stubbornly persist in the population.
329 confirmed and probable cases of Ebola virus infections have so far caused the biggest explosion in the history of the nation, without any signs of slowing down. Militia groups clashing in the province of North Kivu DRC, the epicenter of the explosion, have developed health workers' attempts to track the movements of people exposed to the virus. An enormous effort to instill more than 25,000 people from the highest risk group has slowed the rate of transmission but has not yet caused a wave. From October 31 to November 6, 29 new cases were reported in the DRC, including three health professionals.
Now neighboring Uganda is preparing for the virus to cross the 545 mile limit that it shares with the DRC. The border is porous and strongly smuggled, with a large number of local farmers, merchants, traders and refugees constantly moving around. The control point in the region receives an average of 5,000 people a day, and the most active ones swell up to 20,000 times a week on market days.
On Wednesday, the country began vaccinating first-line health workers with an experimental vaccine, which brought good results in the previous outbreak of the epidemic. The Ugandan Ministry of Health said it had 2,100 doses of vaccine available to doctors and nurses working in five border districts. In hospitals in these districts, four special Ebola units were built, in which the staff were ready to manage any suspicious cases. "The risk of cross-border transmission has been assessed as very high at the national level," Ugandan health minister Jane Ruth Aceng said last week. "Hence the need to protect our health care workers."
Since the outbreak of the outbreak in the DRC, anyone who has moved to Uganda has been subjected to health checks at official checkpoints – a series of questions and non-contact infrared thermometers directed towards the head that read body temperatures such as traffic police radar gun. Fever is one of the first red flags of Ebola infection. The process is not reliable; the appearance of symptoms may take up to three weeks, and many other tropical diseases in this part of Africa may also cause a rise in temperature.
Abundance is due to the unstable situation in the DRC. Ebola has never exploded in a war zone, so in many respects the current situation is unique and unprecedented. But when major changes have taken place in the African continent – growing populations, billions of dollars of Chinese infrastructure investment, increased connections between the city and wildlife – some infectious disease doctors see a permanent change in the shape of the Ebola outbreak. "It's a cruel irony that better roads and better connectivity also make traveling easier for people, especially when public health systems are still lagging behind," says Nahid Bhadelia, director of the National Emerging Infectious Disease Laboratory at Boston University, who worked on the first the explosion line in 2014 in Sierra Leone.
For decades, the natural disaster, which most closely resembled the Ebola epidemic, was an earthquake. One would be in an isolated, rural area, and health professionals could quickly converge to heal infected people and seal the disease. But when the disease attacks on more populated areas or in the conflict zone, it is much easier to lose contact with people. Knowing how big the outbreak is is, it becomes impossible. If the disease jumps to Uganda, says Bhadelia, it will not be just a new epicenter, it will be another example of a changing Ebola profile.
Because Uganda is already devoting significant resources to this opportunity, international public health experts are more interested in the spread of Ebola virus to areas controlled by the collision of rebel groups. "We can not afford to reach deep into the red security zones in which we have no access," says Mike Ryan, deputy director general of emergency preparedness and response in the World Health Organization. "Ebola uses cracks, so the longer we can keep it in the open, the better."
Reached on Sunday at his home in Ireland, where he had just returned from the month coordinating WHO's health response in North Kivu, Ryan expressed cautious optimism that the explosion began to change. The teams on earth finally got control of what drives the second wave of epidemic pressure that began in the city of Beni from mid-September. "It's almost total transmission in healthcare facilities," says Ryan.
In every epidemic, some people catch a virus in a hospital or clinic. But only in the past few weeks have health care workers realized how much Ebola has spread to over 300 healthcare facilities, many of which maintain poor patient data. Even when employees vaccinated close friends and the victims' family, new cases would appear seemingly out of thin air. Last week Washington Post report that 60 to 80 percent of new confirmed cases did not have a known epidemiological relationship with previous cases. Ryan says that over the past few weeks, a huge pressure to completely retrain case researchers has a big impact on this. "We've combined 93 percent of new cases with known transmission chains," he says. The supervisory teams also began using tablets to record contacts and vaccinations. By applying this information to the geographic locations of new cases, they begin to build models to understand where the virus can continue to spread.
"The fear that something is endemic is real and rational, but we must also consider it as the worst case scenario," says Ryan. "We still have a lot of possibilities to put this virus back in the box, we just have to find people who risk life on the front line and push for three to six weeks, it will be a long march, but I do not think we should raise it yet. white flag. "
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