WHO announced that the number of Ebola virus cases in the Democratic Republic of the Congo, or DRC, has reached over 2,000 cases, including 1,357 deaths.
Michael Ryan, MD, executive director of the WHO Health Emergencies Programme, explained in a press conference that the outbreak zone represents a smaller geographical footprint than it has previously.
“However, within that geographic zone we are seeing dispersion of cases,” Ryan said. “We have to be very, very cautious and understanding that the disease is still heavily present, there is still a lot of transmission going on in communities and, at any point, it can flare up again in an existing zone or spread — as we’ve seen in the past — to other uninfected areas. So, a note of caution there.”
The number of cases within the last 2 weeks has stabilized, and even fallen. In April, there were approximately 126 new cases per week, but in the last 2 weeks that number has dropped to 88, Ryan reported. Although there have been significant decreases in transmission in Katwa, which was the epicenter of the outbreak 6 weeks ago, health areas such as Butembo are still experiencing substantial transmission rates.
“On the one hand we see improvements and decreases in transmission, and on the other hand we see areas in which we see sustained transmission,” Ryan said.
Ryan also mentioned that since May 18, the reproductive number is 1.04 — meaning that, on average, one case will infect one other person. This suggests that the epidemic rate is flat, but that does not mean transmission is falling, he cautioned.
“It can either continue to reduce, or it could easily flare up again,” Ryan said.
Progress is being made that Ryan credits in part to the “calm” that has settled over the war-torn region in the last 6 weeks. Also, the outbreak response has been hampered by mistrust in DRC communities — one recent survey showed that more than 25% of respondents did not believe the Ebola outbreak in the DRC was real — but Ryan noted that enhanced community engagement led by WHO and UNICEF is beginning to show results.
“[A] tremendous amount of work has been done in the field by our WHO, UNICEF and ministry teams to try an improve that trust relationship,” he said.
Ryan emphasized that the DRC outbreak is a “complex, volatile situation” requiring health agencies to adapt. However, he thinks the current strategies in place to reduce transmission in the country are sound.
“There is no alternative strategy for effective community engagement, rapid identification of cases, good surveillance, excellent contact tracing, quick isolation of patients in health facilities that respect their human rights and saves their lives,” Ryan said. “There’s no alternative to doing that. The real issue with this is execution. Can we execute these public health operations in a sensitive manner that respects communities and in an aggressive manner that gets rid of the virus? And how do we balance sensitivity against the urgency of containing this virus?” – by Marley Ghizzone
Vinck P, et al. Lancet Infect Dis. 2019;doi:10.1016/S1473-3099(19)30044-1.
Disclosure: Ryan is employed by WHO.