FRESH cases of Ebola have been detected just days before the deadly epidemic in the eastern Democratic Republic of the Congo (DRC) was due to be declared over, and as cities lockdown in an effort to stop the spread of coronavirus.
On 10 April, the country鈥檚 Ministry of Health confirmed the death of a man in the city of Beni in North Kivu province. Two further cases then emerged at the same health centre, including an 11-month-old girl, whose death was announced on 12 April, and a 7-year-old girl currently receiving treatment.
The cases are a significant blow to the country, which had previously recorded its last Ebola case on 17 February and was on the verge of ending an outbreak that has killed more than 2200 people since 2018.
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Bringing the epidemic near its end has been a difficult effort. In a country that has experienced decades of civil war, identifying and isolating the contacts of those who contracted Ebola was extremely challenging. But a mass monitoring scheme has conducted almost 160 million screenings for Ebola symptoms at checkpoints since August 2018. Two experimental vaccines have also helped turn the tide.
As part of the country鈥檚 Ebola surveillance system, every day, health teams investigate alerts, which can either be reports of those with Ebola symptoms or deaths in areas that are considered high risk. According to the World Health Organization, 2600 alerts are currently being analysed across the DRC鈥檚 eastern provinces.
Efforts are under way to find all contacts of the newly identified cases in order to offer them vaccination and to monitor their health. If no further cases emerge, the country will have to wait 42 days until the Ebola epidemic can be declared over.
A different kind of virus
The setback underlines just how difficult it is to eradicate infectious viruses. Coronavirus arrived in the country last month.
鈥淭his is now a triple emergency,鈥� said Kate Moger at humanitarian organisation the International Rescue Committee in a statement. 鈥淰ulnerable populations facing ongoing humanitarian crises, the spread of COVID-19, and now again potentially a re-emerging Ebola crisis.鈥�
Like the covid-19 virus, Ebola can pass from animals to humans. But Ebola is different in that it requires direct contact with bodily fluid to spread from person to person, while covid-19 appears to mainly do so through respiratory droplets via coughs and sneezes.
Ebola has a 21-day incubation period and is only infectious once people show symptoms, which are often severe. But the coronavirus can be transmitted even when people are symptomless, meaning it spreads far more easily.
However, the Ebola epidemic has, to some extent, prepared the eastern DRC for the arrival of the coronavirus. Gervais Folefack, the WHO鈥檚 incident manager for covid-19 in the DRC, says healthcare workers are being trained in rapid diagnosis, airports have isolation chambers and treatment centres have been built to provide easy access for rural communities. The country has many checkpoints with mandatory temperature checks and chlorinated hand washes.
While this is a 鈥渂ig advantage鈥�, the coronavirus presents novel problems, says Folefack. 鈥淣ow we need ventilators when that wasn鈥檛 the case for Ebola,鈥� he says. 鈥淎nd because coronavirus spreads more easily, the challenge is to not overwhelm our limited capacity.鈥�
So far, 241 cases of covid-19 have been confirmed in the country. Although only two were in Beni, the city began a two-week lockdown on 6 April in which no one can enter or exit. However, within Beni, business continues as usual, despite many residents being unable to afford face masks.
On the city鈥檚 streets, there is an acute awareness of the fragile state of the country鈥檚 healthcare system and its heavy reliance on international support. This support has helped to fight Ebola, but hasn鈥檛 yet been as forthcoming for the coronavirus.
鈥淲e need the funding,鈥� says Justin Mupanda, a motorbike taxi driver. 鈥淚f it鈥檚 caused this much chaos and death around the world already, then us Congolese could be crushed like flies.鈥�