When Ebola swept through eastern Congo in 2018, it
was a struggle to track cases. Dr Billy Yumaine, a public health official,
recalls steady flows of people moving back and forth across the border with
Uganda while others hid sick family members in their homes because they feared
the authorities. It took at least a week to get test results, and health
officials had difficulty isolating sick people while they waited.
اضافة اعلان
It took two years for the country to bring that outbreak
under control, and more than 2,300 people died.
A similar
disaster threatened Congo in September 2021.
Members of a family in North Kivu province fell ill with fevers, vomiting, and
diarrhea, one after the other. Then their neighbors became sick, too.
But that set off a series of steps that Congo put in place
after the 2018 outbreak. The patients were tested, the cases were quickly
confirmed as a new outbreak of Ebola and, right away, health workers traced 50
contacts of the families.
Then they fanned out to test possible patients at health
centers and screened people at the busy border posts, stopping anyone with
symptoms of the hemorrhagic fever. Local labs that had been set up in the wake
of the previous outbreak tested more than 1,800 blood samples.
It made a difference: This time, Ebola claimed just 11
lives.
“Those people died, but we kept it to 11 deaths, where in
the past we lost thousands,” Yumaine said.
You probably did not hear that story. You probably did not
hear about the outbreak of deadly Nipah virus that a doctor and her colleagues
stopped in southern India last year, either. Or the rabies outbreak that
threatened to race through nomadic Masai communities in Tanzania.
Quick-thinking public health officials brought it in check after a handful of
children died.
Over the past couple of years, the headlines and the social
feeds have been dominated by outbreaks around the world. There was COVID, of
course, but also mpox (formerly known as monkeypox), cholera, and resurgent polio
and measles. But a dozen more outbreaks flickered, threatened — and then were
snuffed out. While it may not feel that way, we have learned a thing or two
about how to do this, and, sometimes, we get it right.
A report by global health strategy organization Resolve to
Save Lives documented six disasters that were not. All emerged in developing
countries, including those that, like Congo, have some of the most fragile
health systems in the world.
While cutting-edge vaccine
technology and genomic sequencing
have received lots of attention in the COVID years, the interventions that
helped prevent these six pandemics were steadfastly unglamorous: building the
trust of communities in the local health system. Training local workers in how
to report a suspected problem effectively. Making funds available to dispense
swiftly, to deploy contact tracers or vaccinate a village against rabies.
Increasing lab capacity in areas far from urban centers. Priming everyone to
move fast at the first sign of potential calamity.
“Outbreaks don’t occur because of a single failure; they
occur because of a series of failures,” said Dr Tom Frieden, CEO of Resolve and
a former director of the US Centers for Disease Control and Prevention. “And
the epidemics that don’t happen don’t happen because there are a series of
barriers that will prevent them from happening.”
Yumaine told me that a key step in shutting down Congo’s
Ebola outbreak in 2021 was having health officials in each community trained in
the response. The Kivu region has lived through decades of armed conflict and
insecurity, and its population faces a near-constant threat of displacement. In
previous
public health emergencies, when people were told they would have to
isolate because of Ebola exposure, they feared it was a trick to move them off
their land.
“In the past, it was always people from Kinshasa who were
coming with these messages,” he said, referring to the country’s capital. But
this time, the instructions about lockdowns and isolation came from trusted
sources, so people were more willing to listen and be tested.
“We could give local control to local people because they
were trained,” he said.
Because labs had been set up in the region, people with
suspected Ebola could be tested in a day or two instead of waiting a week or
more for samples to be sent more than 2,574km to Kinshasa.
In the state of Kerala in southern India, Dr Chandni Sajeevan,
the head of emergency medicine at Kozhikode Government
Medical College
hospital, led the response to an outbreak of Nipah, a virus carried by fruit
bats, in 2018. Seventeen of the 18 people infected died, including a young
trainee nurse who cared for the first victims.
“It was something very frightening,” Chandni said. The
hospital staff got a crash course in intensive infection control, dressing up
in the “moon suits” that seemed so foreign in the pre-COVID era. Nurses were
distraught over the loss of their colleague.
Three years later, in 2021, Chandni and her team were
relieved when the bat breeding season passed with no infections. And then, in
May, deep into India’s terrible COVID wave, a 12-year-old boy with a high fever
was brought to a clinic by his parents. That clinic was full, so he was sent to
the next, and then to a third, where he tested negative for COVID.
But an alert clinician noticed that the child had developed
encephalitis. He sent a sample to the national virology lab. It swiftly
confirmed that this was a new case of Nipah virus. By then, the child could
have exposed several hundred people, including dozens of health workers.
The system Chandni and her colleagues had put in place after
the 2018 outbreak kicked into gear: isolation centers, moon suits, testing
anyone with a fever for Nipah as well as COVID. She held daily news briefings
to quell rumors and keep the public on the lookout for people who might be ill
— and away from bats and their droppings, which litter coconut groves where
children play. Teams were sent out to catch bats for surveillance. Everyone who
had been exposed to the sick boy was put into 21 days of quarantine.
“Everyone, ambulance drivers, elevator operators, security
guards — this time, they knew about Nipah and how to behave not to spread it,”
she said.
Dr Amanda McLelland, who leads epidemic prevention at
Resolve, told me that when she heard of new Ebola cases in Guinea in West
Africa in 2021, she feared disaster. An outbreak that began in Guinea in 2014
had spread to two neighboring countries, and by the time it was declared over,
two years later, nearly 30,000 people had been infected and 11,325 had died.
But this time, although Guinea was already struggling to
respond to COVID, it managed to bring the Ebola outbreak in check in six
months, with just 11 deaths.
“That was a fantastic example of learning those lessons and
investing and building sustainably in the capacity,” McLelland said.
It should be celebrated, she added. While public health
failures, such as those in the face of COVID, receive plenty of attention, she
said, “our success is invisible.”
Nevertheless, progress can be fitful: A new Ebola outbreak
is slowly being brought under control in Uganda, and neighboring nations have
watched it with concern.
“I think what we’re seeing there is the unfortunate harvest
of COVID,” he said. “COVID broke a lot of things. It broke health care worker
resilience, it broke the willingness of many people to follow public health
advice, it broke trust in the health care system and communities that was there
before. Progress is possible, but it’s also fragile.”
But Yumaine said he had growing confidence that even if
Ebola were to spill back across the border from Uganda, Congo could respond
swiftly, with surveillance systems that grow better all the time.
“We’re encouraged by our improvements,” he said. “But we’re
not stopping there.”
Read more Health
Jordan News
.jpg)
.jpg)
