Ebola is a of these scourges where the mere mention of their name is afraid: the virus, which kills about half of those that infect and pass through body fluids, is very difficult to contain. Due to its long incubation period, people with healthy appearance can spread fatal illness for weeks before the symptoms appear.
This means that the best way to contain an outbreak such as the one currently swept the Democratic Republic of the Congo is the obsessive tracking of infected individuals, monitor their social circles and their movements and limit their exposure to other people for weeks in time. But restraint is proving so difficult in the DRC that last week, Robert Redfield, director of the Centers for Disease Control and Prevention, suggested an alarming possibility. The current Ebola epidemic could be out of control, he said, and may – for the first time since the deadly virus was first identified in 1976 – it has persistently strengthened in the population.
The 329 confirmed and probable cases of Ebola infection reported so far have made it the largest outbreak in the history of the country, with no sign of slowing down. The militia groups that oppose the North Kivu province of DRC, the epicenter of the outbreak, have revolutionized attempts by health workers to trace the movements of people exposed to the virus. A massive effort to vaccinate more than 25,000 people at increased risk slowed down transmission rates but tide has not yet occurred. Between October 31 and November 6, 29 new cases were reported in the DRC, including three health workers.
Now neighbor Uganda is preparing the virus to cross the 545-mile limit that it shares with the DRC. The border is porous and very traffic, with a large number of local farmers, merchants, merchants and refugees who constantly move around the area. A control post in the region receives 5,000 people in a middle day, and the busiest ones inflate to 20,000 twice a week on market days.
On Wednesday, the country began immunizing first line health workers with an experimental vaccine that produced good results in a previous epidemic. The Ugandan Ministry of Health has said that it has 2,100 doses of vaccine available for doctors and nurses working in five border districts. In hospitals in these districts, four special Ebola treatment units were also built, with standby personnel to deal with suspicious cases. "The risk of cross-border transmission was very high at the national level," said Uganda Health Minister Jane Ruth Aceng at a press conference last week. "Hence the need to protect our health workers."
Since the onset of the outbreak in the DRC, anyone crossing Uganda has been subjected to health examinations at the official control posts: a series of questions and contact infrared thermometers directed at the side of the head that read body temperatures as a road patrol radar weapon Fever is one of the first red flags of an Ebola infection. The process is not infallible; Symptoms can take up to three weeks to appear, and many other tropical diseases in that part of Africa can also cause high temperatures.
The abundance of prudence arises from the unstable situation in the DRC. Ebola has never before entered a war zone, so the current situation is in many ways unique and unprecedented. But as continental African populations were changed, millions of dollars of investment in Chinese infrastructure, increased urban-wild interfaces, some doctors of infectious diseases see a lasting change in the form of Ebola outbreaks. "It's a cruel irony that better paths and better connectivity for people also facilitate the journey of the disease, especially when public health systems are still behind," says Nahid Bhadelia, director of the National Laboratory of Infectious Diseases at the University of Boston, who worked in the first lines of the outbreak of 2014 in Sierra Leone.
For decades, the natural disaster that the most similar ebola outbreaks was an earthquake. One could reach an isolated rural area and health workers quickly converge to treat infected people and seal the disease. But when the disease is in more populated areas or in a zone of conflict, it is much easier to lose control of people. Knowing if the exploding is impossible. If the disease jumps to Uganda, says Bhadelia, it will not be just a new epicenter, it will be another example of the changing Ebola profile.
When Uganda has already dedicated important resources to this possibility, international public health experts are more concerned about Ebola that extends more to areas controlled by rebel groups. "We can not allow ourselves to leave in the red security zones where we do not have access," says Mike Ryan, Deputy General Director of emergency preparedness and response to the World Health Organization. "Ebola explodes the cracks, therefore, the more we can keep it exposed, the better."
Sunday came to his house in Ireland, where he has just returned from a month coordinating WHO's health response in North Kivu, Ryan expressed a cautious optimism that the outbreak began to spin. The teams on the ground finally got control over what pushed the second wave of pressure from the epidemic, which marked Beni city in mid-September. "Transmission is almost completely within the sanitary facilities," says Ryan.
In each outbreak, some people take the virus in a hospital or clinic. However, only in recent weeks, health workers have observed the extent of Ebola evolution through the network of more than 300 Beni health centers, many of which have had few patient records. Even when workers vaccinated the close friends and relatives of the victims, the new cases appeared apparently out of the air. Last week o Washington Post It reported that between 60 and 80 percent of the confirmed new cases did not have any known epidemiological connection to the previous cases. Ryan responds that a great boost in recent weeks to completely restructure investigators of the case made a great impact to change this. "Now we link 93 percent of the new cases to known transmission chains," he says. Surveillance teams also started using tablets to register contacts and vaccines. By getting used to the information on the geographic locations of the new cases it enters, they are beginning to build models to understand where the virus will probably spread.
"Fears that this is endemic are real and rational, but we also need to see this as a worse scenario," says Ryan. "We still have many opportunities to put this virus back in the box, we just need to get ahead of people risking their lives on the front line and striving for the next three to six weeks. It will be a long march, but I do not think we should get up the white flag still ".
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