Containment Strategies and Future Challenges

This is the Guardian . An outbreak of Ebola has emerged in the Democratic An outbreak of Ebola in the Democratic Republic of Congo has been declared as a public health emergency of international concern by the World Health Organization. So far there have been around 400 suspected cases, and more than 100 people have died . It has a death rate of around 50% . And this outbreak has experts particularly worried because the strain involved is rare and there's currently no vaccine for it. So today, what do we know about the Ebola outbreak and can it be contained? I'm the Guardian Science Editor Ian Sample and this is Science Weekly . Dr. Daniela Mano, you're a clinical epidemiologist at the London School of Hygiene and Tropical Medicine, and you've worked on Ebola vaccine trials. Tell us a bit about what we know so far in terms of when did this outbreak begin? How many people have been affected and and obviously where is it happening. This outbreak likely started weeks ago, and the number of suspected cases and deaths are already quite high. But the true size of this outbreak is still not fully known. So this outbreak is in a region of eastern DRC called the Turi , is a region that is highly populated and has movement of populations within DRC and also cross borders with Uganda and also neighbouring And what exactly is Ebola and you know if you're infected with the virus, what what happens? Ebola is a severe viral infektion that is caus by a gruppen avrés of the genus or bola virus. And it konsists in symptoms such as fever, tiredness, body ache, and then can progress into diarrhea, vomit, and severe manifestation like bleeding complications. And eventually the case could have multi-organ failure and die. And how does it spread? Through direct contact with body fluids from an infected or that person and this body fluids can be vomit, uh, diarrhea, but also breast milk, tears , or contaminated materials. It doesn't spread through air like COVID-19, so it's less trans missible than that . One of the situations where transmission can occur is when family members look after relatives, sick relatives, or when they engage in traditionalal buri praxis that requires touching the den i and washing the död body. The outbreak we're talking about emerged in DRC and has now spread to Uganda. What are some of the factors that make these countries susceptible to ebola outbreaks Ebola viruses are present in wildlife. The reservoir is considered to be species of bats and then occasionally there is a spillover event to humans that can start an outbreak. There are traditional practices that have been considered at risk, so for example, hunting or butchering wild animals or consumption of wild meat. But in general, with landscape changes in those countries and human activities encroaching more and more in wild environments, the contacts between human and animals are increasing. So I would say it's a combination of ecological, environmental, and social factors. And I was going to ask about that, Daniela actually is why is it that these spillover events can then turn into these much larger outbreaks? I mean does that say something about the healthcare system, about awareness of these diseases? So traditionally ebola outbreaks happened in remote areas and possibly died out without involving a large number of cases. But now the regions that are at risk of ebola outbreaks are more and more densely populated and are connected. And so a case can easily travel to a major city. One important factor of the outbreaks is also that sometimes it infect el care worker in a setting where infection prevention and controls are not followed properly. Maybe because the outbreak happens in an area where the el care system is quite weak and there's no suspicion that infection could be Ebola . Daniela it's now been confirmed that the Bundebugio virus is behind this particular outbreak, what do we know about this particular strain? So Bundibuggio is a a rare virus. It appeared the first time in Uganda in 2007 it has caused only two previous outbreaks and so has not been prioritized for vaccine development and therapeutics. There are other vaccines, especially against Ebola virus disease, formerly known as Zaire Ebola virus. And we have also several therapeutics that can be used against Ebola virus. But those vaccines and drugs do not work against Pudimulgio because the virus is different, and that's why we do not have currently a vaccine or a drug that can be used during the current outbreak. I know there are some experimental vaccines for Bunabugio in development, but as you say, these probably won't be available during this outbreak, nor will any specific treatment. So how are patients cared for? There are other treatments that can be used and they are extremely beneficial. I think the first important thing is that if a case is identified early, it's much easier to manage. The treatment that can be given are intensive care treatment, like fluid resuscitation, pain management, management of complications, and those treatment actually reduce mortality of infected cases substantially. It sounds like that is largely supporting the patient to basically get through the infection themselves, is that right? Yes, is right. And what sort of traditional containment measures will the authorities be relying on? They will rely on early identification of cases and generic treatment and then contract tracing and is olation, safe burials, infection prevention and control measures in healthcare settings, and also community engagement. These more traditional outbreak response methods have been extremely important in the response to previous outbreaks and they work when applied properly coming up. With no treatment or vaccine, how will authorities try and get this outbreak under control ? I'm Ky Wright. I'm Car Sherman. And we are here to tell you about our new show, which is rooted in this feeling that at least I have, I know you have, where you know, it's kind of like when you wake up in the morning and you pick up your phone and you're just hit in the face with a fire hose of news, right? Like there's war, there's authoritarianism, our planet is learning. I could go on and on and on and. On on and on, but like we're trying to figure out how to manage it, right? Like, how do you manage it? I manage it by leaning in and trying to learn more and trying to figure out: okay, how can I be smarter about this particular topic? And who can I talk to that's going to make me feel better about it? And who can tell me who's responsible for the mess that I'm reading about? So that's our mission. That's the show. Welcome to Stateside with Kai and Carter. We're a new show from The Guardian. We're talking to big thinkers and the best journalists, just trying to understand the world through smart conversation and honest reporting. We don't have billionaires telling us what to say. Stateside with Kai and Carter is out now, every Monday, Wednesday, and Friday. Follow on Apple Podcasts or catch us wherever you watch or listen. So look what will the response to the outbreak look like now? I mean what will the health authorities from DRC, from Uganda and internationally, what will what will they be doing now? The fact that the WTO has now declared a public health emergency of international concern is extremely important . This is recognizing that the outbreak has the potential to spread regionally . And so it's extremely important that there is a coordinated response effort across different countries, including DRC, Uganda, Rwanda. And this will allow to mobilize international coordination, release of funding, and also technical support and cross border preparedness to avoid further spread. Presumably it is one of those situations where time is of the essence that these health workers need to get in early as early as they can to start doing that case isolation, identification, the contact tracing, and getting all of this um containment procedure in place as soon as they can. Yes, absolutely. Uh this outbreak is worrying because we do not know the exact size of the outbreak at the moment. So it can spre ad uncontrolled. So it's it's extremely important that control measures are applied rapidly. As this emergency response kicks in then, what are going to be the challenges you think that that will lie ahead for containing this? Challenges would be coordination within the country and also among neighbouring countries, but also the area where the outbreak is happening is a difficult area where there is insecurity , conflict and so outbreak control teams could have a difficult job and the population sometimes do not have a huge trust in the authorities and also maybe Ebola is not fully understood and sometimes the reason why the outbreak occurs is not attributed to a virus or an infection but other reasons like black magic or you know believes in the in the community that needs to be understood so the communication efforts can tackle the misjudgment and Ebola is a difficult disease to handle because it affects close contacts. And I think in general, it's difficult for someone to actually report the disease in a family member, like it can be your your son, it can be your husband, it can be parents, and you need to report that case to the authorities and they will come and take it away from you. And sometimes people reasonably do not want to do that. So So it's important that communication is done in a sensitive way with the communities that are affected. Yes. I think it would be important to have an accurate number of cases recorded. And I think in the next weeks probably we will have an increase of these numbers because the transmission has been going on for some weeks already. But once we have an idea of the size of this outbreak and the numbers starts to slow down and decre ase maybe we will uh have reached the tip of the outbreak and uh cases will slowly go down. It's difficult to say when this is going to happen. Well let's hope that all does happen soon and we see signs of that. Daniela, thank you very much. Thank you . Thanks again to Dr. Daniela Mano . You can follow our coverage of the Ebola outbreak at thegardian.com This episode was produced by Madeline Finlay. The sound design was by Joel Cox and the executive producer was Ellie Bury . We'll be back on Thursday. See you then . This is the Guardian .