H5N1

WHO: Ebola virus disease – Democratic Republic of the Congo

WHO has published its weekly update: Ebola virus disease – Democratic Republic of the Congo. Excerpt:

The number of confirmed cases of Ebola virus disease (EVD) has been relatively low in recent weeks, with 15 new confirmed cases reported in North Kivu and Ituri provinces during the epidemiological week of 7 October through 13 October (Figure 1). These encouraging signs are offset by a marked increase in case incidence in Biakato Mine Health Area, Mandima Health Zone. During the past 21 days (from 25 September through 15 October), a total of 50 confirmed cases were reported from ten health zones (Table 1, Figure 2), of which two-thirds (62%, n=31) were reported from or had transmission links to Biakato Mine Health Area. 

Issues with access and security are impacting case finding and investigations, contact tracing, safe and dignified burials, decontamination of affected residences, and vaccination rings in parts of Mandima Health Zone. This is reflected in the decline in the proportion of confirmed cases listed as contacts (from 57% to 13%) and increase in the proportion of cases dying outside of Ebola Treatment Centres or Transit Centres (from 14% to 27%) this past week. This is further demonstrated by the relatively low numbers of alerts reported in the two areas over the past 42 days, with 32% less than the expected number.  

A recent qualitative investigation in these health zones indicated that there is poor understanding among the population and local health workers of the transmission mechanism and symptoms of the disease, compounded with an environment of mistrust surrounding the origin of the disease, and reason for vaccination. This may impact the reporting of cases and engagement with response activities. Less than half of the respondents indicated that they would call a hotline if a member of their community was suspected of having Ebola, and almost half reported that they would encourage a family member to go to a Treatment/Transit Centre if they were suspected of having Ebola. 

Furthermore, less than half of individuals interviewed understood the functions of different interventions in the response, and less than 5% were involved in the response. This investigation highlights the importance of engaging communities in response activities in the upcoming weeks. 

As of 15 October, a total of 3227 EVD cases were reported, including 3113 confirmed and 114 probable cases, of which 2154 cases died (overall case fatality ratio 67%). Of the total confirmed and probable cases, 56% (n=1811) were female, 28% (n=918) were children aged less than 18 years, and 5% ((n=162) were health workers. 

The Director-General will reconvene the Emergency Committee under the International Health Regulations (IHR), as three months have passed since the declaration of the public health emergency of international concern (PHEIC) on 17 July. The committee will review progress in the implementation of the Temporary Recommendations issued by the Director-General on 17 July, discuss whether the event still constitutes a PHEIC, and if yes, advise for new or updated Temporary Recommendations under the IHR. The current recommendations are available here as will be the upcoming statement. 

Under Pillar 1 of the current Strategic Response Plan, the estimated funding requirement for all partners for the period July to December 2019 is US$ 287 million, including US$ 140 million for WHO. As of 17 October 2019, US$ 69.5 million has been received by WHO, with additional funds committed or pledged. Further resources are needed to fully fund the response through to December 2019 and into Q1 2020. 

Under Pillar 5, Regional Preparedness, the funding requirement for all partners is US$ 66 million, of which WHO requires US$ 21 million. As of 17 October 2019, WHO has received US$ 4.3 million. While some additional pledges are in the pipeline, increased funding for preparedness in neighboring countries is urgently needed. WHO is appealing to donors to provide generous support. A summary of funding received by WHO since the start of this outbreak can be found here.

WHO AFRO: Ebola virus disease outbreak in DRC - Sitrep 63 (2019)

WHO AFRO has published Ebola Virus Disease Outbreak in DRC - Sitrep 63 (2019). Excerpt:

In the past week, from 7 to 13 October, 15 new confirmed Ebola virus disease (EVD) cases were reported from five health zones in two affected provinces in the Democratic Republic of the Congo. While it is encouraging to see another week of relatively low numbers of newly confirmed cases, these are occurring in a concentrated area where limited access and insecurity pose challenges for the response. In such environments, risks of resurgence remain very high, as do the risks of re-dispersion of cases. For example, this past week, several people who were eventually confirmed as positive for EVD sought healthcare in health zones which are no longer experiencing ongoing transmission, such as Beni. 

The proportion of confirmed cases listed as contacts has decreased in the past week from 57% to 13%, the lowest since mid-January. The majority (87%) of confirmed cases in the past week had links to the Biakato Mines Health Area in the Mandima Health Zone, with the remaining confirmed cases linked to the Mambasa Health Zone. Insecure environments in both Mandima and Mambasa Health Zones can diminish response activities related to disrupting transmission chains such as contact tracing, linkage of cases, safe and dignified burials, decontamination of affected residences, and vaccination rings. 

In the 21 days from 23 September to 13 October, the number of affected health areas has decreased, with 22 health areas and 10 health zones reporting new cases. During this period, a total of 49 confirmed cases were reported, with the majority coming from the health zones of Mandima (43%; n=21 cases), Mambasa (12%; n=6 cases) and Oicha (12%; n=6 cases). 

As of 13 October 2019, a total of 3220 EVD cases were reported, including 3106 confirmed and 114 probable cases, of which 2150 cases died (overall case fatality ratio 67%). Of the total confirmed and probable cases, 56% (1806) were female, 28% (915) were children aged less than 18 years, and 5% (162) were healthcare workers. 

Following the declaration of the Ebola outbreak in the Democratic Republic of the Congo as a public health emergency of international concern (PHEIC) on 17 July 2019, the Director-General will reconvene the Emergency Committee under the International Health Regulations (IHR) on 18 October to review and potentially update the Temporary Recommendations made, and determine if the event still constitutes a PHEIC. 

Under Pillar 1, the public health pillar of the Strategic Response Plan, the estimated funding requirement for all partners for the period July to December 2019 is US$ 287 million, including US$ 140 million for WHO. As of 15 October 2019, US$ 65.8 million has been received by WHO, with additional funds committed or pledged. 

Further resources are needed to fully fund the response through to December 2019 and into Q1 2020. Under Pillar 5, the Regional Preparedness pillar, the funding requirement for all partners is US$ 66 million, of which WHO requires US$ 21 million. As of 15 October 2019, WHO has received US$ 3.8 million. While some additional pledges are in the pipeline, increased funding for preparedness in neighboring countries is urgently needed. WHO is appealing to donors to provide generous support.

MSF: Ebola response overshadows DRC's fragile health system

Thanks to Mary Marshall for sending the link to this important report from MSF.org: Ebola response overshadows DRC's fragile health system. Excerpt (but read the whole story):

For health centres and hospitals in the region, the scale-up of the internationally funded Ebola response can be a blessing or a curse. 

Where Ebola response teams and international organisations set up isolation and treatment facilities, they often improve infrastructure, pay extra staff, and support primary healthcare services. 

But the health workers needed in the response are almost exclusively hired from other health centres and hospitals in the area, which are now facing critical staff shortages.  

At the General Hospital in the main village of Mabalako, these gaps are strikingly evident. Over half of the doctors and nursing staff are missing, and no one has sufficient time to watch over patients in the four wards around the big courtyard.

As extra wages with the Ebola response tend to be higher and more reliable, many of the remaining staff are disappointed that they were not selected, and moral and motivation are low. 

In the hospital, the staff shortages, unavailable treatments, and missing salaries are a deadly mix.  

“We lost children in the paediatric ward because they were not put on the correct malaria treatment straight away – an error that could have been avoided with the right human resources and more vigilance,” said MSF doctor Brian Da Cruz, who is supporting the two remaining doctors in charge of an operating theatre, maternity department, paediatric clinic, and a regular ward with more than 40 beds. 

The hospital also has a basic isolation zone for patients with infectious diseases, but the small structure has no changing rooms, no decontamination zone, and there is no safe access for families to visit patients.  

As suspect Ebola patients are taken to another, better equipped structure, its rooms are currently used to observe four children with measles, a vaccine-preventable, but highly infectious disease leading to regular epidemics in the DRC. 

On the opposite side of the courtyard, MSF drilled a borehole and installed a water point, which is in permanent use by people living in the neighbourhood for clean drinking water.

While MSF’s support was mostly focused on improving infrastructure and working alongside the remaining staff in health centres and the regional hospital, the team is currently evaluating a different model, including a regular payment scheme to supplement staff salaries and offer bedside training. 

“We are discussing playing a stronger role in the hospital and the three health centres we support, by taking supervisory responsibility, offering training on the job, and ensuring patients have access to free care while staff are getting paid,” explained MSF project coordinator Amandine Colin. 

Back in Metale, MSF community outreach specialist Wivine Bokotogi hands a set of flashcards on malaria prevention and treatment to two local health promoters. 

Malaria is another major health burden at risk of being neglected as the attention and resources chase after the Ebola epidemic. In the DRC, malaria accounted for 13 per cent of deaths in children under five years old in 2016, and up to half of the people screened in Ebola treatment centres last year tested positive for malaria alone. 

“We train the local health promoters on key messages to prevent malaria, including instructions to cover stagnant water sources, use mosquito nets, and take children to the nearest health centres so they can be treated in time,” said Wivine.

Effect of economic recession and impact of health and social protection expenditures on adult mortality

Via The Lancet Global Health, an important study: Effect of economic recession and impact of health and social protection expenditures on adult mortality: a longitudinal analysis of 5565 Brazilian municipalities. The summary:

Background 

Economic recession might worsen health in low-income and middle-income countries with precarious job markets and weak social protection systems. Between 2014–16, a major economic crisis occurred in Brazil. We aimed to assess the association between economic recession and adult mortality in Brazil and to ascertain whether health and social welfare programmes in the country had a protective effect against the negative impact of this recession. 

Methods 

In this longitudinal analysis, we obtained data from the Brazilian Ministry of Health, the Brazilian Institute for Geography and Statistics, the Ministry of Social Development and Fight Against Hunger, and the Information System for the Public Budget in Health to assess changes in state unemployment level and mortality among adults (aged ≥15 years) in Brazil between 2012 and 2017. Outcomes were municipal all-cause and cause-specific mortality rates for all adults and across population subgroups stratified by age, sex, and race. 

We used fixed-effect panel regression models with quarterly timepoints to assess the association between recession and changes in mortality. Mortality and unemployment rates were detrended using Hodrick–Prescott filters to assess cyclical variation and control for underlying trends. We tested interactions between unemployment and terciles of municipal social protection and health-care expenditure to assess whether the relationship between unemployment and mortality varied. 

Findings 

Between 2012 and 2017, 7 069 242 deaths were recorded among adults (aged ≥15 years) in 5565 municipalities in Brazil. During this time period, the mean crude municipal adult mortality rate increased by 8·0% from 143·1 deaths per 100 000 in 2012 to 154·5 deaths per 100 000 in 2017. An increase in unemployment rate of 1 percentage-point was associated with a 0·50 increase per 100 000 population per rter (95% CI 0·09–0·91) in all-cause mortality, mainly due to cancer and cardiovascular disease. 

Between 2012 and 2017, higher unemployment accounted for 31 415 excess deaths (95% CI 29 698–33 132). All-cause mortality increased among black or mixed race (pardo) Brazilians (a 0·46 increase [95% CI 0·15–0·80]), men (0·67 [0·22–1·13]), and individuals aged 30–59 years (0·43 [0·16–0·69] per 1 percentage-point increase in the unemployment rate. 

No significant association was identified between unemployment and all-cause mortality for white Brazilian, women, adolescents (aged 15–29 years), or older and retired individuals (aged ≥60 years). In municipalities with high expenditure on health and social protection programmes, no significant increases in recession-related mortality were observed. 

Interpretation 

The Brazilian recession contributed to increases in mortality. However, health and social protection expenditure seemed to mitigate detrimental health effects, especially among vulnerable populations. This evidence provides support for stronger health and social protection systems globally.

Worst global health news of the year

Via the UN, Secretary General António Guterres has published his Remarks to the Fifth Committee of the General Assembly on the Proposed Programme Budget for 2020. Excerpt, with my bolding, and then a comment:

Earlier this year, I proposed measures to resolve the financial crises facing our Organization.  

You have responded positively to some of the proposals for the peacekeeping budget, which will reduce, but not cancel completely, the debt to troop- and police-contributing countries – for which I am grateful.  

But we have not yet addressed the regular budget crisis, and the situation continues to deteriorate. 

This month, we will reach the deepest deficit of the decade. We risk exhausting the closed peacekeeping cash reserves, and entering November without enough cash to cover payrolls. 

This situation would have been much worse if I had not worked since January to curtail spending, align our real vacancy rate with the approved rate, and manage cash on a month-by-month basis. Without these steps, we would not have had, I repeat, we would not have had the liquidity to support the opening of the General Assembly debate and the mandated high-level meetings last month. 

Last week, I was forced to introduce extraordinary measures to cope with the record-level shortage of cash. Vacant posts cannot be filled, travel will be limited to essential travel only, meetings may have to be canceled or deferred, webcasting of non-mandated events will not be available, and support to meetings will have to be adjusted. The Secretariat will no longer be able to support any non-mandated events after 6 p.m. These steps will affect our operations in New York, Geneva, Vienna and Nairobi and at the regional commissions. 

Our work and our reforms are at risk. 

As I introduce the 2020 programme budget proposals, I reiterate my call on you to recommit to paying your financial obligations on time and in full. I thank those Member States that have done so. I also thank those that continue to make every effort to do so, notwithstanding the difficult economic conditions they face. I equally urge you to consider measures to ease the structural impediments preventing us from managing the resources more effectively. 

The full and efficient implementation of our programme of work depends on the financial support of Member States through the adoption of realistic budget levels and the provision of timely contributions to ensure a stable financial situation throughout the year. 

I look forward to your full and enthusiastic support.

This is not just the Ebola response that's running out of money—it's the whole UN. The health consequences scarcely bear thinking about: shelter, food security and basic nutrition and education among refugees, internally displaced people, and disaster survivors; surveillance and response to countless outbreaks around the world; long-term studies of population health. 

You can add to this list. A major factor appears to be the nonpayment of UN dues by the United States, but a quick scan of today's major American media shows little or no mention of the shortfall, let alone the Trump administration's responsibility for it. 

 

The repercussions will be felt all over the world.

Ituri: Paralysis of economic activities in Mongbwalu over Ebola charges

Via Radio Okapi: Ituri: paralysis of economic activities in Mongbwalu. The Google translation:

Economic activities were paralyzed on Tuesday (October 1st) in the rural commune of Mongbwalu, 80 kilometers north of Bunia (Ituri), in accordance with the slogan issued by the Yira community, which declared three days of dead city in this mining entity. 

The president of this cultural association says that this measure aims to denounce the stigmatization of the Yira community. It is accused of spreading Ebola virus disease in the region.  

All business houses were closed Tuesday in Mongbwalu-center, where 75% of economic operators are members of the Yira community. They accuse the civil society of broadcasting news through local radio accusing the Nande of spreading the Ebola virus disease. According to their provincial president, Reagan Kambale, this message is likely to cause hatred and disturb social peace. 

"These are extremely serious things that we can not stand as a community, especially since the Ebola virus disease has taken away loved ones. That's why the Yira community has decreed three days of dead cities to express their dissatisfaction," Reagan Kambale said. 

Mongbwalu's civil society, on the other hand, claims that it has not cited any community in its message of raising public awareness about Ebola prevention.  

According to the mayor of this commune, the safety committee initiated the investigations on this subject. Pending the outcome of the investigations, he asked these operators to reopen their stores. Sources agree that economic activities have resumed normally since Wednesday morning in Mongwalu.   

DRC Ebola: CMRE update, October 1

CMRE has published Situation épidémiologique du 01 Octobre 2019. Excerpt from the Google translation:

EVOLUTION OF THE EPIDEMIC IN THE PROVINCES OF NORTH KIVU AND ITURI AS AT 30 SEPTEMBER 2019   

Tuesday, October 01, 2019  

• Since the beginning of the epidemic, the cumulative number of cases is 3,194, of which 3,080 are confirmed and 114 are probable. In total, there were 2,136 deaths (2022 confirmed and 114 probable) and 991 people cured. 

• 388 suspected cases under investigation; 

• 3 new confirmed cases, including: 

• 2 in North Kivu, including 1 in Kalunguta and 1 in Oicha; 

• 1 in Ituri in Mandima; 

• 3 new confirmed deaths in Ituri, including: 

• 1 community death in North Kivu in Kalunguta;

• 2 confirmed deaths in CTEs, including 1 in North Kivu in Oicha and 1 in Ituri in Mandima; 

• No healed person left the CTE; 

• No health worker is among the new confirmed cases. The cumulative number of confirmed / probable cases among health workers is 160 (5% of all confirmed / probable cases), including 41 deaths.

 

The data presented in this table are subject to change after extensive investigation and after redistribution of cases and deaths in their respective health areas. 

NEWS  

Nine high-risk contacts from MVE from Lwemba in Ituri intercepted in Ngongolyio, North Kivu 

• Beni's Ebola Virus Disease Sub-Coordinator, Dr. Pierre-Celeste Adike, announced on Tuesday October 01, 2019 that nine high-risk contacts of a confirmed case of #Ebola Virus Disease from Lwemba, a Health Area of ​​Mandima Health Zone in Ituri Province in inter-ethnic conflict and insecurity, were intercepted Tuesday by the community in the Ngongolyo Health Area in North Kivu; 

• They were intercepted by a neighborhood chief, who automatically alerted the rebel teams at Beni level. A rapid intervention team was dispatched to this place, where the presence of the mayor of the city of Beni was also noted; 

• These nine people were in transit in Beni to one of their family members for Kabasha in Kalunguta in Butembo's sub-coordination, where they resided from Lwemba, where they went to attend a bereavement. Immediately after this interception, the members of the host family were vaccinated; 

• The follow-up of these nine contacts will continue in Butembo, especially since their names have already been communicated in all the coordinations of the response; 

• As a reminder, for 15 days, the response activities have been suspended in Lwemba following inter-ethnic conflicts and insecurity.  

Coordinating the Epidemic Response to Ebola Virus Disease for the Consumable Products Provided by Mambasa Economic Operators in Ituri 

• Overall Coordination of the Epidemic Response to Virus Disease #Ebola (MVE) has expressed support for the supply of consumables provided and offered by Mambasa's economic operators in Ituri province. 

• Vice President of the Economic Federation of Congo (FEC) of Mambasa, Alpha Nasibu Katele, who told the press on Monday to coordinate the response of Mambasa at the end of a meeting chaired by the coordinator Deputy Director of Epidemic Response to the Ebola Virus Disease, Dr Justus Nsio Mbeta in the presence of the FEC President and some members of the MECCA Committee, some Mambasa traders and partners supporting the response, including WHO, ALIMA and the Red Cross. 

• According to Mr. Alpha Nasibu, economic operators in Mambasa are able to refuel the base of the response in building materials, food and want a rotation be made between traders regarding the rental of large car for everything the world can benefit from the demand for the response. 

• This meeting was for the response to interact with economic operators to harmonize products that the response can buy locally in Mambasa, especially since other needs of the response are international and there is also has deposits that are already pre-positioned to meet some possible needs. 

• During this meeting, they were asked to list the products that could be available in Mambasa to allow the response to remove them from its list to be ordered elsewhere or to warn the economic operators of Mambasa of their stock on such or such other product. 

• Indeed, there has already been a first meeting between the economic operators of Mambasa and the teams of response. During this first meeting, economic operators complained that the response commands their consumables elsewhere, while in this territory economic operators are ready to respond favorably to their needs.

VACCINATION

• A total of 15 days without opening of vaccination rings around 5 confirmed cases in the Lwemba Health Zone in Mandima due to inter-ethnic conflicts and insecurity;

• No opening of an expanded ring around confirmed cases from 30 September in Biakato health area in Mandima as a result of community reluctance.

• A Satellite Ring was opened in the Lolwa Health Area in Mandima;

• Since the start of vaccination on August 8, 2018, 230,956 people have been vaccinated;

• The only vaccine to be used in this outbreak is the rVSV-ZEBOV vaccine, manufactured by the pharmaceutical group Merck, following approval by the Ethics Committee in its decision of 20 May 2018.

MONITORING AT ENTRY POINTS

• Since the beginning of the epidemic, the total number of travelers checked (temperature rise) at the sanitary control points is 100,964,142;

• To date, a total of 111 entry points (PoE) and sanitary control points (PoCs) have been set up in the provinces of North Kivu and Ituri to protect the country's major cities and prevent the spread of the epidemic in neighboring countries.

WHO AFRO: Situation report 60, Ebola virus disease outbreak in DRC

WHO AFRO has published Situation Report - Ebola Virus Disease Outbreak in DRC - Sitrep 60 (2019). Excerpt:

In the past week, from 16 to 22 September, 39 new confirmed Ebola virus disease (EVD) cases, with an additional 22 deaths, have been reported from nine health zones in three affected provinces in the Democratic Republic of the Congo. 

 Pockets of insecurity in the affected areas, along with localised security incidents, continue to hinder response activities, including safe and dignified burials (SDB), vaccination, contact tracing and case reporting. For instance, a recent major security incident in Lwemba, within Mandima health zone is still preventing response activities in this area. Overall, these incidents underscore the need for continued and proactive engagement and sensitizing of local communities, especially in the high risk areas that may not currently be affected.

In the 21 days from 2 to 22 September 2019, 45 health areas in 13 health zones reported new cases. During this period, a total of 129 confirmed cases were reported, with the majority coming from the health zones of Mambasa (25%, n=32 cases), Mandima (19%, n=25 cases), Kalunguta (17%, n=22 cases) and Beni (11%, n=14 cases). 

As of 22 September 2019, a total of 3168 EVD cases were reported, including 3057 confirmed and 111 probable cases, of which 2118 cases died (overall case fatality ratio 67%). Of the total confirmed and probable cases with reported sex and age data, 56% (1772) were female, 28% (900) were children aged less than 18 years, and 5% (160) were healthcare workers. 

The Democratic Republic of the Congo health authorities have endorsed the use of a second investigational Ebola vaccine with at-risk populations in areas that do not have active EVD transmission. Regular vaccination activities in EVD-affected areas will continue. See the full update here (https://www.who.int/news-room/detail/23-09-2019-second-ebola-vaccine-to-complement-ring-vaccination-given-green-light-in-drc). 

Under Pillar 1 of the current Strategic Response Plan, the estimated funding requirement for all partners for the period July to December 2019 is US$ 287 million, including US$ 120-140 million for WHO. As of 24 September 2019, close to US$ 60 million have been received by WHO, with further funds committed or pledged. Currently available funds will close the financing gap up until the end of October 2019. Further resources are needed to fund the response through to December 2019, and WHO is appealing to donors to provide generous support.

UNICEF DR Congo Ebola Situation Report North Kivu, Ituri and South Kivu - 16 September 2019

Via ReliefWeb, UNICEF has published UNICEF DR Congo Ebola Situation Report North Kivu, Ituri and South Kivu - 16 September 2019. Excerpt:

Highlights  

• Emerging hotspots continue to pose challenges in terms of accessibility and insecurity: on 14 September, EVD response teams were attacked in Mandima health zones thus slowing down the overall response for days. 

• UNICEF continues to strengthen its presence on the ground. To provide strategic direction closer to the hotspots and support field response teams, 19 staffs previously based in Goma – the coordination hub - have been moved to Beni. 

• More than a hundred international and local NGOs showed interest in partnering with UNICEF for implementing projects to support the access to basic social services in response to population needs in EVD affected and at-risk-areas.  

• During the back to school activities, UNICEF and its partners briefed and sensitized 6,473 students and 1,582 teachers on Ebola prevention measures information in schools, including through recreational activities. 

SITUATION IN NUMBERS 

3,129 total reported cases (WHO, 15 September 2019) 

3,018 confirmed cases (WHO, 15 September 2019)  

854 children <18 among confirmed cases (WHO, 15 September 2019)  

1,985 deaths among confirmed cases (WHO, 15 September 2019) 

12,214 contacts under surveillance (WHO, 15 September 2019) 

UNICEF Ebola Response Appeal US$ 175.75 million  

Key Epidemiological Developments 

Since August 2018, confirmed cases of Ebola Virus Disease (EVD) continue to be reported in North Kivu and Ituri. As of 15 September, a total of 3,129 EVD cases were reported, among which 3,018 confirmed and 111 probable cases. More than two thirds (2,096) of EVD cases died (global case fatality rate remains 67 per cent). 

During the reporting period, the number of new reported confirmed cases slightly increased in comparison to the previous week: 51 cases during week 37 in comparison to 45 cases during week 36. 

29 health zones have reported at least one confirmed and/or probable case of EVD since the beginning of the epidemic, and 15 of them (52 per cent) have reported at least one confirmed EVD case in the last three weeks. During the reporting period, two new health areas, Mangiva in Komanda health zone and Banana in Mambasa health zone, reported confirmed cases. 

Mambasa, Mandima, Kalunguta and Beni health zones remained the hotspots of the epidemic with 67 per cent of 149 confirmed cases reported during the last three weeks.  

Of the total confirmed and probable cases with reported sex and age, 56 per cent (1,755) were female and 29 per cent (893) were children aged less than 18 years. An additional health worker has been infected by EVD during the last week, bringing the number of infected health staffs to 159 since the beginning of the outbreak (5 per cent of total cases).  

During the reporting period, response activities were slowed down in consequence of security incidents, mainly in Mambasa, Komanda and Mandima. In this latter health zone, a major security incident occurred in Lwemba, from 14-16 September 2019 in response to the EVD-related death of a local healthcare worker. EVD response teams were attacked and the response activities on the ground were seriously impacted.

DRC Ebola: Living from paycheque to paycheque

WHO has published its September 12 weekly update: Ebola virus disease – Democratic Republic of the Congo. Excerpts, with my bolding, and then a comment:

Ebola virus disease (EVD) transmission in the Democratic Republic of the Congo continued to ease this past week, with 40 new confirmed cases reported in North Kivu and Ituri provinces; this is the lowest weekly incidence since March 2019. While these signs are promising, it remains too soon to tell if this trend will persist. Emerging hotspots continue to pose challenges in terms of accessibility, insecurity, and violence. Surveillance indicators highlight that public health risks of further spread remain very high. 

During the past 21 days (from 21 August through 10 September 2019), a total of 157 confirmed cases were reported form 15 health zones (Table 1, Figure 2), with the majority coming from the health zones of Kalunguta (19%, n=30), Beni (18%, n=28), Mambasa (16%, n=25), and Mandima (13%, n=20). Alimbongo, Oicha, and Pinga health zones recently passed 21 days without a new confirmed case of EVD. 

As of 10 September, a total of 3091 EVD cases were reported, including 2980 confirmed and 111 probable cases, of which 2074 cases died (overall case fatality ratio 67%). Of the total confirmed and probable cases, 56% (1737) were female, 29% (886) were children aged less than 18 years, and 5% (157) were health workers. 

Under Pillar 1 of the current Strategic Response Plan, the estimated funding requirement for all partners for the period July to December 2019 is US$ 287 million, including US$ 120-140 million for WHO. As of 12 September 2019, US$ 54.9 million have been received by WHO, with further funds committed or pledged. Currently available funds will close the financing gap up until the end of September 2019. Further resources are needed to fund the response through to December 2019, and WHO is appealing to donors to provide generous support.

...

WHO risk assessment

WHO continuously monitors changes to the epidemiological situation and context of the outbreak to ensure that support to the response is adapted to the evolving circumstances. The last assessment, carried out on 5 August 2019, concluded that the national and regional risk levels remain very high, while global risk levels remain low.

Although there are possible early signs of the outbreak easing, including the decrease in numbers of new confirmed cases in Beni and Mandima, these must be interpreted with caution and it is too soon to know if this is an indication of a decrease in transmission intensity of EVD. The high proportion of community deaths, relatively low proportion of new cases who were known contacts under surveillance, existence of transmission chains linked to possible nosocomial infection, persistent delays in detection and isolation of cases, and challenges in accessing some communities due to insecurity and pockets of community reticence are all factors increasing the likelihood of further chains of transmission in affected communities.

The factors mentioned above, coupled with high rates of population movement from outbreak-affected areas to other parts of the Democratic Republic of the Congo, and across porous borders to neighbouring countries, increase the risk of geographical spread – both within the Democratic Republic of the Congo and to neighbouring countries. Conversely, substantive operational readiness and preparedness activities in a number of neighbouring countries have increased capacity to rapidly detect cases and mitigate local spread. These efforts must continue to be scaled-up and sustained.

So WHO's cheques will start bouncing in a little over two weeks, and no one seems upset about it.

You'd think that the African Union, or at least the governments of Uganda, Rwanda, et al. would be raising hell about having to fight a disastrous outbreak on the "generous support" of donors. It's tough enough for ordinary individuals to live paycheque to paycheque, and just a few hundred bucks or euros from disaster. It's absurd to expect international health agencies to do the same—especially when their workers run the risk not just of infection but of being shot dead.

When the rest of the world did its considerable best to ignore Ebola in West Africa, MSF, at least, stood up and chewed out the politicians: if they wouldn't do the right thing out of human decency, MSF was ready to embarrass them into a semblance of good behaviour. We need someone to do the same thing this time.