H5N1

The Guardian view on treating Ebola: Science is the start

An editorial: The Guardian view on treating Ebola: science is the start.

This week has seen a heartening triumph of medical science: Ebola is now curable, doctors say. The announcement is also a timely one. The outbreak in the war-ravaged territories of the north-eastern Democratic Republic of the Congo, which began over a year ago, has defied the sustained efforts to halt it. Last month, with the death toll above 1,600 people, the World Health Organization declared it an emergency of international concern. The even deadlier West African epidemic of 2014 killed more than 11,000 people before it was extinguished, having prompted fear around the world. The high death rate and agonising nature of the deaths all add to the virus’s terrors. 

So the news that two really effective treatments have been discovered and tested, and that they are being rolled out, could hardly be more welcome. International institutions and Congolese researchers and medics have performed a remarkable, almost impossible feat in trialling these drugs in epidemic conditions.  

Just as important as the existence of these medicines, though, is the question of their use and effectiveness. Getting the science right is only the beginning. Ensuring that the drugs are delivered where they are needed and used by those who need them most is a task at least as difficult and now more urgent. The vaccine used in this outbreak came out of the 2014 epidemic – yet its limited success in containing the virus reflects the complexity of this crisis. 

The scene of the latest outbreak is a province that has been fought over for the last 25 years by more than 120 armed groups and has seen grotesque human rights violations. Inhabitants have a deep and very understandable fear of outsiders. Those infected often hesitate to seek help from medics until they have been ill for several days – so relatives see someone go into a treatment centre and come out dead. These related factors help to explain the shocking attacks that have killed more than 170 health workers and burned down two treatment centres. The hope is that a virtuous cycle can now be created: when families see so many patients being cured, they will gain confidence in the centres, and spread the word.  

Ebola attracts so much more attention than the other scourges of the north-eastern DRC not because it is lethal – violence, measles, cholera and malnutrition all kill more people today – but because it was regarded as incurable, and it potentially threatens outsiders too. In the case of the West African outbreak, this risk prompted huge financial and institutional support to flow into the region. 

The DRC still needs that kind of backing from outside. But local communities must lead the efforts to build trust in medics, because only they are trusted by the people who are falling sick. Effective drugs are a necessary condition for the epidemic to be beaten, but unless people are willing to go to the treatment centres when they are sick, the hope they raise will be once more extinguished.

DRC Ebola: 5 new cases on August 13, 7 deaths, 9 recoveries

Via email, the Technical Secretariat has published the August 14 update, with numbers up to August 13:

MULTISECTORAL NATIONAL COMMITTEE OF THE RESPONSE TO EBOLA VIRUS DISEASE

TECHNICAL SECRETARIAT

SUBJECT: EPIDEMIOLOGICAL SITUATION IN THE PROVINCES OF NORTH KIVU AND ITURI AT AUGUST 13, 2019.

Date: Wednesday, August 14, 2019

Since the beginning of the epidemic, the cumulative number of cases is 2,842, 2,748 confirmed and 94 probable. In total, there were 1,905 deaths (1,811 confirmed and 94 probable) and 844 people healed.

• 380 suspected cases under investigation;

• 5 new confirmed cases, including 4 in North Kivu, including 2 in Beni, 1 in Butembo, 1 in Kalunguta and 1 in Ituri in Komanda;

• 7 new confirmed deaths, including 5 in North Kivu and 2 in Ituri:

º 2 community deaths, including 1 in North Kivu in Kalunguta and 1 in Ituri in Komanda;

º 4 deaths in CTEs, including 3 in North Kivu, including 1 in Butembo, 1 in Katwa and 1 in Mabalako and 1 in Ituri in Komanda;

º 1 death in the CT in North Kivu in Beni;

• 9 people healed from ETCs in North Kivu, including 4 in Katwa, 3 in Beni and 2 in Goma;

• No health worker is among the new confirmed cases. The cumulative number of confirmed / probable cases among health workers is 152 (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*

Cross-border meeting between Rwanda, Uganda, Burundi, South Sudan and the DRC_ held in Goma

• The World Health Organization (WHO) is organizing a trans-boundary meeting between Rwanda, Uganda, Burundi, South Sudan and the DRC from 14 to 15 August 2019 in Goma, North Kivu Province. This meeting is part of the reinforcement of collaboration between the different countries in order to put an end to the Ebola virus epidemic that has been raging since 1 August 2018 in the DRC, precisely in the provinces of North Kivu and Ituri;

• Indeed, the cross-border meeting between these different countries

• follows the decision of WHO to place this 10th epidemic as a health emergency of international concern;

• Several stakeholders took part in this meeting, including the North Kivu Provincial Minister of Health, the Secretary General for Health, the representatives of the Technical Secretariat of the Multisectoral Committee for the Ebola Virus Disease Response (CMRE), including Prof. Stève Ahuka, members of the response coordination, representatives of WHO, IOM, CDC Atlanta and Africa, UNICEF and Ocha.

A dignified and safe burial team threatened in Nyiragongo

• A dignified and secure burial team (EDS) was threatened by stone throwing at the HERI clinic in the Ngangi 3 health area in the Nyirangongo Health Zone. The perpetrators of this incivic act are, in particular some members of the community not yet identified,

• Another DHS team was assaulted by Mai Mai in the Kalunguta Health Zone at the Kivetya Health Zone. The balance is three stolen phones. This behavior justifies the failure of the DHS of a positive body, manipulated and buried by the family in this country.

Vaccination

• Since vaccination began on August 8, 2018, 193,246 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.

Surveillance at points of entry 

• Disruption of activities at the KANGOTE checkpoint (PoC) in BUTEMBO Following a rumor that the Mai-Mai were around the PoC.

Ituri: Police disperse protest against Ebola response team

Via Radio Okapi: Ituri: police disperse protest against Ebola response team.

Police on Tuesday (August 13th) dispersed a demonstration by residents of the Mputu district in Mambassa Center (Ituri) against the Ebola response team. In fact, a resident of the neighborhood, suffering from Ebola, died Monday, August 12 at the treatment center of Makayanga.  

According to protesters who develop a conspiracy theory around this case, this death is orchestrated by the response team to obtain funding for its activities.  

Police officers were deployed at strategic points in the city of Mambasa center, as at the Mambasa Reference General Hospital where a temperature control and hand washing device is installed. 

The police commander in Mambassa reports that youths are threatening to attack this site to show their anger. 

According to Franklin Yakani, administrator of the interim territory of Mambassa, the protesters say they are not convinced that the victim, a resident of their neighborhood, died of Ebola.  

The coordinator of the Ebola response in Ituri, Christophe Shako says it is a high-risk contact that has been tested positive. The latter had lost his son on July 30, died of Ebola. The man and his wife had all been admitted to the Makayanga Treatment Center. 

According to statistics provided by the medical team, the health zone of Mambassa has registered to date sixteen confirmed cases of Ebola, with six deaths.

DRC Ebola: Reassured of bail or under house arrest of colleagues, Butembo doctors suspend strike slogan

Via Actualite.cd: DRC: Reassured of bail or under house arrest of colleagues, Butembo doctors suspend strike slogan. The Google translation:

Butembo's doctors decided on Tuesday (August 13th) to suspend their partial strike slogan launched last weekend to demand the release on probation or under house arrest of their three colleagues arrested in connection with the murder investigation. epidemiologist of the World Health Organization (WHO), shot dead last April in Butembo.

In a press release received by ACTUALITE.CD, the local unit of the Butembo Medical Association justified this position by "significant advances" that it said to have noted, after the steps taken with the local authorities, the magistrate instructor, the doctors concerned and their families. 

"After the inventory, we note significant advances: the conditions of temporary release and / or house arrest are defined and started, the sick colleague is transferred to a hospital in the place where he began to receive care. Thus, we, members of the Butembo Cell Corporation, concerned about the well-being of the population, having taken into account the situation of the epidemic in the face of Ebola virus disease, today an international emergency, decide: the suspension of the slogan of the strike, the establishment of a monitoring team for the realization of the promises of bail and / or house arrest," reads their release.  

In the meantime, there will be no doctors' strike in Butembo's health facilities, as they planned at the beginning of the week. The doctors ask the authorities to do their due diligence for the organization of the trial to clarify things within a reasonable time. 

"We do not go against the legal process, nor publicity, nor pressure against justice. The concern was to safeguard the dignity of the detained doctors in relation to the conditions and place of detention, "said the local cell of the medical order, reassuring in the wake that its members agreed on the" no obstruction of justice." 

The doctors who are on trial include Drs. Mundama Witende, Infection Prevention and Control Officer, Grand-Nord, Provincial Health Division, Gilbert Kasereka, Blood Transfusion, Sangala Hyppolyte, in charge of supervising medical activities and Paluku Luendo, all senior executives at the provincial division of health. If the first is out of the country, the last three are at stops Butembo.  

Last week, Colonel Kumbu Ngoma, magistrate instructor of the case confirmed to ACTUALITE.CD that these arrested doctors are part of the fifty people already arrested for their alleged involvement in the murder of the Cameroonian doctor Richard Mouzoko loosely shot by armed men who were equated with militiamen May-May, last April, in the compound of the medical clinic of the Catholic University of Graben (UCG) where he chaired the meeting of a commission of the local coordination of the response to the disease to Ebola virus.

The Guardian view on Ebola in the DRC: Help needed – and dialogue too

Via The Guardian, an editorial: The Guardian view on Ebola in the DRC: help needed – and dialogue too.

Are we able to learn the right lessons when disaster strikes? Five years ago, a devastating outbreak of Ebola in west Africa claimed more than 11,000 lives, and sparked an international panic as it reached the US and Europe. The experience led to the vaccine and experimental treatments now being used in the Democratic Republic of Congo. 

But this outbreak has become the second most deadly despite efforts to combat it over the last year. More than 1,600 people in the north-east of the country have died. Now, with the virus flaring up again in places where it had been contained, reaching the major city of Goma on the border with Rwanda, and spreading over 500km, with cases identified in Uganda, the World Health Organization has declared it an emergency of international concern.  

This is a very different challenge from 2014’s. It is not only a public health but a humanitarian crisis, taking place in a conflict zone, with widespread malnutrition, a struggling health system, and deep suspicion hampering efforts to control the disease: this year has seen 174 attacks on health workers fighting the outbreak. The fear and distrust of outsiders have been compounded by Ebola’s high fatality rates. Vaccines cannot protect those who have already contracted the disease, and though people are more likely to survive with proper treatment, many delay because they do not trust those offering help: by the time they are finally seen, it is far harder to help them. Those around them may wrongly conclude that vaccines or health workers are the problem and not the cure. They see more international groups at work, and more deaths. 

The need for community understanding and engagement – made clear by the 2014 outbreak – is more critical than ever. That means dialogue, not instruction: “We need to listen with the ferocity with which we want to be heard,” says an emergency medical manager for Médecins Sans Frontières. With their most basic health needs unmet, a rapidly spreading measles outbreak, and ongoing problems with cholera, people may not see Ebola as a priority, particularly if their other concerns are not even acknowledged. 

Some experts believe that community leaders and local staff must take the lead in the response, and that supporting home care as an interim, if far from ideal, measure may be necessary. 

But if solutions must be implemented on the ground, they require proper support. WHO hopes that the designation of an emergency will push governments to respond. Its director general, Dr Tedros Adhanom Ghebreyesus, has warned that hundreds of millions of dollars are needed to fight this outbreak; only half of the money pledged has been delivered. Jim Yong Kim, when president of the World Bank, said the west African outbreak could have been snuffed out in months with sufficient funding. But help only trickled in when western countries began to worry about the potential danger to their own citizens. 

The risk is that neighbours may close their borders – crippling the economy, increasing hostility and suspicion, and driving transmission chains further underground as people take unmonitored routes or mask their symptoms at crossings. In 2014, WHO’s advice against travel restrictions was ignored by governments and airlines. 

As the WHO chief said, the decision to call this an emergency should not be used to stigmatise or penalise the very people who most need help. The humanitarian case for backing the fight against Ebola is simple and undeniable. Mothers, fathers, siblings and children are dying, in communities that have already suffered so much. 

If that is not enough to compel greater action, perhaps self-interest will help. One lesson from the 2014 outbreak was that real international commitment can bring the disease under control. Another was that without such efforts it poses a far broader risk.

DRC Ebola: Protest against the response teams reported in Goma

Via Actualite.cd: DRC Ebola: Protest against the response teams reported in Goma. The Google translation:

A strong tension is observed this Tuesday, August 13, 2019 in the district Majengo, north of Goma in the commune of Karisimbi. At the base, some angry residents are protesting the arrival of a response team at a clinic where a woman who came from Kiwanja in Rutshuru territory died. 

"Young people barricaded the road from the three-lantern entrance to Majengo before reaching Buhene. They attack any Land Cruiser vehicle thinking they have teams on board. They say that Ebola is a business imported from Beni-Butembo to Goma. It is now that I have just seen elements of the force of the order to go towards there, maybe to calm my situation," testifies a resident who is at the place of the demonstration.  

"I heard a few shots," the same source added. These protests come as two Ebola cases have been declared cured and have left the Ebola treatment center in Goma. 

At his last press conference, before resigning from the health ministry, Dr. Oly Ilunga demanded that tests be done on all the deaths that will be recorded in the city of Goma and about to prevent the spread of the Ebola virus disease. The city of Goma recorded the first case of Ebola on July 14th.

Mouzoko case: Doctors will not go on strike next Monday

Via Topcongofm.net: Butembo: doctors will not go on strike next Monday.

The decision to postpone the dry strike of protest and solidarity, initially scheduled for Monday [August 12], was taken this Saturday, August 10, at the end of a meeting of the "Butembo cell"  of the national council of the order of doctors.  

The doctors of this territory of the North Kivu province say they want to give a chance to the negotiations carried out to obtain the lightening of conditions of detention of their colleagues, accused of being involved in the assassination last April, of an epidemiologist World Health Organization (WHO) from Cameroon in a militia attack on an Ebola team. 

"We ask that they be under house arrest. We still have the weekend to continue the negotiations," Kalima Nzanu, president of the Butembo Cell of the National Council of the Medical Association , told TOP CONGO. 

Only "if Monday, August 12, they [arrested doctors] are not released on bail and the public hearing is not scheduled, we will start a strike excluding first all outpatient consultations. We will only take in-patients and those who come in emergency," he warned.  

A clear way for Butembo's white coats to escalate pressure on civilian authorities and military justice who, moreover,  "showed a positive attitude,"  suggests Dr. Kalima. "We hope that by this [Saturday] evening or even tomorrow [Sunday], our colleagues will be under house arrest at home," he continues.  

A total of 52 people are arrested in connection with this case. The defendants include 24 suspected Mai-Mai fighters and four Congolese doctors. 3 of them are presumed sponsors and moral authors of this murder, another suspect is on the run and actively sought by the military justice.  

It is besides the military justice which announced to have completed, Thursday August 8th, its investigation of four months which would allow it to understand the circumstances of the fatal attack, on April 19th, of the clinics of the Catholic University of Graben in Butembo. 

It was during this incursion that the Cameroonian doctor Richard Valery Mouzoko Kiboung, coordinator of the response to the Ebola virus epidemic in the health area of ​​Mutsanga, was killed while chairing a meeting with members of his team.

Ebola DRC: Who killed the WHO doctor Richard Mouzoko?

Thanks to GeopoliticalJD for tweeting the link to this long RFI report: Ebola in the DRC: Who killed the WHO doctor Richard Mouzoko? Excerpt from the Google translation:

The emotion is strong in Butembo where one speaks about "new conspiracy against the Nande," one of the main ethnic groups living in the affected areas, or "against the local health system." The four doctors, sons of the country, are well known in this region, as the coordination of the response. 

"Doctors Luendo and Mundana were in the same investigative team that sent the first six samples to Kinshasa on July 29, 2018, which turned out to be positive," said one in the entourage of these doctors. It is these tests that would have allowed the Congolese Ministry of Health to declare the outbreak on 1 August. 

They were, according to their entourage, a group of local doctors who would have proposed an alternative plan of response "which had to better take into account the interests of the communities.".For the local council of the order, with these arrests, key services "are beheaded," such as blood transfusion services, infection prevention and control. Its leaders do not believe in the responsibility of their colleagues and say they have increased the number of arrests with the authorities. 

"Doctors who have sought to destroy the response" 

The Congolese military court said it had arrested 54 people in connection with the attacks on the Butembo response, of which 24 have "confessed." including one who shot Dr. Richard Mouzoko. 

For the general auditor of the army, number 1 Congolese military prosecutor, General Timothé Mukuntu, the case is serious: "We are checking everything, but we can not keep in the response of doctors who have sought to destroy the response." 

A source in the Congolese military justice says: "Two Mai-Mai leaders and two locally-recruited agents of the response, all arrested, have accused two of the doctors." They would have named Dr. John Paul Mundama Witende and Dr. Gilbert Kasereka, arguably two of the best-known local figures in the response, even accused of giving the Mai-Mai money to attack the Horizon Center. 

It would be the latter, Gilbert Kasereka, who allegedly "denounced" the other two doctors, Hyppolite Kisako Sangala and Dr. Aurélien Luendo Paluku, for having participated in meetings "aimed at getting the strangers away from the response, all those who did not come of Butembo." 

In the investigation file, the military prosecutor's office mentions two meetings, one "preparatory" in December and a second in January where these doctors would have decided to act. Its leader, General Timothée Mukuntu confirms: "During these meetings, according to the testimony of Dr. Kasereka, they felt that there were inequalities of treatment between local staff and foreigners in this region and that they had to to send these foreign doctors away." 

The boss of the Congolese military floor ensures that his services have tried to be understanding. "We also had cases of doctors who, because they feared for their safety, gave a little money to the Mai-Mai," he said, assuring that all of these practitioners had been relaxed "given the context and the security situation." 

A "black hand" to "counter the response to communities" 

These Mai-Mai groups control affected areas in which the agents of the response try to surrender. In Butembo's civil society, an activist pointed to the arrest of two ANR collaborators, including a driver in the attacks on the response, as proof of the complexity of the relations between these groups and the "milieu". One of them, nephew of one of the armed group leaders arrested, asked him to assassinate the bishop of Butembo for his support of the riposte. 

"It's true that there was a lot of anger against the riposte, but there was also a lot of manipulation," insists this activist.  

On the side of the defense team of the four doctors, we are overwhelmed by everything, but we refuse "at this stage of education" to speak publicly. A lawyer denounces an "irregular procedure," with long-term detentions on mere "appearance warrants." 

Dr. Mundana, one of the main perpetrators, was "absent" from Butembo, he was traveling to Nairobi for family reasons. Today, according to this lawyer, he would be outside the country. But like his colleagues, "he continued to work within the response" after the death of Dr. Richard Mouzoko and had "no conflict" with the victim. 

"It will still be necessary for the military prosecutor to explain to us the link between these meetings and the murder four months later," he added.

Killing of WHO epidemiologist in Butembo: MP accuses investigators of demanding up to US $ 5,000 for those arrested for their release

Thanks to Augustín Benito for alerting me to this August 6 report, which I'd missed, in Actualite.cd: Killing of WHO Epidemiologist in Butembo: MP accuses investigators of demanding up to US $ 5,000 for those arrested for their release. The Mouzoko Affair grows ever more complex. The Google translation:

The national deputy Tembos Yotama denounced this Tuesday, August 6, 2019 "harassment" in the investigation into the assassination of Dr. Richard Mouzoko, epidemiologist of the World Health Organization (WHO) killed last April by militiamen, then that he was involved in the Ebola response in Butembo town. 

In an interview with ACTUALITE.CD, this Butembo elected accuses investigating officers of the Operational Military Court of North Kivu, "wanting to get rich behind the case, arresting innocent people and conditioning their release by the payment of exorbitant sums of money. 

"Investigations in the case of the murder of Dr. Mouzoko, became a business. Twenty innocents, including three local doctors, are now arrested. And the investigators condition their release by the payment of exorbitant amounts of money, which vary from 3 000 to 5 000 US dollars according to the identity of defendant. I have just returned from the parliamentary holidays of Butembo, several relatives of the victims came to see me and to ask for my implication. People to whom the investigators ask, by intermediaries, exorbitant sums. I even exchanged with the relatives of an innocent victim who had to pay $3,500 for his release. It exaggerates. Instead of searching for the truth, people make inquiries a business.

He pointed out that for the time being, the arrested persons, including three doctors, were languishing in prison, some in Bunia, where they had been transferred, and others in Beni and Butembo. The Butembo representative demands the involvement of the military hierarchy, for the urgent holding of a public trial in Butembo, in order to "condemn the real perpetrators and release innocent citizens". 

"In principle, this trial was a flagrant case because suspects were immediately arrested. An urgent trial was needed for the truth to be known. But now, four months later, nothing is done. We are seeking the involvement of Kinshasa authorities in holding a trial in Butembo. Otherwise, there is still a risk of making work difficult for friends involved in the response to Ebola, by provoking resistance, especially in the heads of disaffected residents to see their loved ones suffer innocently in prison," he warns.  

The Cameroonian doctor Richard Mouzoko was shot dead by militiamen while he was chairing a meeting of the "active research" committee of the local coordination of fight against the Ebola virus disease, in the walls of the medical clinic of the Catholic University of Graben (UCG) of Butembo. 

In the aftermath of the tragedy, the Operational Military Court of North Kivu announced the arrest of the suspects and promised the "immediate" holding of a public trial. But four months later nothing was done.  

In an August 7 Actualite.cd report, the investigating magistrate, Col. Kumbu Ngoma Marcel, denies the charges, saying that at this point, those charged can't be freed on bail. 

Typhoons, disease outbreaks and now escalating protests: Hong Kong isn’t ready for a citywide disaster

An op-ed in the South China Morning Post: Typhoons, disease outbreaks and now escalating protests: Hong Kong isn’t ready for a citywide disaster. Excerpt:

The UN Office for Disaster Risk Reduction launched a worldwide “Making Cities Resilient” campaign in 2010, identifying 10 essential points. This was evaluated locally in the 2018 study “Assessing the Disaster Resilience of Megacities: The Case of Hong Kong”. 

Unfortunately, Hong Kong’s disaster preparedness was judged to have failed on three counts. Specifically, the city came up short in “institutional capacity” and “risk identification”; and, under “organising for disaster resilience”, Hong Kong was said to have inadequate governance and a lack of a strategic “city vision”. 

Infrastructure development and financial resourcing were seen as the strengths. But, notably, new and unpredictable risks precipitated by unstable sociopolitical dynamics were flagged as challenges comparable to climate change.  

The emergency and disaster response system in Hong Kong is administered by the Security Bureau, and consists of three tiers. The first level is based on primary emergency services. Aggravated risk to property or life requires the second tier, involving government monitoring by a Security Bureau duty officer and emergency support unit.  

In the event of large-scale threats to property, life, public order or security, the third-tier response is triggered, coordinating emergency services, security control, civil support actors (including auxiliary medical staff and hospitals) and maintenance of essential infrastructure, supervised by the chief executive’s security committee. 

This system is designed to operate the three phases of emergency response – rescue, recovery and restoration – under one umbrella. Events requiring more assets than those used on a day-to-day basis by emergency services are deemed major incidents; when the capacity is overwhelmed by the number of injured, the situation becomes a mass-casualty incident. 

Relevant here are the concepts of “population at risk” and the “casualty estimate”. Recent public demonstrations have involved hundreds of thousands, even millions – and violent confrontations with police are taking place. A misjudgment in protest control by law enforcement officers, causing a crowd crush or stampede, or an overly vigorous ballistic response, could result in a (conservative) casualty rate of 0.1 per cent, potentially creating many hundreds of victims.  

This should be considered in the context of the overall “casualty handling capacity” of Hong Kong’s hospitals, where intensive care unit beds – totalling perhaps 300 – would be quickly overwhelmed. 

When the response system itself becomes impaired, it can lead to a compound disaster. Given the critical role of police in disaster management – in terms of cordon, control and co-ordination (with ambulance and first aid responders for triage and casualty evacuation) – a conflict where there is widespread hostility between the public and law enforcement officers involves an amplified risk of a crisis during the handling of victims. 

The right to medical care for injured civilian protesters is provided under international human rights law (and these protections extend to the humanitarian work of identified first aid volunteers embedded within the protests). These global norms would still apply even if martial law were declared.