Ebola spread to Goma triggers new emergency talks, cases top 2,500

Goma DRC

MONUSCO /Abel Kavanagh/Flickr cc

Amid two new worrying developments—the spread of Ebola to the provincial capital Goma and the murders of two response workers in Beni—experts and potential donors took part in a high-level meeting in Geneva today to assess current conditions and build more support for the Democratic Republic of Congo's (DRC) outbreak.

Based on the spread of the virus to Goma, a major transit hub and home to about 1 million people, World Health Organization (WHO) Secretary-General Tedros Adhanom Ghebreyesus, PhD, said he will reconvene the Ebola emergency committee as soon as possible to consider if developments warrant a public health emergency declaration. The committee has denied the designation three separate times during this outbreak.

In other developments, over the weekend the DRC health ministry reported 27 new cases and today is expected to confirm 12 more.

Spread to Goma triggers new call for emergency committee deliberations

The patient who tested positive for Ebola in Goma is a 46-year-old pastor whose first symptoms appeared while he was in Butembo, where he visited seven churches and laid hands on Christians, including those who were sick, the ministry said in an update yesterday. The man was treated at home by a nurse before leaving for Goma by bus on Jul 12.

During the trip from Butembo to Goma, the bus passed through three health checkpoints, but the patient apparently didn't show signs of disease, though he wrote different names on traveler lists, which the ministry said may have been an attempt to hide his identify and illness symptoms.

Goma is the capital of North Kivu province, and health officials have been preparing the city for possible Ebola cases since November 2018, due to a large influx of travelers from areas affected by the outbreak. As part of the efforts, more than 3,000 of the city's health workers have been vaccinated and trained on how to detect and manage Ebola patients.  Goma is south of North Kivu province's main outbreak area and borders the Rwandan city of Gisenyi, which has a population of about 86,000.

When he arrived in Goma yesterday, the case-patient sought care at a health center for his symptoms, which included fever. Health workers quickly recognized that the man had Ebola symptoms and alerted responders who transferred him to Goma's Ebola treatment center, where lab tests confirmed an Ebola infection. No other patients were at the health center, which the ministry said reduces the risk of spread.

The ministry said the risk of spread in Goma is low, due to how quickly the case was detected and because all bus passengers—18 plus the driver—have been identified. To prevent transmission, the health center will be contaminated and all contacts will be identified, vaccinated, and monitored.

Doctors Without Borders (MSF), which supports Goma's Ebola treatment center and has been working for 6 months to help the city prepare for cases, said today that the patient was transferred to Butembo this morning, based on the health ministry's decision.  It said the spread of Ebola to Goma shows that the situation is still concerning and that the outbreak is still not under control.

On Twitter yesterday, Tedros said health officials have long anticipated the spread of Ebola to Goma. "We have been doing intensive work to prepare Goma so that any case is identified and responded to immediately." Today he added that the illness in the city could be a "game-changer" in the epidemic.  "I have therefore decided to reconvene the Emergency Committee as soon as possible to assess the threat of this development and advise me accordingly."

The upcoming meeting would be the fourth time the emergency committee has met to discuss outbreak developments. In mid-June after a cluster of imported cases was detected in Uganda, the group said the situation hadn't met all criteria for a public health emergency of international concern (PHEIC) under the International Health Regulations.

Attacks kill two Beni responders

Also yesterday the ministry said two Ebola responders in Beni, including a community relay member and a street leader, were each killed in their homes on the nights of Jul 13 and 14 in the Mukulia health area, which borders Butembo.

The members of the local response team had been receiving threats since December, and the female community relay member had been attacked a few times a few weeks ago, but was saved after giving money to her attackers.

Several sources told the ministry that the attackers are from the same neighborhood as the two victims and they envied the workers because they had found jobs with the Ebola response.

Meeting affirms support for DRC response, calls for international support

At the end of the high-level meeting in Geneva today, hosted by the United Nations, the WHO said in a statement that though the outbreak is still confined to North Kivu and Ituri provinces in the DRC, it is at a critical juncture and that the spread to neighboring provinces and countries is very high. Tedros said health officials have better tools to battle the outbreak, including an effective vaccine. "But we need to see an end to the attacks and other disruptions to the response."

Since January, the health response has been hit by 198 attacks, resulting in 7 deaths and 58 injuries.

Mark Lowcock, the UN's undersecretary general for humanitarian affairs and emergency relief coordinator, said donors and responders at today's meeting expressed confidence in the current approach to battle the virus. However, he added, "Unless we get substantially more financial resources immediately, it will not be possible to end the outbreak."

At the meeting, Rory Stewart, secretary of the United Kingdom's Department for International Development (DFID) called on other countries to step up their support for the Ebola response in the DRC. In a Twitter post today, Stewart, who toured the outbreak region last week, said, "Unless we get this right, what we've seen in Uganda, what we've seen in Goma, will happen again and we're going to have some very, very deep regrets." The British government has so far donated £37.7 million to the DRC's two most recent outbreak responses, and today Steward announced £50 million more.

New cases boost outbreak total past 2,500

In a pair of updates over the weekend, the health ministry reported 27 new cases from 7 different locations, including Beni (13), Mabalako (6), and Katwa (4). Four health zones each reported a single case: Alimbongo, Butembo, Mandima, and Manguredjipa. In its update yesterday, the health ministry said it was still investigating 335 suspected cases.

Three of the new cases involve healthcare workers, two from Beni and one from Mabalako. One was vaccinated, another was unvaccinated, and the third has an unspecified vaccination status.  So far, 136 Ebola infections, 41 of them fatal, have been reported in health workers.

Today's WHO online Ebola dashboard suggests that later today the health ministry may announce 12 more cases, which would push the overall outbreak total to 2,501 cases.

Over the weekend the health ministry said 17 more people died from their infections, lifting the fatality count to 1,665. Seven people died in community settings and seven patients died in Ebola treatment centers.

See also:

Jul 13 DRC update

Jul 14 DRC update

Tedros Twitter feed

Jul 15 MSF statement

Jul 15 WHO press release

Jul 15 DFID Twitter feed

Jul 15 Express story

WHO online Ebola dashboard

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