〇month after new moon Ebora An outbreak was reported in the East African country of Uganda, World Health Organization (WHO) officials said this week. outbreak It is “rapidly evolving”. We spoke with Ebola survivor Craig Spencer, an emergency room physician and associate professor of health services, policy, and practice at the Brown University School of Public Health. 60 infected According to the Uganda Ministry of Health, 24 people have died..
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Consider global health: What do we know about the current Ebola outbreak in Uganda?
Craig Spencer: Uganda declared an outbreak on 20 September. It’s no surprise that Uganda has had another Ebola outbreak. There have been multiple occurrences. What struck me was how fast they grew. In just a few weeks, it has become the top half of all Ebola epidemics. It seems to have slowed down a bit now. However, it is not clear whether it reflects the true reality of the outbreak.
Consider global health: Is slowing down a good sign? Also, are there any specific regions where spread is of greater concern at this time?
Craig Spencer: It’s the waiting game to see what happens with this outbreak. Five districts have been affected so far.Health activists there have focused primarily on Mubende [a town in the central region of Uganda]They are working with Uganda’s Ministry of Health to set up treatment facilities and set up case management and follow-up.
Ebola survivor and caregiver Rachel Kahindo holds her Ebola baby outside the Ebola treatment center in Butembo, Democratic Republic of the Congo, March 25, 2019.
Reuters/Baz Ratner
Consider global health: Is it a multi-pronged effort or is it led by one entity?
Craig Spencer: WHO and other stakeholders have set up epidemiological tracing. It is clear that the Ugandan government and the Ministry of Health want to take the lead and are taking the lead.
Other groups, such as MSF, have been in the country before and have built treatment centers and are involved in managing the disease. WHO, MSF and the Uganda Ministry of Health are doing most of the work. Here it became very clear that the Ugandan government was in control.
Consider global health: Can you talk a little bit more about why the government took the lead?
Craig Spencer: Uganda has managed multiple outbreaks in the past. They have had Ebola before. But Ebola is not alone. There have been many other infectious threats in recent history.They obviously have experience and many [people in Uganda] It is much more comfortable to have the Ugandan government manage it. Clearly, gaining local leadership and buy-in is critical.
In most other large-scale outbreaks, we have found that responses are coordinated by international groups. Use us.” The lack of large numbers of humanitarian workers on the front lines can lead to rumors, misinformation and resistance about the virus. [to disease prevention and vaccination] by the community.
Consider global health: Is there a downside to governments implementing their response to this outbreak?
Craig Spencer: We must remember the militaristic responses to enforce quarantines in Congo, Sierra Leone and Liberia. So there has to be some balance between what is necessary to control an outbreak and what is beneficial to do so. However, both international and local governments can make mistakes.
Uganda declared an outbreak on 20 September, but Ebola may have been circulating for weeks or months before it was recognized and confirmed.
Consider global health: How, if any, should the global health community get involved?
Craig Spencer: There are some big things. We know we need community involvement. We know this: All the lessons learned from the Ebola outbreak say that the community should have been more involved.We need to understand how the socio-cultural impact of Ebola affects communities, not just the big picture [of eradicating the virus].
We also need to recognize that the risk of spread to neighboring countries can be devastating. Uganda is far better prepared for Ebola than its neighbor South Sudan, for example. There were some warnings there, but no confirmed cases.
Burundi needs testing capacity as it historically lacks the infrastructure to deal with Ebola. Also, it is a test that returns results within 1-2 days, as opposed to 5-7 days for him to request results from a lab in South Africa. Countries that have not yet expanded should prepare to respond early.
Consider global health: What is Uganda’s testing capacity like today?
Craig Spencer: Within Uganda, testing appears to be increasing at central government facilities and at the Ebola Treatment Center in Mubende. With Ebola, we’ve learned that we need to expand our testing beyond what you might think. It requires a huge amount of infrastructure.
Consider global health: Why are burial sites a concern?
Craig Spencer: Swab everyone who died in West Africa. They are tested for Ebola to make sure they have not died of Ebola. In West Africa, burial practices have been found to be a major factor in the spread of Ebola. The “Witch Doctor” was a big diffuser.
Ebola is often described as a highly contagious disease, but it is not. But if you’re preparing to bury someone and cleaning up, that’s dangerous, and WHO has certainly monitored burials.
Consider global health: How can people in Uganda and other countries avoid infection?
Craig Spencer: most of what we do [hygiene-wise] in daily work. If you just wash your hands, it’s pretty safe. Contagious in certain settings. Especially the burial setting.
It is also dangerous to be a healthcare provider, especially without gloves. PPE is useless unless used correctly. Correct use can reduce most of the infections. There is a great focus by the international community, the United States, to ensure that there is sufficient PPE. And it matters how variable and well implemented they are.
Consider global health: You have personally experienced Ebola. Aren’t you worried about re-infection?
Craig Spencer: I had Ebola Zaire in 2014. I’m not 100% sure, but I’ve never heard of anyone getting Ebola twice she got it. We believe that once infected, reinfection with the same virus can be prevented in the long term. It is very unlikely, if not impossible, to catch Ebola Zaire again. Is it possible to catch Ebola Sudan, the species that now lives in Uganda? It is reasonable to assume that it will not work for
There were often people who recovered and helped care for other sick people.We also see that a very small number of people who have been previously infected can carry the virus for a long period of time and later have a relapse of the disease. in guinea soon.
Consider global health: Are certain types of patients at increased risk of dying from Ebola?
Craig Spencer: Children do not do well. In my experience, it was basically Ebola Zaire’s death sentence for her children under the age of five. But among the last cases in Guinea, a newborn survived – it’s not known why – if you look at children under the age of 5 or over her 60s, the baseline mortality rate is already very high. It is
Consider global health: What is the current state of the Ebola vaccine?
Craig Spencer: Two vaccines used against Ebola Zaire have been found to be highly effective. Vaccines have been incredibly successful in virus-exposed populations. But getting these vaccines to people has been difficult.
As for the Ebola-Sudan vaccine candidate, the Sabin Institute is working on one, with 100 doses available and hopes to scale up to thousands in November. For the few candidates that do exist, we do not yet have as much safety and efficacy data as we would ideally like.
Consider global health: The United States announced earlier this month that all Traveler from Uganda You must enter and pass through one of five airports. Should travelers be worried about Ebola?
Craig Spencer: People with Ebola probably won’t travel. I’m not too concerned about our ability to respond here in the United States. Gloves, hygiene, etc. will help prevent Ebola at any of our facilities. I was a little disappointed with the travel screening notice — what we already do in Uganda, and what we should do elsewhere — did not involve providing material and logistical assistance.
We have seen a lot of stigma in previous outbreaks. The last Ebola outbreak has shown us that we need to protect this at the root. A travel ban will not help if this issue is not addressed in the community.
We provide funding and help the US with logistics and resources. But this is another kind of virus. What I always keep an eye on is that despite fighting many outbreaks before the Ebola outbreak, even though these outbreaks have occurred over and over again, the same mistakes are being made over and over again. We focus on biomedical imperatives for societal phenomena. Community engagement is often not at the forefront of our response. Contact tracing and testing are very important in the first few weeks. But having an anthropologist, a trusted community leader, and a religious leader can help.Stopping Ebola in Liberia
Over the past few years, there have been many concerns about how we will respond to another COVID-19 pandemic, or the next. I think the way we are responding to the Ebola outbreak shows that.
The Uganda Red Cross Medical Note tracks the number of people tested for Ebola at the Uganda-Democratic Republic of Congo border on June 13, 2019 in Mpondowe, Uganda.
Reuters/James Akena
