‘A disease you get when you care for someone’: WHO on the Ebola frontline

Early detection and community mobilisation remain critical to saving lives, as potential treatments and vaccines are being still being assessed, the UN health agency said on Friday.

Since 15 May, UN agencies have been supporting both the DRC and neighbouring Uganda to contain the outbreak caused by the rare Bundibugyo strain of the Ebola virus, which spreads through close contact.

“It’s a disease that you get when you care for someone, for your husband or your partner or your child or your mother,” Anaïs Legand, a WHO Technical Officer told reporters in Geneva.

“You get it when you want to help someone with symptoms, and this is terrible,” she said, explaining that families and friends must be instructed not to touch loved ones who are falling sick.

30 to 50 per cent chance of death

Ms. Legand highlighted the critical importance of prevention and early access to care, in the face of this particularly deadly disease. Based on previous outbreaks the lethality “ranges between 30 and 50 per cent,” she said – “it’s huge.” 

While “five out of 10 people are likely to die,” more can be done to promote recovery, according to the WHO expert. 

“We can scale up optimized intensive care,” she said. “We can support the communities to recognize the symptoms early to get early diagnostics, so that they can receive the level of care they need.”

Experience shows that Ebola flare-ups can only be controlled when communities are “fully involved” in the response, Ms. Legrand insisted — highlighting a recent case in the DRC where a patient fully recovered and was discharged from the hospital.

Detective work

WHO has gathered experts to review potential treatments and vaccines against the virus, with several products now identified for further assessment. 

For confirmed cases, three candidate therapeutics for treatment  have been prioritised for clinical trials, Ms. Legand revealed: the monoclonal antibodies MBP 134 and maftivimab, and the antiviral remdesivir. 

For prevention, the oral antiviral obeldesivir is being prioritised within a clinical study as a post-exposure measure for those who have been in contact with confirmed cases.

The WHO expert added that two candidate vaccines have been identified for evaluation once doses become available.

The agency is working closely with the governments of DRC and Uganda while at the same time “urgently scaling up care capacities.”

Access issue

“This outbreak is happening in a very complex context,” she stressed, recalling that in the affected Ituri province alone, 1.2 million people require humanitarian assistance, while ongoing conflict and food insecurity are hampering the response.

“The issue that we have in the field is not necessarily an issue of resources,” Ms. Legand insisted. “It’s an issue of access.”

The airport in Ituri province’s capital Bunia has been closed, and while the DRC Government has allowed humanitarian flights to proceed, operational constraints remain. “One day I got a call from my team telling me there is no fuel,” the WHO expert said.

Tedros on the ground

The WHO chief Tedros Adhanom Ghebreyesus arrived in DRC on Friday, telling reporters in the capital Kinshasa that he was there to show the community is “not alone”.

He appealed to the multiple armed groups who act with impunity in the war-ravaged eastern region to declare a ceasefire so that health workers can reach people in need and halt spread of the disease.

The DRC notified WHO of an outbreak of Bundibugyo virus disease on 15 May and as of Thursday, 125 confirmed cases have been reported, including 17 deaths across Ituri, North Kivu and South Kivu provinces. 

In addition, 906 suspected cases including over 223 deaths are under investigation and are being reviewed as testing capacity improves.

In Uganda, as of Thursday there were seven confirmed cases, including one death. WHO said that there is no evidence of community transmission in the country at this stage.

No travel restrictions, for now

While indicating that people from the affected areas who may have been exposed to Ebola should not travel, the UN health agency does not recommend any restriction on travel or trade with the DRC or Uganda based on the current information.