On Saturday, a man who had been sick for about a month landed in Nairobi, and the airport didn't flag him. Kenya is now watching dozens of people because of it. And in Geneva, the head of WHO gave a split verdict on Congo: slowing in some places, still growing in others. This is Ebola Watch for Thursday, October 8. I'm Cera. New listeners: this is the Bundibugyo strain, declared in Congo on May 15, with no licensed vaccine or treatment. Today, WHO's newest count, Kenya's contact list, a hard AP report from North Kivu, and a vaccine trial in Uganda. Tap follow so the next episode finds you.
WHO Director-General Tedros Adhanom Ghebreyesus, at Wednesday's media briefing in Geneva:
While transmission is going down overall, new hotspots continue to appear, including in areas close to the border with South Sudan.
South Sudan. That's a new edge on the map. Where are the numbers? Tedros put it at 8,665 confirmed cases and 4,178 confirmed deaths. That's up from the 8,603 and 4,148 we gave you yesterday. The same totals are in Congo's national epidemiological report published Tuesday, which Outbreak News Today summarized, and that report puts the overall contact tracing rate at 80.4 percent. So transmission is going down, and there are new hotspots. Both in one sentence. Which am I supposed to believe? Both. He says about 2,000 alerts come in daily, more than 600 people are enrolled in treatment trials, and a vaccine trial is expected to start later this month. But the majority of deaths still happen in the community rather than in treatment centres, and he said contact tracing is still not at the level needed. And he said something about travel bans, right? He did. WHO advises against blanket travel or trade restrictions, which he called less effective than screening and contact tracing. His line was, quote, transparency should be rewarded, not punished. That comes four days before the U.S. entry ban on covered foreign nationals recently in Congo, Uganda or South Sudan is set to expire this Sunday, October 11, unless it's amended. So Sunday tells us whether anyone in Washington was taking notes.
Yvonne Kawira, writing for Willow Health Media:
Yet the airport did not flag a man who, by the ministry’s account, had been ill for a month. Officials have not said what his screening found, whether a health officer stopped him or whether the thermal scanners worked.
We covered Kenya's first Ebola death yesterday. So what's actually changed? Mostly the contact list. The ministry's first list had 28 names. State House now says 56 people are being traced or monitored: eight family members in quarantine, 21 health workers who cared for him, and 27 passengers from his flight. Tedros put it at 55. Close, not identical, so you get both. Fine. Now the airport. How does somebody a month into this illness get through? Officials haven't explained it. Health Cabinet Secretary Aden Duale said he went through normal public screening when he landed at Jomo Kenyatta International. Uganda's health ministry says screeners at Entebbe recorded a normal temperature when he left, and that Uganda remains free of Ebola. And Willow's own team says the sensor on a screening machine at that airport was switched off when they flew in on September 28. To their credit, they also say they can't tell whether that affected his flight, and that one observation is not a verdict on the airport. It's a question for Port Health Services, not an answer. Okay, the practical one. Somebody listening has a ticket to Nairobi. Now what? An HHS spokesperson told the Africa Bazaar on Tuesday that CDC is evaluating whether additional travel measures are needed, and that its assessment of the risk to the U.S. public hasn't changed. And WHO's Africa regional director, Mohamed Janabi, said an outbreak in Kenya would require ongoing local transmission there, which he said had not occurred.
Chinedu Asadu, reporting for the Associated Press:
More than 70% of new cases are still coming from outside of known contacts and at least 60% of deaths are outside of treatment centers, Africa CDC Director-General Dr. Jean Kaseya told The Associated Press. “There are so many other people who are becoming sick, who are not tested, treated, or listed,” said Kaseya on Tuesday.
Wait. A few minutes ago we said the contact tracing rate was 80 percent. That's the national report. Kaseya told AP only 23 percent of expected contacts have been traced. The reporting doesn't explain the gap, so I won't smooth it over. What's clear is that most new cases are turning up among people nobody had listed. That's exactly the tension people should hear. So where's it worst? North Kivu. It now accounts for about 40 percent of newly confirmed cases, up from 24 percent at the end of August. Its fatality rate among confirmed cases is 58 percent, the highest of the seven affected provinces, and the virus has reached half of its 34 health zones. And MSF's word for the response there is chaotic. Aid groups don't usually say that on the record. Stéphanie Hoffmann, who coordinates MSF's treatment centre in Butembo, told AP there's a lack of coordination and a lack of actors present. We aired MSF's full-beds warning on Tuesday; what's new is the cost to ordinary clinics. She says local health workers must choose between sending sick community members home or putting themselves at risk to treat them. And the families in the middle of this? Michel Ngimba of the National Institute of Biomedical Research in Butembo says some residents still have a hard time believing the disease exists, and some families are reluctant to report a death or allow a sample. That's a trust gap. Kaseya's answer is a village-centred approach, with local leaders directly involved in tracing, burials and isolation.
From a release on the Uganda Research Unit's new trial, distributed by the Serum Institute of India:
The Serum Institute of India (SII), based in Pune, India, has collaborated to manufacture and stockpiled approximately 620,000 doses of the ChAdOx1 BDBV vaccine candidate in two weeks for potential future use.
Six hundred twenty thousand doses, already sitting there, for a vaccine that's only now starting human testing in Uganda? Stockpiled for potential future use, per the release. The trial itself is Phase I. Researchers in Masaka City, southwestern Uganda, are testing the Oxford-developed candidate in healthy adult volunteers for safety and immune response. It follows a first-in-human trial of the same candidate in the UK, and CEPI funds both. When did the first shots go in? Small wrinkle. The release is dated October 6, but one version says the first volunteers were vaccinated Monday the 5th, and two others say Tuesday the 6th. Either way, early this week. Is this the vaccine trial Tedros said starts later this month? His remarks don't say which trial he meant, so I won't link them. What I can tell you is that Phase I measures safety and immune response, not protection. If it succeeds, CEPI expects to back late-stage trials aimed at emergency use authorisation or licensure. And the lead researcher talks about future outbreaks. So not this one. Professor Eugene Ruzagira does frame it that way. For a nurse in Butembo this week, the tools are still beds, tests and tracing.
One quick ask. Is there a figure you want us to keep tracking, maybe Kenya's contact list or that 23-versus-80 tracing gap? Or did we get something wrong? Write to ebolawatch at lantern podcasts dot com. We want the corrections too.
Tomorrow, Friday, we'll be watching for any word from Washington before Sunday's entry-ban deadline, for updates on Kenya's 21-day contact monitoring, and for Congo's next national count. Every source we used today is in the show notes. Ebola Watch is a Lantern Podcast. Look after each other, and we'll talk tomorrow.