Three hundred and thirty-five of the last five hundred and twelve deaths happened outside a treatment centre. That number, from WHO's newest outbreak report, runs underneath everything in today's briefing. This is Ebola Watch for Monday, November 9th. First, what WHO's Friday update says about spread, tracing and Kenya's countdown. Then an armed attack in North Kivu that scattered Ebola patients and contacts, and a near-arson at a treatment centre in Beni.
From the World Health Organization's Disease Outbreak News, published Friday, November 6th:
The high proportion of deaths occurring in communities, especially among young children, continues to highlight challenges in early case detection and timely access to appropriate care. Of the 512 deaths reported since 21 October, 335 occurred in communities and 177 in treatment centres.
So most of these people died without ever reaching care. Why does WHO put that up front? WHO treats it as a detection problem. People aren't being found early enough or getting to care in time, and it names young children specifically. The totals as of Tuesday, November 3rd: 10,668 confirmed cases, including 5,198 deaths, a crude case fatality ratio of 48.7 percent. Confirmed cases now span 67 health zones in eight provinces, and 51 of those zones reported a new case in the past 21 days. The newest is Yakoma, in Nord-Ubangi province, with three confirmed cases. Last week Africa CDC had a higher death count. Does WHO explain the gap? Not in this report. And Africa CDC's own figures move around too. At its briefing Thursday, as reported by Xinhua, it gave 10,699 confirmed cases across countries and more than 5,202 deaths. That's lower than the 5,376 it gave AFP a week earlier. We'll keep naming the source and date for every figure. Is contact tracing catching up? Not yet. Over two weeks, the share of contacts seen each day averaged 86 percent, against a 95 percent target. Tshopo was at 71 and North Kivu at 82. North Kivu also had the most new cases in the last seven days, 232, and the highest provincial fatality ratio, 54.8 percent. Kenya. Last week we couldn't confirm those discharges. Did they happen? WHO says yes. Five patients were discharged on November 3rd and two are still in treatment. Kenya has nine confirmed cases and two deaths, all in one cluster, and no new case since October 19th. The last 52 contacts are due to finish monitoring this Wednesday, November 11th. The 42-day countdown starts only after the last patient is discharged. Anything on vaccines? Expert groups convened by WHO recommend adding two Bundibugyo candidates to the Tumaini trial: ChAdOx1, from Oxford and the Serum Institute of India, and Moderna's mRNA-1469. Both still need national approvals. And WHO continues to advise against restricting travel to, or trade with, affected countries.
Al Jazeera, drawing on AP and Reuters, quoting Christian Kakule, medical director of the Kelekele Hospital Centre in Cantine:
“High-risk contacts and other individuals under monitoring have all fled,” he said. “Our concern is that when probable cases end up out in the open like this, they can become a source of transmission and trigger an outbreak of the disease.”
Start with the basics. Where is this, and what happened? Cantine is about 50 kilometres west of Beni, in North Kivu. Overnight from Thursday into Friday, armed men raided villages there, and local officials and civil society leaders blame the ADF armed group. A civil society leader told AP that 33 bodies had been counted. The attackers also set fire to a health post. How many patients got out? I've seen very different numbers. They are different. Dr. Kakule said 180 patients left the hospital, including suspected Ebola cases and one confirmed case. A human rights group in Beni, cited by the Congolese Press Agency, listed five suspected contacts, three of them high-risk, and one confirmed case. Africa CDC's statement on Sunday says hundreds of people with confirmed or suspected infection fled. We haven't seen a report on how many have been found since. And then Beni itself, the next night. Right. On Friday night, according to that same group's statement, police guarding the Médecins Sans Frontières treatment centre in Beni's Byautu neighbourhood stopped people trying to set it on fire. The unrest followed the death of a woman reportedly being treated there. No casualties were reported. Two nights, two attacks, in the province with the most new cases this past week. And we were already covering the October 31st arson in Bafwasende. I'm done treating security as a side note to this outbreak. Africa CDC makes much the same argument. It's calling for a corridor of peace and for protection of patients, health workers and facilities, and it says every interruption to care, tracing and surveillance adds risk. If you're following this from abroad: WHO rates the risk as very high inside Congo, high for countries bordering it, and low globally. It says that assessment is being revised.
We'd like your view on something. When agencies publish totals that don't match, how much of that detail do you want on air? Send us a note at ebolawatch at lantern podcasts dot com.
Tomorrow we'll be watching for word on the patients who fled Cantine, and for Kenya's last contacts as their monitoring winds down. Ebola Watch is a Lantern Podcast. Thanks for starting your week with us. We're back tomorrow.