One attack in North Kivu, and more than a thousand people the Ebola response was tracking are suddenly out of reach. This is Ebola Watch for Friday, November 13th. First, what WHO and Africa CDC said at their briefings on Thursday about violence in eastern Congo, along with a new confirmed count. Then Kenya, where the last patient has gone home and the countdown to an end date has begun. If today's show was useful, follow us wherever you're listening — the next one will be waiting.
Kerry Cullinan, writing for Health Policy Watch:
Three Ebola patients and 1,000 contacts fled last week after rebels attacked the North Kivu town of Cantine-Aloya last week, WHO Director-General Dr Tedros Adhanom Ghebreyesus told heads of state this week.
Hang on. On Monday we reported at least 33 killed in that attack. Is this the same one? Same attack, and the count has gone up. The 33 was a civil society tally. WHO now says the November 5th attack on Cantine-Aloya, in Beni territory, killed 66 civilians, three of them health workers, and that three health facilities were looted and burned. Africa CDC's Wessam Mankoula gave Reuters the same figure of 66 and blamed the Allied Democratic Forces. He said more than 1,000 contacts were lost to follow-up, and that three confirmed cases are still unaccounted for. Three confirmed patients nobody can locate. That's exactly the gap tracing is meant to close. And it doesn't look like a one-off. Mankoula counts four armed attacks, 16 assaults on responders and 11 health facilities burned or otherwise targeted, and he says the attacks have grown deadlier since late September. Xinhua reports that WHO has verified 81 attacks on health care since the outbreak began. According to WHO incident manager Catherine Smallwood, there were more attacks in Mabalako health zone on Wednesday night, which means response work there stays suspended. So where are the numbers now? Congo's health authorities reported 11,114 confirmed cases and 5,433 deaths as of November 10th, which Xinhua puts at a case fatality rate of 48.9 percent. That's up from the 11,042 we reported on Wednesday. WHO's Marie Roseline Belizaire said 400 to 500 new cases are still being reported every week. In the 21 days to November 7th, Congo confirmed 1,472 cases, compared with 1,388 in the 21 days before that. Cases fell in Ituri but rose 31 percent in North Kivu. Is anywhere actually finished, then? Smallwood warned against assuming that. Mahagi, in Ituri, reported new infections after about 90 days without a case. WHO's Chikwe Ihekweazu said around 60 percent of deaths are being reported in communities, and that includes private and traditional facilities. Congo's Professor Steve Ahuka said many of those private facilities lack isolation units. And WHO told another briefing that children make up more than a quarter of confirmed infections and about a third of deaths.
Mercy Chelangat, reporting for Kenya's Daily Nation:
"Tomorrow marks day one of the 42 days to the end of this outbreak. If no case is recorded within that period, Kenya will officially be declared free of Ebola on December 23," he said.
That's Health Secretary Aden Duale. On Tuesday he still had one patient in care. Now that patient's gone home? Yes, discharged on Wednesday, November 11th. Duale said the patient left healthy and free of the virus, and the last 11 contacts in quarantine also went home after finishing monitoring. In his words, for the first time since Ebola was announced, Kenya has no patient under treatment or in quarantine. Day one of the clock was Thursday. Forty-two days is twice the longest incubation period, so if no new case turns up, the declaration falls on Wednesday, December 23rd. Kenya had nine cases, right? Where did they all end up? Two deaths, the first patient and his mother, and seven recoveries, according to Travel Industry Today. Every case traced back to the first patient's contact list. WHO Africa's Abdourahmane Diallo called it a moment of cautious celebration. He was Guinea's health minister during the West Africa outbreak, and he reminded everyone that Guinea once celebrated an end too early. The virus persisted in a survivor's body fluid for two months after discharge, and that led to a resurgence. Which explains why survivors are still getting follow-up care. Now the travel side. Does any of this change things for travelers? Not yet. Duale says the travel restrictions on Kenyans, Saudi Arabia's included, should be reviewed, because transparency should not be punished. He was also clear that his ministry won't issue Ebola-free or quarantine certificates for travel, since they have no basis in the International Health Regulations. And for Kenyans in Congo who want to come home for the holidays, he said the foreign ministry will issue an advisory within days. And Nigeria? Today was supposed to be its date too. WHO said Nigeria's remaining contacts were expected to complete monitoring by today, November 13th. We haven't seen confirmation that they did, so we'll report it once it comes.
Is there a number you'd like us to track every day, such as contacts under follow-up or the countdown dates for each country? Send your suggestion to ebolawatch at lantern podcasts dot com.
Next episode is Monday. We'll be watching for word on Nigeria's contacts and for anything new before Tuesday's vaccine advisers' meeting. Ebola Watch is a Lantern Podcast. Have a good weekend.