If Someone Is Cured From Ebola Can You Still Get It Again

Un peacekeepers stand next to a patient during a visit of the U.North. secretary-general at an Ebola treatment center in Mangina, North Kivu province, concluding September. Alexis Huguet /AFP via Getty Images hide caption

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Alexis Huguet /AFP via Getty Images

United nations peacekeepers stand next to a patient during a visit of the U.N. secretary-general at an Ebola handling center in Mangina, North Kivu province, last September.

Alexis Huguet /AFP via Getty Images

Last autumn, Félix Tshisekedi, the president of Democratic Republic of Congo, fabricated a triumphant prediction: Before 2019 was over, the Ebola outbreak that had ravaged his country for more than a twelvemonth would finally exist brought to a close. Already, health workers had managed to quash the Ebola virus in all but a small set of remaining hot zones. New infections had slowed to a trickle.

Then, on November. 28, unidentified armed men launched a series of attacks on the offices and living quarters of several Ebola response teams, killing 3 workers and forcing scores of others to evacuate. Within days, new Ebola infections were once again on the rise.

It was just the latest setback in an outbreak that has proved devilishly hard to incorporate every bit it has unfolded in a part of Congo with a long history of disharmonize between the government and multiple armed groups. Since the epidemic was alleged on Aug. ane, 2018, more than three,300 people take been infected with Ebola, making the outbreak the worst on record for Congo, and the second worst in human history subsequently the much larger West Africa Ebola outbreak of 2013-2016.

So is it possible to finally end this outbreak in 2020? And if and then, what volition information technology have?

NPR put that question to five people involved in the Ebola response; here's what they said:

Ensure Ebola responders tin can safely get to the hot spots

Dr. Marie Roseline Belizaire, a field coordinator with the Globe Wellness Organisation who has been moving from hot spot to hot spot since the very start of the outbreak, was in one of the facilities that was attacked on Nov. 28 (yous can read her account of that feel here and here). She says that in the backwash, her teams have had to cut dorsum on the fourth dimension they spend in areas where the Ebola virus is spreading.

Near of them have relocated to the relatively safer city of Beni, two hours' drive from the closest hot spot. To accomplish the farthest hot spot, they are ferrying staff in by helicopter for a few hours at a time. So while they are even so managing to carry out key activities like identifying Ebola cases and tracking down and vaccinating those who've been in contact with them, they can't do so in every location every day.

"It has never been this difficult before," says Belizaire. "Fifty-fifty though we have suffered [previous] attacks, nosotros didn't get out. We didn't evacuate our squad."

Worst of all, she says, she's non convinced that the United Nations — which has peacekeepers in the area — and Congo's government can protect Ebola responders from further harm.

"They have failed us," she says.

But what'due south the best fashion to go along Ebola responders safe? On this betoken the answers diverge.

Put in more armed guards to protect health workers ...

David Gressly, the U.N.'due south emergency Ebola response coordinator for the Congo outbreak, says that since the Nov. 28 attacks he has been in communication with both the U.North. and Congo's government about how each may bolster the security it provides to Ebola responders as well as to the general population.

For instance, in a remote rural area called Lwemba where many new cases appear to be full-bodied, "the Congolese army told me that they were going to double the number of troops on the ground in terms of providing security," Gressly says. "And, of class, municipal forces are patrolling in that area as well. There may be some more than work to be done on that side. Only those steps are very encouraging every bit a style forward."

... or maybe don't

Brian Moller, emergency coordinator for the aid group Doctors Without Borders in N Kivu province, where the outbreak has been about intense, says the impulse to step-up armed guards is "understandable." Only he argues that it'southward short-sighted and volition likely backlash, specially if the guards are stationed at or virtually health care facilities, or used as escorts for Ebola responders.

After years of abuse at the easily of Congo'due south military machine, the local population is already mistrustful of these troops, Moller notes. Most recently, the local population has protested both the armed forces and U.N. peacekeepers for failing to protect them from a spate of massacres over the past several months past one of the largest rebel groups in the surface area, the Centrolineal Democratic Forces.

And then if wellness workers are seen to exist aligned with security forces, "this simply adds to the mistrust that already exists around Ebola," Moller says. "This mistrust so leads to increased security presence [by armed forces], which leads to more mistrust, in a down spiral."

Citing this very concern, last month Doctors Without Borders halted its operations in 1 of the hot spots where Ebola responders were attacked — a rural region called Biakato.

Find out who was behind the latest attacks

In that location is at least one solution to the violence for which there seems to exist widespread support. As Dr. Jean-Paul Mundama, who monitors diseases with epidemic potential for Congo's Ministry of Wellness, put it: "Every time we are shut to controlling the epidemic there has been some attack that destabilizes the response teams. And so we need to detect out what is provoking these attacks."

Moller, of Doctors Without Borders, agrees, and adds that if the sponsors of the latest assail can be identified, then in that location'southward a run a risk to "speak to those backside the violence to gain their agreement and acceptance of the Ebola response."

Gressly, the U.N. Ebola emergency coordinator, is more than focused on the possibility that bringing those responsible to justice could deter future attacks — either by setting an case or simply putting the attackers out of commission.

Gressly says that approach seems to have contributed to a slowdown in violence concluding spring, subsequently a like outburst of direct attacks on Ebola responders. Congo's government has charged several Congolese doctors in the most serious of those jump incidents: the assassination-way killing in Apr 2019 in the urban center of Butembo of a WHO epidemiologist, Dr. Richard Mouzoko.

There'southward a lot of money to be made from the Ebola response, given all the logistical spending information technology requires and the jobs it generates for locals, explains Gressly. And so the authorities's theory, he says, is that these doctors' interests were "financial — beingness able to take a greater share of the business organization that was going on in relation to the response."

Gressly says it's possible the November. 28 attacks had a similar motive — even if the attackers themselves were non from the same group. But tracking them down has been complicated.

"A number of arrests have been made," Gressly says. All are men who belong to i of the many rebel militias in the expanse. And through those arrests, he says, "nosotros have been able to generate a number of leads."

Yet shortly after a senior leader of the militia was arrested, his men attacked the convoy that was transporting him to prison. According to Gressly, the driver and police escort were all killed, and the militia leader escaped.

Ramp up the role of U.N. peacekeepers

Directly attacks aren't the just challenge that Ebola responders are facing. In contempo weeks their piece of work has been continually disrupted by massacres of hundreds of civilians in the Ebola outbreak zone that accept been launched by the Centrolineal Democratic Forces — likewise as violent protests by members of the community against the Congolese military and U.N. peacekeepers for declining to protect them.

Stephen Morrison, director of global health policy at the Heart for Strategic and International Studies, says this has been the predictable result of a decision by Congo's government decision last fall to launch a major offensive confronting the ADF. Retaliating against civilians is "a playbook the ADF resorts to in these types of situations," he says. "This is not a new pattern."

And Morrison says information technology'south particularly problematic that Congo's government chose to launch the offensive against the ADF without analogous with, or even really consulting, the large U.Northward. peacekeeping strength in the area.

"The Congolese have been very reluctant to partner with other forces. They're very sensitive to their own sovereign interests. So they're trying to exercise this on their own," says Morrison. "But they've failed repeatedly."

In other words, he says, Congo's military has done just enough damage to provoke the ADF into killing civilians, only not enough to actually disarm them.

Morrison argues that by enlisting the aid of U.N. peacekeepers, Congo's military would stand a much better chance. Only and so far the U.Northward. member states that fix the peacekeepers' mission — particularly those on the Security Council, such as the United States — accept shown piddling interest in pressuring Congo's government to bring peacekeepers into the endeavor.

"We just don't have the type of high-level political leadership focused on this trouble and the threat that information technology poses," laments Morrison.

Bolster Congo's wellness care system

Mundama, of Congo's wellness ministry, says one misstep early on in the outbreak was to set up the Ebola response equally a largely standalone effort, rather than embedding it within Congo's existing network of health centers.

To some extent this was natural, he says: "We were like firefighters — chasing the Ebola outbreak from this place to that."

In the short term, he says, it'south easier to outsource Ebola response work to specialized temporary teams. But over the long run, it would be much more effective to eternalize the power of preexisting health centers to exercise Ebola response work — essentially training them up to do much of the contact tracing and vaccinating.

To a large extent, he says, the focus of the response has at present shifted in this direction. That in turn has also fostered more community credence of Ebola response measures.

Even after this outbreak is over, "eventually Ebola will come back," Mundama says. "And the local health centers need to be ready."

Set up for flare-ups resulting from this outbreak even after it's officially "over"

If and when the electric current outbreak is independent, information technology's very possible that the next resurgence of Ebola in Congo will exist sparked by a relapse in someone who was originally infected in this outbreak, says Gressly. Already, in early December, the caseload would have been down to zero, but for an Ebola survivor who relapsed — and so infected more than a dozen people who came into contact with him.

"It's extremely rare that this happens. But it does happen," says Gressly. "And we take a thousand plus survivors of this outbreak now."

The key, he says, volition be to ensure careful long-term monitoring of Ebola survivors in a way that's also sensitive to their state of affairs.

"People need to be aware of the risks," says Gressly. "But if we're not careful in communication, information technology may create a kind of stigmatization that that will make these people's lives very difficult."

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Source: https://www.npr.org/sections/goatsandsoda/2020/01/09/794675939/what-will-it-take-to-finally-end-congos-ebola-outbreak-in-2020

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